Emotional food cravings predicts poor short‐term weight loss following laparoscopic sleeve gastrectomy

Exploration of Food Attitudes and Management of Eating Behavior from a Psycho-Nutritional Perspective

BACKGROUND/OBJECTIVES

This study investigates the relationship between food attitudes and the management of eating behavior from a psycho-nutritional perspective, with a focus on the Health Belief Model (HBM). The objective was to explore how emotional food cravings influence different aspects of eating behavior and dietary attitudes, and to identify indirect pathways through which these cravings affect attitudes toward dieting behaviors.

METHODS

Data were collected from 659 participants using validated scales that assessed dieting tendencies, bulimia and food preoccupation, culinary behaviors, food preoccupation, expectations of positive outcomes, and emotional food cravings. Descriptive statistics, Pearson's correlations, and network analysis were employed to uncover significant associations among these variables. A sequential mediation analysis was conducted using SPSS PROCESS Macro Model 6 to identify indirect pathways.

RESULTS

The analysis revealed significant associations among the variables. Emotional food craving had a negative indirect effect on dieting attitudes through bulimia tendencies (effect size: -0.523) and a positive indirect effect through food preoccupation (effect size: 0.1006). These results highlight the complex interplay between emotional food cravings, bulimia tendencies, and food preoccupation in shaping dieting attitudes.

CONCLUSIONS

The findings emphasize the complex dynamic between emotional food cravings, bulimia tendencies, and food preoccupation, and their collective impact on dieting attitudes. This study provides insights into potential intervention strategies aimed at improving eating habits by addressing emotional food cravings and their indirect effects on dietary behavior.

Three-Month Excessive Body Weight Loss < 37.7% as a Predictor of Mid-term Suboptimal Outcomes Postlaparoscopic Sleeve Gastrectomy: Risk Factors and the Impact of Neutrophil-to-Lymphocyte Ratio on Adipocyte Function

INTRODUCTION

This study aimed to evaluate the impact of achieving < 37.7% excess body-weight loss (EBWL) within 3 months of postlaparoscopic sleeve gastrectomy (LSG) on clinical outcomes and its correlation with adipocyte function.

METHODS

Patients (n = 176) who underwent LSG between January 2019 and January 2023 were included. Weight loss and status of health markers were monitored postoperatively. The cohort was stratified based on EBWL < 37.7% at 3 months or not. Variables including neutrophil-to-lymphocyte ratio (NLR), insulin resistance, and comorbidities were analyzed. Omental visceral and subcutaneous adipose tissue samples were used to analyze the differences in adipocyte function by western blot.

RESULTS

Patients with EBWL < 37.7% at 3 months post-LSG (suboptimal group) comprised less likelihood of achieving ≥ 50% EBWL than those who achieved ≥ 37.7% EBWL (optimal group) at 6 months (42.55% vs. 95.52% in optimal group, p < 0.001), 12 months (85.11% vs. 99.25% in optimal group, p < 0.001) and 24 months (77.14% vs. 94.74% in optimal group, p = 0.009) post-LSG. High BMI (OR = 1.222, 95% CI 1.138-1.312, p < 0.001), NLR ≥ 2.36 (OR = 2.915, 95% CI 1.257-6.670, p = 0.013), and female sex (OR = 3.243, 95% CI 1.306-8.051, p = 0.011) significantly predicted EBWL < 37.7% at 3 months post-LSG. Patients with NLR ≥ 2.36 had significantly lower adipose triglyceride lipase in omental fat (p = 0.025).

CONCLUSION

EBWL < 37.7% at 3 months post-LSG is a strong predictor of subsequent suboptimal weight loss. High BMI, NLR ≥ 2.36, and female sex are risk factors in predicting EBWL < 37.7% at 3 months post-LSG. These findings may offer a reference to apply adjuvant weight loss medications to patients who are predisposed to suboptimal outcomes.

Food cravings after bariatric surgery: comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

BACKGROUND

Research suggests that food choices, preferences, and tastes change after bariatric surgery, but evidence regarding changes in food cravings is mixed.

OBJECTIVES

The primary aim of this cohort study was to compare food cravings during the first year following bariatric surgery in patients who had undergone sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB).

SETTING

Integrated multispecialty health system, United States.

