Obesity Surgery

, Volume 29, Issue 11, pp 3698–3705 | Cite as

Long-Term Modulation of Appetitive Hormones and Sweet Cravings After Adjustable Gastric Banding and Roux-en-Y Gastric Bypass

  • Alina I. Tsouristakis
  • Gerardo Febres
  • Donald J. McMahon
  • Beverly Tchang
  • Irene M. Conwell
  • Amanda J. Tsang
  • Leaque Ahmed
  • Marc Bessler
  • Judith KornerEmail author
Original Contributions



Roux-en-Y gastric bypass (RYGB) produces greater weight loss compared with a purely restrictive procedure such as laparoscopic adjustable gastric banding (LAGB).


The objective of this study was to quantify changes in hormones that regulate energy homeostasis and appetitive sensations before and after LAGB (n = 18) and RYGB (n = 38) in order to better understand the mechanisms underlying the greater weight loss after RYGB.


A standardized test meal was administered prior to surgery, at 6 months, and annually thereafter to year 2 after LAGB and year 4 after RYGB. Blood samples were obtained in the fasted state and 30, 60, 90, and 120 min post-meal.


Progressive increases in fasting PYY were observed after RYGB together with increases in postprandial area under the curve (AUC) levels that were unchanged after LAGB. GLP-1 AUC increased only after RYGB. There was a weight loss-related increase in fasting ghrelin levels after LAGB that was unchanged 1 year after RYGB despite greater percentage weight loss; ghrelin subsequently increased at years 2–4 post-RYGB. HOMA-IR decreased after both procedures but correlated with weight loss only after LAGB, whereas leptin correlated with weight loss in both groups. Sweet cravings decreased after RYGB.


A number of weight loss-independent changes in the gut hormonal milieu likely act in concert to promote a decrease in insulin resistance and greater weight loss efficacy after RYGB. A progressive change in hormone levels over time may reflect gut enteroplasticity after RYGB. A decrease in sweet cravings specific to RYGB may further promote superior weight loss outcomes.


Roux-en-Y gastric bypass Adjustable gastric banding Metabolic surgery Ghrelin Glp-1 PYY Insulin resistance Appetite Sweet cravings Bariatric surgery 


Funding Sources

NIH DK072011; NIH T32 DK07271; NCRR UL1 RR024156.

Compliance with Ethical Standards

Conflict of Interest

AT, GF, DJM, BT, AT, IMC, LA have nothing to declare. MB has patent 16046592 pending, and patent 20040039452 issued. JK serves on the Scientific Advisory Board of Digma Medical and receives stock options, and receives financial compensation for serving on the Scientific Advisory Board of GI Dynamics.

Ethical Statement

All procedures performed in the study 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.

Consent Statement

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


  1. 1.
    Chang SH, Stoll CRT, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Korner J, Inabnet W, Febres G, et al. Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass. Int J Obes. 2009;33(7):786–95.CrossRefGoogle Scholar
  3. 3.
    Korner J, Bessler M, Cirilo LJ, et al. Effects of Roux-en-Y gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab. 2005;90(1):359–65.CrossRefPubMedGoogle Scholar
  4. 4.
    Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.CrossRefGoogle Scholar
  5. 5.
    Seeley RJ, Chambers AP, Sandoval DA. The role of gut adaptation in the potent effects of multiple bariatric surgeries on obesity and diabetes. Cell Metab. 2015;21(3):369–78.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    le Roux CW, Borg C, Wallis K, et al. Gut hypertrophy after gastric bypass is associated with increased glucagon-like peptide 2 and intestinal crypt cell proliferation. Ann Surg. 2010;252(1):50–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Mumphrey MB, Patterson LM, Zheng H, et al. Roux-en-Y gastric bypass surgery increases number but not density of CCK-, GLP-1-, 5-HT-, and neurotensin-expressing enteroendocrine cells in rats. Neurogastroenterol Motil. 2013;25(1):e70–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Vrang N, Madsen AN, Tang-Christensen M, et al. PYY(3-36) reduces food intake and body weight and improves insulin sensitivity in rodent models of diet-induced obesity. Am J Physiol Regul Integr Comp Physiol. 2006;291(2):R367–75.CrossRefPubMedGoogle Scholar
  9. 9.
    Wren AM, Seal LJ, Cohen MA, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86(12):5992.CrossRefPubMedGoogle Scholar
  10. 10.
    Stoeckli R, Chanda R, Langer I, et al. Changes of body weight and plasma ghrelin levels after gastric banding and gastric bypass. Obes Res. 2004;12(2):346–50.CrossRefPubMedGoogle Scholar
  11. 11.
    Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346(21):1623–30.CrossRefPubMedGoogle Scholar
  12. 12.
    Beckman LM, Beckman TR, Earthman CP. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass procedure: a review. J Am Diet Assoc. 2010;110(4):571–84.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Batterham RL, Cohen MA, Ellis SM, et al. Inhibition of food intake in obese subjects by peptide YY3-36. N Engl J Med. 2003;349(10):941–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Mathes CM, Spector AC. Food selection and taste changes in humans after Roux-en-Y gastric bypass surgery: a direct-measures approach. Physiol Behav. 2012;107(4):476–83.CrossRefPubMedGoogle Scholar
  15. 15.
    Bueter M, Miras AD, Chichger H, et al. Alterations of sucrose preference after Roux-en-Y gastric bypass. Physiol Behav. 2011;104(5):709–21.CrossRefPubMedGoogle Scholar
  16. 16.
    Shigemura N, Ohta R, Kusakabe Y, et al. Leptin modulates behavioral responses to sweet substances by influencing peripheral taste structures. Endocrinology. 2004;145(2):839–47.CrossRefPubMedGoogle Scholar
  17. 17.
    Lee EB, Ahima RS. Alteration of hypothalamic cellular dynamics in obesity. J Clin Invest. 2012;122(1):22–5.CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Alina I. Tsouristakis
    • 1
  • Gerardo Febres
    • 1
  • Donald J. McMahon
    • 1
  • Beverly Tchang
    • 1
  • Irene M. Conwell
    • 1
  • Amanda J. Tsang
    • 1
  • Leaque Ahmed
    • 2
  • Marc Bessler
    • 3
  • Judith Korner
    • 1
    Email author
  1. 1.Department of MedicineColumbia University College of Physicians & SurgeonsNew YorkUSA
  2. 2.Department of SurgeryWyckoff Heights HospitalBrooklynUSA
  3. 3.Department of SurgeryColumbia University College of Physicians & SurgeonsNew YorkUSA

Personalised recommendations