Restricted Intake and Then Some: Relationship of Changes in Ghrelin and Eating Behavior Patterns One Year After Laparoscopic Banding Surgery

Purpose: Laparoscopic Banding Surgery (LBS) promotes loss of excess weight, presumably through reduced energy intake imposed by band restriction. There currently exists controversy regarding the direct impact that LBS may have on appetite regulating hormones such as ghrelin (GHR), independent of weight loss. Furthermore, little is known about the relationship between changes in ghrelin with eating behavior patterns after LBS. The purpose of the present study was to examine relationships between GHR and eating behavior patterns before and after LBS. It was hypothesized that (1) abnormal GHR will be associated with maladaptive eating patterns, and (2) normalization of GHR post-LBS will be associated with improved eating behavior patterns independent of reduction in central adiposity. Methods: A secondary data analysis was conducted on data from a 1-year prospective study in a community bariatric surgical setting. Obese patients (OB) (n=71, Mean age=44.6 years, Mean BMI=43 kg/m2) underwent assessment before (T1) and 12-months after LBS (T3). Age and gender matched controls (NW) (n=30) were also assessed. Self-report surveys included the Eating Inventory (Cognitive Restraint; CR, Disinhibition; DI, and Hunger; HN). Active GHR was measured in a fasting state (FGHR) and post-prandially (PGHR). CT scan determined central adiposity (L4L5VAT). Changes from T1 to T3 were calculated. Partial correlation controlling for L4L5VAT was utilized to determine associations of GHR with CR, DI, and HN at T1. Changes from T1 to T3 were compared using paired t-tests. Partial correlations controlling for changes in L4L5VAT were utilized to determine associations of changes in GHR with changes in CR, DI, and HN. Results: For all subjects at T1, FGHR and HN were significantly correlated (r=-.259, p=.014) while controlling for L4L5VAT. PGHR and HN approached significance (r=-.195, p=.067). At T3 there were no differences between OB and NW in FGHR, PGHR, or RGHR. For OB at T3, there were significant correlations between changes in FGHR and HN (r=-.527, p= .017) and C-PGHR (r=-.465, p=.039) while controlling for changes in L4L5VAT. Conclusion: Fasting and postprandial ghrelin are related to eating behavior patterns, specifically in eating in response to hunger cues. This appears to normalize after LBS regardless of loss in central VAT. Effectiveness of LBS via hormonal regulation of appetite may be independent of weight loss.