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Gut Hormones as Mediators of Appetite and Weight Loss After Roux-en-Y Gastric Bypass
Abstract
In Brief Objective: To evaluate the physiologic importance of the satiety gut hormones. Background: Controversy surrounds the physiologic role of gut hormones in the control of appetite. Bariatric surgery remains the most effective treatment option for obesity, and gut hormones are implicated in the reduction of appetite and weight after Roux-en-Y gastric bypass. Methods: We correlated peptide YY (PYY) and glucagon-like peptide 1 (GLP-1) changes within the first week after gastric bypass with changes in appetite. We also evaluated the gut hormone responses of patients with good or poor weight loss after gastric bypass. Finally, we inhibited the gut hormone responses in gastric bypass patients and then evaluated appetite and food intake. Results: Postprandial PYY and GLP-1 profiles start rising as early as 2 days after gastric bypass (P < 0.05). Changes in appetite are evident within days after gastric bypass surgery (P < 0.05), and unlike other operations, the reduced appetite continues. However, in patients with poor weight loss after gastric bypass associated with increased appetite, the postprandial PYY and GLP-1 responses are attenuated compared with patients with good weight loss (P < 0.05). Inhibiting gut hormone responses, including PYY and GLP-1 after gastric bypass, results in return of appetite and increased food intake (P < 0.05). Conclusion: The attenuated appetite after gastric bypass is associated with elevated PYY and GLP-1 concentrations, and appetite returns when the release of gut hormones is inhibited. The results suggest a role for gut hormones in the mechanism of weight loss after gastric bypass and may have implications for the treatment of obesity. Roux-en-Y gastric bypass is an effective treatment for obesity, and gut hormones have been implicated as causing reduction of appetite and weight. We showed that significant weight loss depends on gut hormone concentrations and that attenuated appetite after gastric bypass is associated with increased gut hormones, and appetite returns when the release of gut hormones is inhibited.
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“GB subjects have elevated plasma concentrations of GLP-1 (6,8–13).”
From Gastric Bypass Surgery Enhances Glucagon-Like Peptide 1–Stimulated Postprandial Insulin Secretion in Humans (2011) · cites this paper as [10]
In the citing paper
“Genetic factors [8], increases in gut hormones such as glucagon-like-peptide-1 (GLP-1) and peptide YY (PYY) [9], and decreases in the production of ghrelin play an important role in appetite regulation and post-surgical weight outcomes [10].”
From Patients' Experiences of Weight Regain After Bariatric Surgery (2022) · cites this paper as [9]
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LUCAS, C. M. S., Zaniqueli, D. D. A., Alvim, R. D. O., Miguel, G. P. S., & Mill, J. G. (2020) · Anais da Academia Brasileira de Ciências · doi:10.1590/0001-3765202020181184 · Cited by 3
Weight regain after bariatric surgery: Promoters and potential predictors
Demerdash, H. M. (2021) · World Journal of Meta-Analysis · doi:10.13105/wjma.v9.i5.438 · Cited by 3
Hupfeld, C. J., Courtney, C. H., & Olefsky, J. M. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-5583-9.00041-1 · Cited by 5
“Conversely, in obese human subjects undergoing Roux-en-Y gastric bypass, GLP-1 levels were increased within 2 days postoperatively, and this elevation was correlated with reduced appetite.(196)”
BackgroundRanjit, R., Lapik, I. A., Гаппарова, К. М., & Galchenko, A. V. (2022) · Nutrition Today · doi:10.1097/nt.0000000000000540 · Cited by 4
Effect of bariatric surgery on maternal cardiovascular system
Patel, D., Borrelli, N., Patey, O. V., Johnson, M. R., Salvo, G. D., & Savvidou, M. D. (2022) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.26042 · Cited by 3
Control of Eating Attributes and Weight Loss Outcomes over One Year After Sleeve Gastrectomy
Lytvyak, E., Zarrinpar, A., Ore, C. L. D., Lee, E., Yazdani-Boset, K., Horgan, S., & Grunvald, E. L. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07158-9 · Cited by 3
“Gastrointestinal hormonal signals are known to exert effects on satiety, satiation, and hedonic ingestive behaviors [6].”
Mechanisms of Action of the Bariatric Procedures
Menzo, E. L., Szomstein, S., & Rosenthal, R. J. (2014) · Springer eBooks · doi:10.1007/978-1-4939-1206-3_5 · Cited by 3
Willbond, S., & Doucet, É. (2010) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2010.188 · Cited by 3
From gut changes to type 2 diabetes remission after gastric bypass surgeries
Li, B., Zhou, X., Wu, J., & Zhou, H. (2013) · Frontiers of Medicine · doi:10.1007/s11684-013-0258-2 · Cited by 3
“No clear conclusions have yet been drawn from publications about ghrelin changes after RYGB: most reported an increase [92–97]; however, no changes were also found [98,99].”
