This article aims to question the utility of current surgical methods and their alternatives for the treatment of worldthreatening “diabesity” pandemic. We, as surgeons, need to address the following question honestly—“Are we offering the best surgical procedure to our patients?” Despite the evidence suggestive of inadequate and disappointing results with restrictive techniques like vertical ba...

The cardiac natriuretic peptides (NPs) atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are both secreted by the heart in response to myocardial stress and stretch and act via binding to guanylyl cyclase-A (GC-A), with subsequent generation of the second messenger cyclic guanosine monophosphate. GC-A is widely expressed in mammals, e.g., in heart, kidney, vascular smooth mu...

The cloning of the glucagon gene from anglerfish, rodents and humans ((1) and references therein) in the early 1980s yielded the surprising finding that the glucagon gene not only encoded the known peptide hormone glucagon, but also contained sequences for two additional peptides, which, because of their homology to glucagon, were named glucagon-like peptide (GLP)-1 and -2 (Fig. 1). The protein...

Many surgeons and most laypeople think that there is a strict correlation between the size of the stomach and the size of the meals. The term ‘‘stomach reduction’’ became a synonym for weight loss surgeries, as if by reducing the stomach, all meals would automatically be small. However, there is no strict correlation between the size of this organ and the size of meals. Some morbidly obese pati...

Intestinal function and mucosal epithelial integrity are regulated by the combined actions of different hormonal and neuronal signals. Enteral nutrition is an essential determinant of mucosal epithelial function, and peptide hormones released after nutrient ingestion regulate gastric motility, pancreatic and biliary secretions, nutrient transport, and the growth and differentiated actions of th...

Knowledge about the relationship between exercise and appetite is important both for athletes wishing to optimise performance and for those interested in maintaining a healthy body weight. A variety of hormones are involved in appetite regulation including both episodic hormones, which are responsive to episodes of feeding, and tonic hormones, which are important regulators of energy storage ov...

Weight loss after gastric bypass surgery can typically amount to 30–50 kg the first year and is generally well maintained, with only slight regain over several years. Gastric bypass started to replace jejunoileal bypass procedure in the 1970s (1), as the latter caused too many serious adverse events. At that time, weight loss was attributed to the restriction of food intake caused by the reduce...