The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Prevalence of Sleep Apnea in Morbidly Obese Patients who Presented for Weight Loss Surgery Evaluation: More Evidence for Routine Screening for Obstructive Sleep Apnea before Weight Loss Surgery Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. Reduction in obesity-related comorbidities: is gastric bypass better than sleeve gastrectomy? Impact of Bariatric Surgery on Heme Oxygenase-1, Inflammation, and Insulin Resistance in Morbid Obesity with Obstructive Sleep Apnea Sleeve Gastrectomy in Morbidly Obese HIV Patients: Focus on Anti-retroviral Treatment Absorption After Surgery The Sleeve Bypass Trial: a multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. Post-traumatic stress disorder (PTSD) is not a contraindication to gastric bypass in veterans with morbid obesity Outcomes of bariatric surgery in patients with body mass index <35 kg/m2. Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2 Gastric bypass surgery for severe obesity: what can be achieved? Treatment of Mild to Moderate Obesity with Laparoscopic Adjustable Gastric Banding or an Intensive Medical Program Laparoscopic sleeve gastrectomy in the South Pacific. Retrospective evaluation of 510 patients in a single institution. Muscle Force and Force Control After Weight Loss in Obese and Morbidly Obese Men Sleep Apnea Determines Soluble TNF-α Receptor 2 Response to Massive Weight Loss Continuous Positive Airway Pressure via the Boussignac System Immediately after Extubation Improves Lung Function in Morbidly Obese Patients with Obstructive Sleep Apnea Undergoing Laparoscopic Bariatric Surgery What are the long-term results 8 years after sleeve gastrectomy? Determinants of testosterone recovery after bariatric surgery: is it only a matter of reduction of body mass index? Musculoskeletal function following bariatric surgery. Melanocortin-4 Receptor Mutations and Polymorphisms Do Not Affect Weight Loss after Bariatric Surgery Very Low-Carbohydrate Ketogenic Diet Before Bariatric Surgery: Prospective Evaluation of a Sequential Diet Increase of Osteopontin Plasma Concentrations After Bariatric Surgery Independent from Inflammation and Insulin Resistance
BACKGROUND Bariatric surgery is considered as being contraindicated for morbidly obese patients who also have inflammatory bowel disease ( IBD ) . The aim of our study was to report the outcomes of bariatric surgery in morbidly obese IBD patients . METHODS The prospect ively collected data of all the patients diagnosed as having IBD who underwent bariatric operations in 2 medical centers between October 2006 and January 2014 were retrieved and analyzed . RESULTS One male and 9 female morbidly obese IBD patients ( 8 with Crohn 's disease and 2 with ulcerative colitis ) underwent bariatric surgery .  Their mean age was 40 years , and their mean body mass index was 42.6 kg/m2 . Nine of them underwent a laparoscopic sleeve gastrectomy and 1 underwent a laparoscopic adjustable gastric b and .  Eight patients had obesity-related co-morbidities , including type 2 diabetes , hypertension , sleep apnea , osteoarthropathy , etc  . After a median follow-up of 46 months ( range 9 - 67 ) , all of the patients lost weight , with an excess weight loss of 71 % , and 10 out of 16 obesity-related co-morbidities were resolved . There was 1 complication not related to IBD , and no IBD exacerbation . CONCLUSION Bariatric surgery was safe and effective in our morbidly obese IBD patients . The surgical outcome in this selected patient group was similar to that of comparable non-IBD patients The incidence of obstructive sleep apnea has been underestimated in morbidly obese patients who present for evaluation for weight loss surgery . This retrospective study shows that the incidence of obstructive sleep apnea in this patient population is greater than 70 per cent and increases in incidence as the body mass index increases . Obstructive sleep apnea ( OSA ) is a common comorbidity in obese patients who present for evaluation for gastric bypass surgery . The incidence of sleep apnea in obese patients has been reported to be as high as 40 per cent . A retrospective review of our prospect ively collected data base was performed . All patients being evaluated for weight loss surgery for obesity were screened preoperatively for OSA using a sleep study . The  overall incidence of sleep apnea in our patients was 78 per cent ( 227 of 290 ) . All 227 were diagnosed by formal sleep study . There were 63 ( 22 % ) males and 227 ( 78 % ) females . The mean age was 43 years ( range , 17–75 years ) . The mean body mass index ( BMI ) was 52 kg/m2 ( range , 31–94 kg/m2 ) . The prevalence of OSA in the severely obese group ( BMI 35–39.9 kg/m2 ) was 71 per cent . For the morbidly obese group ( BMI 40–40.9 kg/m2 ) , the prevalence was 74 per cent and for the superobese group ( BMI 50–59.9 kg/m2 ) 77 per cent . Those with a BMI 60 kg/m2 or greater , the prevalence of OSA rose to 95 per cent . The incidence of sleep apnea in patients presenting for weight loss surgery was greater than 70 per cent in our study . Patients presenting for weight loss surgery should undergo a formal sleep study to diagnose OSA before bariatric surgery CONTEXT Obstructive sleep apnea ( OSA ) is strongly related to obesity . Weight loss is recommended as part of the overall management plan for obese patients diagnosed with OSA . OBJECTIVE To determine whether surgically induced weight loss is more effective than conventional weight loss therapy in the management of OSA . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial of 60 obese patients ( body mass index : > 35 and < 55 ) with recently diagnosed ( < 6 months ) OSA and an apnea-hypopnea index ( AHI ) of 20 events/hour or more . These patients had been prescribed continuous positive airway pressure ( CPAP )  therapy to manage OSA and were identified via accredited community sleep clinics . The trial was conducted between September 2006 and March 2009 by university- and teaching hospital-based clinical research ers in Melbourne , Australia . Patients with obesity hypoventilation syndrome , previous bariatric surgery , contraindications to bariatric surgery , or significant cardiopulmonary , neurological , vascular , gastrointestinal , or neoplastic disease were excluded . INTERVENTIONS Patients were r and omized to a conventional weight loss program that included regular consultations with a dietitian and physician , and the use of very low-calorie diets as necessary ( n = 30 ) or to bariatric surgery ( laparoscopic adjustable gastric b and ing ; n = 30 ) . MAIN OUTCOME MEASURES The primary outcome was baseline to 2-year change in AHI on