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4. Foundations of Bariatric Surgery

Author

Corpodean, Florina, Kachmar, Michael, Albaugh, Vance, Schauer, Philip, Ghanem, Omar M., editor, Husain, Farah, editor, Chen, Judy Y., editor, Lim, Robert B., editor, and Kroh, Matthew, editor

Published
2024
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14. Handbook of Obesity, Two-Volume Set

Author

Bray, George A., primary, Katzmarzyk, Peter T., additional, Bouchard, Claude, additional, Kirwan, John P., additional, Redman, Leanne M., additional, and Schauer, Philip R., additional

Published
2024
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16. What Should I Eat and Why? The Environmental, Genetic, and Behavioral Determinants of Food Choice: Summary from a Pennington Scientific Symposium

Author

Qualls‐Creekmore, Emily, Marlatt, Kara L, Aarts, Esther, Bruce‐Keller, Annadora, Church, Tim S, Clément, Karine, Fisher, Jennifer O, Gordon‐Larsen, Penny, Morrison, Christopher D, Raybould, Helen E, Ryan, Donna H, Schauer, Philip R, Spector, Alan C, Spetter, Maartje S, Stuber, Garret D, Berthoud, Hans‐Rudolf, and Ravussin, Eric

Subjects
Biological Sciences, Biomedical and Clinical Sciences, Public Health, Health Sciences, Nutrition and Dietetics, Prevention, Behavioral and Social Science, Obesity, Nutrition, Cancer, Stroke, Oral and gastrointestinal, Cardiovascular, Metabolic and endocrine, Exercise, Feeding Behavior, Food Preferences, Humans, Endocrinology & Metabolism
Abstract

This review details the proceedings of a Pennington Biomedical scientific symposium titled, "What Should I Eat and Why? The Environmental, Genetic, and Behavioral Determinants of Food Choice." The symposium was designed to review the literature about energy homeostasis, particularly related to food choice and feeding behaviors, from psychology to physiology. This review discusses the intrinsic determinants of food choice, including biological mechanisms (genetics), peripheral and central signals, brain correlates, and the potential role of the microbiome. This review also address the extrinsic determinants (environment) of food choice within our physical and social environments. Finally, this review reports the current treatment practices for the clinical management of eating-induced overweight and obesity. An improved understanding of these determinants will inform best practices for the clinical treatment and prevention of obesity. Strategies paired with systemic shifts in our public health policies and changes in our "obesogenic" environment will be most effective at attenuating the obesity epidemic.

Published
2020

20. Long‐term outcomes of metabolic surgery versus medical/lifestyle therapy on metabolic dysfunction‐associated fatty liver disease in adults with obesity and type 2 diabetes.

Author

Lundholm, Michelle D., Kirschling, Sarah, Hu, Bo, Aminian, Ali, Arterburn, David E., Courcoulas, Anita P., Cummings, David E., Gourash, William F., Patti, Mary Elizabeth, Schauer, Philip R., Simonson, Donald C., Vernon, Ashley H., Kirwan, John P., and Kashyap, Sangeeta R.

Subjects
NON-alcoholic fatty liver disease, DIGESTIVE system diseases, GLUCAGON-like peptide-1 receptor, FATTY liver, HEPATIC fibrosis, ASPARTATE aminotransferase
Abstract

The article discusses the long-term outcomes of metabolic surgery versus medical/lifestyle therapy on metabolic dysfunction-associated fatty liver disease (MAFLD) in adults with obesity and type 2 diabetes. Metabolic surgery has been shown to be effective in treating obesity, resulting in weight loss and benefits for diabetes and its complications. The study aims to assess the durability of the effects of metabolic surgery on MAFLD compared to medical/lifestyle management. Results show that metabolic surgery leads to greater improvements in hepatic steatosis compared to medical/lifestyle interventions, emphasizing the role of weight loss in treating MAFLD. [Extracted from the article]

Published
2024
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28. Metabolomic Fingerprints of Medical Therapy Versus Bariatric Surgery in Patients With Obesity and Type 2 Diabetes: The STAMPEDE Trial.

Author

Axelrod, Christopher L., Hari, Adithya, Dantas, Wagner S., Kashyap, Sangeeta R., Schauer, Philip R., and Kirwan, John P.