METHODS

Patients aged ≥ 18 years seen between May 2017 and July 2019, provided informed consent, completed the Food Craving Inventory (FCI), and had ≥ 1 year of follow-up after undergoing primary SG or RYGB were included in the study. Secondary data captured included psychological and behavioral measures. Preoperative and postoperative (3, 6, 9, and 12 months) FCI scores of patients who underwent SG and RYGB were compared.

RESULTS

Some attrition occurred postoperatively (N = 187 at baseline, 141 at 3 months, 108 at 6 months, 89 at 9 months, and 84 at 12 months). No significant relationship between pre- or postoperative food cravings and surgery type was found except on the carbohydrate subscale. Patients with higher preoperative food addiction symptoms were not more likely to experience an earlier reoccurrence of food cravings during the first 12 months after surgery. Likewise, patients with higher levels of preoperative depression and anxiety were not more likely to have early reoccurrence of food cravings during the first 12 months after surgery; however, those with higher PHQ9 scores at baseline had uniformly higher food craving scores at all timepoints (pre-surgery, 3 m, 6 m, 9 m, and 12 m).

CONCLUSIONS

Results suggest that food cravings in the year after bariatric surgery are equivalent by surgery type and do not appear to be related to preoperative psychological factors or eating behaviors.

LEVEL OF EVIDENCE

Level III: Evidence obtained from well-designed cohort.

How Does an Eating Disorder Affect Your Physical and Mental Health and How It Is Related to Sleeve Gastrectomy?

Background Obesity is the pandemic of this era. At the same time, the commercialisation of thinness has also increased its adversity. Dissatisfaction with body shape is leading to many eating disorders. These disorders further cause several health problems. It has been found that individuals with eating disorders experience insomnia, depression, and anxiety. It also affects the endocrine system and digestive systems of the body. The surgical approach provides a more efficient treatment of obesity with sustainable results. Sleeve gastrectomy is the most popular surgical treatment. Sleeve gastrectomy is one of the prominent bariatric surgeries. Patients going through sleeve gastrectomy not only lose weight but also improve their mental health. Objective This study assesses the relationship between obesity, eating disorders, and physical health. It also focuses on the prevalence of sleeve gastrectomy procedures in such individuals and their outcomes. Methods This study used a cross-sectional design and a convenient sampling technique. The obese individuals who had eating disorders residing in Medina Al-Munawara and Riyadh city were taken as the samples. Online questionnaires were shared with participants to collect their perspectives on their weight, eating disorders, and their impact on physical health. The study collected both retrospective and present data. Results A total sample of 335 participants was taken, of which 181 (54%) were females and 154 (46%) were males, with a mean BMI of 28.85±2.57. The fear of weight gain was found among 265 (79%) of participants, 151 (45%) were feeling guilt while eating, 275 (82%) were weighing themselves daily, 325 (97%) were unable to stop eating even when complete, and 117 (35%) were unable to control themselves when they have food. As per the methods of avoiding weight gain, 166 (49.6%) were skipping a meal, 157 (47%) were following a diet, 17 (5%) were inducing vomiting, and 16 (4.8%) reused laxatives and diuretics. A total of 158 (47.2%) were involved in sports, but it was reduced to 61 (18.25%) upon sickness. Only 24 (7%) participants had undergone sleeve gastrostomy, and 181 (54%) believed that their cravings had increased, 238 (71%) complained of dizziness, and 151 (45%) believed that fast food caused gut unrest. Conclusion Obese individuals who are going through eating disorders are psychologically and physically compromised. They consider skipping meals to be the most efficient means of weight loss, and only a small percentage prefer to go for sleeve gastrectomy.

Potential contributors to variation in weight-loss response to liraglutide

Obesity treatment requires a chronic state of negative energy balance. Obesity medications can help with this, increasing long-term dietary compliance by promoting satiety or reducing hunger. However, efficacy and safety of obesity medications vary for individuals. Early identification of non-responders to obesity medications may limit drug exposure while optimizing benefits for responders. This review summarizes factors that impact weight-loss response to liraglutide. Factors linked to greater weight loss on liraglutide include being female, not having diabetes, having relatively high baseline weight, and losing at least 4% of initial weight after 16 weeks of treatment. Other covariates that may predict treatment response but require further confirmation include central effects, nausea, gastric emptying of solids, and genotype. Baseline body mass index, race, and age seem less relevant for predicting weight-loss response to liraglutide. Lesser known and harder-to-measure factors such as cerebral blood flow, food cue reactivity, gut hormone levels, and dietary adherence possibly impact variability of response to liraglutide. This information should assist healthcare providers with establishing realistic weight-loss probability for individual patients. Future research should improve the ability to identify responders to liraglutide. Importantly, this review may provide a framework to identify responders to other obesity medications.

