Energetic adaptations persist after bariatric surgery in severely obese adolescents

Obesity (Silver Spring). 2015 Mar;23(3):591-601. doi: 10.1002/oby.20994.


Objective: Energetic adaptations induced by bariatric surgery have not been studied in adolescents or for extended periods postsurgery. Energetic, metabolic, and neuroendocrine responses to Roux-en-Y gastric bypass (RYGB) surgery were investigated in extremely obese adolescents.

Methods: At baseline and at 1.5, 6, and 12 months post-baseline, 24-h room calorimetry, body composition, and fasting blood biochemistries were measured in 11 obese adolescents relative to five matched controls.

Results: In the RYGB group, mean weight loss was 44 ± 19 kg at 12 months. Total energy expenditure (TEE), activity EE, basal metabolic rate (BMR), sleep EE, and walking EE significantly declined by 1.5 months (P = 0.001) and remained suppressed at 6 and 12 months. Adjusted for age, sex, fat-free mass, and fat mass, EE was still lower than baseline (P = 0.001). Decreases in serum insulin, leptin, and triiodothyronine (T3), gut hormones, and urinary norepinephrine (NE) paralleled the decline in EE. Adjusted changes in TEE, BMR, and/or sleep EE were associated with decreases in insulin, homeostatic model assessment, leptin, thyroid stimulating hormone, total T3, peptide YY3-36, glucagon-like peptide-2, and urinary NE and epinephrine (P = 0.001-0.05).

Conclusions: Energetic adaptations in response to RYGB-induced weight loss are associated with changes in insulin, adipokines, thyroid hormones, gut hormones, and sympathetic nervous system activity and persists 12 months postsurgery.

Publication types

  • Controlled Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adaptation, Physiological*
  • Adipokines / blood
  • Adolescent
  • Bariatric Surgery*
  • Basal Metabolism
  • Body Composition
  • Energy Metabolism / physiology*
  • Female
  • Gastrointestinal Hormones / metabolism
  • Humans
  • Insulin / blood
  • Leptin / blood
  • Male
  • Obesity, Morbid / metabolism*
  • Obesity, Morbid / surgery*
  • Pediatric Obesity / metabolism*
  • Pediatric Obesity / surgery*
  • Peptide Fragments / blood
  • Peptide YY / blood
  • Weight Loss / physiology


  • Adipokines
  • Gastrointestinal Hormones
  • Insulin
  • Leptin
  • Peptide Fragments
  • Peptide YY
  • peptide YY (3-36)