Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass

Int J Obes (Lond). 2013 Nov;37(11):1452-9. doi: 10.1038/ijo.2013.15. Epub 2013 Feb 19.


Objective: To identify factors contributing to the variation in weight loss after Roux-en-Y gastric bypass (RYGB).

Design: Cross-sectional study of patients with good (excess body mass index lost (EBL) >60%) and poor weight loss response (EBL <50%) >12 months after RYGB and a lean control group matched for age and gender.

Materials and methods: Sixteen patients with good weight loss response, 17 patients with poor weight loss response, and eight control subjects were included in the study. Participants underwent dual energy X-ray absorptiometry scan, indirect calorimetry and a 9 h multiple-meal test with measurements of glucose, insulin, total bile acids (TBA), glucagon-like peptide (GLP)-1, peptide YY3-36 (PYY), cholecystokinin (CCK), ghrelin, neurotensin and pancreatic polypeptide (PP) as well as assessment of early dumping and appetite.

Results: Suppression of hunger was more pronounced in the good than the poor responders in response to the multiple-meal test (P=0.006). In addition, the good responders had a larger release of GLP-1 (P=0.009) and a greater suppression of ghrelin (P=0.037) during the test, whereas the postprandial secretion of CCK was highest in the poor responders (P=0.005). PYY, neurotensin, PP and TBA release did not differ between the RYGB-operated groups. Compared with control subjects, patients had exaggerated release of GLP-1 (P<0.001), PYY (P=0.008), CCK (P=0.010) and neurotensin (P<0.001). Early dumping was comparable in the good and poor responders, but more pronounced than in controlled subjects. Differences in resting energy expenditure between the three groups were entirely explained by differences in body composition.

Conclusion: Favorable meal-induced changes in hunger and gut hormone release in patients with good compared with poor weight loss response support the role of gut hormones in the weight loss after RYGB.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Appetite Regulation*
  • Bile Acids and Salts / metabolism
  • Blood Glucose / metabolism
  • Body Mass Index
  • Cholecystokinin / metabolism
  • Cross-Sectional Studies
  • Dumping Syndrome / etiology
  • Dumping Syndrome / metabolism*
  • Energy Metabolism*
  • Female
  • Follow-Up Studies
  • Gastric Bypass* / adverse effects
  • Ghrelin / metabolism
  • Glucagon-Like Peptide 1 / metabolism
  • Humans
  • Male
  • Middle Aged
  • Neurotensin / metabolism
  • Obesity, Morbid / metabolism*
  • Obesity, Morbid / surgery
  • Peptide YY / metabolism
  • Treatment Outcome
  • Weight Loss*


  • Bile Acids and Salts
  • Blood Glucose
  • Ghrelin
  • Peptide YY
  • Neurotensin
  • Glucagon-Like Peptide 1
  • Cholecystokinin