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To the Editor: I would like to comment on 2 aspects of Dr Brolin's Contempo Updates article about bariatric surgery and long-term control of morbid obesity.¹ First, the mechanism by which bariatric surgery induces weight loss is probably related to a complex interplay between mechanical effects of the surgery and neurohormonal feedback loops involved in body weight homeostasis. It is sometimes asserted that the surgical creation of a small gastric pouch restricts food intake and thereby causes weight loss because patients are forced to eat less. The additional effect of mild malabsorption is said to further reduce dietary energy intake. These effects alone, however, are probably insufficient to explain the profound clinical effects of bariatric surgery. On the basis of current understanding of body weight homeostatic feedback loops,² weight loss resulting merely from mechanical restriction of food intake alone (or in combination with mild malabsorption) would be associated with amplification . . . [Full Text of this Article]

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