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At least 19 recordsLinked to original sources

PubMed2005

The pharmacokinetics of daptomycin in moderately obese, morbidly obese, and matched nonobese subjects.

Daptomycin pharmacokinetics were studied in adult volunteers who were moderately obese (body mass index [BMI] = 25-39.9 kg/m2) or morbidly obese (BMI > or =40 kg/m2) and a matched (gender, age, renal function) nonobese (BMI between 18.5 and 24.9 kg/m2) control group. All subjects received a dose of 4 mg/kg total body weight (TBW) by intravenous infusion (30 minutes). Daptomycin plasma half-life, the fraction of the dose excreted unchanged in urine, and daptomycin absolute renal clearance (mL/h) were unchanged as a function of obesity. The absolute volume of distribution (Vz and Vss) and plasma clearance (CL) for daptomycin were higher in obese subjects as compared to nonobese matched controls. The rate of change of Vz and CL with increasing BMI was greater when these pharmacokinetic parameters were expressed in absolute terms compared to when they were normalized for TBW or ideal body weight. This suggests that increases in body mass associated with obesity are proportionality higher than the corresponding increases in Vd and CL. Exposure to daptomycin in obese subjects (Cmax, AUC) was increased 25% and 30%, respectively, compared to nonobese matched controls, well within the range that was previously determined to be safe and well tolerated. Daptomycin may be dosed based on total body weight, and no adjustment in daptomycin dose or dose regimen should be required based solely on obesity.

Adult↗

PubMed1987

Pulmonary function in morbid obesity.

Morbid obesity is not infrequently associated with severe respiratory impairment. In our experience approximately 10 per cent of morbidly obese patients who underwent gastric surgery had severe respiratory impairment. Respiratory insufficiency of obesity can be divided into two primary breathing disorders: the obstructive sleep apnea syndrome (SAS) and the obesity hypoventilation syndrome (OHS). In its most severe form, when both SAS and OHS are present, it is called the Pickwickian syndrome. In our series 59 morbidly obese patients with respiratory insufficiency secondary to obesity underwent gastric surgery for weight reduction. Fourteen had OHS, 19 had SAS and 26 had both. Of these, two patients died of postoperative complications and one died at five weeks with an inconclusive autopsy, totalling an operative mortality rate of 3.4 per cent and a total mortality of 5.1 per cent. In our overall experience morbidly obese patients lost 67 per cent of excess weight after gastric procedures. In conclusion, surgically induced weight loss will markedly improve or correct respiratory insufficiency secondary to obesity. It will improve arterial oxygenation, minimize CO2 retention, expand lung volumes, correct polycythemia, and reduce apnea frequency. The magnitude of changes in these variables is clinically significant. Therefore, respiratory insufficiency of obesity should be considered a major indication for an aggressive approach to weight reduction. The jejunoileal bypass and unbanded gastroplasty operations have an unacceptable incidence of complications or failure, respectively. There is a high degree of recidivism following dietary programs. Sweets eaters will not do well with a gastroplasty procedure. Gastric bypass for individuals addicted to sweets or the vertical banded gastroplasty for "gorgers" are currently our procedures of choice and are associated with the average loss of two thirds of excess weight and correction of breathing problems associated with morbid obesity.

Anesthesia↗

PubMed2006

Thyroid function in humans with morbid obesity.

Morbidly obese subjects may present with abnormal thyroid function tests but the reported data are scarce. Therefore, we studied the thyroid parameters in 144 morbidly obese patients, 110 females and 34 males, to assess the prevalence of hypothyroidism. Eleven percent (11.8%) carried the diagnosis of hypothyroidism and were undergoing levothyroxine (LT4) replacement therapy, 7.7% had newly diagnosed subclinical hypothyroidism, 0.7% had subclinical hyperthyroidism and 7.7% were euthyroid with positive antibodies (anti-thyroid peroxidase antibodies [TPOAb]). From the 144 subjects, we selected a cohort of 78 euthyroid subjects with negative TPOAb, who did not receive LT4 replacement or suppression therapy (the experimental group) and compared them to 77 normal-weight euthyroid subjects, TPOA-negative, matched for age and gender who served as controls. The experimental group had higher serum levels of triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), and thyrotropin (TSH) compared to the control group. Serum TSH concentration was associated with fasting serum insulin levels and insulin resistance but not with serum leptin levels, body mass index (BMI), fat mass, and lean body mass. In conclusion, in morbidly obese individuals, the prevalence of overt and subclinical hypothyroidism was high (19.5%). The morbidly obese subjects have higher levels of T3, FT3, T4, and TSH, probably the result of the reset of their central thyrostat at higher level.

