Triple hormone combination could hold the key to sustainable weight loss

The best treatment that we currently have to fight obesity is bariatric surgery. These include surgical procedures, for example the Roux-en-Y gastric bypass (RYGB), that have been performed for over 40 years. There are a number of studies that have demonstrated people with obesity who undergo this kind of surgery live longer as a result, have fewer heart attacks, fewer cancers and – remarkably – can be cured of diabetes without any medication in some cases.

Bariatric surgery appears to work by increasing the secretion of satiety hormones from the gut. These hormones – such as glucagon-like peptide-1, oxyntomodulin and peptide YY – work normally to control our appetite and regulate the systems in the body that digest, absorb and store food. The levels of these hormones in our blood increases whenever we eat, and the hormones in turn affect the parts of our brain that control eating and appetite. They also increase the amount of insulin produced by the pancreas, hence reducing blood sugar levels.

Surgical gastric bypass increases gut hormone levels by three to four times normal levels. Researchers from the NIHR Imperial BRC Metabolic Medicine & Endocrinology Theme wanted to explore whether this enhanced gut hormone secretion is one of the major ways by which the surgery causes patients to eat less, and can improve their blood sugar levels if they are diabetic.

Results from a new study demonstrate the benefits of bariatric surgery without having to do the surgery itself. In this study, patients were administered a hormonal mixture – GLP-1, oxyntomodulin and peptide YY, or GOP for short – through a pump under the skin using a soft plastic tube for up to 12 hours per day over a 4 week period.

The results showed that the GOP infusion at home was feasible and well tolerated and led to a substantial mean weight loss of 4.4 kg. GOP infusion also led to improvements in fructosamine comparable with RYGB and very low calorie diet (VLCD), both of which can lead to diabetes remission.

The researchers conclude that the GOP achieves superior glucose tolerance to VLCD, reduces glucose variability, and lowers the risk of provoking hypoglycemia compared with RYGB. This makes it a viable alternative to RYGB for the treatment of diabetes in patients who may not be able to have bariatric surgery.