Many people with obesity and type 2 diabetes achieve remission of their diabetes after Roux-en-Y gastric bypass surgery, but the mechanisms of remission remain disputed. We provide our perspective on competing datasets that point towards this effect being due either entirely to the loss of weight or to weight loss-independent effects.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
American Diabetes Association Professional Practice Committee. Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care 45 (Suppl. 1), S113–S124 (2022).
Schauer, P. R. et al. Bariatric surgery versus intensive medical therapy for diabetes 3-year outcomes. N. Engl. J. Med. 370, 2002–2013 (2014).
Schauer, P. R. et al. Effect of laparoscopic Roux-En Y gastric bypass on type 2 diabetes mellitus. Ann. Surg. 238, 467–485 (2003).
Rubino, F., Schauer, P. R., Kaplan, L. M. & Cummings, D. E. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu. Rev. Med. 61, 393–411 (2010).
Das, S. K. et al. Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. Am. J. Clin. Nutr. 78, 22–30 (2003).
Isbell, J. M., Tamboli, R. A. & Hansen, E. N. The importance of caloric restriction in the early improvements in insulin sensitivity after Roux-en-Y gastric bypass surgery. Diabetes Care 33, 1438–42.
Steven, S. et al. Calorie restriction and not glucagon-like peptide-1 explains the acute improvement in glucose control after gastric bypass in type 2 diabetes. Diabet. Med. 33, 1723–1731 (2016).
Kirk, E. et al. Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction. Gastroenterology 136, 1552–1560 (2009).
Markovic, T. P. et al. The determinants of glycemic responses to diet restriction and weight loss in obesity and NIDDM. Diabetes Care 21, 687–694 (1998).
Jazet, I. M., Pijl, H., Frölich, M., Romijn, J. A. & Meinders, A. E. Two days of a very low calorie diet reduces endogenous glucose production in obese type 2 diabetic patients despite the withdrawal of blood glucose-lowering therapies including insulin. Metabolism 54, 705–712 (2005).
Bradley, D. et al. Gastric bypass and banding equally improve insulin sensitivity and β cell function. J. Clin. Invest. 122, 4667–4674 (2012).
Nguyen, N. Q. et al. Rapid gastric and intestinal transit is a major determinant of changes in blood glucose, intestinal hormones, glucose absorption and postprandial symptoms after gastric bypass. Obesity 22, 2003–2009 (2014).
Salehi, M., Gastaldelli, A. & D’Alessio, D. A. Beta-cell sensitivity to glucose is impaired after gastric bypass surgery. Diabetes Obes. Metab. 20, 872–878 (2017).
Yoshino, M. et al. Effects of diet versus gastric bypass on metabolic function in diabetes. N. Engl. J. Med. 383, 721–732 (2020).
Laferrere, B. et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J. Clin. Endocrinol. Metab. 93, 2479–2485 (2008).
Jackness, C., Karmally, W. & Febres, G. Very low-calorie diet mimics the early beneficial effect of Roux-en-Y gastric bypass on insulin sensitivity and beta-cell function in type 2 diabetic patients. Diabetes 62, 3027–3032 (2013).
Holter, M. M. et al. Glucose metabolism after gastric banding and gastric bypass in individuals with type 2 diabetes: weight loss effect. Diabetes Care 40, 7–15 (2016).
Yoshino, M. et al. Effect of diet versus gastric bypass on metabolic function in diabetes. N. Engl. J. Med. 383, 2390–2394 (2020).
Plum, L. et al. Comparison of glucostatic parameters after hypocaloric diet or bariatric surgery and equivalent weight loss. Obesity 19, 2149–2157 (2011).
Kong, X. et al. Roux-en-Y gastric bypass enhances insulin secretion in type 2 diabetes via FXR-mediated TRPA1 expression. Mol. Metab. https://doi.org/10.1016/j.molmet.2019.08.009 (2019).
Chambers, A. P. et al. Weight-independent changes in blood glucose homeostasis after gastric bypass or vertical sleeve gastrectomy in rats. Gastroenterology 141, 950–958 (2011).
Harris, L.-A. et al. Biliopancreatic diversion induces greater metabolic improvement than Roux-en-Y gastric bypass. Cell Metab. 30, 855–864.e3 (2019).
Iozzo, P. et al. Physiological hyperinsulinemia impairs insulin-stimulated glycogen synthase activity and glycogen synthesis. Am. J. Physiol. Metab. 280, E712–E719 (2001).
Seeley, R. J., Chambers, A. P. & Sandoval, D. A. The role of gut adaptation in the potent effects of multiple bariatric surgeries on obesity and diabetes. Cell Metab. 21, 369–378 (2015).
Evers, S. S. et al. Gut HIF2α signaling is increased after VSG, and gut activation of HIF2α decreases weight, improves glucose, and increases GLP-1 secretion. Cell Rep. 38, 110270 (2022).
Acknowledgements
The writing of this article was supported by a number of awards from the NIH including P30 DK056341, P30 DK092950, P30DK20579, UL1 TR002345 (all to S.K.) and P01DK117821 P30DK089503, R01DK133140 (all to R.J.S.).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
S.K. serves on scientific advisory boards for Altimmune and Merck and as a consultant for B2M Medical. R.J.S. has received research support from Novo Nordisk, Fractyl, Astra Zeneca and Eli Lilly. R.J.S. has served as a paid consultant for Novo Nordisk, Eli Lilly, Scohia, CinRx, Fractyl, Structure Therapeutics and Congruence Therapeutics. R.J.S. has equity in Calibrate and Rewind.
Peer review
Peer review information
Nature Metabolism thanks Caroline Apovian for their contribution to the peer review of this work.
Rights and permissions
About this article
Cite this article
Klein, S., Seeley, R.J. Weight versus weight-independent effects of Roux-en-Y gastric bypass on type 2 diabetes. Nat Metab 5, 912–914 (2023). https://doi.org/10.1038/s42255-023-00823-w
Published:
Issue Date:
DOI: https://doi.org/10.1038/s42255-023-00823-w