BackgroundDoes Bariatric Surgery Improve Obesity Associated Comorbid Conditions
Engin, A. (2017) · Advances in experimental medicine and biology · doi:10.1007/978-3-319-48382-5_24 · Cited by 3
Timmermans, M., Topal, B., Sanches, E. E., de Jongh, F. W., Çağıltay, E., Çelik, A., Ribeiro, R. J. D. S., Parmar, C. D., Ugale, S. M., Proczko, M., et al. (2021) · Minerva Endocrinology · doi:10.23736/s2724-6507.21.03296-x · Cited by 4
Weight loss produced by gastric bypass surgery: more gut feelings hit the brain
Astrup, A. V. (2012) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.112.045179 · Cited by 3
“weight loss and how it is sustained over time have also evolved, and a number of studies from le Roux’s group (4) have linked the exaggerated postprandial response of the satiety hormones GLP-1, peptide YY, and oxyntomodulin to the weight loss in”
BackgroundPetcka, N. L., Wu, J., Smith, S. R., Arshad, S. A., Yost, C., Srinivasan, J. K., Davis, S. S., Lin, E., Hechenbleikner, E. M., & Mou, D. (2025) · Surgical Endoscopy · doi:10.1007/s00464-025-11844-9 · Cited by 2
“Hormonal changes following MBS have been shown to decrease appetite which helps reduce caloric intake contributing to the weight loss observed after these procedures [7].”
The Paradox and Future of GLP-1/GIP Combination Therapies: Efficacy and Mechanisms
Davies, I., Holst, J. J., ROSENKILDE, M. M., & Tan, T. (2026) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-061824-043740 · Cited by 2
Käkelä, P., Rantanen, T. K., & Virtanen, K. A. (2021) · Obesity Surgery · doi:10.1007/s11695-021-05421-x · Cited by 2
“This all can lead to a loss of hunger and increase in satiety [17].”
BackgroundRegulation of Appetite and Satiety by Gastrointestinal Peptides
Mhaibes, S. H., Fakree, N. K., & Naser, S. E. (2021) · Iraqi Journal of Pharmaceutical Sciences · doi:10.31351/vol30iss1pp14-21 · Cited by 2
Comparative secretome analysis of rat stomach under different nutritional status
Senín, L. L., Roca-Rivada, A., Castelao, C., Alonso, J., Folgueira, C., Casanueva, F. F., Pardo, M., & Seoane, L. M. (2015) · Journal of Proteomics · doi:10.1016/j.jprot.2015.01.001 · Cited by 2
Escanilla, O., Hajnal, A. S., Czaja, K., & Lorenzo, P. M. D. (2022) · Nutrients · doi:10.3390/nu14194129 · Cited by 2
Björkman, S., Höskuldsdóttir, G., Mossberg, K., Laurenius, A., Engström, M., Fändriks, L., Eliasson, B., Wallengren, O., & Larsson, I. (2024) · Obesity · doi:10.1002/oby.24131 · Cited by 2
Crutchlow, M. F., Liu, J., Romero, C., Watkins, E., Zhang, H., Arreglado, A., Vance, A., Boisvert, D., Terracina, G., Chan, B., et al. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70120 · Cited by 2
Understanding the Effects of Roux-en-Y Gastric Bypass (RYGB) Surgery on Type 2 Diabetes Mellitus
Raymond, G. S., Radin, M. S., Collin, E., & Ragoli, L. (2013) · InTech eBooks · doi:10.5772/56398 · Cited by 2
Metabolic Effects of Bariatric Surgery: A Focus on Inflammation and Diabetic Kidney Disease
Neff, K., & le Roux, C. W. (2013) · Current Obesity Reports · doi:10.1007/s13679-013-0050-2 · Cited by 2
“RYGB can increase the secretion of the satiety promoting gut hormones peptide YY (PYY) and GLP-1 [49, 50].”
Guo, X., Mattar, S. G., Navia, J. A., & Kassab, G. S. (2012) · Journal of Surgical Research · doi:10.1016/j.jss.2012.02.032 · Cited by 2
Bariatric Surgery and Reversal of Metabolic Disorders
Manco, M. (2012) · CRC Press eBooks · doi:10.1201/b12261-71 · Cited by 2
Metadata
- Authors
- le Roux, C. W., Welbourn, R., Werling, M., Osborne, A., Kokkinos, A., Laurenius, A., Lönroth, H., Fändriks, L., Ghatei, M. A., Bloom, S. R., & Olbers, T.
- Affiliations
- Musgrove Park Hospital (GB)
- Sahlgrenska University Hospital (SE)
- Hammersmith Hospital (GB)
- Corresponding author
- Kokkinos, Alexander
- Ghatei, Mohammad A.
- Bloom, Stephen R.
- ORCID
- Venue
- Annals of Surgery
- Published
- 2007-11
- Volume
- 246
- Issue
- 5
- Pages
- 780-785
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W2079737026
- Cited by
- 741
- References
- 31
- Citations by year
- 2026: 20 · 2025: 20 · 2024: 28 · 2023: 25 · 2022: 28 · 2021: 49 · 2020: 36 · 2019: 38 · 2018: 35 · 2017: 38 · 2016: 53 · 2015: 61 · 2014: 49 · 2013: 45 · 2012: 63
- FWCI
- 34.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (DHCS/05/05)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
- Health Sciences › Medicine › Pharmacology (medical) › Pharmacology and Obesity Treatment
- Keywords
- gastrointestinal hormones, appetite regulation, Roux-en-Y gastric bypass, peptide YY, glucagon-like peptide-1, satiety, weight loss, obesity, postprandial hormone response, dietary intake, bariatric surgery
- MeSH terms
- Appetite Regulation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Obesity, Morbid, Prospective Studies, Gastric Bypass, Weight Loss, Body Mass Index, Treatment Outcome, Peptide YY, Glucagon-Like Peptide 1, Ghrelin
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