Original articleAccelerated satiation after duodenal switch
Section snippets
Satiety test protocol
After a 12-hour overnight fast, a candidate was repeatedly offered a common commercial candy (caramel 6 g, 25 total calories; 4 calories from fat) every 3 minutes. The candy was chewed and swallowed. Fifteen seconds after a candy was introduced in the mouth, the candidate graded on a chart the sensation it created. The chart presented a 200-mm line with pleasantness at one end and unpleasantness at the other, with the middle indicating indifference. In this way, we were able to measure the
Results
Figure 1 shows the weight loss resulting from surgery. It shows the decreased BMI 3 and 6 months after surgery and the stable BMI for the three tests, 3 months apart, for the control group. After surgery, the BMI had decreased from 56.7 ± 4.2 kg/m2 to 46.5 ± 4.0 kg/m2 (P <0.0001) at 3 months and to 40.3 ± 3.5 kg/m2 (P <0.0001) at 6 months. The weight remained stable for the control group, with a constant BMI around 46 kg/m2 for the whole period. Figure 2 shows the acceleration of negative
Discussion
From our clinical experience, most of us believe that hunger and satiety do not have a primary role in the etiology of severe obesity and that these signals are not abnormal in these patients. Nor do we believe that those sensations are responsible for treatment failure. Rather, we believe that severe obesity is a metabolic disease, in which hunger/satiety are only contributing factors [15]. In search of a way to measure these physiologic signals, we investigated the usefulness of a test used
Conclusion
It is too early to conclude what role this test may have in bariatric surgery. We know too little regarding the negative alliesthesia phenomenon, its relation to satiety, and the state of energy balance. However, we believe that anything measurable and reproducible that may be related to satiety is relevant. This test has the great advantage of being simple, harmless, inexpensive, and scientifically provocative. More data are needed on normal weight individuals and morbidly obese patients and
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