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Bariatric surgery and inflammatory markers: the jury is still out: reply

Ursula Hanusch-Enserer , Kurt Huber
DOI: http://dx.doi.org/10.1093/eurheartj/ehp465 3082-3083 First published online: 30 October 2009

We are grateful for the discussion, which is now offered by the letter of Burgstahler et al. with respect to our recent publication on ‘Non-conventional markers of atherosclerosis before and after gastric banding surgery’.1 These authors discussed that the increase in physical exercise after bariatric surgery, based on the excessive weight loss and suspected concomitant increase in daily physical exercise, might have influenced the decreasing signs of chronic inflammation in our patients. Indeed, our patients demonstrated a weight loss from initially 129.7 ± 18.1 kg (mean ± SD) before surgery to 109.7 ± 16.0 kg and 97.6 ± 15.2 kg 6 and 12 months thereafter (P < 0.001), respectively.

We believe that the mechanism of increased physical activity had no or only limited impact on our study population, because (i) we offered no additional programme to increase the patients' physical activity after weight loss in order not to influence the impact of surgical reduction of body fat mass; (ii) patients were known for long-term before bariatric surgery and had proved not to be able and willing to participate in specific exercise and diet programmes; and (iii) our patients were relatively young (41.9 ± 9.0 years) and did not show specific orthopaedic and mechanical barriers before bariatric surgery.

Gastric banding reduces the excess of weight for about 60% on average.2,3 Accordingly, most of the patients do not reach normal BMI classes after this procedure. As shown repeatedly, after gastric banding, weight loss reaches a plateau usually after 12 months. Later on, weight gain of 3–4 kg is frequently seen.4 Different from other methods of weight reduction, bariatric procedures achieve satiety and reduce hunger soon after the surgery.24 The mechanisms are not fully understood but might be explained by changes of circulating gut hormones, e.g. a reduction in ghrelin or peptide YY, which is followed by less food intake and further augments the initial reduction in weight.5,6 As also shown by others,7 increased physical activity seems to be a minor player in weight reduction and consecutive changes in pro-atherosclerotic parameters in comparison with bariatric surgery in the first months after surgery. However, regular physical exercise might contribute later by avoiding renewed weight gain, which in turn might help to improve metabolic status and reduce subclinical inflammation. Only a small number of bariatric patients are willing to start with regular exercise, which is nevertheless an important co-factor for a long-term benefit in these patients.