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Is Success in Your Cards

By Carl A. Weiss, III, MD PhD FACS

Taking the first step to living a healthier lifestyle by having a bariatric procedure is a winning situation for every patient. But, it’s a fact that some bariatric patients do much better than others. So, whenever we see a patient who is interested in bariatric surgery, the first question in our mind is: “Will they succeed or not?”


To date, the consensus answer to this question is that we have no way of predicting who will do well. However, one frequently overlooked aspect of behavioral change that is necessary for long term success after bariatric surgery is the role of emotional eating. We tend to see that patients who rely on food and eating as a measure of comfort often seem to have higher rates of disappointing weight loss and weight regain after 3 or 5 years. While insight and motivation are part of the equation for success, the role of emotional feedback after eating is less well defined.


Recently, MRI (magnetic resonance imaging) scans of the brain were performed on two separate groups of patients who underwent gastric bypass. One group had success while the other did not. Imaging studies of the brain were performed focusing on the metabolic activity of the brain after showing pictures of meals. Interestingly, the areas of the brain that had the greatest metabolic activity were distinctly different in the two groups. In those patients who had success, the frontal lobe or cortical area of the brain demonstrated more metabolic activity. This is the cognitive area of the brain, the so called frontal lobes, where information is processed. In patients who were not successful, the posterior aspect of the brain demonstrated increased metabolic activity, suggesting that a different way of processing the information was occurring. This may be part of the area of the brain associated with habitual behavior. Or in other words, an area of the brain separate from the cortical part of the brain where logical decision making occurs.


These findings suggest that inherent in success and failure after bariatric surgery is the way in which we respond to eating stimuli. There may in fact be a contribution from the “way we are wired” to whether or not bariatric surgery will lead to success or failure. But that raises even more questions: Does bariatric surgery have any influence over eating habits or food-related information processing? Can emotional eating be curbed or changed after bariatric surgery? We will likely hear more questions and answers about cognitive behavior after bariatric surgery in the near future.