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Cited by 68Bariatric Surgery and OutcomesAdipokines, Inflammation, and Metabolic DiseasesBody Contouring and Surgery

Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects

Open access
Biobaku, Fatimo, Ghanim, Husam, Monte, Scott V, Caruana, Joseph A, Dandona, Paresh·2020·Journal of the Endocrine Society
DOI 10.1210/jendso/bvaa049PMC PMC7402590
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Abstract

Obesity is associated with increased mortality as a result of several comorbidities which occur in tandem with the obese state. Chronic inflammation is well documented in obesity, and evidence from numerous studies support the notion that the increased inflammation in individuals with obesity accentuates the comorbidities seen in this condition. The remission of comorbidities such as metabolic, cardiovascular, and neurological complications occurs following bariatric procedures. Bariatric surgery significantly reduces mortality and results in remarkable weight loss and reversal in several obesity-related comorbidities. There is indisputable evidence that the resolution of inflammation that occurs after bariatric surgery mitigates some of these comorbidities. With the increasing use of bariatric surgery for the treatment of severe obesity, it is pivotal to elucidate the underlying mechanisms responsible for the notable improvements seen after the procedure. This review summarizes underlying mechanisms responsible for the remission of obesity-related abnormalities and discusses the common adverse effects of bariatric surgery. Well-stratified, large-scale studies are still needed for a proper evaluation of these underlying mechanisms.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes mechanisms by which bariatric surgery remits obesity-related inflammation and cardiometabolic, reproductive, pulmonary, and neurological comorbidities, while also reviewing common adverse effects. It concludes that surgery produces marked weight loss and broad clinical improvement, but that well-stratified, large-scale studies are still needed to clarify underlying mechanisms.

Key findings

  • Bariatric surgery reduces systemic inflammation: MCP-1 fell by over 50% after surgery, and RYGB at 6 months reduced CRP, MMP-9, MCP-1, NF-κB binding, LPS, CD14, TLR-2, and TLR-4; CRP is the most consistently reduced inflammatory marker. HOMA-IR decreased by 50% within 1 week after RYGB.
  • Partial or total type 2 diabetes remission rates as high as 80% to 90% have been observed after bariatric surgery, with glycemic improvement appearing within days; proposed mechanisms include acute caloric restriction, increased GLP-1, PYY, bile acid signaling, and gut microbiome changes.
  • Cardiometabolic and other benefits include resolution of hypertension, reduced all-cause mortality and major adverse cardiovascular events, reduced incident obesity-associated cancers, and improvements in asthma-related mediators after weight loss: IL-4 fell 49%, LIGHT 29%, lymphotoxin-β receptor 33%, ADAM-33 20%, MMP-9 59%, MCP-1 23%, chemokine receptor type 2 27%, and plasma nitric oxide metabolites 22%.
  • Adverse effects include operative mortality of 0.28% to 0.4% overall, lowest with adjustable gastric banding at 0.04% and highest serious complication rate with BPD/DS at 8%; 15% to 20% of patients fail to lose weight or regain lost weight; micronutrient deficiencies and bone loss are common, especially with malabsorptive procedures.

Methods

  • Narrative review summarizing mechanisms responsible for remission of obesity-related abnormalities and common adverse effects of bariatric surgery; it is not a systematic review and reports no primary data collection.
  • Synthesizes findings from cited clinical studies, including a table of inflammatory outcomes after RYGB, SG, AGB, VBG, and BPD, and discusses gut hormones, bile acids, microbiome, vasoactive factors, and micronutrient/bone outcomes.
  • No formal search strategy, inclusion criteria, or meta-analysis is described.

Limitations

  • The paper states that well-stratified, large-scale studies are still needed for proper evaluation of underlying mechanisms.
  • The paper states that studies on TNFα, IL-6, MCP-1, and other inflammatory markers after bariatric surgery have been inconsistent, with heterogeneity attributed to limited study sizes, study design/laboratory techniques, timing of postoperative evaluation, and inherent differences in study populations.
  • The paper states there is no consensus on mechanisms of poor weight loss or weight regain and no published studies comparing segmented transit times through the stomach, proximal small bowel, and distal small bowel between successful and failed bariatric procedures; evident from the text, this is a narrative review without systematic quality assessment, so conclusions depend on selected cited studies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1210/jendso/bvaa049

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 101 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    Bariatric surgery results in reversal in several obesity-related comorbidities.