SHORT TERM EFFECTS OF SEMAGLUTIDE ON EMOTIONAL EATING AND OTHER ABNORMAL EATING PATTERNS AMONG SUBJECTS LIVING WITH OBESITY

OBJECTIVE

Emotional eating (EE) and other abnormal eating patterns are highly prevalent among people living with obesity (PWO). In this sense, semaglutide, by acting on areas of the brain involved in the reward system and emotion regulation, could have the potential to ameliorate these eating patterns.

METHOD

69 PWO attending an obesity clinic were evaluated baseline and after 3 months since the beginning of semaglutide. To rule out abnormal EE, the Emotional Eating Questionnaire was administered, and a structured interview was conducted.

RESULTS

69 PWO (82.6%♀, 43.7±1years, and 34.3±6kg/m 2) were included. After 3 months of semaglutide, there was a significant reduction in weight (96.1±20.9 vs 91.3±19.7kg; p<0.001) and BMI (34.3±6 vs 32.4±5.6kg/m 2; p<0.0001). The proportion of patients with EE (72.5% vs 11.5%; p<0.001), external eating (27.5% vs 10.1%; p<0.001) cravings (49.3% vs 21.7%; p<0.001) and savory cravings (53.6% vs 14.5%; p<0.001) was significantly reduced after 3 months of semaglutide. Also, the proportion of PWO with regular exercise was increased (15.9% vs 39.1%; p<0.001). However, Logistic regression analysis showed that only sweet cravings at baseline were the only factor associated, although not significant, with a poorer weight loss (p=0.05).

DISCUSSION

Semaglutide is an effective weight-loss treatment in PWO at short term. Moreover, semaglutide was highly effective in ameliorating EE and other abnormal eating patterns that exert a negative influence on weight.

Follow-up after bariatric surgery: is it time to tailor it? Analysis of early predictive factors of 3-year weight loss predictors of unsuccess in bariatric patients

Bariatric surgery (BS) is the most effective treatment strategy for obesity. Nevertheless, a subset of patients does not reach a successful weight loss or experience long-term weight regain. Conflicting evidence exists regarding predictors of BS outcomes. We aimed to define the early factors linked to 3 year unsuccessful weight loss in order to promote a tailored close follow-up. We enrolled 443 patients who underwent BS from January 2014 to December 2018 with a 3 year follow-up. An unsuccessful BS outcome was defined as a percentage of total weight loss (%TWL) < 20. We compared the characteristics between successful and unsuccessful patients in order to identify predictor factors of unsuccess after surgery. We found that the proportion of patients with unsuccessful weight loss progressively increased from one to three years after BS. In a multiple regression model, only 1 month %TWL and sleeve gastrectomy (SG) were significantly associated with 3 year unsuccessful weight loss. We stratified our cohort in four groups according to the risk of BS unsuccess, in terms of 1 month %TWL and type of surgery (SG vs gastric bypass). Interestingly, groups showed a significant difference in terms of %TWL at each follow-up point. Patients submitted to SG with lower 1 month %TWL must be considered at higher risk of future weight regain; consequently, they require a tailored and closer follow-up.

Predictors of weight loss in participants with obesity following bariatric surgery - A prospective longitudinal fMRI study

