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M. Gagner382
33. Chambers AP, Kirchner H, Wilson-Perez HE, Willency JA, Hale JE, Gaylinn BD, et al. The
effects of vertical sleeve gastrectomy in rodents are ghrelin independent. Gastroenterology.
2013;144:50–5.
34. McFarlane MR, Brown MS, Goldstein JL, Zhao T-J. Induced ablation of ghrelin cells in
adult mice does not decrease food intake, body weight, or response to high-fat diet. Cell
Metab. 2014;20:54–60.
35. Kulkarni BV, LaSance K, Sorrell JE, Lemen L, Woods SC, Seeley RJ, et al. The role of prox-
imal versus distal stomach resection in the weight loss seen after vertical sleeve gastrectomy.
AJP: Regulatory, Integrative and Comparative Physiology. 2016; 311:R979–87.
36. McCarty TR, Jirapinyo P, Thompson CC. Effect of Sleeve Gastrectomy on Ghrelin,
GLP-1, PYY, and GIP Gut Hormones: A Systematic Review and Meta-analysis. Ann Surg.
2020;272(1):72–80.
37. Peterli R, Steinert RE, Woelnerhanssen B, Peters T, Christoffel-Courtin C, Gass M, et al.
Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve
gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22:740–8.
38. Mallipedhi A, Prior SL, Barry JD, Caplin S, Baxter JN, Stephens JW. Temporal changes in
glucose homeostasis and incretin hormone response at 1 and 6 months after laparoscopic
sleeve gastrectomy. Surg Obes Relat Dis. 2014;10:860–9.
39. Papamargaritis D, le Roux CW, Sioka E, Koukoulis G, Tzovaras G, Zacharoulis D. Changes
in gut hormone profile and glucose homeostasis after laparoscopic sleeve gastrectomy. Surg
Obes Relat Dis. 2013;9:192–201.
40. Sista F, Abruzzese V, Clementi M, Carandina S, Cecilia M, Amicucci G. The effect of sleeve
gastrectomy on GLP-1 secretion and gastric emptying: a prospective study. Surg Obes Relat
Dis. 2017;13:7–14.
41. Alamuddin N, Vetter ML, Ahima RS, Hesson L, Ritter S, Minnick A, et al. Changes in
fasting and prandial gut and adiposity hormones following vertical sleeve gastrectomy or
Roux-en-Y-Gastric bypass: an 18-month prospective study. Obes Surg. 2016;27:1563–72.
42. Wilson-Perez HE, Chambers AP, Ryan KK, Li B, Sandoval DA, Stoffers D, et al. Vertical
sleeve gastrectomy is effective in two genetic mouse models of glucagon-like Peptide 1
receptor deficiency. Diabetes. 2013;62:2380–5.
43. Evers SS, Kim KS, Bozadjieva N, et al. Continuous glucose monitoring reveals glyce-
mic variability and hypoglycemia after vertical sleeve gastrectomy in rats. Mol Metab.
2020;32:148–59.
44. Al-Regaiey K, Alshubrami S, Al-Beeshi I, et al. Effects of gastric sleeve surgery on the
serum levels of GH, IGF-1 and IGF-binding protein 2 in healthy obese patients. BMC
Gastroenterol. 2020;20(1):199.
45. Trahtemberg U, Darawshe F, Elazary R, et al. Longitudinal patterns of cytokine expression
at the individual level in humans after laparoscopic sleeve gastrectomy. J Cell Mol Med.
2020;24(12):6622–33.
46. Ryan KK, Tremaroli V, Clemmensen C, Kovatcheva-Datchary P, Myronovych A, Karns
R, et al. FXR is a molecular target for the effects of vertical sleeve gastrectomy. Nature.
2014;509:183–8.
47. Jahansouz C, Xu H, Hertzel AV, Serrot FJ, Kvalheim N, Cole A, et al. Bile acids
increase independently from hypocaloric restriction after bariatric surgery. Ann Surg.
2016;264:1022–8.
48. Steinert RE, Peterli R, Keller S, Meyer-Gerspach AC, Drewe J, Peters T, et al. Bile acids
and gut peptide secretion after bariatric surgery: a 1-year prospective randomized pilot trial.
Obesity (Silver Spring). 2013;21:E660–8.
