*8.2.7 Cost of gut microbiome manipulation*

Cost of gut microbiome manipulation in obesity management is reported in **Table 3**.


**263**

*Gut Microbiome in Obesity Management DOI: http://dx.doi.org/10.5772/intechopen.91974*

phyla ratio [45, 51, 57, 58].

**8.3 Gut microbiome after weight loss**

made during the statistical analysis.

**10. Ideal gut microbiome**

fiber (≥ 30 g/day).

**11. Conclusions**

prevent or manage obesity.

**Conflict of interest**

subjects.

After successful weight loss, there is a decrease in Firmicutes phylum, an increase in Bacteroidetes phylum, and a decrease of Firmicutes-to-Bacteroidetes

Well-designed clinical studies are urgently needed to better understand the

Several factors affect the quality of weight-loss studies aimed to assess gut microbiome. A well-calculated sample size allowing subgroup analysis is a key factor. Relevant stratification factors (e.g., race, age, gender, BMI, diet, and medications) at randomization will make the study more informative. Any underestimation of these stratification factors, as it has been the case in several clinical studies, especially in relation to diet and medications, may lead to misleading and conflicting results. The duration of the clinical studies has to be sufficient to allow both short-term and long-term/follow-up assessments. Adequate adjustments should be

An ideal gut microbiome should have high diversity. At the level of phyla, the ideal gut microbiome should have low Firmicutes phylum and high Bacteroidetes phylum with a Firmicutes-to-Bacteroidetes phyla ratio < 1.0. At the level of genera,

The recommended diet to reach the above objectives is a diet adequate in calories (adjusted to the activity), low in fat (< 20% of total macronutrients), and rich in

Gut microbiome influences normal physiology and susceptibility to diseases. Profound changes affecting the diversity and the abundance of gut microbiome are associated with obesity. A decrease in microbiome diversity and an increase in the ratio of Firmicutes-to-Bacteroidetes phyla have been reported in obese

Gut microbiome can be manipulated to change the host metabolism and manage obesity. Potential interventions include diet, prebiotics, probiotics, synbiotics,

A better understanding of the interactions between different diets and gut microbiome should help the development of new guidelines for feeding humans to

The author received honorarium for consultancy from Gelesis, Inc.

the ideal gut microbiome should be rich in *Prevotella* genus.

bariatric surgery, and fecal microbiota transplantation.

**9. Clinical study design to assess gut microbiome in obesity**

interactions between obesity/obesity treatment and gut microbiome.

#### **Table 3.**

*Cost of different tools used for gut microbiome manipulation in obesity management in the USA.*

*Weight Management*

body weight [56].

*8.2.4 Synbiotics*

probiotics alone.

[57, 58].

**Table 3**.

*8.2.5 Bariatric surgery*

(e.g., yogurt, cheese, and milk).

tested for safety risks before marketing. Probiotics can be found in several foods

Probiotics can manage obesity by reducing the production of lipopolysaccharide through an impact on gut microbiome. In a double-blind, placebo-controlled clinical study, administration of fermented milk containing *Lactobacillus gasseri* species (LG2055) to overweight/obese adults for 12 weeks caused a significant decrease in

Synbiotics are combination of prebiotics and probiotics. They have the potential

Bariatric surgery can modify gut microbiome and further affect body weight [57, 58]. The mechanisms include reduced caloric intake, reduced gastric emptying,

After Roux-en-Y gastric bypass surgery in obese subjects, there is a decrease in Firmicutes-to-Bacteroidetes phyla ratio and an increase in Proteobacteria phylum

Fecal microbiota transplantation, which consists of transfer of feces from a healthy donor to a recipient, is an exciting therapy with important potential. It can modify gut microbiome for the purpose of obesity management [59, 60]. The addition of healthy stool can be done through colonoscopy, orogastric tube, esophagogastroduodenoscopy, or oral capsule. It is important to carefully select and screen the donor to avoid risk of infection, aggravation of obesity, or other complications [61, 62]. Available clinical data are very preliminary and limited. Several studies are ongoing. There is no regulatory guidance for the use of fecal microbiota transplan-

Cost of gut microbiome manipulation in obesity management is reported in

Fecal microbiota transplantation \$1,800 (\$1,600–\$2,000) + cost of administration/dose

**Tool for gut microbiome manipulation Average cost (range)**

Bariatric surgery (Roux-en-Y gastric bypass) \$23,000 (\$20,000–\$30,000)

*Cost of different tools used for gut microbiome manipulation in obesity management in the USA.*

Diet Cost of food Prebiotics < \$100/month Probiotics < \$100/month Synbiotics < \$100/month

to induce more effects on gut microbiome and body weight than prebiotics or

and alterations in gastric acid production and bile acids.

*8.2.6 Fecal microbiota transplantation*

tation in the management of obesity.

*8.2.7 Cost of gut microbiome manipulation*

**262**

**Table 3.**

#### **8.3 Gut microbiome after weight loss**

After successful weight loss, there is a decrease in Firmicutes phylum, an increase in Bacteroidetes phylum, and a decrease of Firmicutes-to-Bacteroidetes phyla ratio [45, 51, 57, 58].
