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Surgery and food cravings

Bariatric surgery changes patients' perception of food

(credit: digitalbob8. The image was published under the Creative Commons license)
Behavioural results showed lower wanting and liking scores as well as lower eating behaviour-related pathologies for the patients after RYGB than for similar obese subjects without surgery but with impaired glycaemic control

Not only does bariatric surgery help people lose weight may work by reducing the amount they eat, it can also change what they want to eat improving glycaemic control after surgery, according to research in Diabetes Care, the journal of the American Diabetes Association (ADA).

In the study, ‘Neuronal Food Reward Activity in Patients With Type 2 Diabetes With Improved Glycemic Control After Bariatric Surgery’, the researchers, led by Sabine Frank of the University of Tubingen in Germany, sought to identify how the neuronal and behavioural reward centres in the brain, correlates with improved glycaemic control after bariatric surgery.

They established two patient groups with T2DM:tThe treatment group (n=12) consisted of patients who had undergone Roux-en-Y gastric bypass (RYGB) surgery, and a control group consisted of patients who did not undergo surgery (n=12). The groups were matched for age and current BMI. HbA1c was matched by using the presurgical HbA1c of the RYGB group and the current HbA1c of the nonsurgical group. Neuronal activation during a food reward task was measured using functional MRI (fMRI) and behavioural data were assessed through questionnaires.

Outcomes

They reported that in the first group, RYGB improved HbA1c from 7.07±0.50 to 5.70±0 (16%, p<0.05) and BMI from 52.21±1.90 to 35.71±0.84 (p<0.001). Behavioural results showed lower wanting and liking scores as well as lower eating behaviour-related pathologies for the patients after RYGB than for similar obese subjects without surgery but with impaired glycaemic control.

The fMRI analysis showed higher activation for the non-surgical group in areas associated with inhibition and reward as well as in the precuneus, a major connectivity hub in the brain. By contrast, patients after RYGB showed higher activation in the visual, motor, cognitive control, memory, and gustatory regions.

The study is consistent with recent results from a study from the University of Texas Southwestern Medical Center, who reported in the journal Obesity, that brain scans showed severely obese women had very different responses to food than others that their reward centres, in effect, kept telling them to eat even after they were no longer hungry.

“In obese patients with diabetes, RYGB normalises glycaemic control and leads to food reward-related brain activation patterns that are different from those of obese patients with less-well-controlled T2DM and without bariatric surgery,” the authors concluded. “The differences in food reward processing might be one factor in determining the outcome of bariatric surgery in patients with T2DM.”

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