Post Obesity Research Articles

498. LATROGENIC ESOPHAGEAL DISEASE POST OBESITY TREATMENT: SEVERE ESOPHAGEAL DILATATION RELATED TO ADJUSTABLE GASTRIC BANDING (AGB)

Abstract Iatrogenic Esophageal Disease post obesity treatment: severe esophageal dilatation related to adjustable gastric banding (AGB) Introduction Obesity is considered one of the biggest epidemics of the 21st century, which pushes us as health professionals to seek for solutions to this pathology. Within the medical-surgical approach, the most used techniques are gastric bypass, vertical gastrectomy and adjustable gastric banding (AGB). Even though they are frequently used, they are not free of complications. In this communication based on a case we would like to comment on the main complications of the use of the gastric band. These side effects has being between 0.5-5% to 20%: stoma stenosis, band slippage, intraluminal erosion, gastric volvulus and perforation. Clinical Case 54-year-old woman underwent surgery 20 years ago for obesity using a restrictive technique with adjustable gastric banding. The patient began 18 years later with retrosternal pain, epigastric pain, vomiting and dysphagia. Endoscopic tests revealed esophageal dilation with retention of food remains, tortuous and macerated mucosa; said achalasia was caused by a gastroesophageal stenosis. Among the diagnostic tests, an esophageal-gastric-duodenal barium transit was performed, showing a decrease in peristalsis with diffuse esophageal dilation of up to 7cm in diameter. Stenosis was observed in the lower esophageal third at the level of the esophagogastric junction of approximately 16 x 11 mm in longitudinal and transverse diameters. Evolution Surgical removal of the device is decided by a multidisciplinary team. Laparoscopic release of the gastric band was performed with electrocautery following adhesions around the device. Complete withdrawal upon release. Intraoperative endoscopy was performed, showing significant esophageal dilation with retained fermented food remains, mucous membrane affected by esophageal candidiasis. After the esophagogastric junction, a gastric fibrous ring was evidenced at the place of location of the gastric band, with good passage without evidence of gastric or esophageal lesions. Favorable postoperative evolution, being discharged 24 hours after surgery. After the case we observed the failure of the safety mechanism of the gastric band that regulates the internal diameter of the device due to the formation of a fibrotic constriction ring. Removal of the device improves the symptoms without requiring, in this case, section of the constriction ring. Currently, the patient shows improvement in her symptoms 6 months after the bariatric revision surgery.

#6389 EARLY WEIGHT LOSS AFTER BARIATRIC SURGERY IN PATIENTS WITH ORGAN FAILURE OR TRANSPLANTATION

Abstract Background and Aims Obesity is an epidemic that complicates global health and economies. Surgery for obesity (OS) is one effective treatment that results in significant weight loss. Patients with chronic organ failure who are obese undergo OS but it is unknown whether they achieve similar weight loss response as patients who do not have organ failure. Method Patient records of OS cases between May 2016 and June 2022 from a large healthcare system were examined to review weight changes after OS by whether the patient was a transplant patient or not. The proportion of excess weight lost was determined for 1month, 3months, 6months and 1year post OS. Non-parametric analyses were performed; p <0.05 was considered significant. Results of 1,673 OS cases, the mean (SD) age was 47.6 (12.5) years, the majority were female (1,276, 76.3%), and 58% identified as Caucasian. Within this number, 92 patients were transplant candidates (n=50, 3%) or recipients (n=42, 2.5%). The transplant patients were older [51.5 (10.8) years vs 47.3 (12.6) years, P = .0008], had similar body weight [124.4 (22.5) kg vs 126.0 (27.2) kg, P = .8271] but a lower body mass index [42.6 (5.7) kg/m2 vs 45.1 (8.1) kg/m2, P = .0046] compared to patients who were not having a transplant. Transplant patients experienced different weight loss in the early post-operative period but similar weight loss after OS as non-transplant patients (Table 1 and Table 2). Conclusion Though early post-operative differences were noted in this study, patients with organ failure responded similarly to OS as patients without organ failure.

Low-Grade Inflammation Is Not Present in Former Obese Males but Adipose Tissue Macrophage Infiltration Persists.

