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Weight loss bypass surgery may muffle temptation Fri, Oct 14 2011By Rob Goodier

NEW YORK (Reuters Health) - People who've had gastric bypass surgery might make healthier eating choices than those who opt for the weight loss procedure known as gastric banding, say UK researchers who found bypass patients less tempted by sweets and other fattening foods.

After surveying patients who had either type of surgery, and performing brain scans on several dozen of them, Dr. Tony Goldstone of Imperial College London and Hammersmith Hospital and his colleagues found that even deep down in their brains, the gastric bypass patients seemed to like high-calorie foods less.

"The results suggest that gastric-banding patients had to exert quite a lot of self-control over their eating behavior. Banding patients also had higher concern about their weight," Goldstone told Reuters Health.

In contrast, gastric bypass patients "don't feel they have to exert as much cognitive control over what they're eating," said Goldstone, who presented the findings October 4th at the Obesity Society's annual meeting in Orlando, Florida.

The two weight loss operations have similar broad goals -- to shrink the stomach so people feel full with less food. In gastric bypass, the stomach is surgically reduced and one end of it is rerouted to bypass part of the small intestine. With gastric banding, a silicone band placed around the top of the stomach reduces its capacity.

Goldstone's team studied 30 gastric bypass patients, 28 gastric banding patients and 20 people who did not have weight loss surgery. All the participants started out obese and the two surgery groups had lost similar amounts of body weight since their respective procedures, an average of 28 percent.

Since banding patients lose weight more slowly, those in this study had undergone their procedure an average of 18 months earlier, compared to the bypass patients at 10 months post-surgery.

Participants filled out an eating behavior questionnaire, and 20 people in each group underwent functional magnetic resonance imaging (fMRI) while looking at pictures of food.

Among the significant differences in questionnaire responses, researchers found, the gastric bypass patients reported having to restrain themselves less, or finding it easier to restrain themselves from eating poorly. They also did less impulsive eating -- eating something on sight, not out of hunger -- and less eating to boost their mood, or "emotional eating."

Those who underwent fMRI had fasted overnight, and then viewed pictures of foods and ate ice cream during the brain scan. The gastric bypass patients rated the ice cream and pictures of high-calorie foods as less appealing than did the gastric banding patients.

Bypass patients also showed lower activity in brain areas like the orbitofrontal cortex (associated with a reward response), the amygdala (associated with emotion) and in the ventral striatum (which would register the expectation of a reward like food).

"The connections between the biology of obesity and the mechanisms of the surgery we use is really a new science established in the last three to five years," said Dr. Robin Blackstone, president of the American Society for Metabolic and Bariatric Surgery, who was not involved in the study. "Now that we understand more about how these procedures are working, it makes sense that the bypass patients would have more control. The band would not produce those same effects."

© Thomson Reuters 2011. .

Thomson Reuters journalists are subject to an Editorial Handbook which requires fair presentation and disclosure of relevant interests.

What this study doesn't appear to take into account is the long term weight loss success of the 2 procedures. Perhaps one of the reasons that banding patients statistically take the weight off and keep it off vs. bypass patients is that they work harder to achieve their weight loss goal. That is....going strictly on what the article and study are saying about the tendency to make poorer eating choices as a banding patient.

The other reasons are physiological of course, but could it be that you tend to cherish and protect something that you work harder to attain.

Most of these studies are just a numbers game anyway, IMHO.

Yeah, I still get my cravings. I knew they wouldn't go away and I'd have to work harder at weightloss from the beginning. The bypass actually changes your digestive track. If you can't digest sugar, wouldn't your body want it less? The article doesn't seem to present any earth shattering news.

It also does not say how much more dangerous a surgery it is. There is no way someone is going to cut me up and reroute my organs. So I can never obsorb nuetrients norally. What happens when the stomach expands during by pass. If by pass was the answer why do so many by pass patients have the band placed after their by pass surgery? If one is going to report about a subject get it all correct. Give out all the information. Go Banders.

If you were a bypass person would you be excited to see or eat something that would cause you to “dump”. According to my friend who had the bypass you would never put yourself through that if you had a choice.

Cheri

I'm not sure what about this article would be upsetting or "agitating"... jlaroux, can you fill us in on why it bothered you?

I absolutely have to use self-control for success with this band, every day. Heck, probably hourly I have to have a fight with myself and say "don't eat that." People who have had bypass get violently ill if they eat sugar so of COURSE their brains have re-wired themselves 10 months after surgery. It's not like the article is making a value judgment about which surgery is better.

It wasnt the article itself, it was the fact that I (and some of the other bandsters) always feel tlike the doctors office is putting down the band and saying it doesn't work. And this just was another way to go about that. When I went in for my initial consultation with my doc, he told me I would never be successful with the band, that most people are not. he said I had too much weight to lose and I would never be happy. (little did he know, this put a fire under my behind, after I made the decision to go with the band!)