Mechanisms that Predict Weight Trajectory after Bariatric Surgery: The Interactive Roles of Behavior and Biology

摘要 减肥手术是目前最有效和持久的干预严重肥胖。 许多合并症（例如，糖尿病、高血压）一般缓解或解决以下 减肥手术然而，一些患者在手术后经历了次优的体重结果， 这通常是由于成功减肥后体重的大量反弹。不幸的是， 体重累犯也经常与肥胖相关的 合并症。在美国最常进行的手术是Roux-en-Y 胃旁路术（RYGB）和腹腔镜袖状胃切除术（SG）。两种程序 涉及导致行为变化的显著解剖学和生理学变化， 生物学手术后体重减轻的病因学原因还不清楚， 因此很难预测哪些患者可能经历次优的术后 体重结果。饮食和体力活动行为、情绪和 据报道，微生物组都发生在减肥手术后， 体重变化。体重变化可能涉及行为和行为之间的复杂相互作用。 和生物变量。肠道微生物组变化之间的纵向关系 和术后体重轨迹还没有被彻底探索， 微生物组和其他影响体重的变量之间的关系 替补演员因此，我们建议进行一项为期24个月的前瞻性纵向研究， 计划接受RYGB或SG的患者，旨在确定 观察减肥手术后24个月的体重减轻轨迹。这尤其 应用程序旨在研究经验支持的行为之间的关系 和手术后的生物学变量及其对体重结果的综合影响。这些 数据将通过收集行为和生物学数据， 长期随访的参与者登记，并通过研究更大的样本量。新颖的数据 本方案中的收集将包括对有问题的饮食行为的深入测量 以及术后饮食和运动方案的依从性，这可能会同时改变 与肠道微生物群中观察到的变化相关或对其做出响应。术后识别 体重减轻和并发症解决的预测因素将允许开发 可以根据患者的风险状况为个体患者量身定制的干预措施， 然后尽早实施，以优化手术相关的结果。

Abstract Bariatric surgery is currently the most efficacious and durable intervention for severe obesity. Many comorbid conditions (e.g., diabetes, hypertension) generally remit or resolve following bariatric surgery. Yet, some patients experience suboptimal weight outcomes following surgery, often resulting from substantial weight regain following successful weight loss. Unfortunately, weight recidivism is also often associated with reemergence of obesity-associated comorbidities. The most commonly performed procedures in the U.S. are the Roux-en-Y Gastric Bypass (RYGB) and the laparoscopic Sleeve Gastrectomy (SG). Both procedures involve significant anatomical and physiological changes that lead to changes in behavior and biology. The etiological contributors to weight loss following surgery are not well understood, and it is therefore difficult to predict which patients may experience suboptimal post-surgical weight outcomes. Changes in eating and physical activity behaviors, mood, and the microbiome have all been reported to occur following bariatric surgery and have an association with weight change. Weight change likely involves complex interactions between behavioral and biological variables. The longitudinal relationship between changes in the gut microbiome and post-surgery weight trajectory has not been explored thoroughly, and the associations between the microbiome and other variables that impact weight have been similarly understudied. Therefore, we propose to conduct a prospective, 24-month longitudinal study of patients planning to undergo RYGB or SG and aim to identify correlates and predictors of observed weight loss trajectories over 24 months following bariatric surgery. In particular, this application is designed to examine the relationships between empirically supported behavioral and biological variables following surgery and their combined impact on weight outcome. These data will extend the current literature by collecting behavioral and biological data, by carrying out longer term follow-up of participants enrolled, and by studying a larger sample size. Novel data collection in this protocol will include intensive measurement of problematic eating behaviors and compliance with diet and exercise regimens post-surgically, which may be altered in parallel with, or in response to, changes observed in the gut microbiota. Identifying post-surgical predictors of weight loss and comorbidity resolution will allow for the development of interventions that can be tailored to individual patients based upon his/her risk profile which can then be implemented early to optimize surgery-related outcomes.