    “Bariatric surgery significantly reduces mortality and results in remarkable weight loss and reversal in several obesity-related comorbidities.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Bariatric surgery results in remarkable weight loss.

    “Bariatric surgery significantly reduces mortality and results in remarkable weight loss and reversal in several obesity-related comorbidities.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Bariatric surgery significantly reduces mortality.

    “Bariatric surgery significantly reduces mortality and results in remarkable weight loss and reversal in several obesity-related comorbidities.”
    Quote in the paperNot a substantial claim
  • Findingreasoning

    Remission of metabolic, cardiovascular, and neurological complications occurs following bariatric procedures.

    “The remission of comorbidities such as metabolic, cardiovascular, and neurological complications occurs following bariatric procedures.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Remarkable improvement in glycemia is seen in obese patients with diabetes who undergo bariatric surgery, even before clinically significant weight loss occurs.

    “A remarkable improvement in glycemia is seen in obese patients with diabetes who undergo bariatric surgery, even before clinically significant weight loss occurs.”
    Quote in the paperSubstantial claim
  • May combine two claims. 34
  • Classified as probably not a substantial claim. 2

  • May combine two claims.

    Findingnone given

    Anti-inflammatory mediators such as adiponectin and IL-10 are reduced in the obese state and most studies report an increase after bariatric surgery.

    “Anti-inflammatory mediators such as adiponectin and IL-10 are reduced in the obese state and most studies report an increase in these mediators (especially those of adiponectin) after bariatric surgery.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    SCFAs inhibit degradation of primary bile acids to carcinogenic secondary bile acids and decrease solubility of free bile acids, rendering bile acids less carcinogenic.

    “They inhibit the degradation of primary bile acids to the carcinogenic secondary bile acids, and decrease the solubility of free bile acids, thus rendering the bile acids less carcinogenic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    SCFAs lower intracolonic pH, preventing growth of pH-sensitive pathogenic bacteria, and promote satiety by modulating secretion of satiety peptides from the gut.

    “SCFAs lower intracolonic pH, hence preventing the growth of pH-sensitive pathogenic bacteria, and they also promote satiety by modulating secretion of satiety peptides from the gut [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Vipperla, 2012, The microbiota and its metabolites in colonic mucosal health and cancer risk, Nutr Clin Pract. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Gut microbial diversity increases after metabolic surgery, although observations for Bacteroidetes and Firmicutes are inconsistent.

    “Gut microbial diversity is seen to increase after metabolic surgery, although inconsistent observations are reported in the literature especially for changes that occur in Bacteroidetes and Firmicutes phyla.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Shen, 2019, Longitudinal changes of microbiome composition and microbial metabolomics after surgical weight loss in individuals with obesity, Surg Obes Relat Dis. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Bariatric surgery-induced weight loss reduced expression of IL-4 by 49%, LIGHT by 29%, lymphotoxin-β receptor by 33%, ADAM-33 by 20%, MMP-9 by 59%, MCP-1 by 23%, and CCR2 by 27%; plasma nitric oxide metabolites fell by 22%.

    “We noted reductions in the expression of IL-4 by 49%, LIGHT by 29%, lymphotoxin-β receptor by 33%, A Disintegrin and Metalloproteinase (ADAM)-33 by 20%, MMP-9 by 59%, MCP-1 by 23%, and chemokine receptor type 2 by 27%. Plasma nitric oxide metabolites also fell by 22%.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Resolution of obstructive sleep apnea and dyslipidemia (reductions in triglycerides, LDL, total cholesterol, and increment in HDL) occur following bariatric surgery-induced weight loss.

    “Resolution of obstructive sleep apnea and dyslipidemia (reductions in triglycerides, low-density lipoprotein, and total cholesterol, and increment in high-density lipoprotein cholesterol) occur following bariatric surgery-induced weight loss.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Although levels of micronutrients are frequently decreased at baseline in the obese state, metabolic surgery often results in marked reductions necessitating replacement therapy.

    “Although the levels of these micronutrients are frequently decreased at baseline in the obese state, metabolic surgery often results in marked reductions in their levels necessitating replacement therapy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Compelling studies show both short- and long-term mortality are reduced in morbidly obese patients who undergo bariatric surgery.

    “Compelling studies show that both short- and long-term mortality are reduced in morbidly obese patients who undergo bariatric surgery.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Sjöström, 2007, Effects of bariatric surgery on mortality in Swedish obese subjects, N Engl J Med. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Micronutrient deficiency is very rampant following bariatric surgery and highly dependent on the type of bariatric procedure.

