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Energetic adaptations persist in adolescents with extreme obesity after Roux-en-Y
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Adolescents with extreme obesity who underwent Roux-en-Y gastric bypass experienced energetic adaptations that favor weight regain, along with changes in insulin, adipokines, thyroid hormones, gut hormones and sympathetic nervous system activity, according to research published in Obesity.
Adolescents continue to experience the compensatory changes in energy expenditure 12 months after Roux-en-Y gastric bypass (RYGB), according to researchers
“RYGB surgery not only improved insulin sensitivity, decreased heart rate, and reduced inflammation but also induced persistent energetic, metabolic and endocrine adaptations that favor weight regain,” the researchers wrote.
Nancy F. Butte, of the department of pediatrics, Baylor College of Medicine, Houston, and colleagues conducted a prospective study involving adolescents with extreme obesity (n = 11; BMI ≥ 50 kg/m2 or BMI ≥ 40 kg/m2 with comorbidities) who underwent RYGB and a control group (n = 5) matched for initial weight, BMI and body composition to examine energetic, metabolic and neuroendocrine responses.
The investigators measured 24-hour room calorimetry, body composition and fasting blood biochemistries at baseline and again at 1.5, 6 and 12 months.
With RYGB, patients demonstrated a mean weight loss of 44 ± 19 kg at 12 months. Decreases in total energy expenditure, activity energy expenditure, basal metabolic rate, sleep energy expenditure and walking energy expenditure were seen by 1.5 months (P = .001) and continued at 6 and 12 months. Energy expenditure remained lower than baseline (P = .001) with adjustments for age, sex, fat-free mass and fat mass.
Reductions in serum insulin, leptin, and triiodothyronine, gut hormones, and urinary norepinephrine paralleled the decreases in energy expenditure. Adjusted changes in total energy expenditure, basal metabolic rate and/or sleep energy expenditure were associated with drops in insulin, homeostatic model assessment, leptin, thyroid-stimulating hormone, total T3, peptide YY3-36, glucagon-like peptide-2, and urinary norepinephrine and epinephrine (P = .001-.05).
“The elucidation of these adaptations induced by weight loss after RYGB surgery will be instrumental in guiding the clinical management of these patients to prevent recidivism and future research into alternate surgical and nonsurgical treatments for morbid obesity,” the researchers wrote. – by Allegra Tiver
Disclosure: The researchers report no relevant financial disclosures.
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