Clinical Studies and Practice

Recovery of brain structural abnormalities in morbidly obese patients after bariatric surgery



Obesity-related brain structural abnormalities have been reported extensively, and bariatric surgery (BS) is currently the most effective intervention to produce sustained weight reduction in overtly obese (OB) people. It is unknown whether BS can repair the brain circuitry abnormalities concomitantly with long-term weight loss.


In order to investigate whether BS promotes neuroplastic structural recovery in morbidly OB patients, we quantified fractional anisotropy (FA), mean diffusivity (MD) and gray (GM) and white (WM) matter densities in 15 morbidly OB patients and in 18 normal weight (NW) individuals. OB patients were studied at baseline and also 1 month after laparoscopic sleeve gastrectomy surgery.


Two-sample t-test between OB (baseline) and NW groups showed decreased FA values, GM/WM densities and increased MD value in brain regions associated with food intake control (that is, caudate, orbitofrontal cortex, body and genu of corpus callosum) and cognitive-emotion regulation (that is, inferior frontal gyrus, hippocampus, insula, external capsule) (P<0.05, family-wise error correction). Paired t-test in the OB group between before and after surgery showed that BS generated partial neuroplastic structural recovery in the OB group, but the differences had relative less strength and smaller volume (P<0.001).


This study provides the first anatomical evidence for BS-induced acute neuroplastic recovery that might in part mediate the long-term benefit of BS in weight reduction. It also highlights the importance of this line of gut–brain axis research employing the combined BS and neuroimaging model for identifying longitudinal changes in brain structure that correlated with obesity status.

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This work is supported by the National Natural Science Foundation of China under Grant Nos. 81271549, 81470816, 61131003, 61431013, 81201081, 81227901, 81120108005, 81501543, 81371530, 81571751 and 81571753; the Shaanxi Provincial Natural Science Foundation under Grant No. 2015JM3117; and the Project for the National Key Basic Research and Development Program (973) under Grant No. 2011CB707700. We thank Dr Samantha Cunningham of NIAAA and Dr Jiayu Liu of Yale University for proofreading.

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Correspondence to Y Zhang or Y Nie or G-J Wang.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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