    “Micronutrient deficiency is very rampant following bariatric surgery and highly dependent on the type of bariatric procedure.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Diabetes, hypertension, cardiovascular/renal/hepatic complications, hypogonadotropic hypogonadism, bronchial asthma, and Alzheimer's disease are associated with obesity.

    “Several comorbidities such as diabetes, hypertension, cardiovascular/renal/hepatic complications, hypogonadotropic hypogonadism, bronchial asthma, and Alzheimer’s disease are associated with obesity [10-13].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [10] Seravalle, 2017, Obesity and hypertension, Pharmacol Res. source

      Not checked in the free run.

    • cites [11] Mogri, 2013, Testosterone concentrations in young pubertal and post-pubertal obese males, Clin Endocrinol (Oxf). source

      Not checked in the free run.

    • cites [12] Dandona, 2014, Increase in the mediators of asthma in obesity and obesity with type 2 diabetes: reduction with weight loss, Obesity (Silver Spring). source

      Not checked in the free run.

    • cites [13] Profenno, 2010, Meta-analysis of Alzheimer’s disease risk with obesity, diabetes, and related disorders, Biol Psychiatry. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Oxidative stress is increased in obese humans and diminishes after caloric restriction and weight loss.

    “Oxidative stress, related to inflammation, was also shown to be increased in obese humans and it diminished after caloric restriction and weight loss [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Dandona, 2001, The suppressive effect of dietary restriction and weight loss in the obese on the generation of reactive oxygen species by leukocytes, lipid peroxidation, and protein carbonylation1, J Clin Endocrinol Metab

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Enhanced GLP-1 response persists long term and improves insulin action and β-cell function.

    “This enhanced GLP-1 response, shown to persist in the long term, improves insulin action and β-cell function [48].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Manning, 2015, GLP-1: a mediator of the beneficial metabolic effects of bariatric surgery?, Physiology (Bethesda).

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Procedures altering normal GI anatomy (BPD/DS and gastric bypass) are more effective for weight loss and amelioration of diabetes than restrictive procedures like sleeve gastrectomy and gastric banding.

    “It appears that the procedures which alter the normal anatomy of the gastrointestinal tract (such as BPD/DS and gastric bypass) are more effective for weight loss and amelioration of diabetes than restrictive procedures like sleeve gastrectomy and gastric banding.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Resolution of diabetes and weight loss are greater with BPD/DS, followed by gastric bypass, sleeve gastrectomy, then gastric banding.

    “Similarly, resolution of diabetes and weight loss are greater with BPD/DS procedures followed by gastric bypass, sleeve gastrectomy, and then gastric banding [44].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Buchwald, 2009, Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis, Am J Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Six months after RYGB, plasma MMP-9 and CRP concentrations and CD14 expression were reduced.

    “Concomitant reductions in plasma concentrations of matrix metallopeptidase (MMP)-9 and C-reactive protein (CRP) were seen and there was also a reduction in the expression of CD14, the marker of activated monocytes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Monte, 2012, Reduction in endotoxemia, oxidative and inflammatory stress, and insulin resistance after Roux-en-Y gastric bypass surgery in patients with morbid obesity and type 2 diabetes mellitus, Surgery. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Marked decreases in CRP are seen within 1 month following bariatric procedures, with more prominent reductions in insulin-sensitive patients.

    “Marked decreases in CRP are seen within 1 month following bariatric procedures, with more prominent reductions seen in insulin-sensitive patients [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Holdstock, 2005, CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects, Int J Obes (Lond). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Weight loss from metabolic surgery resulted in reductions in CRP at 3, 6, and 12 months in nondiabetic patients, whereas patients with diabetes showed significant CRP reductions only at 12 months.

    “In a study, weight loss from metabolic surgery resulted in reductions in CRP in the third, sixth, and twelfth month after the procedure in nondiabetic patients whereas significant reductions in CRP were observed in patients with diabetes only 12 months after bariatric surgery [17].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Shih, 2016, Effects of bariatric weight loss surgery on glucose metabolism, inflammatory cytokines, and serum tartrate-resistant acid phosphatase 5a in obese Chinese adults, Clin Chim Acta. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Adiponectin is an antiatherogenic adipokine that protects against metabolic disorders through improvements in insulin secretion and sensitivity.

