Our patient underwent the Roux-en-Y gastric bypass, which resolved most of his comorbidities, including type 2 diabetes mellitus, hypertension, reflux disease, and osteoarthritis. The Roux-en-Y gastric bypass can produce on average a 25% weight loss by 9 to 12 months after the procedure. There is robust literature highlighting the immediate and consistent amelioration of metabolic abnormalities after bariatric surgery, in many cases much before major weight loss begins. This improvement, in the case of type 2 diabetes mellitus, may occur immediately and results from alterations in the secretion of several gut-derived hormones, notably GLP-1, GIP (gastric inhibitory polypeptide), PYY (peptide YY), and ghrelin, with endocrine functions that modulate insulin sensitivity and glucose utilization.17