49. McGavigan AK, Garibay D, Henseler ZM, Chen J, Bettaieb A, Haj FG, et al. TGR5 con-
tributes to glucoregulatory improvements after vertical sleeve gastrectomy in mice. Gut.
2017;66:226–34.
50. Chen Y, Lu J, Nemati R, Plank LD, Murphy R. Acute changes of bile acids and FGF19 after
sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2019;29(11):3605–21.
How Laparoscopic Sleeve Gastrectomy May Cause Weight Loss
51. Ikeda T, Aida M, Yoshida Y, et al. Alteration in faecal bile acids, gut microbial composition
and diversity after laparoscopic sleeve gastrectomy [published online ahead of print, 2020
May 20]. Br J Surg. 2020; https://doi.org/10.1002/bjs.11654.
52. Baboumian S, Pantazatos SP, Kothari S, McGinty J, Holst J, Geliebter A. Functional
Magnetic Resonance Imaging (fMRI) of neural responses to visual and auditory food
stimuli pre and post Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG).
Neuroscience. 2019;409:290–8.
53. Arble DM, Evers SS, Bozadjieva N, et al. Metabolic comparison of one-anastomosis gastric
bypass, single-anastomosis duodenal-switch, Roux-en-Y gastric bypass, and vertical sleeve
gastrectomy in rat. Surg Obes Relat Dis. 2018;14(12):1857–67.
383
Expected Weight Loss After the Sleeve
Rickesha L. Wilson and Ali Aminian
1 Introduction
There is strong and growing clinical evidence that metabolic and bariatric surgery
have a significant impact on the overall metabolic health of recipients. As surgeons
and other healthcare providers continue to strive to educate the public on the myriad of benefits, weight loss remains the primary motivation for those considering
metabolic and bariatric surgery. Thus, it is important for the healthcare provider,
and especially the metabolic and bariatric surgeon, to offer realistic expectations
for weight loss for the patient seeking surgery. The sleeve gastrectomy is now the
most commonly performed procedure, potentially due to its technical simplicity compared to other diversionary operations [1]. This chapter will describe the
expected weight loss after sleeve gastrectomy at various time points following surgery as well as cover special circumstances for specific groups of patients.
2 Preoperative Weight Loss
Weight loss begins in the preoperative period. Studies suggest that baseline body
mass index (BMI) as well as preoperative weight loss can be indicative of postoperative weight loss [2]. Steinbeisser et al. published results of a small surgical
cohort of patients who underwent laparoscopic sleeve gastrectomy (SG) by a single surgeon in a community health practice. This study reported a significant difference in percent excess body weight lost (% EWL) and change in BMI between
R. L. Wilson (*) · A. Aminian
Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic,
Cleveland, OH, USA
e-mail: WILSONR13@ccf.org
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer
Nature Switzerland AG 2021
S. Al-Sabah et al. (eds.), Laparoscopic Sleeve Gastrectomy,
https://doi.org/10.1007/978-3-030-57373-7_37
385
R. L. Wilson and A. Aminian386
patients who lost less than 5% EWL preoperatively and those who lost ≥ 5%
EWL at 1-year follow-up: 50% versus 57% for %EWL and −11.2 kg/m2 versus
−13.2 kg/m2 for change in BMI, postoperatively. On average, patients in this study
had a 68% EWL and had a decrease in BMI of 16 kg/m2 at 1 year follow-up [2].
Watanabe et al. reported results of their retrospective evaluation of 247 patients
who were compared based on preoperative weight loss. Total weight loss (%TWL)
at 1 year for all patients was 31.9% overall and 29.3%, postoperatively. There was
an inverse relationship between preoperative and postoperative %TWL. Those
with preoperative %TWL of 0–3% versus greater than 10% TWL, had postoperative %TWL of 33% versus 27%, respectively [3]. Tan et al. also show that a
very low calorie liquid diet does not impact total weight loss or excess BMI loss
beyond 6 months after surgery and evidence is lacking for mandating a preoperative low calorie diet [4]. Therefore, the studies on the impacts of preoperative
weight loss on total weight loss after surgery have been inconclusive.
