Bariatric Surgery for Morbid Obesity
Condition: Obesity; Morbid Obesity
MeSH terms: Obesity; Obesity, Morbid
Study type: Observational

Summary: 
      Despite progress in understanding the pathophysiology of obesity, current strategies for its
      medical management remain largely ineffective. Most efforts have focused on reducing caloric
      intake or increasing energy expenditure, either through behavior modification (e.g. dieting,
      regular exercise) alone, or augmented by pharmacologic efforts to decrease appetite, inhibit
      fat absorption, or alter metabolism. Bariatric surgery remains the only proven long term
      treatment of morbid obesity.

      Super morbidly obese (SMO: Body Mass Index (BMI) > 50) and super super morbidly obese (SSMO:
      BMI > 60) patients lose considerable weight, but stabilize at Body Mass Indexes (BMIs) that
      are still obese or even morbidly obese after risking considerable morbidity and/or mortality.
      Among commonly performed bariatric surgeries, a laparoscopic two-stage procedure, in which an
      initial restrictive procedure is followed after a weight loss of ~100 lbs by a more complex
      procedure that creates malabsorption, is gaining interest. Initial studies have demonstrated
      very good long-term weight loss with minimal morbidity, and no operative mortality in these
      high risk patients.

      Availability of biospecimens obtained at each stage of this protocol will allow participating
      scientists a unique opportunity to test in human tissues hypotheses developed in animals.
      Studies proposed under this application focus on fatty acids and overall fat disposition in
      fat depots (adipose tissue) of your body, and the role of adipose tissue hormones and
      inflammatory processes in obesity and its associated health related issues.
    

Detailed description: 
      Despite rapidly growing interest in the pathogenesis of the obesity epidemic, the
      pathophysiology of obesity remain poorly understood. While studies in animals have yielded
      many insights, it has become clear that human obesity differs in important ways from that in
      rodents. Bariatric surgery offers better outcomes, but in the highest grades of obesity
      (BMI>50) remains a high risk undertaking with >5% operative mortality being reported when
      commonly performed bariatric surgical approaches are employed. By contrast, laparoscopic
      two-stage approach has resulted in excellent weight loss, minimal morbidity, and <1%
      mortality.

      Availability of blood samples and biopsies of omental and subcutaneous fat from each of the
      paired bariatric procedures in this protocol will provide a unique opportunity to study key
      issues in human obesity. This study tests the broad hypothesis that there are significant and
      as yet unrecognized differences between the pathobiology of obesity in man and rodents, the
      identification of which may lead to new therapeutic targets. Accordingly, to facilitate
      comparisons with aspects of obesity we have already investigated in animal models, we will 1.
      seek fat depot specific differences in Long Chain Fatty Acid (LCFA) disposition, macrophage
      infiltration and adipokine production in obesity and after surgery-induced weight loss in
      man, and correlate them with the presence/severity of the metabolic syndrome (MetSyn); and
      2., quantify the relative significance and response to weight loss of different mechanisms
      contributing to hepatic steatosis and the elevated triglycerides (TG) and reduced
      High-Density Lipoprotein (HDL) typical of obesity and MetSyn.
    

Intervention name(s): Initial Surgery; Second Bariatric Surgery
Intervention type(s): Procedure; Procedure
Intervention description(s): NO patients had initial abdominal laparoscopic surgery at study entry, during which research fat biopsies were obtained, completing their participation.
MO patients had initial laparoscopic bariatric surgery (gastric bypass, adjustable gastric band, or sleeve gastrectomy) and fat biopsies at entry, completing their participation.
All 30 SMO patients had initial laparoscopic bariatric surgery (sleeve gastrectomy) & fat biopsies. The first 10 to lose 100 lbs but who needed further surgery to reach optimal weight and who consented to further surgery underwent a 2nd laparoscopic bariatric surgery (either a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass) and biopsies. The interval between surgeries averaged 15 mos. and the weight loss 55 kg. 30 SMO patients were initially enrolled to insure that 10 would complete 2 surgeries. When 10 had had their 2nd operation, the study was considered complete, and the remaining 20 SMO participants were so notified.; A second bariatric procedure was performed on only 10 of the original 30 Super-morbidly Obese (SMO) subjects.
Other intervention name(s): Intervention names:; NO patients all had one surgery: Abdominal Laparoscopic Surgery. Specific procedure determined by underlying medical condition.; MO patients all had one surgery: Abdominal Laparoscopic Bariatric Surgery.; All 30 SO patients had an initial Abdominal Laparoscopic Bariatric Surgery.; The first 10 SMO patients to meet defined requirements had a second Abdominal Laparoscopic Bariatric Surgery. Details below.
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The subject population will be drawn from adults referred for bariatric surgery at New York
        Presbyterian Hospital.
      
Biospecimen description: 
      Blood samples and biopsies of omental and subcutaneous fat.
    
Keywords: Obesity; morbid obesity; bariatric surgery