Abstract
SummaryGastric bypass surgery is an effective long‐term treatment for individuals with severe obesity. Changes in appetite, dietary intake, and food preferences have all been postulated to contribute to postoperative body weight regulation, however, findings are inconsistent. The aim of this systematic review was to evaluate the current literature on changes in dietary intake and appetite following gastric bypass surgery, in the context of the methodology used and the analysis, interpretation, and presentation of results. Four databases were systematically searched with terms related to “gastric bypass surgery,” “appetite,” and “dietary intake,” and 49 papers (n = 2384 patients after gastric bypass) were eligible for inclusion. The evidence indicated that only a reduction in overall energy intake and an increase in postprandial satiety are maintained beyond 6‐month post‐surgery, whereas relative macronutrient intake and premeal hunger remain unchanged. However, available data were limited by inconsistencies in the methods, analysis, presentation, and interpretation of results. In particular, there was a reliance on data collected by subjective methods with minimal acknowledgment of the limitations, such as misreporting of food intake. There is a need for further work employing objective measurement of appetite and dietary intake following gastric bypass surgery to determine how these mechanisms may contribute to weight regulation in the longer term.
Highlights
Gastric bypass surgery is a successful established treatment for individuals with severe obesity, with weight loss superior to nonsurgical lifestyle interventions[1] and maintained by the individual in the long term.[2]
The aim of this review is to evaluate the current literature on changes in dietary intake and reported appetite following gastric bypass surgery, in the context of the methodology used and the analysis, interpretation, and presentation of results from these studies
Note: All data measured as change from baseline following gastric bypass surgery
Summary
Gastric bypass surgery is a successful established treatment for individuals with severe obesity (body mass index [BMI] ≥ 40 kg/m2 or a BMI > 35 kg/m2 with one or more associated comorbidities that would improve with weight loss), with weight loss superior to nonsurgical lifestyle interventions[1] and maintained by the individual in the long term.[2]. Postulated mechanisms contributing to the long-term success of gastric bypass surgery include changes in circulating gut hormones,[6] attenuated resting energy expenditure through the management and preservation of lean mass,[5,7] and changes in taste sensitivity thresholds,[8,9,10,11] which may affect food preferences and selection. Proposed mechanisms accounting for these possible shifts in macronutrient contribution to the diet of patients post-gastric bypass surgery include changes in taste[25] and diminished preference for palatable (high-fat, high-sugar) foods.[26] Preserving or increasing dietary protein postoperatively may both increase satiety and protect against the loss of lean mass,[27] whereas reducing dietary fat may reduce overall dietary energy density (ED) and EI.[24]
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