3 Short-Term and Mid-Term Outcomes
As summarized in a position statement by the leading organization in weight loss
surgery, the American Society of Metabolic and Bariatric Surgery (ASMBS), shortterm results after SG reveal %EWL ranging from 53% to 88% and estimated BMI
loss (%EBMIL) of 58% to 81% [5]. A systematic review and meta-analysis was
performed by Osland et al. to evaluate short-term weight loss results of 9 unique
randomized controlled trials (RCTs) comparing Roux-en-Y gastric bypass (RYGB)
and SG procedures. Postoperative follow-up ranged from 3 months to 5 years and
437 out of 865 patients underwent SG, with %EWL ranging from 69% to 83% at
12 months [6]. Three studies included in this systematic review reported %TWL
outcomes. Keidar et al. reported an average TWL of 24 kg at 3 months and 34 kg
at 12 months after SG [7]. Peterli et al. reported a 36 to 37 kg TWL within the first
12 months [8], and Yang et al. report a TWL of 25 kg at 3 years after SG [9].
The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS) randomized 217
patients to receive either SG or RYGB with the primary goal of measuring weight
loss expressed as %EBMIL. For SG (n = 107), the EBMIL at years 1, 2, 3, and 4
was 72%, 72%, 69%, and 64%, respectively [10]. The STAMPEDE trial authors
reported their outcomes of weight loss by change in BMI and for the SG cohort,
the baseline, and years 1, 2, 3, and 4 BMI values changed from 36 to 27, 28, 28,
and 28, respectively [11].
A large retrospective study of 1,395 patients by Ellatif and colleagues noted
from 6 months to 1, 2, 3, and 4 years postoperatively that %EWL was 42, 52, 61,
73, and 67% (Fig. 1) [12]. Short and mid-term weight loss results are acceptable
for patients undergoing SG and can be offered to patients depending on their specific weight loss goals and metabolic risk profile.
Expected Weight Loss After the Sleeve
Fig. 1 Short-term to Long-term weight loss results in a study of 1395 patients after sleeve gastrectomy. Adapted from International Journal of Surgery, 2014–05-01, Volume 12, Issue 5, Pages
504–508
387
4 Long-Term Outcomes
Long-term results for weight loss after SG have been studied, however, the
follow-up rates for study participants has been consistently low in the literature.
The ASMBS offers results on the durability of weight loss after SG and highlight long-term outcomes from combined published data. At 5 years after SG, the
weighted average %EWL is 58% (40 to 86%) and %EBMIL is 68% (46 to 78%)
in a combined 953 patients. Excess weight loss at 6 to 9 years is 58% (n = 865), at
10 years is 53% (n = 32), and at ≥10 years is 28% (n = 70) [5].
A systematic review and meta-analysis was performed by Sharples et al. evaluating RCTs comparing the long-term (≥ 5 years) results of SG versus RYGB.
Meta-analysis included 4 studies and 320 patients that reported a %EWL of
57.3% after SG compared to 65.7% for 309 RYGB patients [13]. The STAMPEDE
trial comparing RYGB and SG and intensive medical therapy alone was not
included in the previously mentioned meta-analysis due to different weight loss
reporting measures. In the RCT by Schauer et al., after SG there was a reduction
in BMI from 36 to 29 kg/m
change in waist circumference. These weight loss parameters were significant
from baseline and superior compared to participants who only received medical
therapy, however, slightly inferior to those participants in the RYGB cohort [11].
The SM-BOSS trial, after 5 years of follow-up, reported a %EBMIL of 61% for
the SG cohort compared to 68% for the RYGB cohort, which was not significant
after multiple comparisons adjustment [10].
The systematic review performed by O’Brien et al. highlights metabolic and
bariatric procedures that published %EWL as well as other outcomes beyond
10 years [14]. This study was able to include only two studies reporting long-term
weight loss outcomes after the SG procedure with a mean %EWL of 58% [15, 16].
2
, a –18.5% change in body weight (kg), and a -12.2%
R. L. Wilson and A. Aminian388
Evaluating these studies, specifically, Arman et al. were able to maintain follow-up
data on 65 of the 110 patients who originally underwent SG and 47 of those that
kept their sleeve reconstruction. They report a 62.5% EBMIL for those who did not
have revisional surgery and 81.7% for those 16 who underwent revisional surgery
[15]. Felsenreich et al. were able to follow 32 of 53 patients who underwent SG
without revision at 10 years and noted a %EWL of 53% and a %TWL of 26% [16].
Evidence certainly demonstrates that the SG procedure has superior weight loss
outcomes compared to medical therapy or lifestyle intervention alone and weight
loss results decrease over time but are maintained up to 5 years [5]. Long-term
data from retrospective and prospective studies have captured %EWL ranging
from 48% to 69% (Fig. 2) [17].
