Severe obesity and gut microbiota: does bariatric surgery really reset the system?

The gut microbiota is considered as one of the relevant contributors involved in the complex causes of obesity and related metabolic disorders. Indeed, a plethora of publications describing the composition of the microbiota in subjects suffering from overweight or obesity as well as type 2 diabetes and cardiometabolic diseases are available (for review1 2). Conversely, the characteristics of the microbiome in extreme forms of obesity (ie, severe and morbid Body Mass Index >35–40 kg/m²) has been barely described.

Bariatric surgery has dramatically increased worldwide and is now appearing as a solution to reduce cardiovascular risks and diabetes, thereby leading to consider this surgical procedure as a 'metabolic surgery'.3 4 Interestingly, one of the key features of the microbiome characterising obesity is the so-called low microbial gene richness, which strongly correlates with metabolic disorders such as low-grade inflammation, insulin resistance, adipocyte size but also chance of...

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