Prevalence rates of overweight and obesity are increasing worldwide and are amongst the leading causes of death. Participants with obesity also suffer from poorer mental health with a concomitant reduced quality of life. Bariatric surgery outperforms other existing weight optimization approaches. However, hitherto, it was not possible to identify factors predicting weight loss following surgery. Therefore, we aimed at investigating neural and behavioral predictors of weight loss, as well as the neurological underpinnings of food cue-induced craving before and after bariatric surgery. The total sample consisted of 26 participants with obesity (17 females and 9 males, mean age 41 ± 12 years, mean BMI 46 ± 6 kg/m2, 21 received Roux-en-Y gastric bypass and 5 sleeve gastrectomy). Participants with obesity were prospectively assessed using functional magnetic resonance imaging two weeks before, as well as eight and 24 weeks after surgery. Imaging data were available for 11 individuals; 10 received Roux-en-Y gastric bypass and one sleeve gastrectomy. Subjective cue-induced food craving correlated positively with brain activation in the amygdala, the parahippocampal gyrus, and hippocampus, and negatively with brain activation in frontal brain regions. In the total sample (N = 26), perceived feeling of hunger and YFAS sum score explained 50.6% of the variance (R² = 0.506, F_(1,23) = 10.759, p < 0.001) and in the imaging sample, cue-induced food craving at baseline before surgery explained 49.6% of the variance (R² = 0.496, F_(1,23) = 7.862, p = 0.023) of % total weight loss (%TWL). In other words, with respect to %TWL, bariatric surgery was most efficient in candidates characterized by high cue-induced food craving, high-perceived feeling of hunger and a low YFAS sum score.

Identifying stress-related eating in behavioural research: A review

Stress is a commonly reported precipitant of overeating. Understanding the relationship between stress and food intake is important, particularly in view of the increasing prevalence of obesity. The purpose of this review is to examine how stress-related eating has been defined and measured in the literature to date. There are no established diagnostic criteria or gold standards for quantification of stress-related eating. Questionnaires relying on the accuracy of self-report are the mainstay of identifying people who tend to eat in response to stress and emotions. There is a paucity of clinical research linking objective measurements of stress and appetite with self-reported eating behaviour. Limitations of the methodological approaches used and the heterogeneity between studies leave significant knowledge gaps in our understanding of the mechanism of stress related eating, and how best to identify it. These issues are discussed, and areas for further research are explored.

Check point to get adequate weight loss within 6-months after laparoscopic sleeve gastrectomy for morbid obesity in Asian population

Purpose of this study is to develope a scoring system to predict the likelihood of excess body weight loss (EBWL) ≥ 50% 6-months after laparoscopic sleeve gastrectomy (LSG). From April 2016 to September 2018, data was collected from 160 patients (BMI ≥ 32) who underwent primary LSG with at least 6-months follow-up. They were separated into score generation (operated by one surgeon, n = 122) and validation groups (operated by 3 different surgeons, n = 38). EBWL at 6-months ≥ 50% was considered adequate weight loss. Independent variables including age, gender, initial body mass index (BMI), comorbidities, life-style habits, percentage of EBWL and percentage of total body weight loss at 1-week, 1-month, and 3-months were analyzed with mutivariate logistic regression to generate the scoring system. The system was applied to internal and external validation groups to determine efficacy. As results, between the score generation and internal validation groups, the only significant difference in patient characteristics was in exercise participation. EBWL at 1-month > 19.5% (1 point) and EBWL at 3-months > 37.7% (2 points) were identified as independent factors to predict EBWL at 6-months ≥ 50%. When scores were > 1, the system had 94.03% positive predictive value (PPV) and 81.82% negative predictive value (NPV) (AUC: 0.923). Internal validation scores > 1 had a 95.83% PPV and 85.71% NPV (AUC: 0.975). External validation results showed 88.59% PPV and 72.00% NPV (AUC: 0.802). We concluded that this scoring system provides a reliable, objective prediction of EBWL at 6-months ≥ 50%. Patients requiring more aggressive clinical follow-up and intervention can be detected as early as 1- to 3-months after LSG.

GLP-1 Analog Modulates Appetite, Taste Preference, Gut Hormones, and Regional Body Fat Stores in Adults with Obesity

PURPOSE

Obesity is associated with alterations in appetite, gastrointestinal hormone levels and excessive fat mass. We previously published a double-blind, placebo-controlled, randomized, 16-week trial on effects of once-daily glucagon-like peptide-1 (GLP-1) analog, liraglutide on weight, satiation, and gastric functions in obese volunteers. The aim of this substudy is to compare to placebo the effects of liraglutide on appetite, taste preference, regional body fat stores, and anthropometric measurements.

METHODS

Forty obese adults received standard instruction for weight management, monthly behavioral intervention utilizing motivational interviews, and 16-week treatment of once-daily liraglutide (escalated to 3 mg SQ daily). At baseline and 16 weeks, the following were measured: appetite and taste preferences rated every 30 min for 5 h after ingesting 300 mL Ensure®; maximal tolerated volume (MTV) with a nutrient drink test; fasting and postprandial bioactive GLP-1 (7-36) and peptide YY (PYY) levels; total and regional body fat with dual-energy X-ray absorptiometry, and waist and hip circumference.

