Ghrelin, the hunger hormone

Ghrelin is produced mostly in the stomach. It rises before meals (the building sense that it is time to eat is largely ghrelin at work) and falls once you have eaten.C-II-03

Ghrelin does not act alone; it is paired against leptin, the signal that reports how much energy is stored. In rough terms, ghrelin says eat and leptin says enough. Weight loss tips both signals the wrong way at once.C-II-01

After weight loss, ghrelin tends to run higher than it did before, and the elevation has been measured over time. Twelve months out, ghrelin was still running high, leptin was around 35% below baseline, and hunger was measurably greater than before the diet started.C-II-04

This is one of the concrete ways the body defends the weight range it has been holding: it uses hunger.

Because so much ghrelin is made in the stomach, it seems reasonable to assume that a procedure that reduces the stomach's capacity would also turn the hunger signal down. The measurements do not support that assumption.

A separate study found no change in fasting ghrelin at all. What the randomized trial did find was delayed emptying (the stomach empties considerably more slowly, and that delay persisted at twelve months), alongside rises in fasting ghrelin, GLP-1 and PYY at 18 months. In practical terms, the procedure works through capacity and timing, which is also how the FDA's own classification describes it. It is not a ghrelin-lowering operation.

There is an endoscopic therapy aimed directly at ghrelin, and it is a different procedure. Gastric mucosal ablation selectively devitalizes the ghrelin-producing lining of the stomach. It is investigational (an international expert consensus uses that exact word), and the first-in-human trial performed it as a separate step before a gastroplasty, which is itself a sign that the two are doing different jobs.C-IV-06

Everself does not offer it. Ghrelin can be targeted directly, in principle, but with a different procedure from the one most people assume.