Bariatric Surgery Induces White and Grey Matter Density Recovery in the Morbidly Obese: A Voxel-Based Morphometric Study

Hum Brain Mapp. 2016 Nov;37(11):3745-3756. doi: 10.1002/hbm.23272.


Obesity is associated with lowered brain's grey (GM) and white matter (WM) density as measured by voxel-based morphometry (VBM). Nevertheless, it remains unknown whether obesity has a causal influence on cerebral atrophy. We recruited 47 morbidly obese subjects (mean BMI = 42.2, SD = 4.0, 42 females and five males) eligible for bariatric surgery and 29 non-obese subjects (mean BMI = 23.2, SD = 2.8, 23 females and six males) served as controls. Baseline scans were acquired with T1-weighted magnetic resonance imaging (MRI) at 1.5 Tesla; obese participants were scanned again six months after the surgery. Local GM and WM densities were quantified using VBM. Full-volume analyses were used for comparing baseline between-group differences as well as the effects of surgery-induced weight loss in the morbidly obese. Metabolic variables were used in linear models to predict WM and GM densities. Obese subjects had initially lower GM densities in widespread cortical areas including frontal, parietal, and temporal regions as well as insulae. Lower WM densities were observed throughout the WM. Bariatric surgery and concomitant weight loss resulted in global increase in WM density. Grey matter increase was limited to occipital and inferior temporal regions. Metabolic variables were associated with brain densities. We conclude that weight loss results in global recovery of WM as well as local recovery of grey matter densities. These changes likely reflect improved brain tissue integrity. Hum Brain Mapp 37:3745-3756, 2016. © 2016 Wiley Periodicals, Inc.

Keywords: bariatric surgery; obesity; structural MRI; voxel-based morphometry; weight loss.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bariatric Surgery*
  • Biomarkers / blood
  • Body Mass Index
  • Cholesterol / blood
  • Female
  • Gray Matter / diagnostic imaging*
  • Gray Matter / metabolism
  • Humans
  • Image Processing, Computer-Assisted
  • Linear Models
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Obesity, Morbid / diagnostic imaging*
  • Obesity, Morbid / metabolism
  • Obesity, Morbid / surgery*
  • Organ Size
  • Treatment Outcome
  • Weight Loss
  • White Matter / diagnostic imaging*
  • White Matter / metabolism
  • Young Adult


  • Biomarkers
  • Cholesterol