RESULTS

Thirty-five participants (17 liraglutide; 18 placebo) completed the trial. Compared to placebo group, liraglutide group had significant reductions in MTV; prospective food consumption score; desire to eat something sweet, salty, savory or fatty; and an increase in perceived fullness. Postprandial plasma levels of GLP-1 decreased and PYY levels increased with liraglutide relative to baseline. Significant reductions in total body, trunk, and upper and lower body fat without reduction in lean body mass were observed.

CONCLUSION

Liraglutide 3 mg SQ modulates appetite, taste preference, gut hormones, and regional body fat stores in adults with obesity without reduction in lean body mass.

The influence of attachment orientation on weight loss, eating behaviour and other health outcomes among patients undergoing bariatric surgery: A scoping review

Attachment orientation is a psychological factor concerning our expectations of ourselves and others in interpersonal relationships. An emerging literature has suggested that attachment orientation may influence a range of outcomes associated with bariatric surgery. The purpose of this scoping review was to map the literature and examine the role of attachment orientation in the context of bariatric surgery. Studies conducted with patients who are undergoing or have undergone bariatric surgery, with a measure of attachment orientation and published by 21st July 2019, were located through electronic searches including Scopus, PubMed and Web of Science. 21180 studies were identified, of which 18 were retained for narrative synthesis. The major outcome themes reported were (1) post-surgery weight-loss/body mass index (k = 10), (2) eating behaviour (k = 9), (3) attachment orientation differences in bariatric surgery patients compared with control groups (k = 4) and 4) other mental and physical health outcomes (k = 12). Overall, the results showed that there was little evidence to suggest that poor attachment orientation is predictor of weight-loss following surgery. There was evidence to suggest that poorer attachment orientation relates to poorer eating behaviours both before and after surgery, that patients undergoing bariatric surgery are more likely to have a poorer attachment orientation and attachment orientation is related to mental health outcomes but not physical health outcomes for patients. However, where relationships were identified, there were considerable inconsistencies regarding the dimension of attachment orientation that drove the relationship. Future studies should consider appropriate sample sizes for studies, replication of key findings and longer durations for longitudinal studies.

Twenty Years of the Food Cravings Questionnaires: a Comprehensive Review

Purpose of Review

The Food Cravings Questionnaires (FCQs; Cepeda-Benito, Gleaves, Williams, & Erath, 2000) are among the most widely used instruments for measuring food cravings. In addition to the Food Cravings Questionnaire–Trait (FCQ–T) and the Food Cravings Questionnaire–State (FCQ–S), several modified versions have been developed as well. For their 20th anniversary, this article provides a comprehensive description of the FCQs and reviews studies on their psychometric properties and correlates.

Recent Findings

The FCQs and their modified versions have excellent internal reliability. Expectedly, the FCQ–T (and its derivatives) has higher retest-reliability than the FCQ–S as the FCQ–S is sensitive to situational changes such as food deprivation and food intake. However, while the FCQ–T is largely unaffected by such momentary states, it is also sensitive to change during weight-loss treatments and other interventions. Factor structure of the FCQ–T and FCQ–S has only partially been replicated. Construct validity of the FCQs is supported by experimental and longitudinal studies that measured food craving and food consumption in the laboratory and with ecological momentary assessment.

Summary

Numerous studies support reliability and validity of the FCQs and their modified versions, yet findings about their factor structures are inconsistent. Thus, using total scores or the short versions of the FCQs may be preferable.

Precision medicine in adult and pediatric obesity: a clinical perspective

It remains largely unknown as to why some individuals experience substantial weight loss with obesity interventions, while others receiving these same interventions do not. Person-specific characteristics likely play a significant role in this heterogeneity in treatment response. The practice of precision medicine accounts for an individual's genes, environment, and lifestyle when deciding upon treatment type and intensity in order to optimize benefit and minimize risk. In this review, we first discuss biopsychosocial determinants of obesity, as understanding the complexity of this disease is necessary for appreciating how difficult it is to develop individualized treatment plans. Next, we present literature on person-specific characteristics associated with, and predictive of, weight loss response to various obesity treatments including lifestyle modification, pharmacotherapy, metabolic and bariatric surgery, and medical devices. Finally, we discuss important gaps in our understanding of the causes of obesity in relation to the suboptimal treatment outcomes in certain patients, and offer solutions that may lead to the development of more effective and targeted obesity therapies.