    “Adiponectin is an antiatherogenic adipokine that also protects against metabolic disorders through improvements in insulin secretion and sensitivity [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Ouchi, 2011, Adipokines in inflammation and metabolic disease, Nat Rev Immunol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a retrospective cohort study, bariatric surgery was associated with substantial reduction in all-cause mortality and incident major adverse cardiovascular events.

    “In a recently published retrospective cohort study, a substantial reduction in all-cause mortality and incident cases of major adverse cardiovascular events such as coronary artery events, cerebrovascular events, nephropathy, heart failure and atrial fibrillation was noted in those who had bariatric surgery [62].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [62] Aminian, 2019, Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Amelioration of metabolic syndrome, chronic kidney disease, left ventricular hypertrophy, and nonalcoholic fatty liver disease are seen after bariatric surgery.

    “Also, amelioration of other obesity-related comorbidities including metabolic syndrome, chronic kidney disease, left ventricular hypertrophy, and nonalcoholic fatty liver disease are seen after bariatric surgery [61].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [61] Athyros, 2011, Cardiovascular benefits of bariatric surgery in morbidly obese patients, Obes Rev. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In participants of the Biggest Loser competition, 6-year follow-up showed an average weight regain of approximately 70%, with a subset regaining weight above baseline.

    “The 6-year follow-up data of participants in the biggest loser competition demonstrated an average weight regain of approximately 70%, with a subset of the participants regaining weight above their baseline weight before the competition [119, 120].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [119] Fothergill, 2016, Persistent metabolic adaptation 6 years after “The Biggest Loser” competition, Obesity (Silver Spring). source

      Not checked in the free run.

    • cites [120] Kerns, 2017, Increased physical activity associated with less weight regain six years after “The Biggest Loser” competition, Obesity (Silver Spring). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among bariatric procedures, adjustable gastric banding has the lowest mortality rate (0.04%) and the lowest rate of serious complications (0.9%), while BPD/DS has the highest rate of serious complications (8%).

    “Restrictive procedures such as adjustable gastric banding have the lowest mortality rate (0.04%) and the lowest rate of serious complications (0.9%), while BPD/DS has the highest rate of serious complications (8%), although the weight loss response is quite impressive [113].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [113] Finks, 2011, Predicting risk for serious complications with bariatric surgery, Ann. Surg. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Biliopancreatic diversion procedures induce more significant declines in fat-soluble vitamins, copper, and zinc compared with gastric bypass, whereas vitamin B12 deficiency is more commonly seen with gastric bypass than other procedures.

    “Biliopancreatic diversion procedures induce more significant declines in fat-soluble vitamins, copper, and zinc when compared with gastric bypass, whereas vitamin B12 deficiency (ensuing from decreased intrinsic factor) is more commonly seen with gastric bypass than the other procedures [109].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [109] Parrott, 2017, American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients, Surg Obes Relat Dis. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Because the greatest micronutrient deficiency occurs with the BPB/DS procedure, maximal need for dietary supplementation is seen with this procedure, followed by gastric bypass.

    “Because the greatest micronutrient deficiency occurs with the BPB/DS procedure, maximal need for dietary supplementation is seen with this procedure, followed by gastric bypass.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    After bariatric surgery, ghrelin levels are reduced, and cholecystokinin and bile acids are increased.

    “As previously stated, reductions in ghrelin levels are seen, with increments in cholecystokinin and bile acids.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The net effects of these hormonal changes are significantly altered feeding behavior (decreased appetite/increased satiety) and enhanced energy expenditure through signaling at hypothalamic nuclei.

    “The net effects of these changes are significantly altered feeding behavior (decreased appetite/increased satiety) and enhanced energy expenditure through signaling at hypothalamic nuclei.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A prospective surgical intervention trial in 4047 obese patients with follow-up 4 to 18 years revealed significantly higher long-term weight loss in the bariatric surgical group led to marked overall reductions in mortality compared with controls.

    “A prospective surgical intervention trial in 4047 obese patients with a follow-up period ranging from 4 to 18 years revealed that significantly higher long-term weight loss in the bariatric surgical intervention group led to marked, overall reductions in mortality compared with controls [41].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Sjöström, 2007, Effects of bariatric surgery on mortality in Swedish obese subjects, N Engl J Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Bariatric surgery is superior to medical/lifestyle interventions in the maintenance of weight loss and the remission of diabetes and dyslipidemia.

