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Surgery for Severe Obesity
Published in James M. Rippe, Lifestyle Medicine, 2019
Robert F. Kushner, Lisa A. Neff
Weight loss surgeries have traditionally been classified into three categories on the basis of anatomic changes: restrictive, restrictive-malabsorptive, and malabsorptive. More recently, however, the clinical benefits of bariatric surgery in achieving weight loss and alleviating metabolic comorbidities have been attributed largely to changes in the physiologic responses of gut hormones, bile acid metabolism, the microbiota, and adipose tissue metabolism.8 Metabolic effects resulting from bypassing the foregut include altered responses of ghrelin, glucagon-like peptide 1, peptide YY3-36, and oxyntomodulin. Additional effects on food intake and body weight control may be attributed to changes in vagal signaling. The loss of fat mass, particularly visceral fat, is associated with multiple metabolic, adipokine, and inflammatory changes that include improved insulin sensitivity and glucose disposal; reduced free fatty acid flux; increased adiponectin levels; and decreased interleukin 6, tumor necrosis factor α, and high-sensitivity C-reactive protein levels. The surgical procedures commonly performed are shown in Figure 40.1.
Is vagal stimulation or inhibition benefit on the regulation of the stomach brain axis in obesity?
Published in Nutritional Neuroscience, 2022
Işınsu Alkan, Berrin Zuhal Altunkaynak, Elfide Gizem Kivrak, Arife Ahsen Kaplan, Gülay Arslan
It should also be considered that the secretion of neurons in the arcuate nucleus generates signals to increase the activity of the vagal afferent system. Laskiewicz et al. reported that short-term stimulation increased gene expression of NPY and AgRP in the arcuate nucleus. The lesion of the ventromedial nucleus, another hypothalamic nucleus, has been shown to cause overeating and obesity [34]. In this study, the neuron density in the ventromedial nucleus was significantly increased in the stimulation group. In particular, enterostatin appears likely, given the feedback of electrically stimulated mechanisms by stimulation of the gastrointestinal tract and generation of signals such as peptide YY3-36. In the dorsomedial nucleus of the stimulation group, which is accepted as the satiety center [14,35,36] the decrease in neuron density was noticeable. This result shows that stimulation affects the satiety center, not the hunger center.
Psychopharmacological advances in eating disorders
Published in Expert Review of Clinical Pharmacology, 2018
Hubertus Himmerich, Janet Treasure
Drugs used for obesity may also reduce weight in BED as there is a significant overlap between both diagnoses [86–92]. Therefore, we would like to briefly mention these drugs as well, even though they are not yet tested for BED but only for obesity. Liraglutide is an analog of the anorexigenic bowel hormone GLP-1 which binds to the GLP-1 receptors in the hypothalamus. It has been shown to lead to significant weight loss in obese patients and to an improvement regarding the various health consequences of obesity in a number of RCTs [151–156]. Two RCTs with naltrexone plus bupropion showed superior weight outcomes to placebo in patients with obesity with no adverse effects [157,158]. This combination is thought to lead to weight loss by modulation of opioid, dopamine, and norepinephrine signaling in both the self-regulatory and the reward system. Further new pharmacological approaches for obesity include the norepinephrine reuptake inhibitor reboxetine [159], the monoamine reuptake inhibitor tesofesin [160], the CB1 receptor antagonist taranabant [161], the peptide YY3-36 [162] which is a product of enteroendocrine cells, the pancreatic and lipase inhibitor cetilistat [163]. From preclinical and healthy studies, there is also evidence for the efficacy of intranasal insulin to reduce appetite and food intake [164]. Furthermore, there is already sufficient evidence from RCTs for the beneficial clinical effect of the serotonin receptor agonist lorcaserin [165] and the combination of the stimulant phentermine which has similarities with amphetamine plus topiramate [166–169].
Effect of feeding regimen on circadian activity rhythms of food anticipatory by ghrelin hormone in a pig model
Published in Nutritional Neuroscience, 2023
He Zhang, Xiaoxi Yan, Ailian Lin, Pengke Xia, Menglan Jia, Yong Su
The concentrations of melatonin, leptin, cholecystokinin (CCK), and peptide YY3-36 (PYY) in serum; the concentrations of glucagon-like peptide-1 (GLP-1) in serum and hypothalamus, the concentrations of ghrelin in serum, hypothalamus, stomach, and duodenum were determined by ELISA kits. Briefly, the serum was centrifuged at 2000 g for 20 min at 4°C, and the tissue samples of the hypothalamus, stomach, and duodenum were suspended in sterile phosphate-buffered saline and centrifuged at 2000 g for 20 min at 4°C. The supernatants were analyzed using ELISA kits according to the manufacturer’s instructions (Nanjing Jiancheng Bioengineering Institution, Nanjing, China).