Bariatric surgery can help treat obesity and related health conditions through restrictive and malabsorptive techniques. Key hormonal changes may contribute to reduced appetite and improved metabolism. Specifically, surgeries like Roux-en-Y gastric bypass and sleeve gastrectomy may lower levels of the appetite-stimulating hormone ghrelin in the short term. Long-term nutritional deficiencies are less common with restrictive procedures but still require monitoring and supplementation. Bariatric surgery has been shown to resolve or improve conditions like diabetes, hypertension, and sleep apnea in the majority of patients.

1. Metabolic Sequelae of Bariatric Surgery Dr Sumeet Shah Laparoscopic & Bariatric Surgeon Sir Ganga Ram Hospital

2. WEIGHT LOSS SURGERY Gastric Bypass

4. Visceral Obesity Heart Disease, Stroke Risk Insulin Resistance & Hyperinsulinemia Dense LDL HDL Cholesterol Triglycerides Source: NAASO, 2005 The emergence of metabolic disease: a direct clinical pathway from obesity

6. Weight Loss Benefits vs . Nutritional Risk

7. N Engl J Med. May 24 2007;356(21):2176-2183.

18. Regulation of Food Intake Brain NPY AGRP galanin Orexin-A Dynorphin ECS/CB1 Stimulate α -MSH CRH/UCN GLP-I CART NE 5-HT Inibit Central Signals Glucose CCK, GLP-1, Apo-A-IV Vagal afferents Insulin Ghrelin Leptin Cortisol Peripheral signals Peripheral organs Gastrointestinal tract Adipose tissue Food Intake Adrenal glands +   + External factors Emotions, Drugs Food characteristics Lifestyle behaviors Environmental cues

19. Modified from Marx, Science 2003 February 7; 299: 846-849. (in News) Gastrointestinal Peptides Hormones food intake regulation digestion and metabolism Anti-obesity potential Anti-diabetes potential Vagus nerve Ghrelin Insulin Amylin Glucagon Leptin PYY GLP-1 CCK

23. Review: what gets absorbed where?

26. Recommended management Am J Med Sci. Apr 2006;331(4):219-225 .