Adult↗

PubMed2006

Obstetric outcomes after in vitro fertilization in obese and morbidly obese women.

OBJECTIVE: In addition to numerous health detriments caused by obesity, fertility and pregnancy success may also be compromised. The aims of this study were to compare the effects of obesity and morbid obesity on in vitro fertilization (IVF) outcomes. We also investigated the effects of obesity on obstetric outcomes after IVF treatment. METHODS: Retrospective study of women less than 38 years of age during their first fresh IVF cycle (January 1995 to April 2005). RESULTS: A total of 1,293 women were included in the study, with 236 obese women (body mass index [BMI] = 30-39.9) and 79 morbidly obese women (BMI > or = 40). The morbidly obese group had a 25.3% IVF cycle cancellation rate compared with 10.9% in normal-weight women (odds ratio 2.73, 95% confidence interval 1.49-5.0), P < .001). Morbidly obese women without polycystic ovarian syndrome had an even higher cancellation rate (33%). Women with higher BMI required significantly more days of gonadotropin stimulation but had lower peak estradiol levels (P < .001). There were no significant differences in clinical pregnancy or delivery rates between the four BMI groups. Of the women who delivered, there was a significant linear trend for risk of preeclampsia, gestational diabetes, and cesarean delivery with increasing BMI (P < .03). CONCLUSION: We report a significantly higher risk for IVF cycle cancellation in morbidly obese patients with no effect of BMI on clinical pregnancy or delivery rate. However, obese and morbidly obese subjects had a significantly higher risk for obstetric complications. This target population should be aggressively counseled regarding their increased obstetric risk and offered treatment options for weight reduction before the initiation of fertility therapy. LEVEL OF EVIDENCE: II-2.

Adult↗

PubMed2000

[Case reports of morbid obesity].

Morbid obesity (BMI over 40 kg/m2) is typically complicated by many serious diseases including early death. Using 7 case studies of morbid obese patients we are documenting severe polymorbidity of these persons including severe manifestation of metabolic syndrome. Using adequate therapy, e.g. gastric banding, risk of these patients can be reduced. Some parts of metabolic syndrome can be documented in adolescent children of these patients. The aim of this study is to show the importance of early intervention in patients with morbid obesity.

Adult↗

PubMed2004

A primer on bariatric surgery: treatment of last resort for morbid obesity.

Morbid obesity represents the highest risk state of a growing national problem that is eminently preventable and therefore highly relevant to the disease management community. The obesity epidemic, the failure of conservative treatments to achieve long-term weight loss and heightened media attention to positive short-term results of bariatric procedures among national celebrities has resulted in a dramatic increase in the number of surgeries performed every year. Familiarity with the clinical issues surrounding morbid obesity and bariatric surgery is therefore essential to the disease management community. This paper reviews the state of bariatric surgery, common surgical approaches, their effectiveness, complications, impact on co-morbidities, cost and evolving insurance coverage policies. I also will propose a proactive approach to arrest disease progression to morbid obesity.

Adolescent↗

PubMed1990

A prospective assessment of the Garren-Edwards Gastric Bubble and bariatric surgery in the treatment of morbid obesity.

Morbid obesity is a serious medical hazard, and effective alternatives to surgery have been unsuccessful. In 1985, the Garren-Edwards Gastric Bubble (GEGB) was offered as an adjunct to dietary and behavioral therapy for weight loss treatment. The safety and efficacy of the GEGB were compared with bariatric surgery, the current standard for the treatment of morbid obesity. Fifty-seven patients received GEGB and 77 underwent bariatric surgery. GEGB patients were divided into two groups: those who attended group therapy and those who did not. This study showed that bariatric surgery was far more effective in reducing excess body weight during a 12-month period compared with the GEGB plus group therapy and the GEGB alone. The morbidity from bariatric surgery was greater than in the GEGB-treated groups, while the cost for uncomplicated cases for a year's treatment was comparable. It is concluded that the GEGB does not offer an effective alternative to bariatric surgery in the treatment of morbid obesity.