Subjects
LIQUID chromatography-mass spectrometry, SUPERVISED learning, SLEEVE gastrectomy, TYPE 2 diabetes, METABOLOMIC fingerprinting, TIME-of-flight mass spectrometry, GASTRIC bypass
Abstract

OBJECTIVE: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are effective procedures to treat and manage type 2 diabetes (T2D). However, the underlying metabolic adaptations that mediate improvements in glucose homeostasis remain largely elusive. The purpose of this study was to identify metabolic signatures associated with biochemical resolution of T2D after medical therapy (MT) or bariatric surgery. RESEARCH DESIGN AND METHODS: Plasma samples from 90 patients (age 49.9 ± 7.6 years; 57.7% female) randomly assigned to MT (n = 30), RYGB (n = 30), or SG (n = 30) were retrospectively subjected to untargeted metabolomic analysis using ultra performance liquid chromatography with tandem mass spectrometry at baseline and 24 months of treatment. Phenotypic importance was determined by supervised machine learning. Associations between change in glucose homeostasis and circulating metabolites were assessed using a linear mixed effects model. RESULTS: The circulating metabolome was dramatically remodeled after SG and RYGB, with largely overlapping signatures after MT. Compared with MT, SG and RYGB profoundly enhanced the concentration of metabolites associated with lipid and amino acid signaling, while limiting xenobiotic metabolites, a function of decreased medication use. Random forest analysis revealed 2-hydroxydecanoate as having selective importance to RYGB and as the most distinguishing feature between MT, SG, and RYGB. To this end, change in 2-hydroxydecanoate correlated with reductions in fasting glucose after RYGB but not SG or MT. CONCLUSIONS: We identified a novel metabolomic fingerprint characterizing the longer-term adaptations to MT, RYGB, and SG. Notably, the metabolomic profiles of RYGB and SG procedures were distinct, indicating equivalent weight loss may be achieved by divergent effects on metabolism. [ABSTRACT FROM AUTHOR]

Published
2024
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29. Renoprotective Effects of Metabolic Surgery Versus GLP1 Receptor Agonists on Progression of Kidney Impairment in Patients with Established Kidney Disease.

Author

Aminian, Ali, Gasoyan, Hamlet, Zajichek, Alexander, Alavi, Mohammad Hesam, Casacchia, Nicholas J., Wilson, Rickesha, Xiaoxi Feng, Corcelles, Ricard, Brethauer, Stacy A., Schauer, Philip R., Kroh, Matthew, Rosenthal, Raul J., Taliercio, Jonathan J., Poggio, Emilio D., Nissen, Steven E., and Rothberg, Michael B.

Abstract

Objective: To examine the renoprotective effects of metabolic surgery in patients with established chronic kidney disease (CKD). Background: The impact of metabolic surgery compared with glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with established CKD has not been fully characterized. Methods: Patients with obesity (body mass index =30 kg/m²), type 2 diabetes, and baseline estimated glomerular filtration rate (eGFR) 20-60 mL/min/1.73 m² who underwent metabolic bariatric surgery at a large US health system (2010-2017) were compared with nonsurgical patients who continuously received GLP-1RA. The primary end point was CKD progression, defined as a decline of eGFR by =50% or to <15 mL/min/1.73 m2, initiation of dialysis, or kidney transplant. The secondary end point was the incident kidney failure (eGFR <15 mL/min/1.73 m2, dialysis, or kidney transplant) or all-cause mortality. Results: 425 patients, including 183 patients in the metabolic surgery group and 242 patients in the GLP-1RA group, with a median follow-up of 5.8 years (IQR, 4.4-7.6), were analyzed. The cumulative incidence of the primary end point at 8 years was 21.7% (95% CI: 12.2-30.6) in the surgical group and 45.1% (95% CI: 27.7 to 58.4) in the nonsurgical group, with an adjusted hazard ratio of 0.40 (95% CI: 0.21 to 0.76), P=0.006. The cumulative incidence of the secondary composite end point at 8 years was 24.0% (95% CI: 14.1 to 33.2) in the surgical group and 43.8% (95% CI: 28.1 to 56.1) in the nonsurgical group, with an adjusted HR of 0.56 (95% CI: 0.31 to 0.99), P= 0.048. Conclusions: Among patients with type 2 diabetes, obesity, and established CKD, metabolic surgery, compared with GLP-1RA, was significantly associated with a 60% lower risk of progression of kidney impairment and a 44% lower risk of kidney failure or death. Metabolic surgery should be considered as a therapeutic option for patients with CKD and obesity. [ABSTRACT FROM AUTHOR]

Published
2024
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31. Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery

