New York Obesity Nutrition Research Center, Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, NY 10025, USA.
Obes Surg. 2013 Feb;23(2):255-66. doi: 10.1007/s11695-012-0839-1.
Diet-induced weight loss is often limited in its magnitude and often of short duration, followed by weight regain. On the contrary, bariatric surgery now commonly used in the treatment of severe obesity favors large and sustained weight loss, with resolution or improvement of most obesity-associated comorbidities. The mechanisms of sustained weight loss are not well understood. Whether changes in the various components of energy expenditure favor weight maintenance after bariatric surgery is unclear. While the impact of diet-induced weight loss on energy expenditure has been widely studied and reviewed, the impact of bariatric surgery on total energy expenditure, resting energy expenditure, and diet-induced thermogenesis remains unclear. Here, we review data on energy expenditure after bariatric surgery from animal and human studies. Bariatric surgery results in decreased total energy expenditure, mainly due to reduced resting energy expenditure and explained by a decreased in both fat-free mass and fat mass. Limited data suggest increased diet-induced thermogenesis after gastric bypass, a surgery that results in gut anatomical changes and modified the digestion processes. Physical activity and sustained intakes of dietary protein may be the best strategies available to increase non-resting and then total energy expenditure, as well as to prevent the decline in lean mass and resting energy expenditure.
饮食诱导的体重减轻往往在其幅度上受到限制，并且持续时间通常较短，随后会出现体重反弹。相反，目前常用于治疗严重肥胖症的减重手术有利于体重的大量和持续减轻，大多数肥胖相关合并症得到解决或改善。持续减轻体重的机制尚不清楚。在减重手术后，能量消耗的各种成分的变化是否有利于体重维持尚不清楚。虽然饮食诱导的体重减轻对能量消耗的影响已经得到了广泛的研究和综述，但减重手术对总能量消耗、静息能量消耗和饮食诱导产热的影响仍不清楚。在这里，我们综述了来自动物和人体研究的关于减重手术后能量消耗的资料。减重手术导致总能量消耗减少，主要是由于静息能量消耗减少，这可以通过去脂体重和脂肪量的减少来解释。有限的数据表明，胃旁路手术后饮食诱导的产热增加，这种手术导致肠道解剖结构发生变化，并改变了消化过程。增加身体活动和持续摄入膳食蛋白质可能是增加非静息和总能量消耗以及预防瘦体重和静息能量消耗下降的最佳策略。
