Pre-operative Exercise and Nutrition Therapy on Cardio-metabolic Health in Patients Undergoing Bariatric Surgery
Pre-operative Exercise and Nutrition Therapy on Cardio-metabolic Health in Patients Undergoing Bariatric Surgery
Obesity is a major health concern that has been associated with an estimated 2.8 million
 deaths worldwide each year. The number of individuals considered obese with a Body Mass Index
 (BMI) above 30 kg/m2 has grown to more than 500 million. The increased morbidity and
 mortality associated with obesity stems from a long list of comorbidities, including
 hypertension, coronary artery disease, stroke, cancer, and type 2 diabetes (T2D). Bariatric
 surgery is an emerging intervention that has been used frequently to induce weight loss for
 obese individuals and it has been shown to improve glycemic control and insulin resistance in
 people at risk for type 2 diabetes. Surgery may also lead to healthy improvements in
 inflammation, immune cells and vascular health. It is already known that exercise and weight
 loss from lifestyle modification can improve glycemic control, insulin resistance,
 inflammation, and arterial stiffness. However, no work has been done to examine a combination
 of bariatric surgery and pre-surgery exercise. Recent work by the team has evidence
 demonstrating that health status pre-surgery has an impact on post-surgery outcomes. Such
 findings suggest that improvements in health status from exercise before surgery may improve
 surgery outcomes as well as surgery-induced health outcomes. To date, no study has
 systematically examined the role of exercise on the prevalence of surgery complications or on
 post-surgery weight loss, glycemic control, and insulin resistance. Moreover, no work
 currently exists on exercise, with or without bariatric surgery on adipose tissue derived
 inflammation. Therefore, the purpose of this study is to investigate the effect of
 pre-surgery lifestyle intervention with exercise on bariatric surgery outcomes. To test this
 objective, subjects will participate in a match paired study, based on BMI. Subjects will
 undergo testing of blood chemistry and related measures of health before (pre-test) and after
 (post) intervention. Then all subjects will receive bariatric surgery. Post surgery outcomes
 will be assessed by examining surgery operating time, changes in blood chemistry, adipose
 tissue biopsies and other measures indicative of glucose and vascular health. After this
 surgery, subjects will return for testing about 30d later.
Inclusion Criteria:

 -  Males and Females, 18-70 years of age

 -  BMI >30 and <70 kg/m2

 -  Sedentary (Not currently participating in exercise training: >30 min. of physical
 activity per day, >3 days/week)

 -  HCT for women > 36%, Men >38%

 -  Non-pregnant (women).-self reported

 -  Smoker (if bariatric surgery patient) or non-smoker (enrolled for the dietary portion
 of the study)

 -  Has the ability/willingness to participate in the study and agree to any of the arms
 involved in the study.

 -  No prior surgical procedure for obesity with the exception of a laparoscopic
 adjustable gastric banding (LAGB) under the condition that the band had not been
 adjusted in less than or equal to 1 year

 Exclusion Criteria:

 -  Currently participating in exercise training: >30 min. of physical activity per day,
 >2 days/week)

 -  Cigarette smoking (presently or in the past 6 months), drug or alcohol abuse

 -  Pregnancy or breastfeeding

 -  History of congestive heart failure, ischemic heart disease, severe pulmonary disease.

 -  History of cancer (within 5 years)

 -  Diagnosed as insulin-dependent diabetes.

 -  Change in psychotropic medication dosage in past six weeks

 -  AST or ALT > 3 times normal range

 -  Currently involved in any active weight loss treatment program (other than
 self-directed attempt at calorie restricting diet) or lean patients (BMI <29 kg/m2).

 -  Current purging behavior occurring > once a week over the past six weeks (self-induced
 vomiting for weight control purposes, laxative or diuretic abuse)

 -  Revisional bariatric procedures including a RYGB reversal to a SG or a LAGB revision
 to a SG or RYGB if the band has been adjusted in greater than or equal to 1 year.

 -  Active psychotic illness, including bipolar affective disorders.

 -  Evidence of current suicidality or homicidality

 -  Conditions associated with significant cognitive dysfunction (e.g. dementia) or
 medical instability that puts the participant at risk

 -  Contraindication to exercise (severe/uncontrolled CVD; inability to walk 2 blocks,
 bone or joint problems )

 -  Allergy to "caine" family drugs (e.g. lidocaine).

 -  Currently taking active weight suppression medication (e.g. phentermine,bupropion SR,
 topiramate).

 -  On medication known to cause substantial weight gain (e.g. atypical antipsychotics
 such as olanzapine, sodium valproate, steroid therapy). This would not include
 medications commonly used in this population that usually result in only mild weight
 loss (e.g. SSRIs).