Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Dr Duell introduces several hypotheses
about the mechanisms of weight loss with bariatric surgery. I agree with his
observation that nearly all patients lose their appetite for some period of
time after the surgery. The duration for the loss of appetite varies among
patients who have had various types of surgical procedures. Certainly there
is no amplication of hunger in the first few weeks postoperatively. However,
later on after body weight has stabilized, I find that many patients redevelop
a voracious appetite with specific food cravings, particularly sweets. The
mechanisms for these observations are unclear. The role of the hypothalamus,
ghrelin, cholecystokinin, and other regulators of energy metabolism after
bariatric surgery remains largely unknown. This is a fertile area for investigation.
It is surprising that there has been virtually no study of potential mechanisms
by which these operations produce weight loss.
Brolin RE. Bariatric Surgery for Morbid Obesity—ReplyBariatric Surgery for Morbid Obesity—Reply. JAMA. 2003;289(14):1779. doi:10.1001/jama.289.14.1779-a