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Energy Economy Hampers Body Weight Loss after Gastric Bypass

Division of Therapeutic Education for Chronic Diseases (E.B.-H., T.L., A.G.) and Clinic of Digestive Surgery (P.M., O.H., G.C., M.V.), Geneva University Hospital; and Medical Biochemistry Department (F.A.-J.), Geneva Medical School, 1211 Geneva 14, Switzerland

Address correspondence and requests for reprints to: Dr. E. Bobbioni-Harsch, Division of Therapeutic Education for Chronic Diseases, Geneva University Hospital, 1211 Geneva 14, Switzerland.

The impact of energy economy on body weight loss was investigated in 20 obese women, submitted to Roux-en-Y gastric bypass. Resting energy expenditure (REE), substrate oxidation rates, plasma glucose, free fatty acid, and insulin and leptin levels were measured before and 3, 6, and 12 months after surgery. Predicted REE was obtained from linear regression analysis of REE and fat free mass, in a group of 85 women, whose body mass index ranged between 20 and 60 kg/m². The deviation from predicted REE, calculated as area under the curve (AUC) over the 12-month period for each patient, was considered as the expression of energy economy. Energy economy AUC was significantly (P < 0.005) negatively related to the weight lost during 12 months after surgery.

Energy intake, calculated from self-reported food consumption, was also expressed as AUC. Energy intake AUC showed a significant (P < 0.002) positive correlation with weight loss.

Lipid oxidation rate, also calculated as AUC, significantly correlated, negatively, with energy economy (P < 0.001) and, positively, with energy intake (P < 0.002). Preoperative leptin values were significantly (P < 0.01) linked to individual energy economy capacity.

In conclusion, after Roux-en-Y gastric bypass, energy economy hampers the weight loss process, probably through a low fat oxidation rate.

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