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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.

I disagree with Duell about insurance for . . . [Full Text of this Article]

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RELATED ARTICLE

Bariatric Surgery for Morbid Obesity
P. Barton Duell
JAMA. 2003;289(14):1779.
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