Author

Rubino, Francesco, Cohen, Ricardo V, Mingrone, Geltrude, le Roux, Carel W, Mechanick, Jeffrey I, Arterburn, David E, Vidal, Josep, Alberti, George, Amiel, Stephanie A, Batterham, Rachel L, Bornstein, Stefan, Chamseddine, Ghassan, Del Prato, Stefano, Dixon, John B, Eckel, Robert H, Hopkins, David, McGowan, Barbara M, Pan, An, Patel, Ameet, Pattou, François, Schauer, Philip R, Zimmet, Paul Z, and Cummings, David E

Published
2020
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37. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence

Author

Fox, Caroline S, Golden, Sherita Hill, Anderson, Cheryl, Bray, George A, Burke, Lora E, de Boer, Ian H, Deedwania, Prakash, Eckel, Robert H, Ershow, Abby G, Fradkin, Judith, Inzucchi, Silvio E, Kosiborod, Mikhail, Nelson, Robert G, Patel, Mahesh J, Pignone, Michael, Quinn, Laurie, Schauer, Philip R, Selvin, Elizabeth, and Vafiadis, Dorothea K

Subjects
Clinical Research, Heart Disease, Nutrition, Cardiovascular, Diabetes, Prevention, Metabolic and endocrine, Good Health and Well Being, American Heart Association, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Practice Guidelines as Topic, Primary Prevention, Randomized Controlled Trials as Topic, Risk Factors, United States, American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health, Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Quality of Care and Outcomes Research, and the American Diabetes Association, AHA Scientific Statements, cardiovascular disease, diabetes, primary prevention, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Public Health and Health Services, Cardiovascular System & Hematology
Abstract

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.

Published
2015

40. Obesity, Challenges, and Weight-Loss Strategies for Patients With Ventricular Assist Devices

Author

daSilva-deAbreu, Adrian, Rodgers, Jo E., Seltz, Jessica, Mandras, Stacy A., Lavie, Carl J., Loro-Ferrer, Juan Francisco, Ventura, Hector O., Schauer, Philip R., and Vest, Amanda R.

Abstract

For adults with advanced heart failure, class II/III obesity (body mass index ≥35 kg/m2) represents major challenges, and it is even considered a contraindication for heart transplantation (HT) at many centers. This has led to growing interest in preventing and treating obesity to help patients with advanced heart failure become HT candidates. Among all weight-loss strategies, bariatric surgery (BSx) has the greatest weight loss efficacy and has shown value in enabling select patients with left ventricular assist devices (LVADs) and obesity to lose sufficient weight to access HT. Nevertheless, both BSx and antiobesity medications warrant caution in the LVAD population. In this review, the authors describe and interpret the available published reports on the impact of obesity and weight-loss strategies for patients with LVADs from general and HT candidacy standpoints. The authors also provide an overview of the journey of LVAD recipients who undergo BSx and review major aspects of perioperative protocols.

Published
2024
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41. Obesity and Weight Loss Strategies for Patients With Heart Failure

Author

Vest, Amanda R., Schauer, Philip R., Rodgers, Jo E., Sanderson, Emily, LaChute, Courtney L., Seltz, Jessica, Lavie, Carl J., Mandras, Stacy A., Tang, W.H. Wilson, and daSilva-deAbreu, Adrian

Abstract

Obesity is a common comorbidity among patients with heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), with the strongest pathophysiologic link of obesity being seen for HFpEF. Lifestyle measures are the cornerstone of weight loss management, but sustainability is a challenge, and there are limited efficacy data in the heart failure (HF) population. Bariatric surgery has moderate efficacy and safety data for patients with preoperative HF or left ventricular dysfunction and has been associated with reductions in HF hospitalizations and medium-term mortality. Antiobesity medications historically carried concerns for cardiovascular adverse effects, but the safety and weight loss efficacy seen in general population trials of glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide/GLP-1 agonists are highly encouraging. Although there are safety concerns regarding GLP-1 agonists in advanced HFrEF, trials of the GLP-1 agonist semaglutide for treatment of obesity have confirmed safety and efficacy in patients with HFpEF.

Published
2024
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42. Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes

Author

Courcoulas, Anita P., primary, Patti, Mary Elizabeth, additional, Hu, Bo, additional, Arterburn, David E., additional, Simonson, Donald C., additional, Gourash, William F., additional, Jakicic, John M., additional, Vernon, Ashley H., additional, Beck, Gerald J., additional, Schauer, Philip R., additional, Kashyap, Sangeeta R., additional, Aminian, Ali, additional, Cummings, David E., additional, and Kirwan, John P., additional

Published
2024
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