diagnostic polysomnography scored by staff blinded to r and omization . Secondary outcomes were changes in weight , CPAP adherence , and functional status . RESULTS Patients lost a mean of 5.1 kg ( 95 % CI , 0.8 to 9.3 kg ) in the conventional weight loss program compared with 27.8 kg ( 95 % CI , 20.9 to 34.7 kg ) in the bariatric surgery group ( P < .001 ) . The AHI decreased by 14.0 events/hour ( 95 % CI , 3.3 to 24.6 events/hour ) in the conventional weight loss group and by 25.5 events/hour ( 95 % CI , 14.2 to 36.7 events/hour ) in the bariatric surgery group . The between-group difference was -11.5 events/hour ( 95 % CI , -28.3 to 5.3 events/hour ; P = .18 ) . CPAP adherence did not differ between the groups . The bariatric surgery group had greater improvement in the Short Form 36 physical component summary score ( mean , 9.3 [ 95 % CI , 0.5 to 18.0 ] ; P = .04 ) . CONCLUSION Among a group of obese patients with OSA , the use of bariatric surgery compared with conventional weight loss therapy did not result in a statistically greater reduction in AHI despite major differences in weight loss . TRIAL REGISTRATION anzctr.org Identifier : 12605000161628 Background Bariatric surgery is currently the most effective treatment for morbid obesity . It provides not only substantial weight loss , but also resolution of obesity-related comorbidities .  Laparoscopic sleeve gastrectomy ( LSG ) has rapidly been gaining in popularity . However , there are limited data on the reduction of obesity-related comorbidities for LSG compared to laparoscopic Roux-en-Y gastric bypass ( LRYGB ) . The aim of this study was to assess the effectiveness of laparoscopic LSG versus LRYGB for the treatment of obesity-related comorbidities . Methods A total of 558 patients who underwent either LSG or LRYGB for morbid obesity at the Westchester Medical Center between April 2008 and September 2010 were included . Data were collected prospect ively into a computerized data base and review ed for this study . Fisher ’s exact test analyses compared 30-day , 6-month , and 1-year outcomes of obesity-related comorbidities . Results A total of 558 patients were included in the analysis of obesity-related comorbidity resolution ; 200 underwent LSG and 358 underwent LRYGB . After 1 year , 86.2 % of the LSG patients had one or more comorbidities in remission compared to 83.1 % LRYGB patients ( P = 0.688 ) . With the exception of GERD ( −0.09 vs. 50 % ; P < 0.001 ) , similar comorbidity remission rates were observed between LSG and LRYGB for sleep apnea ( 91.2 vs. 82.8 % ; P = 0.338 ) , hyperlipidemia ( 63 vs. 55.8 % ; P = 0.633 ) , hypertension ( 38.8 vs. 52.9 % ; P = 0.062 ) , diabetes ( 58.6 vs. 65.5 % ; P = 0.638 ) , and musculoskeletal disease ( 66.7 vs. 79.4 % ; P = 0.472 ) . Conclusions Laparoscopic sleeve gastrectomy markedly improves most obesity-related comorbidities . Compared to LRYGB , LSG may have equal in reducing sleep apnea , hyperlipidemia , hypertension , diabetes , and musculoskeletal disease . LRYGB appears to be more effective at GERD resolution than LSG Introduction Morbid obesity and obstructive sleep apnea ( OSA ) interact at an inflammatory level . Bariatric surgery reduces inflammatory responses associated with obesity . Heme oxygenase-1 ( HO-1 ) is an enzyme with anti-inflammatory properties , which might be increased in morbid obesity or OSA . We studied morbidly obese patients with OSA to determine : ( a ) HO-1 plasma concentrations according to OSA severity and their relationship with insulin resistance and inflammation and ( b ) the impact of bariatric surgery on HO-1 and parameters of insulin resistance and inflammation . Material and Methods We analyzed the homeostasis model insulin resistance index ( HOMA ) and plasma concentrations of HO-1 , tumor necrosis factor alpha , interleukin-6 , interleukin-1-beta , C reactive protein ( CRP ) , and adiponectin according to polysomnography findings in 66 morbidly obese patients before bariatric surgery  and 12 months after surgery . Results Before surgery , HO-1 plasma concentrations were similar in three groups of patients with mild , moderate , and severe OSA , and correlated with HOMA ( r = 0.27 , p = 0.02 ) . Twelve months after surgery , low- grade inflammation and insulin resistance had decreased in all the groups , but HO-1 plasma concentration had decreased only in the severe OSA group ( p = 0.02 ) . In this group , the reduction in HO-1 correlated with a reduction in CRP concentrations ( r = 0.43 , p = 0.04 ) and with improved HOMA score ( r = 0.37 , p = 0.03 ) . Conclusions Bariatric surgery decreases HO-1 concentrations in morbid obesity with severe OSA , and this decrease is associated with decreases in insulin resistance and in inflammation Context Anti-retroviral therapy ( ART ) dramatically reduced AIDS development , thus enabling patients to live as long as the general population . New challenges have emerged particularly cardiometabolic diseases and weight gain , with some HIV patients seeking bariatric surgery ( BS ) . However , BS outcomes during HIV remain poorly described , with scarce data on ART pharmacokinetic post-BS . Objective Describing sleeve gastrectomy  ( SG ) results in HIV patients in terms of ART pharmacokinetic , HIV control , weight loss , and metabolic outcomes . Design , Setting , and Patients Prospect i ve study of HIV patients undergoing SG in a referral academic center , with at least 6 months follow-up . Main Outcome Measure Clinical and biological parameters , HIV medical history , and ART pharmacokinetics were gathered before and post-SG . Results Seventeen patients ( mean BMI = 44.2 ± 5.7 kg m−2 ) and major obesity-related diseases ( 47 % type-2 diabetes , 64 % obstructive sleep apnea , 70 % hypertension ) underwent SG during a mean 2 years of follow-up . They displayed an average of 20 % reduction of initial BMI and improved body composition , similarly to obese non-HIV patients . SG improved metabolic status . All patients had undetectable viral load before BS . Upon HIV follow-up , 12 patients had undetectable viral load with correct ART kinetic parameters ( 3 and 6 months ) ; 4 displayed detectable viral load along with significant decrease in raltegravir and atazanavir treatment exposure , leading to ART change with subsequent undetectable viral load ; and 1 had persistent detectable viral load despite ART change . Conclusions SG seems effective and safe in obese HIV patients . However , ART treatment should be monitored post-SG to control HIV infection . We suggest that some ART should be adapted before SG conjoints with infectious disease specialists Background Obesity is an increasing disease worldwide . Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients .  Laparoscopic Roux-en-Y Gastric Bypass ( LRYGB ) is the gold st and ard surgical technique . Laparoscopic Sleeve Gastrectomy ( LSG ) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract . The aim of this study is to evaluate the efficiency of both techniques . Our hypothesis is that LSG has a similar percentage excess BMI loss ( % E BMI L ) after 5 years compared to LRYGB . Methods / Design The Sleeve Bypass Trial is a r and omized multicentre clinical trial : patients eligible for bariatric surgery are r and omized to either LSG or LRYGB . Patients with a body mass index ( BMI ) ≥ 40 kg/m2 or BMI 35 kg/m2 with obesity related comorbidity ( T2 DM , sleep apnoea , hypertension ) are eligible for r and omization . At r and omization patients are stratified for centre , sex , T2 DM and BMI ≥ 50 kg/m2 . A total number of 620 patients will be enrolled and equally ( 1:1 ) r and omized to both treatment arms . Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial . The primary endpoint is the 5-year weight loss ( % E BMI L ) of LSG and LRYGB . Secondary endpoints are resolution of obesity related comorbidity , complications , revision bariatric surgery and quality of life ( QOL ) defined in various question naires . Discussion Long-term % E BMI L between the two treatment strategies used to be in favour of LRYGB , but more recent results throughout the world show similar % E BMI L in both techniques . If weight loss is comparable , obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future . Trial registration Dutch Trial Register : NTR 4741 STUDY OBJECTIVES To evaluate the effect of bariatric surgery on  sleep apnea symptoms and obesity-associated morbidity  in patients with severe obesity . DESIGN Prospect i ve study . SETTING University hospitals and community centers in Sweden . INTERVENTION We investigated the influence of  weight loss surgery ( n=1729 ) on  sleep apnea symptoms and obesity-related morbidity using a  conservatively treated group ( n=1748 ) as a control . MEASUREMENTS AND RESULTS Baseline BMI in surgical group ( 42.2+/-4.4 kg/m(2 ) ) and control group ( 40.1+/-4.6 kg/m(2 ) ) changed -9.7+/-5 kg/m(2 ) and 0+/-3 kg/m(2 ) , respectively , at 2-year follow-up . In the surgery group , there was a marked improvement in all obstructive sleep apnea ( OSA ) symptoms compared with the control group ( P < 0.001 ) . Persistence of snoring ( 21.6 vs 65.5 % , adjusted OR 0.14 , 95 % CI 0.10 - 0.19 ) and apnea ( 27.9 vs 71.3 % , adjusted OR 0.16 , 95 % I 0.10 - 0.23 ) were much less in the surgery group compared with controls . Compared with subjects with no observed apnea at follow-up ( n=2453 ) , subjects who continued to have or developed observed apnea ( n=404 ) had a higher incidence of diabetes ( adjusted OR 2.03 , 95 % CI 1.19 - 3.47 ) and hypertriglyceridemia ( adjusted OR 1.86 , 95 % CI 1.07 - 3.25 ) but not hypertension ( adjusted OR 1.09 , 95 % CI 0.65 - 1.83 ) or hypercholesterolemia ( adjusted OR 0.91 , 95 % CI 0.53 - 1.58 ) . CONCLUSION Bariatric surgery results in a marked improvement in sleep apnea symptoms at 2 years . Despite adjustment for weight change and baseline central obesity , subjects reporting loss of OSA symptoms had a lower 2-year incidence of diabetes and hypertriglyceridemia . Improvement in OSA in patients losing weight may provide health benefits in addition to weight loss alone Background The veteran population is routinely screened for post-traumatic stress disorder ( PTSD ) . The prevalence of obesity in this population continues to increase . We examined whether weight loss outcomes in veterans with PTSD is comparable to results in veterans who do not suffer from PTSD , after gastric bypass .  We also examined the effect of bariatric surgery on PTSD symptoms . Methods This retrospective review of prospect i ve data compares veterans with and without PTSD who underwent laparoscopic gastric bypass .  Differences between the means of age , initial BMI , and percent excess weight loss were compared between the groups using a Student ’s t test . Pearson ’s χ2 was used to evaluate the relationship between a diagnosis of PTSD , major depressive disorder ( MDD ) , and other Axis I psychiatric disorders . A similar analysis was done to assess for a relationship between PTSD and obesity-related comorbidities , including diabetes mellitus ( DM ) , hypertension ( HTN ) , hyperlipidemia , and GERD . Results We identified 24 patients who had gastric bypass and a diagnosis of PTSD before surgery and compared them to those without PTSD . Both groups had a similar mean age and initial BMI . There was no significant difference between the percent excess weight lost after 1 year follow-up between the PTSD group ( 66 % ) and the non-PTSD group ( 72 % ) ( p = 0.102 ) . In assessing comorbid conditions , we found a significant association between the diagnosis of PTSD and MDD ( p = 0.002 ) , PTSD and other Axis I disorders ( p = 0.004 ) , and PTSD and GERD ( p = 0.002 ) . However , we saw no significant association between PTSD and DM ( p = 0.977 ) , HTN ( p = 0.332 ) , and obstructive sleep apnea ( OSA ) ( p = 0.676 ) . The severity of PTSD symptoms fluctuated in the postoperative period . Conclusions Veterans with PTSD have comparable weight loss to those without PTSD after gastric bypass . In addition , surgery does not seem to have an adverse effect on PTSD symptoms , although PTSD symptomatology tends to fluctuate over time . Further study in this patient population is warranted BACKGROUND Patients who are categorized with class I obesity have a body mass index ( BMI ) of 30 - 34.99 kg/m(2 ) . This population of patients has a predisposition to diabetes , hypertension , and dyslipidemia . The aim of the present study was to investigate the improvements of these co-morbidities in a class I obese population that had undergone a bariatric procedure . METHODS After internal review board approval and with adherence to the Health Insurance Portability and Accountability Act guidelines , a retrospective review was performed of a prospect ively maintained data base of 42 class I obese patients who underwent a bariatric procedure at our institution during a 10-year period , from February 2000 to May 2010 . The fasting glucose level , glycosylated hemoglobin level , lipid profile , initial weight , and BMI were measured in the preoperative and postoperative periods . RESULTS Our patient population consisted of 30 women and 12 men , with a preoperative mean BMI of 33.9 kg/m(2 ) .  