5 Weight Regain and Other Factors Affecting Weight
Loss
Similar to other weight loss interventions, SG is subject to long-term weight
regain in some patients secondary to compensatory behavioral and physiologic
adaptations. Weight regain is difficult to define in the literature as studies do not
consistently use one definition to define this phenomenon and often combine the
term with others such as “insufficient weight loss” and SG “failure”. A common
definition of weight regain has been an increase in weight of 10kg from weight
nadir. Insufficient weight loss is often defined as never having achieved %EWL
of ≥ 50%. A systematic review by Lauti et al. found 9 heterogenous studies to
report weight regain ranging from 6% at 2 years to 76% at 6 years [18]. This systematic review and other reviews also describe factors that have been found to
contribute to weight regain for SG patients followed at least 2 years: namely initial
sleeve size, sleeve dilatation over time, increased ghrelin levels, inadequate follow-up support, and maladaptive lifestyle behaviors [19].
Arman et al. demonstrated that 21% of the 110 patients undergoing SG
required revision due to weight regain. At long-term follow-up of 11+ years, the
EBMIL was 82% for those undergoing revision versus 62% for those who kept the
original sleeve construction [15].
Panella and colleagues correlated weight loss outcomes with gastric reservoir volumes after SG in 50 patients. Gastric volume was measured at 1 month, 1 year, and
5 years after surgery and measured to be 114 ml, 216 ml, and 367 ml, respectively.
The %EWL at 1 and 5 years was 74.5% and 55.5%, the %EBMIL was 86% and 64%,
and %TWL was 35.7 and 27.4% [20]. Long-term weight loss has not been shown to
correlate with gastric volume after SG. A different study has shown that smaller bougie size of ≤ 6Fr and closer distance of the staple line to the pylorus (2 to 4 cm) was
correlated with superior weight loss outcomes at 4 to 7 years after SG [12].
Eid et al evaluated long-term outcomes after SG in super obese patients (BMI ≥
2
60 kg/m
weight loss at 72, 84, and 96 months after LSG was 52%, 43%, and 46%, respectively, with an overall %EWL of 48%. The mean BMI decreased from 66 kg/m2 to
) who did not undergo a planned second stage operation after SG. Excess
Expected Weight Loss After the Sleeve
Fig. 2 Long-term results of weight loss after sleeve gastrectomy according to publications with
follow-up equal or longer than 72 months. Adapted from Csendes, A., Burgos, A.M., Martinez,
G. et al. Loss and Regain of Weight After Laparoscopic Sleeve Gastrectomy According to
Preoperative BMI. OBES SURG 28, 3424–3430 (2018)
389
46 kg/m2 [21]. Csendes et al. showed significant rates of weight regain for patients
with BMI ≥ 40 kg/m2. Specifically, in patients with an initial BMI ≥ 40 kg/
m2 , 15% of patients (n = 20) had a BMI over 30 at 1 year and that increased to
85% of patients beyond 5 years. For those patients with a BMI ≥ 50 kg/m2, 100%
of patients (n = 4) had a BMI > 30 kg/m2 at 1 year and ≥ 6 years [17]. Patient edu-
cation is important in patients with high BMIs (≥40 kg/m2) who are considering
SG for weight loss as they should be counseled that weight loss outcomes may not
meet expectations and other metabolic procedures may be a better option.
Women seeking to become pregnant following SG can be counseled that longterm weight loss has not been shown to be negatively impacted by pregnancy, but
studies are conflicting [22]. Bakr et al. evaluated 100 patients after SG with up to
5 years follow-up, and 25 patients who became pregnant within 3 years had a 54%
EWL compared to the 52 patients who did not become pregnant and had a 64%
EWL [23]. Weight loss results may be acceptable after pregnancy but, in some
cases, may be inferior to those not becoming pregnant. Lastly, while SG is deemed
safe in the pediatric and elderly populations, more studies are to be done to determine the long-term weight loss outcomes and if they differ from the adult population [24, 25].
