Sympathetic support of energy expenditure and sympathetic nervous system activity after gastric bypass surgery

Resting energy expenditure (REE) is partially dependent on the sympathetic nervous system as evidenced by the fact REE decreases during systemic beta-adrenergic blockade. It is not known how gastric bypass affects the sympathetically mediated component of REE or muscle sympathetic nerve activity (MSNA). We measured REE before and after beta-blockade in female subjects approximately three years post-gastric bypass surgery and in female obese individuals for comparison. We also measured MSNA in a subset of these subjects. The gastric bypass subjects had no change in REE after systemic beta-blockade, reflecting a lack of sympathetic support of REE, in contrast to obese subjects where REE was reduced by beta-blockade by approximately 5% (P<0.05). The gastric bypass subjects, while still overweight (BMI = 29.3 vs 38.0 kg/m(2) for obese subjects, P<0.05), also had significantly lower MSNA compared to obese subjects (10.9 ± 2.3 vs. 21.9 ± 4.1 bursts/min, P<0.05). The reasons for low MSNA and a lack of sympathetically mediated support of REE after gastric bypass are likely multifactorial and may be related to changes in insulin sensitivity, body composition, and leptin, among other factors. These findings may have important consequences for the maintenance of weight loss after gastric bypass. Longitudinal studies are needed to further explore the changes in sympathetic support of REE and if changes in MSNA or tissue responsiveness are related to the sympathetic support of REE.