OMA Guidelines Bundle

Bariatric Surgery - Obesity Algorithm 2024

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21 TOP 10 TAKEAWAY MESSAGES: Microbiome 1. The microbiome is a collection of micro-organisms; microbiota are the organisms themselves. 2. The human organism has ~10 trillion human cells. The human gut is colonized by ~100 trillion cells (bacteria, fungi, and viruses). 3. Among gut bacteria species, over 90% are anaerobic that utilize the substrate of sloughed intestinal cells, plant polysaccharides, starch cellulose, and bile components. 4. The phyla Gram-positive Firmicutes and Gram-negative Bacteroidetes make up about 90% of the bacteria in the large intestine. In patients with obesity, Firmicutes is proportionally increased compared to Bacteroidetes. 5. Some intestinal bacteria promote increased density of small intestinal villi capillaries and more efficient absorption of nutrients than other bacteria; Gram-positive Firmicutes may more efficiently extract calories from carbohydrates than Gram- negative Bacteroidetes in patients with obesity. 6. Some intestinal bacteria may also facilitate central nervous system and other body organ signaling that may influence energy balance. 7. Intestinal bacteria can also influence bile acid metabolism and gut hormone secretion, both of which can affect energy balance. 8. Bariatric surgery may alter the microbiome and reduce the efficiency of extracting calories from consumed carbohydrates. 9. Individuals with overweight or obesity may not benefit from microbiota that promote more efficient absorption of nutrients. 10. The effects of fecal transplant in humans with obesity differ compared to rodents, with some fecal microbiota transplantation to patients (humans) with obesity not leading to a reduction in body mass index, despite successful and sustained changes in the intestinal microbiome and bile acid profiles similar to the lean donor.

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