Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical nutrition, enteral and parenteral nutrition

Decreased energy density and changes in food selection following Roux-en-Y gastric bypass

European Journal of Clinical Nutrition volume 67, pages 168–173 (2013)Cite this article

Subjects

Abstract

Background/Objectives:

The main objective was to test the hypothesis that dietary energy density (DED) decreases after Roux-en-Y gastric bypass (gastric bypass).

Subjects/Methods:

A total of 43 patients (31 women and 12 men) aged 43 (s.d. 10) years, with body mass index (BMI) 44.3 kg/m2 (4.9), were assessed preoperatively at 6 weeks and 1 and 2 years after gastric bypass. Self-reported energy intake (EI), food weight (FW) and food choice were assessed using a dietary questionnaire. DED was calculated by dividing EI by FW (kcal/g). Number of dropouts was 4 of 203 visits.

Results:

Percent weight loss (%WL) was 13.5% at 6 weeks, 30.7% at 1 year and 31.8% at 2 years post surgery (P<0.001 for all). EI decreased from 2990 to 1774, 2131 and 2425 kcal after 6 weeks and 1 and 2 years postoperatively, respectively (P<0.001 at all time points). FW changed from 2844 to 1870 g/day at 6 weeks (P<0.001) and 2416 g/day after 1 year (P<0.05), but was not significantly different from baseline 2 years postoperatively (2602 g/day, P=0.105). DED decreased from 1.07 to 0.78 kcal/g at 6 weeks (P<0.001) and 0.90 kcal/g (P<0.001) and 0.96 kcal/g (P=0.001) after 1 and 2 years, respectively. All statistical comparisons were made from baseline. There was no correlation between changes in DED and %WL, neither after 1 year (r=−0.215; P=0.183) nor after 2 years (r=−0.046; P=0.775) post surgery.

Conclusions:

Besides substantial reduction in EI and large variation in FW, patients reported decreased DED over 2 years following gastric bypass. Despite lack of association between the reduction in DED and percentage weight loss, changes in food choice were overall nutritionally beneficial.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Stubbs RJ, Ritz P, Coward WA, Prentice AM . Covert manipulation of the ratio of dietary fat to carbohydrate and energy density: effect on food intake and energy balance in free-living men eating ad libitum. Am J Clin Nutr 1995; 62: 330–337.

    Article  CAS  PubMed  Google Scholar 

  2. Rolls BJ . The relationship between dietary energy density and energy intake. Physiol Behav 2009; 97: 609–615.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC et al. Low-energy-density diets are associated with high diet quality in adults in the United States. J Am Diet Assoc 2006; 106: 1172–1180.

    Article  PubMed  Google Scholar 

  4. Rolls BJ, Bell EA, Castellanos VH, Chow M, Pelkman CL, Thorwart ML . Energy density but not fat content of foods affected energy intake in lean and obese women. Am J Clin Nutr 1999; 69: 863–871.

    Article  CAS  PubMed  Google Scholar 

  5. Bell EA, Rolls BJ . Energy density of foods affects energy intake across multiple levels of fat content in lean and obese women. Am J Clin Nutr 2001; 73: 1010–1018.

    Article  CAS  PubMed  Google Scholar 

  6. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009; 360: 859–873.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Rolls BJ, Roe LS, Meengs JS . Salad and satiety: energy density and portion size of a first-course salad affect energy intake at lunch. J Am Diet Assoc 2004; 104: 1570–1576.

    Article  PubMed  Google Scholar 

  8. Rolls BJ, Bell EA, Thorwart ML . Water incorporated into a food but not served with a food decreases energy intake in lean women. Am J Clin Nutr 1999; 70: 448–455.

    Article  CAS  PubMed  Google Scholar 

  9. Ledikwe JH, Rolls BJ, Smiciklas-Wright H, Mitchell DC, Ard JD, Champagne C et al. Reductions in dietary energy density are associated with weight loss in overweight and obese participants in the PREMIER trial. Am J Clin Nutr 2007; 85: 1212–1221.

    Article  CAS  PubMed  Google Scholar 

  10. Rolls BJ, Roe LS, Beach AM, Kris-Etherton PM . Provision of foods differing in energy density affects long-term weight loss. Obes Res 2005; 13: 1052–1060.

    Article  PubMed  Google Scholar 

  11. Ello-Martin JA, Roe LS, Ledikwe JH, Beach AM, Rolls BJ . Dietary energy density in the treatment of obesity: a year-long trial comparing 2 weight-loss diets. Am J Clin Nutr 2007; 85: 1465–1477.