Macrophage infiltration in two subcutaneous adipose tissue depots and systemic low-grade inflammation were studied in post-obese (PO), obese (O), and control (C) subjects. Young males were recruited into PO: (n = 10, weight-loss avg. 26%, BMI: 26.6 ± 0.7, mean ±SEM kg/m2), O: (n = 10, BMI: 33.8 ± 1.0kg/m2) and C: (n = 10, BMI: 26.6 ± 0.6 kg/m2). PO and C were matched by BMI. Blood and abdominal and gluteal subcutaneous adipose tissue were obtained in the overnight fasted state. Plasma concentrations of IL-6 and CRP were higher (p < 0.05) in O than in PO and C, TNF-α was higher (p < 0.05) only in O compared to PO and IL-18 was similar between groups. The number of CD68+ macrophages was higher (p < 0.05) in the gluteal than the abdominal depot, and higher (p < 0.05) in O and PO compared to C in both depots. The content of CD163+ macrophages was similar between depots but was higher (p < 0.05) in PO compared to C and O in the gluteal depot. In post obese men with a long-term sustained weight loss, systemic low-grade inflammation was similar to non-obese controls despite a higher subcutaneous adipose tissue CD68+ macrophage content. Interestingly, the anti-inflammatory CD163+ macrophage adipose tissue content was consistently higher in post obese than obese and controls.

Too low, too high: is it the Roux-en-Y? Fluctuating thyroid function post obesity surgery

Too low, too high: is it the Roux-en-Y? Fluctuating thyroid function post obesity surgery

Normal mitochondrial function and increased fat oxidation capacity in leg and arm muscles in obese humans

The aim of this study was to investigate mitochondrial function, fibre-type distribution and substrate oxidation during exercise in arm and leg muscles in male postobese (PO), obese (O) and age- and body mass index (BMI)-matched control (C) subjects. The hypothesis of the study was that fat oxidation during exercise might be differentially preserved in leg and arm muscles after weight loss. Indirect calorimetry was used to calculate fat and carbohydrate oxidation during both progressive arm-cranking and leg-cycling exercises. Muscle biopsy samples were obtained from musculus deltoideus (m. deltoideus) and m. vastus lateralis muscles. Fibre-type composition, enzyme activity and O(2) flux capacity of saponin-permeabilized muscle fibres were measured, the latter by high-resolution respirometry. During the graded exercise tests, peak fat oxidation during leg cycling and the relative workload at which it occurred (FatMax) were higher in PO and O than in C. During arm cranking, peak fat oxidation was higher in O than in C, and FatMax was higher in O than in PO and C. Similar fibre-type composition was found between groups. Plasma adiponectin was higher in PO than in C and O, and plasma leptin was higher in O than in PO and C. In O subjects, maximal fat oxidation during exercise and the eliciting relative exercise intensity are increased. This is associated with higher intramuscular triglyceride levels and higher resting non esterified fatty acid (NEFA) concentrations, but not with differences in fibre-type composition, mitochondrial function or muscle enzyme levels compared with Cs. In PO subjects, the changes in fat oxidation are preserved during leg, but not during arm, exercise.

Contributing factors and variability of energy expenditure in non-obese, obese, and post-obese adolescents

Energy expenditure (EE) is a major determinant of energy balance and body composition. The objectives of this paper were to review the contributing factors of the main components of daily EE (DEE) and the inter-individual variability in these components in non-obese (NOb), obese (Ob), and post-obese (POb) adolescents. Body composition especially fat-free mass (FFM), is the major determinant of the basal metabolic rate which contributes 50-70% of DEE, whereas fat mass (FM) is a significant factor only in obese subjects. Physical activity is the second main variation factor of DEE, whereas growth, the thermic effect of food, and thermoregulation are generally of marginal importance. The energy costs and EE associated with various sedentary and physical activities were assessed in NOb, Ob and POb subjects both in standardised and in free-living conditions. The interindividual variability of DEE is high, even after adjustment for body composition, mainly because of great differences in time devoted to the various physical activities. DEE and EE associated with sleep and sedentary activities are significantly higher in Ob than in NOb, but not after adjustment for FFM. On the contrary, EE associated with physical activities is not significantly different between Ob and NOb adolescents, but 61% lower in Ob subjects after adjustment for body composition. Multidisciplinary weight-reduction programmes including moderate energy restriction and physical training result in great FM loss, maintenance of FFM, improvement of physical capacities, but reductions in organ and tissue metabolic rate and in EE associated with the various sedentary and physical activities, which may favour body weight regain in the less active POb subjects.

Relative overhydration of fat-free mass in postobese versus never-obese subjects.