Laparoscopic sleeve gastrectomy was performed in 24 patients ( 57 % ) , laparoscopic Roux-en-Y gastric bypass in 8 ( 19 % ) , and laparoscopic adjustable gastric b and ing in 10 ( 24 % ) . Of these 42 patients , 25 ( 60 % ) had type 2 diabetes , 1 patient was glucose intolerant , 27 ( 64 % ) had arterial hypertension , 25 ( 60 % ) had dyslipidemia , 17 ( 40 % ) had sleep apnea , and 8 ( 19 % ) had osteoarthritis . The postoperative findings included a mean BMI of 26.5 kg/m(2 ) and a mean weight loss of 41.4 lb . Of the 25 diabetic patients , 5 ( 20 % ) gained remission and 12 ( 48 % ) improvement of their diabetic status . The single patient with glucose intolerance showed improvement . Of the 27 patients with arterial hypertension , 9 ( 33 % ) showed remission and 13 ( 52 % ) improvement . Dyslipidemia resolved in 5 patients ( 20 % ) and improved in 13 ( 52 % ) . Obstructive sleep apnea resolved in 10 ( 59 % ) and improvement was seen in 1 patient ( 6 % ) . Finally , osteoarthritis resolved in 1 patient ( 12 % ) and improved in 5 ( 63 % ) . CONCLUSION Bariatric surgery can significantly improve or resolve co-morbid metabolic conditions in patients with class I obesity Background Many mildly to moderately obese individuals with a body mass index ( BMI ) lower than 35 kg/m2 have serious diseases related to their obesity . Nonsurgical therapy is ineffective in the long term , yet surgery has never been made widely available to this population . Methods Between 2002 and 2007 , 53 patients with a BMI lower than 35 kg/m2 underwent laparoscopic adjustable gastric b and ing at our institution . Data on all these patients were collected prospect ively and entered into an institutional review board – approved electronic registry . The study parameters included preoperative age , gender , BMI , presence of comorbidities , percentage of excess weight loss ( % EWL ) , and resolution of comorbidities . Results The mean preoperative age of the patients was 46.9 years ( range , 16–68 years ) , and the mean preoperative BMI was 33.1 kg/m2 ( range , 28.2–35.0 kg/m2 ) . Of the 53 patients , 49 ( 92 % ) had at least one obesity-related comorbidity . The mean BMI decreased to 28.1 ± 2.4 kg/m2 , 25.8 ± 2.9 kg/m2 , and 25.8 ± 3.1 kg/m2 and mean % EWL was 48.3 ± 17.6 , 69.9 ± 28.0 , and 69.7 ± 31.7 at 0.5 , 1 , and 2 years , respectively . Substantial improvement occurred for the following comorbidities evaluated : hypertension , depression , diabetes , asthma , hypertriglyceridemia , obstructive sleep apnea , hypercholesterolemia , and osteoarthritis . There was one slip , two cases of b and obstruction ( from food ) , two cases of esophagitis , and two port leaks , but no mortality . Conclusion The authors are very encouraged by this series of low- BMI patients who underwent laparoscopic adjustable gastric b and ing .  Their weight loss has been excellent , and their complications have been acceptable . Their comorbidities have partially or wholly resolved . With further study , it is reasonable to expect alteration of the weight guidelines for bariatric surgery to include patients with a BMI lower than 35 kg/m2 BACKGROUND As severe obesity becomes an increasing problem , it is important that the role of surgery in the management of the condition becomes better understood and recognised . This study reports the outcome of a large series of gastric bypass operations performed for severe obesity by a single surgeon . METHODS AND RESULTS Between 1990 - 2002 , 310 patients underwent gastric bypass surgery with all data being collected prospect ively and recorded on a computerised data base .  Mean preoperative weight and percentage excess weight were 132 kg and 119 % , respectively . There was no 30-day mortality and only one life threatening complication . Re-operations were required in 43 patients , most of which were related to ring removal or staple line disruption seen in the earlier form of gastric bypass . These problems are largely overcome with the currently performed technique . Percentage excess weight loss at 1 , 2 , 3 , 4 and 5 years was 73 % , 73 % , 66 % , 64 % , and 59 % respectively . Forty-nine of the 52 patients with type 2 diabetes were cured following surgery and 87 % of those with hypertension resolved or improved their condition . Dyslipidaemia resolved or improved in 87 % and asthma was cured or improved in 89 % of those affected . 61 patients had symptoms of obstructive sleep apnoea prior to surgery and in 51 of these symptoms resolved following surgery . CONCLUSION This study confirms that gastric bypass is a very effective treatment for severe obesity  and can be performed with a high level of safety . Gastric transection is an important component of the operation . The majority of important comorbidities seen before surgery either resolve or improve following surgery . Bariatric surgery is establishing itself as a very important and satisfying branch of upper gastrointestinal ( GI ) surgery Context Observational studies have shown sustained weight loss after surgery for extreme obesity . No r and omized trial of contemporary surgical methods has been performed . Contribution The authors r and omly assigned 80 mildly to moderately obese ( body mass index , 30 to 35 kg/m2 ) adults to laparoscopic placement of an adjustable gastric b and or to an intensive nonsurgical weight loss program . After 2 years , the surgical group had lost 21.6 % of initial weight , and the nonsurgical group had lost 5.5 % of initial weight . Four patients required laparoscopic revision of the gastric b and . Caution s The study was not design ed to detect uncommon adverse events . Implication s Laparoscopic gastric b and ing is effective treatment for mild to moderate obesity . The Editors The development of a safe and effective treatment for obesity is a leading challenge in health care today . Obesity is an increasing health problem across the world with a prevalence of more than 20 % among the adult population in Western countries and more than 30 % in the United States ( 1 , 2 ) . The increasing prevalence is associated with a parallel increase of several obesity-related diseases , in particular , the diseases of the metabolic syndrome ( 3 , 4 ) , which include type 2 diabetes , hypertension , and dyslipidemia , and are linked to nonalcoholic steatohepatitis , obstructive sleep apnea , and the polycystic ovary syndrome . For obese individuals , the options are limited . Behavioral therapies of reduced energy intake , improved eating practice s , and increased exercise and activity , supplemented by pharmacotherapy , generally achieve only modest and often transient effects ( 5 , 6 ) . Observational studies have shown that bariatric surgical therapies involving gastric restriction by various forms of stapling with or without diversion of the gut to generate