Changes in Gut Microbiome after Bariatric Surgery Versus Medical Weight Loss in a Pilot Randomized Trial

  • Clare J. LeeEmail author
  • Liliana Florea
  • Cynthia L. Sears
  • Nisa Maruthur
  • James J. Potter
  • Michael Schweitzer
  • Thomas Magnuson
  • Jeanne M. Clark
Original Contributions



Gut microbiota likely impact obesity and metabolic diseases. We evaluated the changes in gut microbiota after surgical versus medical weight loss in adults with diabetes and obesity.


We performed 16S rRNA amplicon sequencing to identify the gut microbial composition at baseline and at 10% weight loss in adults with diabetes who were randomized to medical weight loss (MWL, n = 4), adjustable gastric banding (AGB, n = 4), or Roux-en-Y gastric bypass (RYGB, n = 4).


All participants were female, 75% reported black race with mean age of 51 years. At similar weight loss amount and glycemic improvement, the RYGB group had the most number of bacterial species (10 increased, 1 decreased) that significantly changed (p < 0.05) in relative abundance. Alpha-diversity at follow-up was significantly lower in AGB group compared to MWL and RYGB (observed species for AGB vs. MWL, p = 0.0093; AGB vs. RYGB, p = 0.0093). The relative abundance of Faecalibacterium prausnitzii increased in 3 participants after RYGB, 1 after AGB, and 1 after MWL.


At similar weight loss and glycemic improvement, the greatest alteration in gut microbiota occurred after RYGB with an increase in the potentially beneficial bacterium, F. prausnitzii. Gut microbial diversity tended to decrease after AGB and increase after RYGB and MWL. Future studies are needed to determine the impact and durability of gut microbial changes over time and their role in long-term metabolic improvement after bariatric surgery in adults with type 2 diabetes.

Clinical Trial Registration



Diabetes Obesity Gastric bypass Gastric band Gut microbiome Randomized controlled trial 


Funding Information

CJL was supported by Grant Number 5KL2TR001077-02 as part of the Institute for Clinical and Translational Research Grant from the NIH/NCAT and career development award from the NIH/NIDDK (K23DK107921). JMC and NMM were supported by Grant Number 1R01DK089557 (PI: J Clark, NIH, NIDDK). CLS was supported by the Bloomberg Philanthropies. This study was also supported by the Translational Research Enhancement Core of the Hopkins Digestive Diseases Basic Research Development Center (P30, DK089502-01 NIDDK/NIH).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11695_2019_3976_MOESM1_ESM.xlsx (19 kb)
ESM 1 (XLSX 18 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Divisions of Endocrinology, Diabetes & MetabolismThe Johns Hopkins UniversityBaltimoreUSA
  2. 2.Division of General Internal MedicineThe Johns Hopkins UniversityBaltimoreUSA
  3. 3.Center for Computational BiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Bloomberg-Kimmel Institute for Cancer ImmunotherapyThe Johns Hopkins UniversityBaltimoreUSA
  5. 5.Division of Infectious DiseasesThe Johns Hopkins University BaltimoreBaltimoreUSA
  6. 6.Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  7. 7.Division of Gastroenterology and HepatologyThe Johns Hopkins UniversityBaltimoreUSA
  8. 8.Department of SurgeryThe Johns Hopkins UniversityBaltimoreUSA

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