Neuroendocrine regulation of energy balance: Implications on the development and surgical treatment of obesity

2017 ◽  
Vol 23 (3) ◽  
pp. 131-146 ◽  
Author(s):  
Gisele Farias ◽  
Bárbara Dal Molin Netto ◽  
Solange Cravo Bettini ◽  
Ana Raimunda Dâmaso ◽  
Alexandre Coutinho Teixeira de Freitas
Keyword(s):  
Weight Loss ◽  
Adipose Tissue ◽  
Gastrointestinal Tract ◽  
Energy Balance ◽  
Public Health Problem ◽  
Neuroendocrine Regulation ◽  
Calorie Intake ◽  
Hormone Signaling ◽  
Sustained Weight Loss

Introduction: Obesity, a serious public health problem, occurs mainly when food consumption exceeds energy expenditure. Therefore, energy balance depends on the regulation of the hunger–satiety mechanism, which involves interconnection of the central nervous system and peripheral signals from the adipose tissue, pancreas and gastrointestinal tract, generating responses in short-term food intake and long-term energy balance. Increased body fat alters the gut- and adipose-tissue-derived hormone signaling, which promotes modifications in appetite-regulating hormones, decreasing satiety and increasing hunger senses. With the failure of conventional weight loss interventions (dietary treatment, exercise, drugs and lifestyle modifications), bariatric surgeries are well-accepted tools for the treatment of severe obesity, with long-term and sustained weight loss. Bariatric surgeries may cause weight loss due to restriction/malabsorption of nutrients from the anatomical alteration of the gastrointestinal tract that decreases energy intake, but also by other physiological factors associated with better results of the surgical procedure. Objective: This review discusses the neuroendocrine regulation of energy balance, with description of the predominant hormones and peptides involved in the control of energy balance in obesity and all currently available bariatric surgeries. Conclusions: According to the findings of our review, bariatric surgeries promote effective and sustained weight loss not only by reducing calorie intake, but also by precipitating changes in appetite control, satiation and satiety, and physiological changes in gut-, neuro- and adipose-tissue-derived hormone signaling.

scholarly journals Evaluation of the Effects of Bariatric Surgery in Terms of Weight Loss and Diabetes Remission in the Indian Population

2021 ◽  
pp. 1-7
Author(s):  
Manish Khaitan ◽  
Riddhish Gadani ◽  
Koshish Nandan Pokharel
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Complete Remission ◽  
Predictive Factors ◽  
Indian Population ◽  
Diabetes Remission ◽  
Obese Patients ◽  
Sustained Weight Loss

<b><i>Objectives:</i></b> The growing prevalence of obesity rates worldwide is associated with an upsurge in its comorbidities, particularly type 2 diabetes mellitus (T2DM). Bariatric surgery is a proven treatment modality for producing sustained weight loss and resolution of associated T2DM providing marked improvement in quality of life with rapid recovery. This study aims to investigate the effects of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) on obese patients suffering from T2DM in the Indian population and their long-term association with regard to diabetes remission, resolution of comorbidities, and percentage EWL. <b><i>Methods:</i></b> Retrospective data of obese patients with T2DM (preoperative BMI 45.37 ± 8.1) who underwent bariatric surgery (RYGB, LSG, and MGB) were analyzed in this study over a period of 9 years. The mean follow-up period was 2.2 years. Following surgery, the clinical outcome on BMI, resolution of percentage weight loss, and T2DM were studied. The predictive factors of diabetic remission after surgery were determined. Student’s <i>t</i> test and ANOVA and McNemar’s test were applied. <b><i>Results:</i></b> Out of a total of 274 patients, complete remission of T2DM was achieved in 52.9% (<i>n</i> = 145) with mean fasting blood glucose and glycated hemoglobin values being 6.1 ± 0.769 (<i>p</i> = 0.00) at 1 year after surgery. The independent predictive factors of remission were age, gender, BMI, preoperative comorbidities, and % EWL. Gender had no correlation with the chance of achieving disease remission. <b><i>Conclusion:</i></b> Based on our results, bariatric surgery proves to be a successful treatment option resulting in sustained weight loss in obese patients suffering from T2DM. It is found to be beneficial for the long-term resolution of T2DM and improving comorbidities such as hypertension and dyslipidemia. The outcome of the different surgical methods is found to be similar for all patients irrespective of the independent predictors of complete remission.