6 Summary
In summary, sleeve gastrectomy is now the most commonly performed metabolic
and bariatric procedure worldwide. Heterogeneity of studies in terms of BMI at
the time of surgery, technical details including bougie size and resection of gastric
antrum, along with various retention rates and follow-up times can significantly affect
R. L. Wilson and A. Aminian390
the reported weight loss estimates in the literature. Evidence shows that the expected
weight loss in the long-term is 50% to 60% of excess weight, with an average longterm BMI reduction of 10 kg/m2. Patients should be counseled on the potential of
weight regain that is multifactorial—related to patient characteristics, operative technique, compensatory behavioral and physiologic adaptations, and more [26].
References
1. Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro
N. IFSO worldwide survey 2016: Primary, endoluminal, and revisional procedures. Obes
Surg. 2018;28:3783–94.
2. Steinbeisser M, McCracken J, Kharbutli B. Laparoscopic sleeve gastrectomy: Preoperative
weight loss and other factors as predictors of postoperative success. Obes Surg.
2017;27:1508–13.
3. Watanabe A, Seki Y, Haruta H, Kikkawa E, Kasama K. Preoperative weight loss and opera-
tive outcome after laparoscopic sleeve gastrectomy. Obes Surg. 2017;27:2515–21.
4. Ying S, Tan T, Loi PL, et al. Preoperative weight loss via Very Low Caloric Diet ( VLCD )
and its effect on outcomes after bariatric surgery. Surg: Obes; 2020.
5. Azagury D, Papasavas P, Hamdallah I, Gagner M, Kim J. ASMBS position statement on
medium- and long-term durability of weight loss and diabetic outcomes after conventional
stapled bariatric procedures. Surg Obes Relat Dis. 2018;14:1425–41.
6. Osland E, Nutr B, Mphil D, Yunus RM, Khan S, Memon B. Weight loss outcomes in
Laparoscopic Vertical Sleeve Gastrectomy (LVSG) versus Laparoscopic Roux-en-Y Gastric
Bypass (LRYGB) procedures. Surg Laparosc Endosc Percutan Tech. 2017;27:8–18.
7. Keidar A, Hershkop KJ, Marko L, Schweiger C, Hecht L, Bartov N, Kedar A, Weiss R.
Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: A
randomised trial. Diabetologia. 2013;56:1914–8.
8. Peterli R, Borbély Y, Kern B, Gass M, Peters T, Thurnheer M, Schultes B, Laederach
K, Bueter M, Schiesser M. Early results of the swiss multicentre bypass or sleeve study
(SM-BOSS): A prospective randomized trial comparing laparoscopic sleeve gastrectomy and
Roux-en-Y gastric bypass. Ann Surg. 2013;258:690–5.
9. Yang J, Wang C, Cao G, Yang W, Yu S, Zhai H, Pan Y. Long-term effects of laparoscopic
sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28–35 kg/m2. BMC Surg. 2015;15:1–7.
10. Peterli R, Wolnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs
laparoscopic roux-en-y gastric bypass onweight loss in patients with morbid obesity the
sm-boss randomized clinical trial. JAMA - J Am Med Assoc. 2018;319:255–65.
11. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus —5-Year Outcomes. N
Engl J Med. 2017;376:641–51.
12. Abd Ellatif ME, Abdallah E, Askar W, et al. Long term predictors of success after laparo-
scopic sleeve gastrectomy. Int J Surg. 2014;12:504–8.
13. Sharples AJ, Mahawar K. Systematic review and meta-analysis of randomised controlled
trials comparing long-term outcomes of Roux-En-Y gastric bypass and sleeve gastrectomy.
Obes Surg. 2020;30:664–72.
14. O’Brien PE, Hindle A, Brennan L, Skinner S, Burton P, Smith A, Crosthwaite G, Brown W.
Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight
loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year
outcomes after adjustable gastric banding. Obes Surg. 2019;29:3–14.
15. Arman GA, Himpens J, Dhaenens J, Ballet T, Vilallonga R, Leman G. Long-term (11+years)
outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12:1778–86.
Expected Weight Loss After the Sleeve
16. Felsenreich DM, Langer FB, Kefurt R, Panhofer P, Schermann M, Beckerhinn P, Sperker C,
Prager G. Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year
results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12:1655–62.
17. Csendes A, Burgos AM, Martinez G, Figueroa M, Castillo J, Díaz JC. Loss and regain of
weight after laparoscopic sleeve gastrectomy according to preoperative BMI. Obes Surg.
2018;28:3424–30.
