Effect of Aging on Bariatric Surgery-induced Changes in Metabolism and Cognition

With an aging population that is increasingly susceptible to obesity and obesity-related
comorbidities including sarcopenia and diabetes, effective and safe treatment options
tailored to the needs of older adults are imperative. While medication and lifestyle
interventions generally fail to achieve sustained large-scale weight loss, bariatric surgery
is the most effective long-term weight loss treatment for obese patients and improves many of
the medical complications associated with obesity. Sleeve gastrectomy (SG) results in
substantial weight loss and may be more appropriate for older adults due to its low rate of
complications and mortality. Therefore, SG has been proposed as a reasonable primary
treatment modality in older obese individuals, with a substantial recent increase in the
number of interventions performed. Despite the potential benefits, very little is known of
the physiologic and metabolic effects of bariatric surgery, including SG, on glucose
homeostasis and muscle physiology in older adults. A fundamental understanding of the effects
of excess adiposity and weight loss interventions is of profound importance, especially with
emerging evidence that earlier treatment of obesity may delay/prevent many comorbidities. An
underlying inflammatory state has been implicated in the pathogenesis of sarcopenia and
insulin resistance and may provide an important connection to the age-related declines seen
in older obese patients. Therefore, this study aims to evaluate the modifying effect of age
and inflammation on the SG-induced changes in body composition, muscle physiology, and
insulin sensitivity. This protocol will be conducted in two age cohorts (greater than 60 and
less than 50 years old).

Inclusion Criteria:

- Age 21-80 yrs old

- BMI ≥ 35 kg/m2

- Undergoing laparoscopic sleeve gastrectomy (SG)

Exclusion Criteria:

- Smokers

- Presence of diabetes mellitus

- Taking any medication that might affect metabolism

- Severe organ dysfunction

- Pregnant or breastfeeding

- Prior gastrointestinal surgery that might affect study results

- Unable or unwilling to follow the study protocol or any reason the research team
believes the subject is not an appropriate candidate for this study

- Weight >450 pounds (Will be unable to fit on the DXA scanner)