Adult↗

PubMed2002

TNFalpha expression of subcutaneous adipose tissue in obese and morbid obese females: relationship to adipocyte LPL activity and leptin synthesis.

INTRODUCTION: Tumor necrosis factor (TNFalpha) has been invoked as an adipostat. Accordingly, the adipose tissue expression of TNFalpha has been shown to be proportional to the degree of adiposity. The regulatory role of TNFalpha in obesity may be controlled by several mechanisms. These include the inhibitory effect on LPL activity, the mediation on glucose homeostasis or the effect on leptin. To assess the role of TNFalpha in obesity we measured adipocyte TNFalpha expression in 96 females with a wide range of adiposity and with or without type 2 diabetes. We analysed the relationship between TNFalpha expression, adipocyte LPL activity, insulin resistance and leptin in this population. RESULTS: The TNFalpha and leptin expression of the adipose tissue in obese and morbid obese patients were significantly higher than in controls. Obese and morbid obese patients had slightly higher levels of LPL activity, but these differences were not significant. We observed a significant relationship between adipose TNFalpha expression and body mass index (r=0.35, P<0.001). TNFalpha expression was negatively related to LPL activity (r=-0.28, P<0.05) and positively related to leptin expression (r=0.35, P<0.001). CONCLUSION: Our results indicate that obese women, even those with morbid obesity, over-express TNFalpha in subcutaneous adipose tissue in proportion to the magnitude of the fat depot and independently of the presence of type 2 diabetes. The TNFalpha system may be a homeostatic mechanism that prevents further fat deposition by regulating LPL activity and leptin production.

Adipocytes↗

PubMedDate not supplied

Intragastric balloon: another option for treatment of obesity and morbid obesity.

BACKGROUND/AIMS: The BioEnterics Intragrastric Balloon (BIB, BioEnterics, Santa Barbara, CA) in association with restricted diet has been used for the treatment of obesity and morbid obesity. METHODOLOGY: Since March 1998, 349 BIB were placed in 303 obese and morbidly obese patients; 95 patients were male and 208 female; mean age was 41.5 years (19-70); mean weight was 118.8 Kg (67-229); mean BMI was 42 Kg/m2, % excess weight was 62.3% (4.6-216.3). The balloon was inserted and removed endoscopically under general anesthesia. Patients were given a balanced diet of 1000 Kcal/day. RESULTS: After 4 months of balloon treatment, the mean weight loss was 13.9 Kg and the mean reduction in BMI was 4.8 Kg/m2. Weight loss was greater in male patients. Weight loss was accompanied by an improvement of the diseases associated with obesity, in particular diabetes. CONCLUSIONS: The best indications for BIB were: morbidly obese (BMI >40) and super-obese patients (BMI >50) in preparation for bariatric operations; obese patients with BMI 35-40 with co-morbidity in preparation for bariatric surgery; obese patients with BMI 30-35 with a chronic disease otherwise unresolved; patients with BMI <30 only in a multidisciplinary approach.

Adult↗

PubMed2003

Predictors of 6-minute walk test results in lean, obese and morbidly obese women.

The aim of this study was first, to assess the presence of medical conditions that might interfere with walking; second, to assess the differences in walking capacity, perceived exertion and physical complaints between lean, obese and morbidly obese women; and third, to identify anthropometric, physical fitness and physical activity variables that contribute to the variability in the distance achieved during a 6-minute walk test in lean and obese women. A total of 85 overweight and obese females (18-65 years, body mass index (BMI) > or = 27.5 kg m(-2)), 133 morbidly obese females (BMI > or = 35 kg m-2) and 82 age-matched sedentary lean female volunteers (BMI < or = 26 kg m(-2)) were recruited. Patients suffering from severe musculoskeletal and cardiopulmonary disease were excluded from the study. Prior to the test, conditions that might interfere with walking and hours of TV watching were asked for. Physical activity pattern was assessed using the Baecke questionnaire. Weight, height, body composition (bioelectrical impedance method), isokinetic concentric quadriceps strength (Cybex) and peak oxygen uptake (peakVO2_bicycle ergometer) were measured. A 6-minute walk test was performed and heart rate, walking distance, Borg rating scale of perceived exertion (RPE) and physical complaints at the end of the test were recorded. In obese and particularly in morbidly obese women suffering from skin friction, urinary stress incontinence, varicose veins, foot static problems and pain, wearing insoles, suffering from knee pain, low back pain or hip arthritis were significantly more prevalent than in lean women (P < 0.05). Morbidly obese women (BMI > 35 kg m(-2)N = 133) walked significantly slower (5.4 km h(-1)) than obese (5.9 km h(-1)) and lean women (7.2 km h(-1), P < 0.05), were more exerted (RPE 13.3, 12.8 and 12.4, respectively, P < 0.05) and complained more frequently of dyspnea (9.1%, 4.7% and 0% resp., P < 0.05) and musculoskeletal pain (34.9%, 17.7% and 11.4% resp., P < 0.05) at the end of the walk. In a multiple regression analysis, 75% of the variance in walking distance could be explained by BMI, peakVO2, quadriceps muscle strength age, and hours TV watching or sports participation. These data suggest that in contrast with lean women, walking ability of obese women is hampered not only by overweight, reduced aerobic capacity and a sedentary life style, but also by perceived discomfort and pain. Advice or programs aimed at increasing walking for exercise also need to address the conditions that interfere with walking, as well as perceived symptoms and walking difficulties in order to improve participation and compliance.

