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With increasing density of sensory neurons and glia (the primordial brain) and the emergence of autonomic neural activity throughout the endoderm, transmitters and other signaling molecules enable alimentation before the appearance of innate storage functions. Memory and, ultimately, cognition are prerequisites for processing and producing food to facilitate assimilation and safeguard the supply of nutrients. The gut\u2013brain\u2013gut axis via the vagus nerve is the autonomic neurohumoral pathway integrating these elements of energy homeostasis. Humans uniquely override obligate nutrient needs, eating in the absence of deprivation, resulting in pathological chronic overnutrition arising from dysautonomia. Obesity surgery circumvents powerful redundant mechanisms of alimentation and reduces excess stores of body fat from chronic overnutrition while preventing re\u2010accumulation of fat. All bariatric operations, whether purely restrictive, maldigestive and malabsorptive, or combinations, rely on regulatory mechanisms related to autonomic nervous system function and the brain\u2013gut axis. We review the functional anatomy and the importance of the vagus nerve for maintaining maladaptive chronic overnutrition and describe interventions to abrogate its effects. In aggregate, the preponderance of evidence supported by laboratory and clinical mechanistic studies interrupting abdominal bi\u2010directional vagal transmission demonstrates that the majority of patients report less \u201chunger\u201d and lose weight.<\/jats:p>","DOI":"10.1007\/s00268-009-0138-8","type":"journal-article","created":{"date-parts":[[2009,7,18]],"date-time":"2009-07-18T05:38:28Z","timestamp":1247895508000},"source":"Crossref","is-referenced-by-count":45,"title":["Vagal Nerve Function in Obesity: Therapeutic Implications"],"prefix":"10.1002","volume":"33","author":[{"given":"John G.","family":"Kral","sequence":"first","affiliation":[{"name":"Department of Surgery State University of New York Downstate Medical Center 450 Clarkson Avenue, Box 40 11203 Brooklyn NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wencesley","family":"Paez","sequence":"additional","affiliation":[{"name":"Department of Surgery Oregon Health and Science University 3181 S.W. 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