malabsorption of food are effective in achieving major weight loss and clinical ly significant improvements in health and quality of life ( 7 - 11 ) . Strong direct evidence from r and omized , controlled trials of the relative benefits of nonsurgical and surgical therapies is lacking . We are aware of only a single study , performed in the 1980s , in which 60 morbidly obese patients were r and omly assigned , without informed consent , to diet plus an early form of gastric stapling or to diet alone ( 12 ) . The maximum weight losses did not differ between the groups . However , the weight regain was greater in the diet-only group . The advent of the laparoscopic adjustable gastric b and has provided a new bariatric surgical option , which has proved to be safe , minimally invasive in its application , gentle in its use through its adjustability and easy reversibility , and similarly effective to the other bariatric procedures ( 10 , 13 , 14 ) . Figure 1 shows the LAP-B AND System ( INAMED Health , Santa Barbara , California ) and demonstrates the key feature of adjustability of the area within the b and through which it induces satiety ( 15 ) . Patients require no more than an overnight hospital stay , and the procedure has been shown to be markedly safer than gastric bypass surgery ( 13 ) . Figure 1 . The laparoscopic adjustable gastric b and ( LAP-B AND System , INAMED Health , Santa Barbara , California ) with no added fluid ( top ) and with 2 mL of fluid added ( bottom ) . We hypothesized that surgical therapy would induce more weight loss , health benefit , and improvement in quality of life than nonsurgical therapy and have conducted a r and omized , controlled trial comparing the effectiveness of current nonsurgical therapy with laparoscopic adjustable gastric b and ing in a group of mildly to moderately obese adults ( body mass index , 30 kg/m2 to 35 kg/m2 ) . We did not study patients with a body mass index greater than 35 kg/m2 because current observational data suggest that outcomes after nonsurgical treatment were unlikely to be equal to those after surgical care for these patients . The principal outcome measures were weight change , health , quality of life , and complications of therapy . Methods Patient Recruitment We recruited patients for the study through a newspaper advertisement . All patient assessment s and outpatient treatments were conducted at a community clinic dedicated to obesity management or in the clinics of a university department of surgery . Surgical procedures were conducted at a private community hospital experienced in the care of bariatric surgical patients . Patients in both groups did not pay any medical costs generated by the study . The human ethics committees of The Alfred Hospital and The Avenue Hospital approved the study in accordance with the guidelines of the National Health and Medical Research Council ( www.nhmrc.gov.au/publications/synopses/e35syn.htm ) and with the Helsinki Declaration of 1975 , as revised in 2000 ( www.wma.net/e/ethicsunit/pdf/draft_historical_contemporary_perspectives.pdf ) . Inclusion Criteria We considered patients to be eligible if they were between 20 and 50 years of age ; had a body mass index of 30 kg/m2 to 35 kg/m2 ; had identifiable problems , including an obesity-related comorbid condition ( such as hypertension , dyslipidemia , diabetes , obstructive sleep apnea , or gastroesophageal reflux disease ) , severe physical limitations , or clinical ly significant psychosocial problems associated with their obesity ; had attempted to reduce weight over at least the previous 5 years ; could underst and the options offered and the r and omization process ; and were willing to comply with the requirements of each program . Exclusion Criteria We excluded c and i date s with a history of bariatric surgery or medical problems that contraindicated treatment in either study group , such as impaired mental status , drug or alcohol addiction , or portal hypertension . In addition , we excluded participants if they had undergone an intensive , physician-supervised program that used very-low-calorie diets or pharmacotherapy or if they did not attend the 2 initial patient information visits . Assessment We provided detailed information about the problems of obesity and about the 2 study groups through at least 2 discussion periods and a patient information booklet . Initial assessment included anthropometric measures ; identification of medical , physical , or psychosocial problems ( both weight-related and other ) ; and a discussion of previous weight loss efforts . The assessment included a detailed dietary history by the trial dietitian and a review by a specialist physician to determine the presence and severity of associated medical conditions . Initial investigations included measurements of fasting blood glucose level ; serum insulin level ; and a lipid profile , including HDL cholesterol and LDL cholesterol levels . After initial assessment , we instituted a program of advice on appropriate eating patterns and exercise and followed each patient on a monthly basis for 3 months . During this time , we assessed the patients ' fulfillment of tasks , such as completion of a food diary , and overall adherence to appointments . R and omization Process We r and omly allocated eligible patients to receive a conventional , intensive , nonsurgical program or laparoscopic adjustable gastric b and ing .  A computer-derived r and om allocation sequence , without blocking or stratification , performed the r and omization . This was prepared at the trial office . The trial coordinator enrolled participants and informed them of the trial allocation . After assessment had confirmed a participant 's suitability for r and omization , the coordinator contacted the trial office by telephone for allocation . The study was not blinded . Description of Nonsurgical and Surgical Interventions Common Program We instructed and encouraged all patients to follow appropriate lifestyle behavior of good eating practice s and increased exercise and activity . We also encouraged them to exercise for at least 200 minutes per week . Nonsurgical Program This program centered on the use of behavioral modification , very-low-calorie diet , and pharmacotherapy with education and professional support on appropriate eating and exercise behavior . During the 2-year period , 3 trained physicians developed a program using all the available modalities for each individual on the basis of guidelines prepared and continually review ed by a panel of experienced bariatric physicians . The program began with an intensive 6-month period of very-low-calorie diet ( 500 to 550 