Adolescent↗

PubMed1997

Laparoscopic gastroplasty. Technique and preliminary results in patients with morbid obesity.

Morbid obesity is an aesthetic, social and psychological problem, with characteristic morbidity and mortality. Surgical treatment has been developed due to the high failure rate of medical treatment. In our previous experience with 40 patients, open transverse gastroplasty reinforced with mesh, has been found to be a good procedure to deal with this problem, with very few postoperative complications. In March 1995 we started a prospective study to evaluate the feasibility and results of the same technique done laparoscopically. We operated on 10 morbid obesity patients with several failed medical treatments. Laparoscopic surgery was felt to be easier and faster than the open technique. Weight loss was similar to that in our previous patients with open surgery, but postoperative pain and complications were less frequent, and the aesthetic results were better. More patients and a longer follow-up will be needed to provide definitive conclusions.

Gastroplasty↗

PubMed2005

Laparoscopic gastric bypass for refractory morbid obesity.

Morbid obesity has reached epidemic proportions in the United States. Laparoscopic gastric bypass is rapidly becoming the procedure of choice for treatment of morbid obesity. Results demonstrate that the surgery is technically safe. Outcomes are similar to open gastric bypass,but with markedly lower incidences of wound-related and cardiopulmonary complications. Patients also have shorter hospital stay, decreased pain and faster recovery.

Anastomosis, Roux-en-Y↗

PubMed2005

Radiologic evaluation following Roux-en-Y gastric bypass surgery for morbid obesity.

Morbid obesity is an increasing health problem, and bariatric surgery is becoming a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical postoperative findings of the Roux-en-Y gastric bypass (RYGBP) procedure for morbid obesity on upper gastrointestinal (UGI) series are presented. An overview of the potential complications that may be diagnosed with contrast studies and computed tomography (CT) is provided in addition to a description of potential pitfalls in interpreting these studies.

Anastomosis, Roux-en-Y↗

PubMed2005

Is GAD2 on chromosome 10p12 a potential candidate gene for morbid obesity?

Morbidly obese individuals represent one of the fastest growing subpopulations of obese individuals. Thus, it is of significant interest to broaden our understanding of the potential genetic causes of this public health concern. A recent study investigated a role of positional candidate gene GAD2 (the gene for glutamic acid decarboxylase) in the development of morbid obesity. This commentary carefully examines the genetic and functional arguments for and against the GAD2 gene as an influential gene for obesity. Also discussed are additional research questions that merit inquiry when further evaluating this genetic variant as a putative contributor to human obesity.

Chromosome Mapping↗

PubMed2003

Laparoscopic adjustable gastric banding for morbid obesity.

Morbid obesity, with its accompanying human and monetary costs, is a serious and growing health problem worldwide. Surgical treatments are recognized as being effective, but until recently, the available surgical options entailed invasive techniques that permanently altered the gastrointestinal tract. In June 2001, the US Food and Drug Administration approved an adjustable gastric banding system that can be implanted laparoscopically for the treatment of morbid obesity. This article discusses laparoscopic adjustable gastric banding, including patient selection and evaluation, perioperative care, and the importance of a team approach to patient management and follow-up care.

Gastroplasty↗

PubMed1990

[Manometric study of vertical banded gastroplasty for morbid obesity].

