Adolescent Gastric By-pass and Diabetic Precursors
Condition: Obesity
MeSH terms: Obesity
Study type: Observational

Summary: 
      The purpose of this research study is to find out what effects (good and bad) gastric bypass
      has on metabolism, including pancreatic insulin secretion. In addition, we will compare the
      effects of gastric bypass on the metabolism of adults and adolescents to try to determine
      whether there are greater metabolic and health advantages of performing gastric bypass
      earlier in life versus waiting until adulthood.
    

Detailed description: 
      Overweight and obesity are the most common metabolic disorders affecting the U.S. with 31% of
      adults and 16% of adolescents now meeting Centers for Disease Control criteria for these
      conditions. As the obesity epidemic has unfolded, so too has the increase in prevalence of
      abnormalities of carbohydrate metabolism. The single most effective treatment for type 2
      diabetes in severely obese adults may be bariatric surgery, a procedure that is most commonly
      performed in the 5th and 6th decades of life. While it is clear that rapid and profound
      weight loss can significantly improve carbohydrate metabolism in adults, it is not clear to
      what degree type 2 diabetes is reversible in these patients. The pathophysiology of type 2
      diabetes in adolescents and children is not well understood and no studies have yet examined
      the effect of surgical weight loss on insulin resistance, insulin secretion, or glucose
      tolerance in severely obese young people. However, it seems likely that bariatric surgery
      could improve these conditions in youth. Understanding the relative benefits of surgically
      induced weight reduction on carbohydrate metabolism in adolescents compared to older subjects
      is important for determining optimal timing of this intervention. This knowledge may also
      lead to key insights into obesity-induced diabetes. In this project we will test the
      hypothesis that bariatric surgical intervention will more effectively improve insulin
      resistance, β cell dysfunction, and glucose tolerance in adolescents compared to adults.
      Three specific aims are proposed: 1) To compare the derangements of carbohydrate metabolism
      among very severely obese (body mass index ≥ 40 kg/m2) adolescents and adults referred for
      bariatric surgery; 2) To assess improvement in carbohydrate metabolism longitudinally (during
      and after surgical weight loss) comparing differences in the mechanisms of improvement
      between the two age groups; 3) To compare major complications in the two age groups following
      bariatric surgery. These data will provide critical information about age-related metabolic
      outcomes of bariatric surgery and could inform the design of larger studies to examine the
      role of early bariatric surgery in management of disorders related to insulin resistance in
      patients at high risk for these conditions.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Adolescents undergoing weight loss surgery
      
Keywords: bariatric; obesity; insulin resistance; gastric bypass; adolescent