By Dr. Manish Khaitan

Weight loss, especially through bariatric surgery, is often seen as a physical process focused on the stomach and digestive system. However, the brain plays a vital role in regulating weight loss. Psychological and neurological factors significantly influence eating habits, metabolism, and motivation, making them crucial for long-term success.

Neural Pathways and Hunger Regulation

The brain’s hypothalamus region regulates hunger and satiety. The arcuate nucleus (ARC), located at the ventral surface of the hypothalamus, integrates signals related to energy levels. 

Ghrelin and leptin, two hormones associated with hunger and satiety, play significant roles in this process. Furthermore, neurotransmitters like dopamine and serotonin are critical in regulating appetite. Dopamine, linked to the ventromedial nucleus, influences food intake and body weight, while serotonin promotes carbohydrate ingestion and satiation.

Psychological Factors

Stress, anxiety, and depression can profoundly impact eating behaviours and weight gain. Emotional disturbances often lead to a loss of control over eating, with binge eating disorders observed in 2-50% of bariatric patients, as per Sarwar et al., 2011. Another study observed that stressful emotions activate the hypothalamus-pituitary-adrenal axis, increasing cortisol levels, which in turn can lead to higher caloric intake as a reward-seeking coping mechanism.

Behavioural and Cognitive Strategies

Mindfulness and cognitive-behavioural techniques (CBT) are essential for managing weight. Mindfulness-based CBT helps overcome irrational fears, reduces stress, and controls emotional eating. Habits, formed through positive reinforcement, are key to weight management. Deploy behaviour change techniques to break unhealthy habits and enable long-term success. 

Brain’s Role in Metabolism

The brain regulates metabolism by communicating with organs like the pancreas and liver. Circadian rhythms & sleep cycle, again controlled by the brain, affect weight management. Studies draw linkages between sleep deprivation, insulin resistance, and altered hormone levels, thus interfering with long-term success in weight management. As per Broussard & Van Cauter, Circadian misalignment can further exacerbate weight gain by promoting energy absorption from food.

Neuroplasticity and Weight Loss

Neuroplasticity, the brain’s ability to adapt and change, supports long-term weight loss. By forming new, healthier habits and understanding the consequences of reverting to unhealthy behaviours, individuals can rewire their brains for better eating habits and sustained weight loss.

In essence, the brain is crucial in bariatric surgery and weight loss, influencing hunger, metabolism, and habit formation. Understanding the brain’s role is essential for achieving and maintaining weight loss. By considering psychological and neurological aspects, individuals can develop more effective strategies for long-term success.

(The author is the Director & Sr. Bariatric & Metabolic Surgeon, Nobesity Bariatric Surgery Centre)