Hormonal responses among normal-weight adolescents and obese teenagers undergoing laparoscopic adjustable gastric banding

Background: Bariatric procedures such as laparoscopic adjustable gastric banding (LAGB) can markedly decrease body adiposity in severely obese adolescents, but relatively little is known about the short-term effects of such procedures on meal-related hormonal response. Methods: Participants completed a fixed size breakfast meal and fasting concentrations of appetitive hormones (leptin, insulin/glucose, ghrelin, PYY) were measured. PYY, ghrelin, and visual analog scale (VAS) ratings of fullness, hunger, nausea, and desire to eat were assessed immediately before the meal and 15, 30, 60, and 90 minutes afterwards. Results: A total of 10 normal-weight controls (age: 15.4±2.0 years, BMI: 21.3±1.7 kg/m2; n=5 female) and 21 severely obese (age: 16.1±1.0 years, BMI: 46.4±6.6 kg/m2; n=18 females) adolescents were studied pre-LAGB. Eleven of the obese adolescents were studied again 122.6±17.8 days post-LAGB (BMI 40.9±7.8 kg/m2, mean change in BMI: −3.5±2.5 kg/m2). In comparison to normal-weight controls, surgical candidates had significantly higher fasting insulin and leptin and lower fasting ghrelin. Fasting PYY decreased significantly post-surgery. Meal-related suppression of ghrelin, as measured by area under the curve (AUC), was significantly less in absolute value among pre-operative candidates than among normal weight controls [t(9.65) = 2.90, p = 0.017, d = 1.29], with a trend for a decrease in AUC for candidates pre- to post-LAGB [t(10) = 2.07, p = 0.065, d = 0.811]. No significant differences for AUC for PYY were found between normal-weight controls and surgical candidates, or surgical candidates pre- to post-LAGB. Normal-weight controls and surgical candidates did not differ by AUC for any VAS rating; however, post-LAGB, adolescents reported a significantly greater AUC for nausea [t(10) = − 2.58, p=0.03]. Conclusions: Despite short-term decreases in body mass index post-LAGB, few changes were observed in appetitive hormones prior to or following a standardized breakfast. In addition, subjective ratings of fullness, hunger, nausea, and desire to eat did not differ between surgical candidates and normal-weight controls, but following LAGB, adolescents reported significantly more nausea. Future studies should examine longer-term effects of LAGB on appetitive hormones.