Solutions in weight control: lessons from gastric surgery

Surgical therapy is currently the only proven way to achieve significant long-term weight loss, improve obesity-related comorbidities, reduce the risk of premature death, and improve quality of life in a large proportion of treated individuals. Roux-en-Y gastric bypass, the most widely performed procedure in the United States, is known to achieve permanent (> 14 y of follow-up) and significant (> 50% of excess body weight) weight loss in > 90% of patients who undergo the operation. Gastric bypass procedures induce physiologic and neuroendocrine changes that appear to affect the weight regulatory centers in the brain. Researchers have begun to explore the molecular pathways responsible for these outcomes. Identifying the differences between surgical and nonsurgical treatments will eventually lead to new therapeutic options.