Successful Weight Loss Surgery Improves Eating Control and Energy Metabolism: A Review of the Evidence

The public health situation of many industrialized countries is jeopardized by the increasing incidence of obesity and related cardiovascular disease. 1 , 2 The alarming situation is clearly related to our modern way of living, implicating ad libitum access to food and sedentary lifestyle. The prevalence of obesity increases every year and overrules our tightly controlled energy homeostasis, which tries to keep body weight within narrow boundaries. 3 , 4 Nationwide campaigns against obesity and associated cardiovascular disease are mainly focused on signs and symptoms of the metabolic syndrome. For example, the diagnostic criteria proposed by the American National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) are understandable and can be managed with caloric restriction, exercise, and modern effective drugs. 5 However, many motivated obese patients try hard to reduce weight but gradually lose control of eating behavior, become disappointed, and finally undergo bariatric surgery. Notably, each surgical technique has its specific advantages and drawbacks. For example, laparoscopic adjustable gastric banding (LAGB) is a restrictive technique, which is appropriate for patients with a body mass index (BMI) <50 kg/m 2 and without extreme eating disorders. In this respect, a long-term follow-up study among individuals who underwent LAGB showed ‘treatment failure’ in about 37% after 7 years. 6 On the other hand, gastric bypass (GBP) and biliopancreatic diversion (BPD) combined with restrictive techniques are clearly more effective to maintain durable weight loss. 7 Because there are no safety follow-up data >10 years, GBP with just a minimal degree of malabsorption has earned the reputation as the ‘gold standard’ against all other procedures.