    Article  CAS  PubMed  Google Scholar 

  12. Greene LF, Malpede CZ, Henson CS, Hubbert KA, Heimburger DC, Ard JD . Weight maintenance 2 years after participation in a weight loss program promoting low-energy density foods. Obesity (Silver Spring) 2006; 14: 1795–1801.

    Article  Google Scholar 

  13. Buchwald H, Oien DM . Metabolic/bariatric surgery Worldwide 2008. Obes Surg 2009; 19: 1605–1611.

    Article  PubMed  Google Scholar 

  14. Ernst B, Thurnheer M, Wilms B, Schultes B . Differential changes in dietary habits after gastric bypass versus gastric banding operations. Obes Surg 2009; 19: 274–280.

    Article  PubMed  Google Scholar 

  15. Thomas JR, Gizis F, Marcus E . Food selections of Roux-en-Y gastric bypass patients up to 2.5 years postsurgery. J Am Diet Assoc 2010; 110: 608–612.

    Article  PubMed  Google Scholar 

  16. Olbers T, Bjorkman S, Lindroos A, Maleckas A, Lonn L, Sjostrom L et al. Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial. Ann Surg 2006; 244: 715–722.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Overs SE, Freeman RA, Zarshenas N, Walton KL, Jorgensen JO . Food tolerance and gastrointestinal quality of life following three bariatric procedures: adjustable gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy. Obes Surg 2012; 22: 536–543.

    Article  PubMed  Google Scholar 

  18. Miras AD, le Roux CW . Bariatric surgery and taste: novel mechanisms of weight loss. Curr Opin Gastroenterol 2010; 26: 140–145.

    Article  PubMed  Google Scholar 

  19. Mathes CM, Spector AC . Food selection and taste changes in humans after Roux-en-Y gastric bypass surgery: a direct-measures approach. Physiol Behav 2012; 107: 476–483.

    Article  CAS  PubMed  Google Scholar 

  20. le Roux CW, Bueter M, Theis N, Werling M, Ashrafian H, Lowenstein C et al. Gastric bypass reduces fat intake and preference. Am J Physiol Regul Integr Comp Physiol 2011; 301: R1057–R1066.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Tack J, Arts J, Caenepeel P, De Wulf D, Bisschops R . Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol 2009; 6: 583–590.

    Article  PubMed  Google Scholar 

  22. Laurenius A, Larsson I, Bueter M, Melanson KJ, Bosaeus I, Forslund HB et al. Changes in eating behaviour and meal pattern following Roux-en-Y gastric bypass. Int J Obes (Lond) 2012; 36: 348–355.

    Article  CAS  Google Scholar 

  23. Olbers T, Lonroth H, Fagevik-Olsen M, Lundell L . Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome. Obes Surg 2003; 13: 364–370.

    Article  PubMed  Google Scholar 

  24. Aills L, Blankenship J, Buffington C, Furtado M, Parrott J . ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surg Obes Relat Dis 2008; 4: S73–108.

    Article  PubMed  Google Scholar 

  25. Biesemeier CK, Garland J . ADA Pocket Guide to Bariatric Surgery. Weight Management Dietetic Practice Group. American Dietetic Association: Chicago, IL, 2009.

    Google Scholar 

  26. Sundquist K, Qvist J, Johansson SE, Sundquist J . Increasing trends of obesity in Sweden between 1996/97 and 2000/01. Int J Obes Relat Metab Disord 2004; 28: 254–261.

    Article  CAS  PubMed  Google Scholar 

  27. Lindroos AK, Lissner L, Sjostrom L . Validity and reproducibility of a self-administered dietary questionnaire in obese and non-obese subjects. Eur J Clin Nutr 1993; 47: 461–481.

    CAS  PubMed  Google Scholar 

  28. Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO . A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr 1990; 51: 241–247.

    Article  CAS  PubMed  Google Scholar 

  29. Dobratz JR, Sibley SD, Beckman TR, Valentine BJ, Kellogg TA, Ikramuddin S et al. Predicting energy expenditure in extremely obese women. JPEN J Parenter Enteral Nutr 2007; 31: 217–227.

    Article  PubMed  Google Scholar 

  30. Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA et al. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 1991; 45: 569–581.

