Metabolism and Bariatric Surgery Study

Study Overview
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Brief Summary
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The purpose of this study is to determine if diet-induced weight loss causes different changes in hormones that control appetite and glucose control than surgery-induced weight loss. The overall research plan is a non-randomized prospective study of 3 different weight loss (WL) interventions and a lean and an obese healthy control group.

Detailed Description
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Weight loss (WL) improves obesity-related co-morbidities such as type 2 diabetes mellitus (DM). Unfortunately, WL through life-style interventions has a high degree of relapse and the lack of safe, effective and affordable therapies together with an increase in the prevalence of morbid obesity has led to a rise in bariatric procedures. Clinical trials in patients with DM show that improvements in glycemia vary between procedures and occur in the following order: Roux-en-Y gastric bypass (RYGB) > sleeve gastrectomy (SG) > laparoscopic adjustable gastric banding (LAGB) > medical/life-style therapy. This order mirrors the amount of WL with each intervention and is a major driver of glycemic improvement. The investigators have shown profound changes unique to RYGB and SG in levels of hormones that make up the gut-brain and enteroinsular axes. The association of some of these hormones with insulin sensitivity (IS) and glycemia, independent of WL strongly suggests that glycemic improvements after surgery occur in part through pathways that are distinct from just calorie restriction. This study builds on results showing that levels of fibroblast growth factor 19 (FGF19), a protein secreted by intestinal cells, are increased after RYGB and SG but not after low calorie diet (LCD). This difference may affect hormones that control the stress response to weight loss. The investigators will explore differences in hormones of the gut that affect appetite, body weight, and stress response in healthy lean and obese individuals. Obese individuals will also be studied before and after 15% body weight loss induced by LCD, RYGB or SG, and again at 1 year after study enrollment.

Official Title
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Metabolic and Endocrine Effects of Bariatric Surgery

Conditions
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Insulin Resistance, Obesity

Intervention / Treatment
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* Procedure: Roux-en-Y Gastric Bypass (RYGBP)
* Procedure: Sleeve Gastrectomy (SG)
* Behavioral: Very Low Calorie Diet (VLCD)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men and women Ages 18-65 Years Old Exclusion Criteria: Altered Sleep-wake Cycle Type 1 or 2 Diabetes Previous Bariatric Surgery Lactose Intolerance Any Special Diet restrictions. Use of medications that may affect body weight at screening or during a 3-month period prior. Untreated thyroid disease Other medical conditions like Cushing's, acromegaly, Hearth failure, Crohn's disease, etc. Pregnancy Tobacco or opioid use Alcohol dependence > 3% weight change over the 3month period prior to screening Unwillingness to maintain current level of physical activity over duration of study period

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Cohort
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Gastric Bypass Diabetic and Non-diabetic<br>Roux-en-Y gastric bypass surgery | Procedure: Roux-en-Y Gastric Bypass (RYGBP)<br>* This is a standard RYGBP procedure that would be performed clinically and is not research-specific.<br>* Other names: RYGBP;|
| Other: Sleeve Gastrectomy Diabetic and Non-diabetic<br>sleeve gastrectomy surgery | Procedure: Sleeve Gastrectomy (SG)<br>* This is a standard SG procedure that would be performed clinically and is not research-specific.<br>* Other names: SG;|
| Active Comparator: Very Low Calorie Diet Diabetic and Non-diabetic<br>very low calorie diet | Behavioral: Very Low Calorie Diet (VLCD)<br>* Weight loss with calorie restricted liquid diet. Subjects will be placed on a 800 kcal/day diet with a meal replacement (Optifast) provided by the investigator for 12 weeks. Then, transitioning to a higher calorie diet intake up to a year. Subjects will be closely monitored by study dietitian<br>* Other names: VLCD;|
| No Intervention: Obese Control Group<br>Non-diabetic obese subjects | |
| No Intervention: Lean Control Group<br>Non-diabetic lean subjects | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in urine free cortisol level | A linear mixed effects model will be used to compare the cortisol changes between the LCD and the surgery groups. Specifically, cortisol change will be modeled as longitudinal outcome, and the main predictors are time and treatment group, and the time-treatment interaction. | Baseline and 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Obesity, Insulin Resistance, Bariatric Surgery, Gastric Bypass, Sleeve Gastrectomy