Successful treatment of obesity and insulin resistance via ketogenic diet status post Roux-en-Y

BMJ Case Rep. 2018 Aug 17;2018:bcr2018225643. doi: 10.1136/bcr-2018-225643.


This is a single case of a 65-year-old American woman who presented with substantial weight gain and insulin resistance (IR) post-Roux-en-Y gastric bypass (RYGB) surgery. Before RYGB, she had reached 340 lbs (155 kg) and a body mass index (BMI) of 56.6 kg/m2 The surgery resulted in a 70 lbs (32 kg) weight loss, bringing her BMI, per cent total weight loss (%TWL) and per cent excess weight loss (%EWL) to 44.9 kg/m2, 20.6% and 36.8%, respectively. Unfortunately, her BMI would return to 53.6 kg/m2, nearly her pre-RYGB BMI. It was then she sought the guidance of a primary care physician with expertise in nutrition and medical management of obesity, who placed her on a ketogenic diet. One year later, she had lost 102 lbs (46.4 kg), resulting in a BMI, %TWL and %EWL of 36.6 kg/m2, 31.7%, and 63.1%, respectively, also further resulting in significant improvements of her inflammatory biomarkers. This case presentation will explore current literature, covering the effects of obesity on IR, pre-diabetes and other disease-provoking inflammatory biomarkers.

Keywords: diabetes; endocrine system; gastrointestinal surgery; metabolic disorders; nutrition and metabolism.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Diagnosis, Differential
  • Diet, Ketogenic*
  • Female
  • Gastric Bypass
  • Humans
  • Insulin Resistance*
  • Obesity, Morbid / surgery*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / diet therapy