Adiposopathy and bariatric surgery: Is 'sick fat' a surgical disease?

H. E. Bays, B. Laferrère, J. Dixon, L. Aronne, J. M. González-Campoy, C. Apovian, Bruce Wolfe

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objective: To review how bariatric surgery in obese patients may effectively treat adiposopathy (pathogenic adipose tissue or 'sick fat'), and to provide clinicians a rationale as to why bariatric surgery is a potential treatment option for overweight patients with type 2 diabetes, hypertension, and dyslipidaemia. Methods: A group of clinicians, researchers, and surgeons, all with a background in treating obesity and the adverse metabolic consequences of excessive body fat, reviewed the medical literature regarding the improvement in metabolic disease with bariatric surgery. Results: Bariatric surgery improves metabolic disease through multiple, likely interrelated mechanisms including: (i) initial acute fasting and diminished caloric intake inherent with many gastrointestinal surgical procedures; (ii) favourable alterations in gastrointestinal endocrine and immune responses, especially with bariatric surgeries that reroute nutrient gastrointestinal delivery such as gastric bypass procedures; and (iii) a decrease in adipose tissue mass. Regarding adipose tissue mass, during positive caloric balance, impaired adipogenesis (resulting in limitations in adipocyte number or size) and visceral adiposity are anatomic manifestations of pathogenic adipose tissue (adiposopathy). This may cause adverse adipose tissue endocrine and immune responses that lead to metabolic disease. A decrease in adipocyte size and decrease in visceral adiposity, as often occurs with bariatric surgery, may effectively improve adiposopathy, and thus effectively treat metabolic disease. It is the relationship between bariatric surgery and its effects upon pathogenic adipose tissue that is the focus of this discussion. Conclusions: In selective obese patients with metabolic disease who are refractory to medical management, adiposopathy is a surgical disease.

Original languageEnglish (US)
Pages (from-to)1285-1300
Number of pages16
JournalInternational Journal of Clinical Practice
Volume63
Issue number9
DOIs
StatePublished - 2009

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Bariatric Surgery
Adipose Tissue
Metabolic Diseases
Fats
Adiposity
Adipocytes
Digestive System Surgical Procedures
Adipogenesis
Gastric Bypass
Dyslipidemias
Energy Intake
Type 2 Diabetes Mellitus
Fasting
Obesity
Research Personnel
Hypertension
Food

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bays, H. E., Laferrère, B., Dixon, J., Aronne, L., González-Campoy, J. M., Apovian, C., & Wolfe, B. (2009). Adiposopathy and bariatric surgery: Is 'sick fat' a surgical disease? International Journal of Clinical Practice, 63(9), 1285-1300. https://doi.org/10.1111/j.1742-1241.2009.02151.x

Adiposopathy and bariatric surgery : Is 'sick fat' a surgical disease? / Bays, H. E.; Laferrère, B.; Dixon, J.; Aronne, L.; González-Campoy, J. M.; Apovian, C.; Wolfe, Bruce.

In: International Journal of Clinical Practice, Vol. 63, No. 9, 2009, p. 1285-1300.

Research output: Contribution to journalArticle

Bays, HE, Laferrère, B, Dixon, J, Aronne, L, González-Campoy, JM, Apovian, C & Wolfe, B 2009, 'Adiposopathy and bariatric surgery: Is 'sick fat' a surgical disease?', International Journal of Clinical Practice, vol. 63, no. 9, pp. 1285-1300. https://doi.org/10.1111/j.1742-1241.2009.02151.x
Bays, H. E. ; Laferrère, B. ; Dixon, J. ; Aronne, L. ; González-Campoy, J. M. ; Apovian, C. ; Wolfe, Bruce. / Adiposopathy and bariatric surgery : Is 'sick fat' a surgical disease?. In: International Journal of Clinical Practice. 2009 ; Vol. 63, No. 9. pp. 1285-1300.
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