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Higher Ghrelin Levels May be Linked to Early Weight Regain after RYGB Surgery

But results from the longitudinal study also confirmed that improvements in insulin sensitivity were unaltered by weight regain following Roux-en-Y gastric bypass…. 

The patients who had higher levels of ghrelin before and after the surgery was performed were more likely to regain weight. This meant that ghrelin levels might be used to assist in identifying patients with a higher risk of weight regain. Robyn A. Tamboli, PhD, a researcher at the Department of Surgery at Vanderbilt University, said that, "Being able to identify these patients would provide the opportunity to intervene and prevent weight regain."

The researchers assessed the long-term hepatic and peripheral insulin sensitivity, and ghrelin and leptin plasma levels of 45 patients who underwent RYGB. They observed these patients before the surgery and again 1 month, 6 months, 1 year and 2 years after the surgery. Weight regain was defined as an increase in body weight ≥5% within 1 to 2 years following RYGB.

The results of the study showed that 33% of patients regained weight. The average increase in body weight was 8.5±3.3 kg, amounting to a rate of 10±5%. The weight regain was not associated with diminished hepatic or peripheral insulin sensitivity. The trajectories of leptin levels and fat mass corresponded in the group of patients that regained weight and in the group of patients that maintained or lost weight throughout the study span. However, when compared to the patients who maintained or lost weight, the patients who regained weight demonstrated higher preoperative and postoperative levels of ghrelin.

While the substantial metabolic improvements that occur after RYGB are durable through a small degree of weight gain, the researchers suggested that this should be explored further in long-term studies. As far as interventions go, Tamboli suggested that ghrelin antagonists could be administered in adjunct with RYGB. As an alternative option, she proposed performing a vertical sleeve gastrectomy, where the part of the stomach with the highest density of ghrelin-producing cells is removed as part of the surgical procedure, instead of RYGB in patients with high levels of ghrelin.

Practice Pearls:
  • The study revealed that improvements in insulin sensitivity were not reversed by weight regain occurring during the 1-2 years following Roux-en-Y gastric bypass
  • Research revealed that the patients with higher levels of ghrelin before and after RYGB were more likely to regain weight.
  • Possible intervention would be to administer ghrelin antagonists adjunctively with RYGB or performing a vertical sleeve gastrectomy instead of RYGB in patients with high levels of ghrelin.

Tamboli RA. Obesity. 2014;doi:10.1002/oby.20776.