kcal/d ) using 1 to 3 packets of Optifast ( Novartis , Fremont , Michigan ) daily for 12 weeks , followed by a transition phase over 4 weeks combining some very-low-calorie meals with 120 mg of orlistat before nonvery-low-calorie diet meals , and then 120 mg of orlistat before all meals until the completion of the intensive phase . This intensive 6-month program was followed by further courses of very-low-calorie diets or orlistat as tolerated , as well as continual behavioral , dietary , and exercise advice to assist the participant in maintaining weight loss over a prolonged period . Sibutramine was not approved for use in Australia during the first 12 months of the study and , therefore , was not incorporated into the medical program . The management program for each individual was design ed to reflect good clinical practice . A physician saw each patient every 2 weeks during the very-low-calorie diet program and every 4 to 6 weeks during the rest of the study . All patients were seen at least every 6 weeks . Surgical Program Two experienced surgeons performed the laparoscopic adjustable gastric b and ( LAP-B AND System ) procedure , by a st and ardized method ( 14 ) , within 1 month of r and omization . The b and was placed along the perigastric pathway in all cases ( 16 ) . The treating surgeon review ed patient progress every 4 to 6 weeks during the study period and made adjustments to the volume of saline within the b and in the office by using st and ard clinical criteria ( 17 ) . Adverse Events All patients in the study were question ed about the occurrence of adverse events at each consultation , and physicians recorded the INTRODUCTION The South Pacific has a high prevalence of obesity and super-obesity . We review ed our experience with laparoscopic sleeve gastrectomy ( LSG ) to evaluate its efficacy and safety . METHODS A retrospective review of a prospect ively collected data base of LSGs carried out by one surgeon in one center . The percentage of excess weight loss and the rate of resolution or improvement of comorbidities reflected efficacy , and major complications or mortalities reflected safety . RESULTS From January 2008 to February 2013 , we performed 510 surgeries and included 494 consecutive patients ( 367 females ) ( 45.5 ± 11.2 years ) in our study .  LSG was the primary procedure in 384 patients , 6 patients had redo bariatric surgery after failure of initial LSG , 57 patients had a history of gastric b and ing with insufficient weight loss or b and -related complications , and 46 super-obese patients had an intragastric balloon placed before LSG . Average starting body mass index was 47.8 kg m(-2 ) . Mean percent excess weight loss was 64.3 % at 1 year ; 67.3 % at 2 years and 66.4 % at 3 years . The percentages of resolved comorbidities were as follows : hypertension : 48.3 % , type 2 diabetes mellitus : 72.5 % , dyslipidemia : 61.0 % , and obstructive sleep apnea : 77.8 % . The mortality rate was 1/494 . The postoperative morbidity included gastric fistula in 3.0 % , hemorrhaging in 2.4 % , and postoperative gastroesophageal reflux in 9.4 % . CONCLUSIONS In the South Pacific , LSG is a safe and effective means of treating morbid obesity with sustained weight loss and resolution of comorbid medical conditions Background Decrease in fat mass and fat-free mass have been observed with weight loss induced by a dietary intervention or surgery . There are concerns that fat-free mass decrease could have some negative functional consequences . The aim of this study was to examine how weight loss affects strength and force control in obese and morbidly obese men . Methods Weight loss was obtained in obese individuals by a hypocaloric diet program until resistance to lose fat and in morbidly obese individuals by bariatric surgery .  Maximal force was measured for upper and lower limb and the ability to maintain 15 % and 40 % of that force . These measures were taken at baseline , in those dieting once resistant to weight loss and 1 year after surgery for those operated on . Normal weight individuals used for control were evaluated twice ( 6 to 12 months apart ) . Results At baseline , there was no significant difference between groups for maximal forces and capabilities to maintain force levels . Weight loss averaged 11.1 % of the initial body weight after dieting and 46.3 % 1 year after surgery . At the same time , there was for the lower limb a loss of 10.1 % in maximal force after dieting and 33.5 % after surgery . For the upper limb , there was no change in maximal force after dieting whereas a decrease of 14.4 % was observed after surgery . When transformed in force related to body weight , there was no change in relative force for the lower limb after dieting whereas an increased relative force after surgery . There was no significant difference for the ability for maintaining force levels . Conclusion Despite a large force loss , particularly for the lower limbs in morbidly obese individuals after surgery , this loss is relatively well tolerated because the relation between force and body weight is even improved and the ability to maintain that force is preserved Background The effects of surgical weight loss ( WL ) on inflammatory biomarkers associated with sleep apnea  remain unknown . We sought to determine if any biomarkers can predict amelioration of sleep apnea achieved by bariatric surgery . We hypothesized that surgical WL would substantially reduce severity of sleep apnea and levels of proinflammatory cytokines . Methods Twenty-three morbidly obese adults underwent anthropometric measurements , polysomnography , and serum biomarker profiling  prior to and 1 year following bariatric surgery .  