    CAS  PubMed  Google Scholar 

  31. Dias MC, Ribeiro AG, Scabim VM, Faintuch J, Zilberstein B, Gama-Rodrigues JJ . Dietary intake of female bariatric patients after anti-obesity gastroplasty. Clinics 2006; 61: 93–98.

    Article  PubMed  Google Scholar 

  32. Sarwer DB, Wadden TA, Moore RH, Baker AW, Gibbons LM, Raper SE et al. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis 2008; 4: 640–646.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Leite Faria S, de Oliveira Kelly E, Pereira Faria O, Kiyomi Ito M . Snack-eating patients experience lesser weight loss after Roux-en-Y gastric bypass surgery. Obes Surg 2009; 19: 1293–1296.

    Article  PubMed  Google Scholar 

  34. Kenler HA, Brolin RE, Cody RP . Changes in eating behavior after horizontal gastroplasty and Roux-en-Y gastric bypass. Am J Clin Nutr 1990; 52: 87–92.

    Article  CAS  PubMed  Google Scholar 

  35. Warde-Kamar J, Rogers M, Flancbaum L, Laferrere B . Calorie intake and meal patterns up to 4 years after Roux-en-Y gastric bypass surgery. Obes Surg 2004; 14: 1070–1079.

    Article  PubMed  Google Scholar 

  36. Lissner L . Measuring food intake in studies of obesity. Public Health Nutr 2002; 5: 889–892.

    Article  PubMed  Google Scholar 

  37. Willett W, Stampfer MJ . Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 1986; 124: 17–27.

    Article  CAS  PubMed  Google Scholar 

  38. Lindroos AK, Lissner L, Sjostrom L . Weight change in relation to intake of sugar and sweet foods before and after weight reducing gastric surgery. Int J Obes Relat Metab Disord 1996; 20: 634–643.

    CAS  PubMed  Google Scholar 

  39. Bobbioni-Harsch E, Huber O, Morel P, Chassot G, Lehmann T, Volery M et al. Factors influencing energy intake and body weight loss after gastric bypass. Eur J Clin Nutr 2002; 56: 551–556.

    Article  CAS  PubMed  Google Scholar 

  40. Hallersund P, Sjöström L, Olbers T, Lönroth H, Jacobsson P, Wallenius V et al. Gastric bypass surgery is followed by lowered blood pressure and increased diuresis - long term results from the Swedish Obese Subjects (SOS) Study. PLoS One 2012; 7: e49696.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Bueter M, Ashrafian H, le Roux CW . Mechanisms of weight loss after gastric bypass and gastric banding. Obes Facts 2009; 2: 325–331.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Bueter M, Lowenstein C, Ashrafian H, Hillebrand J, Bloom SR, Olbers T et al. Vagal sparing surgical technique but not stoma size affects body weight loss in rodent model of gastric bypass. Obes Surg 2010; 20: 616–622.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL et al. Quantification of the effect of energy imbalance on bodyweight. Lancet 2011; 378: 826–837.

    Article  PubMed  Google Scholar 

  44. Sjostrom L . Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes (Lond) 2008; 32 (Suppl 7), S93–S97.

    Article  Google Scholar 

  45. Adams TD, Davidson LE, Litwin SE, Kolotkin RL, LaMonte MJ, Pendleton RC et al. Health benefits of gastric bypass surgery after 6 years. JAMA 2012; 308: 1122–1131.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was financially supported by the Western Region, Sweden.

Author information

Authors and Affiliations

  1. Department of Gastrosurgical Research and Education, Sahlgrenska Academy, Gothenburg, Sweden

    A Laurenius, H Lönroth & T Olbers

  2. Department of Endocrinology, Diabetology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden

    A Laurenius, I Larsson & I Bosaeus

  3. Department of Nutrition and Food Sciences, Energy Balance Laboratory, University of Rhode Island, Kingston, RI, USA

    K J Melanson

  4. National Food Agency, Uppsala, Sweden

    A K Lindroos

  5. Department of Clinical Nutrition, Sahlgrenska Academy, Gothenburg, Sweden

    I Bosaeus

Authors
  1. A Laurenius
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I Larsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K J Melanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A K Lindroos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H Lönroth
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I Bosaeus
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T Olbers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Laurenius.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laurenius, A., Larsson, I., Melanson, K. et al. Decreased energy density and changes in food selection following Roux-en-Y gastric bypass. Eur J Clin Nutr 67, 168–173 (2013). https://doi.org/10.1038/ejcn.2012.208

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2012.208

Keywords

This article is cited by

Search

Advanced search

Quick links