Food intake regulation: Relevance to bariatric and metabolic endoscopic therapies

In this review, we aim to cover the key aspects of food intake regulation in health and obesity as well as the presumed mechanisms of action of bariatric endoscopic procedures for weight loss. Food intake regulation is a tightly controlled homeostatic process. The key stages of food intake regulation are hunger, satiation, and satiety. These different stages are regulated by the brain-gut-liver-fat axis. Disruption in this homeostatic process results in increased food intake and further weight gain and obesity. Bariatric endoscopy is an innovative and evolving field in the treatment of obesity. While its effectiveness is becoming rapidly accepted, the mechanisms of action are many times not well recognized. Bariatric endoscopy targets different stages and organs that control food intake. Understanding the mechanisms of action of each endoscopic bariatric therapy will facilitate the future improvement of each device, as well as the patient selection to maximize outcomes and minimize potential side effects.