These mechanisms could be caused by decreased energy intake, modification in gut hormone secretion such as peptide YY (PYY), glucagon-like peptide (GLP-1), ghrelin, bile acid action with activation of GLP-1, and change in gut microbiota activity.29 The above paragraphs highlighted that 12 weeks post-LGS to class 111 obese subjects could improve systemic inflammation and alleviates insulin resistance, diabetes, and metabolic syndrome. This evidence concerns the gene GHRL and metabolic syndrome.