We examined the effect of WL and amelioration of sleep apnea on metabolic and inflammatory markers . Results Surgical WL result ed in significant decreases in BMI ( 16.7 ± 5.97 kg/m2/median 365 days ) , apnea – hypopnea index ( AHI ) , CRP , IL-6 , sTNFαR1 , sTNFαR2 , and leptin levels , while ghrelin , adiponectin , and soluble leptin receptor concentrations increased significantly . Utilizing an AHI cutoff of 15 events/h , we found significantly elevated levels of baseline sTNFαR2 and greater post-WL sTNFαR2 decreases in subjects with baseline AHI ≥15 events/h compared to those with AHI < 15 events/h despite no significant differences in baseline BMI , age , and Δ BMI . In a multivariable linear regression model adjusting for sex , age , impaired glucose metabolism , Δ BMI , and follow-up period , the post-WL decreases in AHI were an independent predictor of the decreases in sTNFαR2 and altogether accounted for 46 % of the variance of ΔsTNFαR2 ( P = 0.011 ) in the entire cohort . Conclusions Of all the biomarkers , the decrease in sTNFαR2 was independently determined by the amelioration of sleep apnea achieved by bariatric surgery . The results suggest that sTNFαR2 may be a specific sleep apnea biomarker across a wide range of body weight Background : Morbidly obese patients are at elevated risk of perioperative pulmonary complications , including airway obstruction and atelectasis . Continuous positive airway pressure may improve postoperative lung mechanics and reduce postoperative complications in patients undergoing abdominal surgery . Methods : Forty morbidly obese patients with known obstructive sleep apnea undergoing laproscopic bariatric surgery with st and ardized anesthesia care were r and omly assigned to receive continuous positive airway pressure via the Boussignac system immediately after extubation ( Boussignac group ) or supplemental oxygen ( st and ard care group ) . All subjects had continuous positive airway pressure initiated 30 min after extubation in the postanesthesia care unit via identical noninvasive ventilators . The primary outcome was the relative reduction in forced vital capacity from baseline to 24 h after extubation . Results : Forty patients were enrolled into the study , 20 into each group . There were no significant differences in baseline characteristics between the groups . The intervention predicted less reduction in all measured lung functions : forced expiratory volume in 1 s ( coefficient 0.37 , SE 0.13 , P = 0.003 , CI 0.13–0.62 ) , forced vital capacity ( coefficient 0.39 , SE 0.14 , P = 0.006 , CI 0.11–0.66 ) , and peak expiratory flow rate ( coefficient 0.82 , SE 0.31 , P = 0.008 , CI 0.21–0.1.4 ) . Conclusions : Administration of continuous positive airway pressure immediately after extubation maintains spirometric lung function at 24 h after laparoscopic bariatric surgery better than continuous positive airway pressure started in the postanesthesia care unit BACKGROUND Laparoscopic sleeve gastrectomy ( LSG ) became the most frequent bariatric procedure performed in France ( 2011 ) and in the United States ( 2013 ) , but studies reporting long-term results are still rare . SETTING Private hospital , France . METHODS This is a retrospective analysis of a prospect i ve cohort of 168 patients who underwent LSG between 2005 and 2008 . The objective of this study was to present the 8-year outcome concerning weight loss , modification of co-morbidities , and to report the revisional surgery after sleeve . RESULTS The preoperative mean body mass index was 42.8 kg/m2 ( 31.1 - 77.9 ) , 35 patients were super obese , and 64 patients had a previous gastric b and . For LSG as a definitive bariatric procedure , 8 years of follow-up data were available for 116 patients ( follow-up : 69 % ) . Of the remainder , 23 patients underwent revisional surgery and 29 were lost to follow-up . For the entire cohort , the mean excess weight loss ( EWL ) was 76 % ( 0 - 149 ) at 5 years and 67 % ( 4 - 135 ) at 8 years , respectively . Of the 116 patients with 8 years of follow-up , 82 patients had>50 % EWL at 8 years ( 70.7 % ) . Percentages of co-morbidities resolved were hypertension , 59.4 % ; type 2 diabetes , 43.4 % ; and obstructive sleep apnea , 72.4 % . Twenty-three patients had revisional surgery for weight regain ( n = 14 ) or for severe reflux ( n = 9 ) at a mean period of 50 months ( 9 - 96 ) . Twelve patients underwent resleeve gastrectomy , 6 patients underwent conversion to a bypass , and 5 patients to duodenal switch ( 1 single anastomosis duodeno-ileostomy ) . A total of 31 % of patients reported gastroesophageal reflux symptoms at 8 years . CONCLUSIONS At 8 years postoperatively , the LSG as a definitive bariatric procedure remained effective for 59 % of cases . The results appear to be more favorable especially for the non-super-obese patients and primary procedures . LSG is a well-tolerated bariatric procedure with low long-term complication rates OBJECTIVE To explore the correlation models between body mass index ( BMI ) and sex hormones constructed from a male cross-sectional survey and evaluate the effects of surgery-induced weight loss on sex hormones in morbidly obese subjects that are not predicted by the constructed BMI correlation models . DESIGN Cross-sectional population and longitudinal studies . SETTING Bariatric surgery center in a university hospital . PATIENT(S ) A cross-sectional survey of a male general population of 161 patients ( BMI median [ interquartile range ] = 29.2 [ 24.8 - 41.9 ] kg/m(2 ) ) in addition to 24 morbidly obese subjects ( BMI = 43.9 [ 40.8 - 53.8 ] kg/m(2 ) ) who were undergoing bariatric surgery  were prospect ively studied for 6 and 12 months . INTERVENTION(S )  Bariatric surgery on 24 morbidly obese men . MAIN OUTCOME MEASURE(S ) Cross-sectional population : construction of the best-fitting models describing the relationship between baseline BMI with total ( TT ) and calculated free ( cFT ) testosterone , E2 , sex hormone-binding globulin ( SHBG ) , FSH , and LH levels . Longitudinal study deviation between the observed sex hormone levels at 6- and 12-month follow-up and those expected on BMI bases . RESULT ( S ) The correlation of BMI with sex hormones was not univocally linear ( E2 ) , but the best-fitting model was exponential for TT , cFT , FSH , LH , and TT/E2 and power for SHBG . In addition to the significant improvement of all parameters observed after surgery in the longitudinal cohort , the increase in TT and SHBG , but not in cFT , was significantly higher than expected from the corresponding weight loss at 6 months from surgery ( 14.80 [ 12.30 - 19.00 ] nM vs. 12.77 [ 10.92 - 13.64 ] nM and 40.0 [ 28.9 - 54.5 ] nM vs. 24.7 [ 22.5 - 25.8 ] nM for TT and SHBG , respectively ) , remaining rather stable at 12 months . CONCLUSION ( S ) The increase in TT and SHBG , but not the increase in cFT , after bariatric surgery is greater than expected based on weight loss OBJECTIVE Bariatric surgery is an effective method for acute weight loss . While the impact of bariatric surgery on general medical conditions ( e.g. , type 2 diabetes ) is well documented , few studies focus on physical functional outcomes following weight-loss induced by bariatric surgery . DESIGN AND METHODS We report on 50 women aged 20 - 74 scheduled for Roux-en-Y gastric bypass ( RYGB ) procedure who were enrolled for a prospect i ve 1-year study . Height , weight , and waist circumference were recorded preoperatively and at 6 and 12 months , postoperatively . To track musculoskeletal/physical function changes , the  timed-get-up- and -go ( TGUG ) and short-form health survey-36 ( SF-36 ) and short musculoskeletal