[Verse 1]
Obesity's not a weakness, it's a chronic disease state
Adipose dysregulation, hypothalamic debate
Energy homeostasis buckled under the weight
Leptin resistance, feedback loops running late
BMI thirty-five with comorbidities, that's the gate
Or forty solo, ASMBS twenty-twenty-two update
Even thirty now qualifies if conditions complicate
Metabolic syndrome, diabetes, don't hesitate
[Chorus]
Restriction, malabsorption, hormonal cascade
GLP-1 rising, ghrelin getting decayed
PYY signals fullness, bile acids remade
Microbiome shifting, that's how the surgery's paid
BMI thresholds, multidisciplinary grade
Psych eval, preop loss, contraindications weighed
Remember the mechanisms — nothing here is vague
Restriction, malabsorption, hormonal cascade
[Verse 2]
Multidisciplinary team assembled at the table
Dietitian, psychologist, physician — all are able
Psychological clearance isn't just a label
Binge eating, uncontrolled depression render patients unable
Preoperative weight loss shrinks the hepatic stabled
Fat around the liver, makes the laparoscope more stable
Active substance misuse, that's a contraindication cabled
Untreated psychiatric illness keeps the case disabled
[Chorus]
Restriction, malabsorption, hormonal cascade
GLP-1 rising, ghrelin getting decayed
PYY signals fullness, bile acids remade
Microbiome shifting, that's how the surgery's paid
BMI thresholds, multidisciplinary grade
Psych eval, preop loss, contraindications weighed
Remember the mechanisms — nothing here is vague
Restriction, malabsorption, hormonal cascade
[Verse 3]
Now the mechanisms — four pillars, hold tight
Restriction limits volume, stomach sealed up right
Malabsorption bypasses where nutrients ignite
But hormones do the heavy lifting, that's the clinical insight
Ghrelin plummets postop, appetite drops from height
GLP-1 surges from the L-cells coming to the fight
PYY extends satiety deep into the night — correction — prolongs it right
Bile acids rerouted, FXR signals in flight
[Bridge]
Microbiome's the wildcard, Firmicutes decline
Bacteroidetes climbing, metabolic redesign
Short-chain fatty acids crossing the mucosal line
Butyrate, propionate — the bacterial pipeline
These aren't side effects, they're mechanisms by design
Four pathways interlocked, surgical and endocrine
[Verse 4]
Contraindications carved sharp — portal hypertension beware
Uncontrolled coagulopathy, surgeon's worst nightmare
Prohibitive anaesthetic risk demands the team declare
Non-compliance history — behaviour must be there
Surgery reshapes anatomy but cannot manufacture care
The patient owns the outcome — postop habits matter where
Supplementation lifelong, B12 and iron, declare
Calcium, vitamin D — malabsorption's affair