Dr. Carel Le Roux

Sleeve & Bypass - Introduction to Obesity: Relevant Anatomy and Physiology

Obesity is a global pandemic, currently affecting around 150 million people in Europe and 650 million people worldwide. The pandemic rise in obesity has increased the current debate over its classification as a disease. Contrary to just being a medical condition or risk factor for other diseases, obesity is a complex disease of multifaceted etiology, with its own disabling capacities, pathophysiologies and comorbidities. Initial weight gain is related to behavioral and environmental factors acting on a biological (mainly genetic) predisposition. The evolution of the disease is characterized by the development of an inflammatory organ disease that involves the adipocytes and other adipose tissue components. These alterations lead to several clinical complications and to a progressive resistance to diet effects.  Some of the complications of obesity include cardiovascular disease, non-insulin-dependent diabetes mellitus, obstructive pulmonary disease, arthritis and cancer. Given the excess mortality, substantial morbidity and the economic cost of obesity, this is a disease that needs serious attention by the medical community.  In this talk, we explain the importance of accepting obesity as a multifactorial disease, this being key to its treatment strategy and the development of widespread interventions. For this, he also talks about the SOPHIA (Stratification of Obesity Phenotypes to Optimize Future Therapy) project, whose aim is delivering evidence and shared value analysis to optimize the future treatment of obesity and predictors for risk and response. SOPHIA will therefore identify and characterise clinically-meaningful subpopulations of patients with obesity using the right treatment for the right people at the right time. The research group will use this knowledge to change how the world talks about obesity based on new understanding and a new vocabulary. It all starts with obesity as a chronic disease, not something people choose to live with. Endorsed by: [Image]

With Johnson & Johnson MedTech

Bile acids. The new gut hormones after metabolic surgery

Carel Le Roux (Imperial College, UK. Diabetes Complications Research Center, Dublin, Ireland) explains in this IFSO lecture the importance of the bile acids on the metabolic signaling function. He reviews the current literature on the effect of bile acids on the liver, enterocytes, intestinal L cells, adipocytes and muscle. He stresses the relation between the shift in the gut microbiome and bile acids in the lumen of the small bowel after gastric bypass and vertical banded gastroplasty. To summarize, bile acids have effects on: - Brown adipose tissue and muscle: increasing energy expenditure. - ß-cells: increasing insulin. - Intestinal L-cells: increasing GLP-1. - Intestinal enterocyte: secreting FGF19 - Liver: due to the secretion of FGF19 by the enterocyte, decreasing gluconeogenesis, increasing glycogen synthesis and increasing protein synthesis. - Adipocyte: increasing glucose intake. Bile acids should be considered a new gut hormone, not only with a digestive function but also with an important metabolic signaling function. This is important in operations such as gastric bypass, in which this mechanism could help to understand weight loss, weight loss maintenance, and the improvement in glycemic control.

With International Federation for the Surgery and Other Therapies for Obesity

Changes in brain activity and behaviour explaining weight loss

Clinical Case The clinical efficacy of bariatric surgery has encouraged the scientific investigation of the gut as a major endocrine organ. Manipulation of gastrointestinal anatomy through surgery has been shown to profoundly affect the physiological and metabolic processes that control body weight and glycaemia. The most popular bariatric surgical procedures are gastric bypass and sleeve gastrectomy. Even though these procedures were designed with the aim of causing restriction of food intake and nutrient malabsorption, evidence suggests that their contributions to weight loss are minimal. By contrast, these  interventions reduce body weight by decreasing hunger, increasing satiation during a meal, changing food preferences and energy expenditure. Carel W. Le Roux explains in this lecture the different changes in brain activity and how these mechanisms as well as their mediators can influence weight loss. [Image]