• Elizabeth Ogden Beale and Michael Horowitz.
• Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. Electronic address: beale@usc.edu.
• Nutrition. 2022 Feb 1; 94: 111537.

BackgroundTherapy for obesity and related comorbidities should be clinically effective, widely available and acceptable, and used in conjunction with an optimized lifestyle. Dieting is widely available and acceptable but has poorly sustained clinical efficacy. By contrast, Roux-en-Y gastric bypass (GB) is highly effective but cost and safety concerns limit widespread use. In this article this we discuss the hypothesis that bolus jejunal feeding (BJ) via an enteral feeding tube simulates key features of GB with the potential for similar clinical benefits. We further hypothesize that a practical manner of providing BJ therapeutically is via an externally inapparent orojejunal feeding tube.RationaleThe first hypothesis is underpinned by the outcomes of research in three fields: 1) investigations into the mechanisms underlying the benefit of GB, 2) studies investigating gastrointestinal physiology and pathophysiology using enteral feeding tubes, and3) investigations into the mechanism underlying involuntary anorexia and weight loss in clinical situations that entail rapid nutrient delivery to the jejunum. There is compelling evidence that a supraphysiologic rate of delivery of nutrient to the jejunum suppresses appetite and energy intake and improves glucose homeostasis, and that these effects can be achieved non-surgically using an enteral feeding tube. The second hypothesis is supported by clinical demonstration of the feasibility of administering intermittent cycles of bolus feeds via an intraorally anchored feeding tube in ambulatory obese adults.ConclusionThe hypotheses are testable in clinical studies. If validated, BJ could be used to induce the clinical benefits of GB, but without its costs or safety concerns.Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

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