Hypothalamic integrity is necessary for sustained weight loss after bariatric surgery: A prospective, cross-sectional study

U. Dischinger, L. Kötzner, P. Kovatcheva-Datchary, H. Kleinschmidt, C. Haas, J. Perez, C. Presek, A.-C. Koschker, A.D. Miras, M.K. Hankir, J. Vogel, C.-T. Germer, M. Fassnacht, M.J. Herrmann, F. Seyfried

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Abstract

Objective: The hypothalamus is the main integrator of peripheral and central signals in the control of energy homeostasis. Its functional relevance for the effectivity of bariatric surgery is not entirely elucidated. Studying the effects of bariatric surgery in patients with hypothalamic damage might provide insight. Summary background data: Prospective study to analyze the effects of bariatric surgery in patients with hypothalamic obesity (HO) vs. matched patients with common obesity (CO) with and without bariatric surgery. Methods: 65 participants were included (HO-surgery: n = 8, HO-control: n = 10, CO-surgery: n = 12, CO-control: n = 12, Lean-control: n = 23). Body weight, levels of anorexic hormones, gut microbiota, as well as subjective well-being/health status, eating behavior, and brain activity (via functional MRI) were evaluated. Results: Patients with HO lost significantly less weight after bariatric surgery than CO-participants (total body weight loss %: 5.5 % vs. 26.2 %, p = 0.0004). After a mixed meal, satiety and abdominal fullness tended to be lowest in HO-surgery and did not correlate with levels of GLP-1 or PYY. Levels of PYY (11,151 ± 1667 pmol/l/h vs. 8099 ± 1235 pmol/l/h, p = 0.028) and GLP-1 (20,975 ± 2893 pmol/l/h vs. 13,060 ± 2357 pmol/l/h, p = 0.009) were significantly higher in the HO-surgery vs. CO-surgery group. Abundance of Enterobacteriaceae and Streptococcus was increased in feces of HO and CO after bariatric surgery. Comparing HO patients with lean-controls revealed an increased activation in insula and cerebellum to viewing high-caloric foods in left insula and cerebellum in fMRI. Conclusions: Hypothalamic integrity is necessary for the effectiveness of bariatric surgery in humans. Peripheral changes after bariatric surgery are not sufficient to induce satiety and long-term weight loss in patients with hypothalamic damage.

Original languageEnglish
Article number155341
Pages (from-to)1-11
Number of pages12
JournalMetabolism: Clinical and Experimental
Volume138
Early online date27 Oct 2022
DOIs
Publication statusPublished (in print/issue) - 31 Jan 2023

Bibliographical note

Funding Information:
We thank Dr. rer. nat. Ulrich Stefenelli for statistical support.

Publisher Copyright:
© 2022 The Author(s)

Keywords

  • Bariatric surgery
  • Craniopharyngioma
  • Gut microbiota
  • Obesity
  • RYGB

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