18. Lauti M, Kularatna M, Hill AG, MacCormick AD. Weight regain following sleeve gastrec-
tomy—a systematic review. Obes Surg. 2016;26:1326–34.
19. Yu Y, Lou KM, Kalarchian MA, Ji M, Burke LE. Predictors of weight regain after sleeve gas-
trectomy: an integrative review. Surg Obes Relat Dis. 2019;15:995–1005.
20. Pañella C, Busto M, González A, Serra C, Goday A, Grande L, Pera M, Ramón JM.
Correlation of gastric volume and weight loss 5 years following sleeve gastrectomy. Obes
Surg. 2020. https://doi.org/10.1007/s11695-020-04445-z.
21. Eid GM, Brethauer S, Mattar SG, Titchner RL, Gourash W, Schauer PR. Laparoscopic sleeve
gastrectomy for super obese patients: Forty-eight percent excess weight loss after 6 to 8
years with 93% follow-up. Ann Surg. 2012;256:262–5.
22. Rottenstreich A, Shufanieh J, Kleinstern G, Goldenshluger A, Elchalal U, Elazary R. The
long-term effect of pregnancy on weight loss after sleeve gastrectomy. Surg Obes Relat Dis.
2018;14:1594–9.
23. Bakr AA, Fahmy MH, Elward AS, Balamoun HA, Ibrahim MY, Eldahdoh RM. Analysis of
Medium-Term Weight Regain 5 Years After Laparoscopic Sleeve Gastrectomy. Obes Surg.
2019;29:3508–13.
24. Jackson WL, Lewis SR, Bagby JP, Hilton LR, Milad M, Bledsoe SE. Laparoscopic sleeve
gastrectomy versus laparoscopic Roux-en-Y gastric bypass in the pediatric population: a
MBSAQIP analysis. Surg Obes Relat Dis. 2020;16:254–60.
25. Janik MR, Mustafa RR, Rogula TG, Alhaj Saleh A, Abbas M, Khaitan L. Safety of laparo-
scopic sleeve gastrectomy and Roux-en-Y gastric bypass in elderly patients—analysis of the
MBSAQIP. Surg Obes Relat Dis. 2018;14:1276–82.
26. Aminian A, Brethauer SA, Andalib A, Punchai S, Mackey J, Rodriguez J, Rogula T, Kroh M,
Schauer PR. Can sleeve gastrectomy “cure” diabetes? long-term metabolic effects of sleeve
gastrectomy in patients with type 2 diabetes. Ann Surg. 2016;264:674–81.
391
Other Potential Benefits of the
Sleeve: Effects on Body Fat
Setpoint
Alexis C. Sudlow, Dimitri J. Pournaras and Carel W. le Roux
1 Introduction
One of the challenges facing clinicians in treating obesity has been the oversimplification and characterisation of the disease in itself, as well as the mechanisms
contributing to its development. Although obesity is typically viewed as a single disease state, it is more likely that an increase in adipose tissue is the result
of a heterogeneous set of complex interactions and disorders which affect appetite, eating behaviours and critically, metabolism. Recognising the multifactorial causes of obesity have shed light on the challenge of adequately treating this
complex disease with lifestyle interventions. These changes may be effective in
producing weight loss however, weight loss through modifications in dietary or
exercise habits have yet to demonstrate the ability to treat the set of diseases of
obesity or to produce a sustained change in the signs of these diseases specifically, long term weight loss maintenance. Lifestyle interventions for those with
significant obesity have consistently found that only 15% of patients are able to
maintain a 10% weight loss over one year and in the majority of patients, most
of the weight is regained within 3–5 years [1, 2]. Rather than seeing these figures
as a sign of the futility of treating obesity, it should serve as a reminder to clinicians and patients that obesity is indeed a challenging disease to treat and weight
regain should not be viewed as a personal failing rather as an indication that we
A. C. Sudlow (*) · D. J. Pournaras
Department of Upper GI Surgery, Southmead Hospital, Bristol, UK
e-mail: asudlow@gmail.com
C. W. le Roux
Department of Experimental Pathology, University College Dublin, Dublin, Ireland
e-mail: carel.leroux@ucd.ie
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer
Nature Switzerland AG 2021
S. Al-Sabah et al. (eds.), Laparoscopic Sleeve Gastrectomy,
https://doi.org/10.1007/978-3-030-57373-7_38
393