    “Data from short- and long-term studies corroborate the superiority of bariatric surgery compared with medical/lifestyle interventions in the maintenance of weight loss and the remission of diabetes and dyslipidemia [117, 118].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [117] Maciejewski, 2016, Bariatric surgery and long-term durability of weight loss, JAMA Surg. source

      Not checked in the free run.

    • cites [118] Schauer, 2017, Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes, N Engl J Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The operative mortality rate after bariatric surgery is low relative to other major surgical procedures and ranges from 0.28% to 0.4%.

    “Relative to other major surgical procedures, the operative mortality rate after bariatric surgery is low and it ranges from 0.28% to 0.4% [110-113].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [110] Buchwald, 2007, Trends in mortality in bariatric surgery: a systematic review and meta-analysis, Surgery. source

      Not checked in the free run.

    • cites [111] Longitudinal Assessment of Bariatric Surgery Consortium, 2009, Perioperative safety in the longitudinal assessment of bariatric surgery, N Engl J Med source

      Not checked in the free run.

    • cites [112] Nguyen, 2011, Predictive factors of mortality in bariatric surgery: data from the nationwide inpatient sample, Surgery. source

      Not checked in the free run.

    • cites [113] Finks, 2011, Predicting risk for serious complications with bariatric surgery, Ann. Surg. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obesity and insulin resistance are significant risk factors for Alzheimer's disease.

    “Obesity and insulin resistance are significant risk factors for Alzheimer’s disease [13] (Fig. 1).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Profenno, 2010, Meta-analysis of Alzheimer’s disease risk with obesity, diabetes, and related disorders, Biol Psychiatry. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Surgical revision to a more distal RYGB induces weight loss and increases postprandial GLP-1 and PYY secretion in those with poor weight loss response.

    “Also, surgical revision to a more distal RYGB induces weight loss and increases postprandial GLP-1 and PYY secretion in those with poor weight loss response [127].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [127] Caruana, 2015, Distal small bowel bypass for weight regain after gastric bypass: safety and efficacy threshold occurs at <70% bypass, Surg Obes Relat Dis source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    RYGB passively transits nutrients through the stomach pouch and deposits them directly into the mid-jejunum, reaching the ileum faster.

    “On the other hand, RYGB passively transits nutrients through the stomach pouch and deposits them directly into the mid-jejunum, reaching the ileum faster [134].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [134] Dirksen, 2013, Fast pouch emptying, delayed small intestinal transit, and exaggerated gut hormone responses after Roux-en-Y gastric bypass, Neurogastroenterol Motil. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Inducing weight loss through very low calorie dietary intervention increases ghrelin, decreases GLP-1 and PYY, and increases perceptions of hunger.

    “Conversely, inducing weight loss through very low calorie dietary intervention increases ghrelin, decreases GLP-1 and PYY, and increases perceptions of hunger [128].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [128] Sumithran, 2011, Long-term persistence of hormonal adaptations to weight loss, N Engl J Med. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Bariatric surgery produces marked weight loss and significant remission in diabetes, hypertension, hypogonadism, asthma, and the risk of Alzheimer's disease.

    “Apart from the marked weight loss that occurs with bariatric surgery, immense benefits such as significant remission in diabetes, hypertension, hypogonadism, asthma, and the risk of Alzheimer’s disease are seen.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Duration of food passage through the stomach and small bowel would be expected to directly impact the time profile and concentrations of the aforementioned gastrointestinal secretions.

    “This is a notable gap because duration of food passage through the stomach and small bowel would be expected to directly impact the time profile and concentrations of the aforementioned gastrointestinal secretions.”
    Quote in the paperNot a substantial claim
35 of 35

  • The paper relies on this without support.

    Obesity is associated with increased mortality as a result of several comorbidities that occur with obesity.

    “Obesity is associated with increased mortality as a result of several comorbidities which occur in tandem with the obese state.”

  • The paper relies on this without support.

    The mechanisms underlying the associations between obesity and its comorbidities are not fully understood.

    “The mechanisms underlying these associations are not fully understood.”

  • The paper relies on this without support.

    The mechanisms underlying testosterone deficiency in the obese state have not been fully elucidated.

    “The mechanisms underlying testosterone deficiency in the obese state have not been fully elucidated.”

  • The paper relies on this without support.

    The underlying mechanisms responsible for the link between asthma and obesity are not fully understood.