Abstract 12368: Impact of Weight Trends on Long-term Outcomes After Atrial Fibrillation Ablation in Obese Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
T J Bunch ◽  
Heidi T May ◽  
Tami L Bair ◽  
Victoria Jacobs ◽  
Brian G Crandall ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Weight Loss ◽  
Catheter Ablation ◽  
Obese Patients ◽  
Long Term Outcomes ◽  
Sustained Weight Loss ◽  
Index Weight ◽  
Af Recurrence

Introduction: Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach in symptomatic patients. Obesity is a dominant driver of AF recurrence after ablation. Weight reduction strategies lower general AF burden and as such may be critical to long-term success rates after ablation. Hypothesis: Long-term outcomes after AF ablation will be better in obese patients with sustained weight loss. Methods: All patients that underwent an index ablation with a BMI recorded and >30 kg/m 2 and at least 3 years of follow-up were included (n=407). The group was separated and compared by weight trends over the 3 years (1. Lost >3% of index weight, n=141; 2. Maintained index weight ±3%, n=147; 3. Gained >3% of index weight at 3 years, n=119). Long-term outcomes included AF recurrence and a composite defined as major adverse clinical events, MACE (stroke/TIA, heart failure (HF) hospitalization, and death). Results: The average age was 63.6±10.4 years, 59.3% were male and 51.7% had paroxysmal AF. AF comorbidities include: hypertension (79.5%), heart failure (36.0%), sleep apnea (35.2%), diabetes (28.9%), and stroke/TIA (5.9%). Those that maintained their weight (HR: 1.45, p=0.05) and those that gained weight (HR 1.54, p=0.07) were more likely to have AF recurrence compared to those that lost weight. Similarly, MACE increased from 18.4% in those that lost weight at 3 years compared to 18.6% (HR 1.32, p=0.29) in those that maintained their weight and 26.5% in those that gained weight (HR 2.01, p=0.02). A small group of patients (n=5), lost >3% then gained it back and ultimately increased their weight by 3%. This group had the highest rates of AF recurrence (100%). Conclusion: Maintained weight loss is a critical component in reducing AF recurrence rates after index catheter ablation in obese patients. Sustained weight loss also results in a reduction in AF-related comorbidities and mortality.

scholarly journals Is It Time to Rethink Our Weight Loss Paradigms?

Biology ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. 70 ◽  
Author(s):  
Paulo Gentil ◽  
Ricardo Borges Viana ◽  
João Pedro Naves ◽  
Fabrício Boscolo Del Vecchio ◽  
Victor Coswig ◽  
...  
Keyword(s):  
Weight Loss ◽  
Interval Training ◽  
Current Evidence ◽  
Physiological Changes ◽  
Exercise Interventions ◽  
High Intensity Training ◽  
Sustained Weight Loss ◽  
Intensity Of Exercise ◽  
Intensity Training

Strategies aiming to promote weight loss usually include anything that results in an increase in energy expenditure (exercise) or a decrease in energy intake (diet). However, the probability of losing weight is low and the probability of sustained weight loss is even lower. Herein, we bring some questions and suggestions about the topic, with a focus on exercise interventions. Based on the current evidence, we should look at how metabolism changes in response to interventions instead of counting calories, so we can choose more efficient models that can account for the complexity of human organisms. In this regard, high-intensity training might be particularly interesting as a strategy to promote fat loss since it seems to promote many physiological changes that might favor long-term weight loss. However, it is important to recognize the controversy of the results regarding interval training (IT), which might be explained by the large variations in its application. For this reason, we have to be more judicious about how exercise is planned and performed and some factors, like supervision, might be important for the results. The intensity of exercise seems to modulate not only how many calories are expended after exercise, but also where they came from. Instead of only estimating the number of calories ingested and expended, it seems that we have to act positively in order to create an adequate environment for promoting healthy and sustainable weight loss.

scholarly journals Hypothalamic γ-melanocyte stimulating hormone gene delivery reduces fat mass in male mice

2018 ◽  
Vol 239 (1) ◽  
pp. 19-31 ◽  
Author(s):  
K Eerola ◽  
S Virtanen ◽  
L Vähätalo ◽  
L Ailanen ◽  
M Cai ◽  
...  
Keyword(s):  
Weight Loss ◽  
Energy Balance ◽  
Gene Delivery ◽  
Fat Mass ◽  
Energy Homeostasis ◽  
Western Diet ◽  
Dependent Manner ◽  
Melanocyte Stimulating Hormone ◽  
Stimulating Hormone

γ-Melanocyte stimulating hormone (γ-MSH) is an endogenous agonist of the melanocortin 3-receptor (MC3R). Genetic disruption of MC3Rs increases adiposity and blunts responses to fasting, suggesting that increased MC3R signaling could be physiologically beneficial in the long term. Interestingly, several studies have concluded that activation of MC3Rs is orexigenic in the short term. Therefore, we aimed to examine the short- and long-term effects of γ-MSH in the hypothalamic arcuate nucleus (ARC) on energy homeostasis and hypothesized that the effect of MC3R agonism is dependent on the state of energy balance and nutrition. Lentiviral gene delivery was used to induce a continuous expression of γ-Msh only in the ARC of male C57Bl/6N mice. Parameters of body energy homeostasis were monitored as food was changed from chow (6 weeks) to Western diet (13 weeks) and back to chow (7 weeks). The γ-MSH treatment decreased the fat mass to lean mass ratio on chow, but the effect was attenuated on Western diet. After the switch back to chow, an enhanced loss in weight (−15% vs −6%) and fat mass (−37% vs −12%) and reduced cumulative food intake were observed in γ-MSH-treated animals. Fasting-induced feeding was increased on chow diet only; however, voluntary running wheel activity on Western diet was increased. The γ-MSH treatment also modulated the expression of key neuropeptides in the ARC favoring weight loss. We have shown that a chronic treatment intended to target ARC MC3Rs modulates energy balance in nutritional state-dependent manner. Enhancement of diet-induced weight loss could be beneficial in treatment of obesity.