Obese subjects who undergo gastrointestinal surgery for weight reduction have relatively greater loss of body cell mass (BCM) than of extracellular fluid. Although the mechanism is uncertain, an implication is that weight-reduced, surgically treated obese subjects are relatively overhydrated. The present investigation explored whether diet-treated postobese (PO) subjects also are relatively overhydrated. Ten PO participants were recruited over a two-year period and matched to never-obese (NO) people by age (+/- 4 years), weight (+/- 3 kg), height (+/- 5 cm), race, and gender. PO participants had lost > or = 18.5 kg and had maintained this loss for 2-16 years. Body density (Db), total body water (TBW), and bone mineral content (BMC) were measured by hydrodensitometry, tritium dilution, and dual-energy X-ray absorptiometry, respectively. Fat and fat-free mass (FFM) were derived using a four-compartment model. BCM was calculated from total body potassium (TBK) measured with a whole body counter. The results indicate that PO subjects were relatively overhydrated and had reduced BCM compared to NO subjects (p < 0.05). These observations are important for interpreting body weight, body composition, and metabolic data of obese subjects who lost weight and maintained their weight loss over the long term.

Substrate oxidation and availability during acute exercise in non-obese, obese, and post-obese sedentary females.

This study compared fat oxidation rates during an acute bout of cycle ergometry exercise (E) typical of progressive fat oxidation in healthy, but sedentary, women of different obesity histories. Five never-obese (NO) (mean age=25+/-3 (s.e.)y, mean body fat=25.0+/-2.8 (s.e.)%), five obese (O) (26+/-3 y, 44. 4+/-1.7%), and five post-obese (PO) (22+/-1 y, 32.2+/-3.0%) women cycled for 60 min at 60-65% peak VO2. To identify the specific effects of E, a control trial consisting of 60 min of seated rest (R) was also performed. E and R trials were counterbalanced one month apart in the follicular phase and conducted following a 3 d normalized, eucaloric diet. Dual energy X-ray absorptiometry (DEXA) was used to determine body composition, and all were weight stable for at least eight weeks prior to experimentation. During both trials breath by breath measurements of VO2 and RER were used to determine substrate oxidation and energy expenditure. Blood samples were collected for hormone and metabolite analysis before, and every 15 min during exercise or rest. All three groups showed a similar and progressive shift toward fat oxidation as exercise progressed. No group differences were observed for E energy expenditure or fat oxidation. Glycerol (P<0.0001) and free fatty acids (P<0.0001) increased similarly in all three groups, but PO maintained the highest free fatty acid level during exercise (group effect; P<0.01). E and R decreased (P<0.001 for both) insulin levels across groups, with lowest levels noted in PO and highest in O. Plasma epinephrine (P<0.0001) and norepinephrine (P<0.001) increased similarly during E in all three groups. Plasma growth hormone (GH) levels rose (P<0.05) during E, with a pronounced increase observed in PO. We conclude that exercise of equal relative intensity elicited similar fat oxidation rates among NO, O, and PO women, despite group differences in free fatty acid availability. The PO women's persistently lower insulin and higher plasma GH levels may have enhanced free fatty acid availability.

Which way to treat obesity? Emotional, eating and behavioural issues in dieting

The roles of psychological and other factors in the treatment of obesity were examined in the context of a Community‐based Slimming Group (CSG), where some regular attenders appeared not to be benefiting as expected from the weight loss programme.A sample of 47 women from the CSG, who were about to embark on a 6 week weight loss programme, completed a series of questionnaires examining factors such as anxiety, depression, self‐efficacy, binge eating and nutritional knowledge. Weight changes were recorded over the course of the programme and at follow up approximately 1 year later. As a basis for comparison similar data were collected from a sample of post obese (PO) women who had at one time had a body mass index (BMI) in the same range as the CSG.Subjects attending the CSG showed a mean weight loss of 1.6 kg over the 6 week programme. This was greatest in those who were only slightly overweight, had not been to the group previously and showed only limited nutritional knowledge at baseline. Seventy per cent regained much if not all the weight or more over the subsequent year (mean weight gain 3 kg), with high levels of anxiety and binge eating the predominant psychological features of the least successful. Large initial weight loss was predictive of good short term success but a poorer long term prognosis. In general the CSG at baseline exhibited greater psychological problems and binge eating behaviour than the PO group, who (on average) showed normal psychological profiles and eating behaviour. However the means disguised a small number of PO women with quite severe psychological and eating problems.Overall results revealed a complex interrelationship between psychological problems, binge eating, dieting behaviour and weight.