Morbidly obese patients undergoing vertical banded gastroplasty were studied preoperatively and/or postoperatively to characterize its manometric pattern. The esophageal manometry using station pull through technique involved 14 preoperative patients with a mean age of 28 +/- 7 years who were a obesity index of 220 +/- 32% and 14 postoperative patients with a mean age of 30 +/- 7 years who were a obesity index of 158 +/- 23%. Preoperative lower esophageal sphincter (LES) pressure using gastric base line as O was 16.1 +/- 8.5 cmH2O and a LES length of 3.4 +/- 0.9 cm. Postoperatively, the vertical banded gastroplasty channel had a pressure of 17.7 +/- 7.1 cmH2O and a length of 8.2 +/- 1.7 cm which was higher than gastric base line. No difference was seen between preoperative LES pressure and postoperative channel pressure, however postoperative channel length was significantly (p less than 0.01) larger than preoperative LES length. We concluded that vertical banded gastroplasty for morbid obesity created a longer high pressure zone in accordance with channel which would inhibit reflux of gastric juice.

Adult↗

PubMed1999

Laparoscopic gastric banding for morbid obesity.

Morbid obesity is a serious disease that is responsible for several comorbid conditions. Body mass indices > 40 require surgical procedures if diet programs fail. Laparoscopic adjustable gastric banding (LAGB), a more recently introduced gastric restrictive procedure, was designed to be a minimally invasive and reversible operation. 184 patients (164 women, 20 men) with a mean body mass index of 47.8 kg/m2 (range 36-79) were operated on. All patients had been excessively overweight for > 5 years. Each patient was given general anesthesia, and an adjustable LAP-BAND was implanted laparoscopically. The pouch size was 15 ml in all cases; and 3-4 sutures were placed to prevent dislocation. The conversion rate was 0%. The median operating time was 65 min (range 45-190). The mortality was 0%. The mean hospital stay was 5 days (range 4-6). The mean excess weight loss was 16% in 4 weeks, 23% in 3 months, 31% in 6 months, 58% in 1 year, and 87% in 2 years. The patient satisfaction index was 97.6%. Once a surgeon has acquired the necessary laparoscopic surgical experience, LAGB is a feasible, safe, and simple procedure with excellent postoperative results. LAGB does not permanently modify the anatomy of the stomach and maintains the natural continuity of the alimentary tract, while at the same time ensuring a steady weight reduction in morbidly obese patients. The fact that the gastric band can be applied laparoscopically is a significant advantage in this group of high-risk patients, who have less pain, faster postoperative recovery, more rapid return to normal activities, fewer wound infections, fewer hernia problems, and better cosmetic results. The rate of postoperative complications is approximately 9%. In 1.1% of patients, erosion occurred, and in 2.2%, slippage of the band. The rate of port-related complications was 3.2%. Reoperations were necessary in 6.4% of the patients.

Adult↗

PubMed2006

Reducing weight increases postural stability in obese and morbid obese men.

OBJECTIVE: To investigate the effect of weight loss on balance control in obese and morbid obese men. METHODS: In a longitudinal and clinical intervention study, postural stability was measured with a force platform before and after weight loss in men. Weight loss was obtained in obese men (mean body mass index (BMI)=33.0 kg/m(2)) by hypocaloric diet until resistance and in morbid obese men (mean BMI=50.5 kg/m(2)) by bariatric surgery. Morbid obese men were tested before surgery, and 3 and 12 months after surgery when they had lost 20 and nearly 50% of initial body weight, respectively. Normal weight individuals (mean BMI=22.7 kg/m(2)) were tested twice within a 6- to 12-month period to serve as control. Body fatness and fat distribution measures, and posturographic parameters of the center of foot pressure (CP) along the antero-posterior and medio-lateral axes for conditions with and without vision were performed in all subjects. RESULTS: Weight loss averaged 12.3 kg after dieting and 71.3 kg after surgery. Body weight remained unchanged in the control group. After weight loss, nearly all measures of postural stability were improved with and without vision (i.e., CP speed and range in antero-posterior and medio-lateral axes). A strong linear relationship was observed between weight loss and improvement in balance control measured from CP speed (adjusted R (2)=0.65, P<0.001). CONCLUSION: Weight loss improves balance control in obese men and the extent of the improvement is directly related to the amount of weight loss. This should decrease the habitual greater risk of falling observed in obese individuals.

Adult↗