Triggers of Lapse and Relapse of Diet and Exercise in Behavioral Weight Loss

OBJECTIVE

This study aimed to (1) develop instruments to evaluate situations that lead to lapse and relapse in diet and exercise and (2) prospectively investigate when and which psychosocial situations predict failure to lose weight in a clinical trial of intentional weight loss.

METHODS

Participants were 469 individuals with overweight or obesity participating in a behavioral weight loss program (age: mean = 53.6 years, SD = 11.4; BMI: mean = 35.7 kg/m² , SD = 6.5).

RESULTS

The Cronbach alphas for the Diet Lapse and Relapse Triggers Scale and the Exercise Lapse and Relapse Triggers Scale were 0.93 and 0.91, respectively. Subscale alphas ranged from 0.60 to 0.96. Lapse and relapse were assessed at 3 and 9 months for associations with weight loss at 12 months. At 9 months, diet triggers were negative emotional states (beta = 0.11, P = 0.02) and urges (beta = 0.14, P = 0.01). Predicted social situations showed the opposite (beta = -0.09, P = 0.02). Exercise subscales were all nonsignificant.

CONCLUSIONS

Findings suggest the ongoing importance of addressing negative emotional states and the contributing influence of urges. The novel finding that participants whose difficulties arise in social situations may do better over time requires further study.

Sustained behaviour change in healthy eating to improve obesity outcomes: It is time to abandon willpower to appreciate wanting

The purpose of this study was to report on a nationally representative survey of the experience of Canadian adults regarding food cravings and the impact of these cravings on behaviour and quality of life. A total of 1532 respondents (16% of members of an online panel emailed an invitation and link) completed a nationally distributed survey. Almost two-thirds of the sample reported experiencing cravings, with women being more likely to report cravings than men. Of those with cravings, 83.1% reported moderate or strong cravings. Cravings impacted eating behaviours and quality of life, especially for those with strong cravings. Cravings were associated with being bored, emotional or watching TV. Those who identified themselves as overweight or as trying to lose weight were more likely to have cravings. Of those reporting to be overweight and trying to lose weight few experienced distress because of lack of access to help and rates of interest in being guided by healthcare professionals were low, except in those with strong cravings. These results reinforce the notion that eating behaviour may differ from other behaviours in that there is a strong drive to eat that is difficult to control for many individuals. Behavioural interventions targeting healthy eating should be developed to address this construct of drive to eat, that is, food cravings.

Vertical Sleeve Gastrectomy Attenuates Hedonic Feeding Without Impacting Alcohol Drinking in Rats

OBJECTIVE

Roux-en-Y gastric bypass surgery and vertical sleeve gastrectomy (VSG) are the most commonly performed bariatric procedures. Whereas studies report new-onset alcohol misuse following Roux-en-Y gastric bypass, the impact of VSG on alcohol intake is less clear. Hedonic feeding, alcohol drinking, and hypothalamic obesity-related gene expression following VSG were evaluated.

METHODS

Male Long-Evans rats underwent VSG or sham surgery. To evaluate hedonic feeding, rats received a high-fat diet following behavioral satiation on chow. Alcohol (5%-10% v/v) drinking was assessed in a two-bottle choice paradigm. Finally, polymerase chain reaction array evaluated gene expression.

RESULTS

VSG induced moderate but significant weight loss. Sham rats significantly escalated high-fat diet intake following behavioral satiation, an effect significantly reduced in VSG rats. A moderate decrease in alcohol intake was observed in VSG rats at low (5%) alcohol concentration. However, overall, no significant between-group differences were evident. Key hypothalamic orexigenic transcripts linked to stimulation of food and alcohol intake were significantly decreased in VSG rats.

CONCLUSIONS

VSG attenuated hedonic feeding without impacting alcohol drinking, an effect potentially mediated by alterations in genetic information flow within the hypothalamus. Importantly, these data highlight VSG as an effective bariatric procedure with a potentially reduced risk of developing alcohol use disorder.