function assessment ( SFMA ) question naires were administered . RESULTS Patients had significant weight loss and functional improvement . At 1 year mean weight loss was 48.5 kg and mean TGUG improvement was 3.1 s. SMFA and SF-36 also showed improvement in functional components with weight loss at 6 months and 1-year post surgery . Significant associations were observed between TGUG and SMFA measures at all time points . Final weight at 1 year post bariatric surgery was also significantly correlated with most functional outcomes and changes in these outcomes . Partial correlations controlling for age revealed additional associations between body weight and functional outcomes , especially at the 6-month visit . CONCLUSION Our results suggest that significant rapid weight loss , such as that attained by bariatric surgery , acutely improves musculoskeletal function in morbidly obese patients . Additionally , for patients with musculoskeletal disease or injury , weight loss result ing from bariatric surgery may serve as an adjunct for improving global functional outcome , and enhancing the rehabilitation potential Bariatric surgery is the most effective long term weight-loss therapy for severe and morbidly obese patients . Melanocortin-4 Receptor ( MC4R ) mutations , the most frequent known cause of monogenic obesity , affect the regulation of energy homeostasis . The impact of such mutations on weight loss after bariatric surgery is still debated . The objective is to determine the impact of MC4R status on weight loss in obese subjects over one year after bariatric surgery . A total of 648 patients , who were referred to bariatric surgery in a single clinical nutrition department , were genotyped for their MC4R status . The following four groups were categorized : functional MC4R mutations , MC4R single nucleotide polymorphisms ( SNPs ) : Val103Ile ( V103L ) and Ile251Leu ( I251L ) , MC4R variant rs17782313 ( downstream of MC4R ) and MC4R SNP A-178C on the promoter . Each patient was matched with two r and omly paired controls without mutation . Matching factors were age , sex , baseline weight and type of surgery procedure ( Roux-en-Y gastric bypass and adjustable gastric b and ing ) . We compared weight loss between cases and controls at 3 , 6 and 12 months after surgery . Among 648 patients , we identified 9 carriers of functional MC4R mutations , 10 carriers of MC4R V103L and I251L SNPs , 7 carriers of the rs17792313 variant and 22 carriers of the A-178C SNP . Weight loss at 3 , 6 and 12 months did not differ between cases and controls , whatever the MC4R mutations . This is the first case-control study to show that MC4R mutations and polymorphisms do not affect weight loss and body composition over one year after bariatric surgery Background We evaluated the effectiveness of a sequential diet regimen termed the obese preoperative diet ( OPOD ) in morbidly obese patients with and without type 2 diabetes mellitus ( T2DM ) scheduled for laparoscopic bariatric surgery . Methods Fifty patients ( body mass index 53.5 ± 8.4 kg/m2 ) scheduled for bariatric surgery , including 14 with T2DM , were prospect ively enrolled and followed the OPOD regimen : a very low-calorie ketogenic diet for 10 days , followed by a very low-calorie diet for 10 days , and then a low-calorie diet for 10 days . Patients were evaluated at baseline ( T0 ) and after 10 days ( T1 ) , 20 days ( T2 ) , and 30 days ( T3 ) . Results Body weight , body mass index , waist circumference , and neck circumference were significantly lower at T1 , T2 , and T3 than at T0 in the 48 patients who completed the OPOD . Two patients discontinued the OPOD after 4–7 days . In patients with T2DM , fasting plasma glucose levels decreased significantly , enabling reduction of diabetic medications . Plasma and urine ketone levels increased at T1 but were all < 1 mmol/L , and hunger decreased during the diet period . Conclusions OPOD , including 10 days of a VLCKD , was safe and effective in morbidly obese patients , and it seems to be promising in morbidly obese patients with and without T2DM scheduled for laparoscopic bariatric surgery Background  Osteopontin ( OPN  ) is a multifunctional matrix glycoprotein associated with bone metabolism and has been linked to chronic inflammation , insulin resistance , and atherosclerosis . Diet-induced weight loss decreases elevated OPN concentrations in obese patients . The aim of the current study was to investigate the role of OPN after bariatric surgery , where not only improvements of chronic inflammation , insulin resistance and comorbidities , but also malabsorption and altered bone metabolism have been reported . Methods OPN plasma concentrations  were determined in 31 morbidly obese patients ( 5 men , 26 women , BMI 46.2 ± 7.1 kg/m2 , age 41 ± 11 years ; mean ± SD ) before and 18 months after bariatric surgery , together with parameters of bone metabolism and inflammation . Results OPN concentrations increased by + 20.3 ± 26.6 ng/ml ( mean ± SD , p < 0.01 ) , concomitant to a weight loss of −38 ± 22 kg , and a decrease in BMI by −13.1 ± 7.7 kg/m2 ( both p < 0.01 ) . HOMA-index improved from 5.2 ± 3.4 to 1.5 ± 1.0 ( p < 0.01 ) . Calcium concentrations slightly decreased , and phosphate increased ( −0.06 ± 0.13 mmol/l and + 0.08 ± 0.16 mmol/l , respectively ; both p < 0.05 ) , while 25-OH-VitaminD3 remained unchanged and PTH tended to increase ( + 5.1 ± 14.0 pg/ml , p = 0.054 ) . Monocyte chemoattractant protein 1 and interleukin 18 were significantly decreased and associated with HOMA both before and after bariatric surgery . ΔOPN was correlated with ΔPTH , but not with other parameters .  Conclusions OPN plasma concentrations increased concomitant to weight loss after bariatric surgery , which was independent from an improvement of insulin sensitivity and a decrease of inflammatory markers . Further studies are needed to differentiate whether these changes in bone metabolism after bariatric surgery are secondary to calcium deficiency or an adaptation to weight loss
Effective weight loss was achieved in morbidly obese patients after undergoing  bariatric surgery .
A substantial majority of patients with diabetes , hyperlipidemia , hypertension , and obstructive sleep apnea experienced complete resolution or improvement
CONTEXT About 5 % of the US population is morbidly obese .
This disease remains largely refractory to diet and drug therapy , but generally responds well to bariatric surgery .
OBJECTIVE To determine the impact of bariatric surgery on weight loss , operative mortality outcome , and 4  obesity  comorbidities ( diabetes , hyperlipidemia , hypertension , and obstructive sleep apnea ) .