    “The underlying mechanisms responsible for the link between asthma and obesity is not fully understood, but some factors such as obesity-related mechanical changes in the airways, increased gastroesophageal reflux, and increased inflammatory/oxidative stress with obesity have been implicated.”

  • The paper relies on this without support.

    There is no consensus on the mechanism of poor weight loss or weight regain following bariatric procedures.

    “There is no consensus on the mechanism of poor weight loss or weight regain following bariatric procedures.”

  • The paper relies on this without support.

    Incompletely understood multifactorial mechanisms underlie successful weight loss maintenance.

    “incompletely understood multifactorial mechanisms underlie successful weight loss maintenance.”

  • The paper relies on this without support.

    There are no published studies that compare segmented transit times through the stomach, the proximal (duodenum/jejunum) and the distal small bowel (ileum) between successful and failed bariatric procedures.

    “To the best of our knowledge, there are no published studies that compare segmented transit times through the stomach, the proximal (duodenum/jejunum) and the distal small bowel (ileum) between successful and failed bariatric procedures.”

  • The paper relies on this without support.

    Intestinal microflora and immunoinflammatory response to meals are expected to have significant impact on weight.

    “Intestinal microflora and immunoinflammatory response to meals are also expected to have significant impact on weight.”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In observational studies of bariatric surgery, postoperative C-reactive protein levels were reduced by 67% to 91%, corresponding to weight reductions of 26% to 37%, at approximately 52 weeks.

    “In observational studies of bariatric surgery, postoperative C-reactive protein levels were reduced by 67% to 91%, corresponding to weight re ductions of 26% to 37%, at approximately 52 weeks. 15”

    From Comprehensive Long-Term Changes in Cardiovascular Risk Biomarkers With Tirzepatide (2026) · cites this paper as [15]

    Section 1 and Table 1 report that CRP declines after bariatric surgery, including at 12 months or one year. They do not report CRP reductions of 67%–91% or corresponding weight reductions of 26%–37%, so the numerical claim is unsupported by our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Weight-related reductions in PAI-1:Ag have previously been observed after bariatric surgery.

    “weight-related reductions in PAI-1:Ag are of potential interest and have previously been observed after bariatric surgery. 15,40”

    From Comprehensive Long-Term Changes in Cardiovascular Risk Biomarkers With Tirzepatide (2026) · cites this paper as [15]

    Table 1 in the section on obesity and inflammation reports decreased PAI-1 after several bariatric procedures. It does not identify the measure as PAI-1 antigen (PAI-1:Ag) or establish that the reductions were related specifically to the amount of weight lost. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Several reviews of bariatric surgery found that E-selectin and sICAM-1 decreased after surgery, although this was not always consistent for sICAM-1.

    “Several reviews of bariatric surgery found that E-selectin and sICAM-1 decreased after surgery, 15,39 although this was not always consistent for sICAM-1. 40”

    From Comprehensive Long-Term Changes in Cardiovascular Risk Biomarkers With Tirzepatide (2026) · cites this paper as [15]

The citation lists haven’t been fetched yet

References 137 · Cited by 68

Research works printed but not linked: 1

  1. Melissas, 2013, Alterations of global gastrointestinal motility after sleeve gastrectomy: a prospective study, Ann Surg., 258, 976, 10.1097/SLA.0b013e3182774522 · DOI · Paper page

Authors
Biobaku, F., Ghanim, H., Monte, S. V., Caruana, J. A., & Dandona, P.
Affiliations
  • University at Buffalo, State University of New York (US)
  • Erie County Medical Center (US)
Corresponding author
Dandona, Paresh
ORCID
Venue
Journal of the Endocrine Society
Publisher
The Endocrine Society
Published
2020-08-04
Volume
4
Issue
9
Pages
bvaa049-bvaa049
ISSN
2472-1972 (ISSN-L)
DOI
10.1210/jendso/bvaa049
PMC
PMC7402590
OpenAlex
W3046947857
Semantic Scholar
6e8964b5bad368f5d402874bf59b2a1858e56825
Cited by
68
References
137
Citations by year
2026: 10 · 2025: 16 · 2024: 14 · 2023: 18 · 2022: 6 · 2021: 4
FWCI
1.59
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the Endocrine Society (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
  • Health Sciences › Medicine › Surgery › Body Contouring and Surgery
Keywords
bariatric surgery, obesity, chronic inflammation, cardiometabolic benefits, weight loss, obesity-related comorbidities

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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