Alternative to bariatric surgery?

September 8, 2013

John DiTraglia MD

Contributing Columnist

Bariatric surgeries, like gastric bypass, work great. Customers lose about a third of their weight and keep it off easily for many years. But this kind of surgery is drastic. It has long been recognized that bariatric surgery does not work by making you eat less or absorb less or exercise more. There seems to be a complicated alteration of hormones in the gut after this surgery and many of the effects of gastric bypass can be simulated by using or blocking these hormones. Also isolating different features of gastric bypass surgery have been tried. Bypassing the first part of the small intestine can be simulated by putting in a sleeve that prevents food from touching the small bowel after it leaves the stomach. The digestive enzymes from the pancreas and bile from the liver pass outside of the sleeve and meet up with the food downstream. This causes weight loss and other effects of gastric bypass surgery.

You could also try diverting just the bile acids from the liver with a catheter so that it doesn’t enter the intestines until further down the tract. This has been done in rats by Dr. Kohli and colleagues at Cincinnati Children’s Hospital Medical Center. (1) Weight loss and many of the other beneficial effects of gastric bypass surgery, like improved insulin sensitivity, were realized by this more simple maneuver. In fact maybe just taking a pill that temporarily blocks the effects of bile acids would accomplish the same thing.

If we pay more attention to and and spend more money on these kinds of things and less on berating obese people to eat less and exercise more we may be close to a breakthrough.

1. Kohli R et al. A surgical model in male obese rats uncovers protective effects of bile acids post-bariatric surgery. Endocrinology 2013 Jul;154(7):2341-51.