scholarly journals Long‐term treatment of hypogonadal men with testosterone produces substantial and sustained weight loss

Obesity ◽  
2013 ◽  
Vol 21 (10) ◽  
pp. 1975-1981 ◽  
Author(s):  
Farid Saad ◽  
Ahmad Haider ◽  
Gheorghe Doros ◽  
Abdulmaged Traish
Keyword(s):  
Weight Loss ◽  
Term Treatment ◽  
Sustained Weight Loss ◽  
Long Term Treatment

scholarly journals Increasing Energy Flux to Maintain Diet-Induced Weight Loss

Nutrients ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 2533 ◽  
Author(s):  
Christopher L. Melby ◽  
Hunter L. Paris ◽  
R. Drew Sayer ◽  
Christopher Bell ◽  
James O. Hill
Keyword(s):  
Physical Activity ◽  
Weight Loss ◽  
Body Weight ◽  
Energy Balance ◽  
Energy Expenditure ◽  
Energy Flux ◽  
Weight Maintenance ◽  
High Energy ◽  
Daily Energy

Long-term maintenance of weight loss requires sustained energy balance at the reduced body weight. This could be attained by coupling low total daily energy intake (TDEI) with low total daily energy expenditure (TDEE; low energy flux), or by pairing high TDEI with high TDEE (high energy flux). Within an environment characterized by high energy dense food and a lack of need for movement, it may be particularly difficult for weight-reduced individuals to maintain energy balance in a low flux state. Most of these individuals will increase body mass due to an inability to sustain the necessary level of food restriction. This increase in TDEI may lead to the re-establishment of high energy flux at or near the original body weight. We propose that following weight loss, increasing physical activity can effectively re-establish a state of high energy flux without significant weight regain. Although the effect of extremely high levels of physical activity on TDEE may be constrained by compensatory reductions in non-activity energy expenditure, moderate increases following weight loss may elevate energy flux and encourage physiological adaptations favorable to weight loss maintenance, including better appetite regulation. It may be time to recognize that few individuals are able to re-establish energy balance at a lower body weight without permanent increases in physical activity. Accordingly, there is an urgent need for more research to better understand the role of energy flux in long-term weight maintenance.

scholarly journals Attenuation of Weight Loss Through Improved Antilipolytic Effect in Adipose Tissue Via the SGLT2 Inhibitor Tofogliflozin

2019 ◽  
Vol 104 (9) ◽  
pp. 3647-3660 ◽  
Author(s):  
Akihiro Yoshida ◽  
Yasuhiro Matsubayashi ◽  
Toshiaki Nojima ◽  
Hideki Suganami ◽  
Takahiro Abe ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Adipose Tissue ◽  
Glycosylated Hemoglobin ◽  
Term Treatment ◽  
Integrated Analysis ◽  
Long Term Treatment ◽  
Urinary Glucose

Abstract Context Although calorie loss from increased urinary glucose excretion continues after long-term treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2is), the mechanisms of the attenuated weight loss due to SGLT2is are not well known. Objective To examine the mechanism of the attenuated weight loss during long-term treatment with an SGLT2i, tofogliflozin, focusing on the antilipolytic effect of insulin on adipose tissue. Design and Participants An integrated analysis was performed using data from two phase 3 studies of 52 weeks of tofogliflozin administration. The antilipolytic effect was evaluated using adipose tissue insulin resistance (Adipo-IR) calculated from the product of the levels of fasting insulin (f-IRI) and fasting free fatty acids (f-FFAs). Results Data from 774 patients with type 2 diabetes (mean age, 58.5 years; glycosylated hemoglobin, 8.1%; body mass index, 25.6 kg/m2; estimated glomerular filtration rate, 83.9 mL/min/1.73m2; 66% men) were analyzed. Weight loss plateaued between weeks 24 and 52 after decreasing significantly. f-IRI levels decreased significantly from baseline to week 24, and the decrease was maintained until Week 52. f-FFA levels significantly increased, peaked at week 24, then declined from weeks 24 to 52. Adipo-IR levels declined progressively throughout the 52 weeks (−3.6 mmol/L·pmol/L and −6.2 mmol/L·pmol/L at weeks 24 and 52, respectively; P < 0.001 baseline vs weeks 24 and 52 and week 24 vs week 52). Higher baseline Adipo-IR levels were independently associated with greater weight loss at week 52. Conclusion The improved antilipolytic effect in adipose tissue may attenuate progressive lipolysis, leading to attenuating future weight loss induced by an SGLT2i in patients with type 2 diabetes.

Sign in / Sign up

Export Citation Format

Share Document