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Physiological Reports Volume 7 ,Issue 7 ,2019-03-29
Comparison of surgical versus diet‐induced weight loss on appetite regulation and metabolic health outcomes
Original Research
Tanya M. Halliday 1 , 2 Sarit Polsky 3 Jonathan A. Schoen 4 Kristina T. Legget 5 Jason R. Tregellas 5 Kayla M. Williamson 6 Marc‐Andre Cornier 1 , 7
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Received 2018-10-04, accepted for publication 2019-03-07, Published 2019-03-07

Abstract Bariatric surgery is associated with significant and sustained weight loss and improved metabolic outcomes. It is unclear if weight loss alone is the main mechanism of improved metabolic health. The purpose of this trial was to compare indices of appetite regulation, insulin sensitivity and energy intake (EI) between participants achieving 10 kg of weight loss via Roux‐en‐Y Gastric Bypass (RYGB) or dietary restriction (DIET); intake of a very low calorie liquid diet (800 kcal/d; 40% protein, 40% fat, 20% carbohydrate that matched the post‐RYGB dietary protocol). Adults qualifying for bariatric surgery were studied before and after 10 kg of weight loss (RYGB [n = 6]) or DIET [n = 17]). Appetite (hunger, satiety, and prospective food consumption [PFC]), appetite–related hormones, and metabolites (ghrelin, PYY, GLP‐1, insulin, glucose, free fatty acids [FFA], and triglycerides [TG]) were measured in the fasting state and every 30 min for 180 min following breakfast. Participants were provided lunch to evaluate acute ad libitum EI, which was similarly reduced in both groups from pre to post weight loss. Fasting ghrelin was reduced to a greater extent following RYGB compared to DIET (P = 0.04). Area under the curve (AUC) for ghrelin (P = 0.01), hunger (P < 0.01) and PFC (P < 0.01) increased after DIET compared to RYGB, following 10 kg weight loss. Satiety AUC increased after RYGB and decreased after DIET (P < 0.01). Glucose and insulin (fasting and AUC) decreased in both groups. FFA increased in both groups, with a greater increase in AUC seen after RYGB versus DIET (P = 0.02). In summary, appetite–related indices were altered in a manner that, if maintained, may promote a sustained reduction in energy intake with RYGB compared to DIET. Future work with a larger sample size and longer follow‐up will be important to confirm and extend these findings.


roux‐en‐y gastric bypass;gut peptides;energy intake;diet‐induced weight loss;Appetite


© 2019 Published by the Physiological Society and the American Physiological Society


Appetite–related peptide response to breakfast test meal pre and post 10 kg of weight loss in participants undergoing RYGB or DIET. Curves for ghrelin (A), PYY (C), and GLP‐1 (E) are shown at 0 min and every 30 min for 180 min following the breakfast meal. Values are means ± SEM. Also shown are individual changes in AUC from pre to post 10 kg of weight loss for ghrelin (B), PYY (D), and GLP‐1 (F). RYGB, Roux‐en‐Y Gastric Bypass (n = 6); DIET, diet‐induced weight loss control group (n = 17); AUC, Area under the curve.

Metabolite response to breakfast test meal pre and post 10 kg of weight loss in participants undergoing RYGB or DIET. Curves for insulin (A), glucose (C), and FFA (E) are shown at 0 min and every 30 min for 180 min following the breakfast meal. Values are means ± SEM. Also shown are individual changes in AUC from pre to post 10 kg of weight loss for insulin (B), glucose (D), and FFA (F). RYGB, Roux‐en‐Y Gastric Bypass (n = 6); DIET, diet‐induced weight loss control group (n = 17); AUC, Area under the curve.

Subjective appetite response to breakfast test meal pre and post 10 kg of weight loss in participants undergoing RYGB or DIET. Curves for hunger (A), satiety (C), and PFC (E) are shown at 0 min and every 30 min for 180 min following the breakfast meal. Values are means ± SEM. Also shown are individual changes in AUC from pre to post 10 kg of weight loss for hunger (B), satiety (D), and PFC (F). Appetite ratings were evaluated with 100 mm VAS. RYGB, Roux‐en‐Y Gastric Bypass (n = 6); DIET: diet‐induced weight loss control group (n = 17); AUC, Area under the curve; PFC, prospective food consumption; VAS, visual analogue scale

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Tanya M. Halliday.Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado;Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah.tanya.halliday@utah.edu


Tanya M. Halliday,Sarit Polsky,Jonathan A. Schoen,Kristina T. Legget,Jason R. Tregellas,Kayla M. Williamson,Marc‐Andre Cornier. Comparison of surgical versus diet‐induced weight loss on appetite regulation and metabolic health outcomes. Physiological Reports ,Vol.7, Issue 7(2019)



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