title: Adiposopathy and bariatric surgery: is 'sick fat' a surgical disease?
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.
authors.affiliation: Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY 40213, USA. hbaysmd@aol.com
authors.forename: H E
authors.initials: HE
authors.lastname: Bays
authors.forename: B
authors.initials: B
authors.lastname: Laferrère
authors.forename: J
authors.initials: J
authors.lastname: Dixon
authors.forename: L
authors.initials: L
authors.lastname: Aronne
authors.forename: J M
authors.initials: JM
authors.lastname: González-Campoy
authors.forename: C
authors.initials: C
authors.lastname: Apovian
authors.forename: B M
authors.initials: BM
authors.lastname: Wolfe
mesh_terms: D050154:Adiposity; D050110:Bariatric Surgery / Q000379:methods*; D003362:Cost-Benefit Analysis; D006801:Humans; D008019:Life Style; D008659:Metabolic Diseases / Q000628:therapy; D009765:Obesity / Q000473:pathology / Q000601:surgery*; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss
references.citation: Ann Surg. 2006 Nov;244(5):741-9
references.pmid: 17060767
references.citation: Ann Epidemiol. 2005 Feb;15(2):87-97
references.pmid: 15652713
references.citation: Curr Atheroscler Rep. 2006 Mar;8(2):144-56
references.pmid: 16510049
references.citation: J Surg Res. 2007 Jul;141(1):31-9
references.pmid: 17574036
references.citation: Exp Clin Endocrinol Diabetes. 2009 Jun;117(6):241-50
references.pmid: 19358089
references.citation: Am J Clin Nutr. 1992 Feb;55(2 Suppl):487S-619S
references.pmid: 1733116
references.citation: Ann Surg. 2004 Sep;240(3):416-23; discussion 423-4
references.pmid: 15319713
references.citation: Obes Surg. 2009 Mar;19(3):327-31
references.pmid: 18975038
references.citation: Arch Physiol Biochem. 2008 Oct;114(4):267-76
references.pmid: 18946787
references.citation: Obes Surg. 2008 Oct;18(10):1233-40
references.pmid: 18452051
references.citation: Surg Obes Relat Dis. 2008 Sep-Oct;4(5 Suppl):S109-84
references.pmid: 18848315
references.citation: Obes Surg. 2006 Aug;16(8):1057-61
references.pmid: 16901360
references.citation: J Am Coll Nutr. 2000 Apr;19(2):270-4
references.pmid: 10763909
references.citation: Surg Obes Relat Dis. 2007 Mar-Apr;3(2):116-26
references.pmid: 17386392
references.citation: Obesity (Silver Spring). 2009 Apr;17 Suppl 1:S1-70, v
references.pmid: 19319140
references.citation: JAMA. 2008 Jan 23;299(3):316-23
references.pmid: 18212316
references.citation: Obesity (Silver Spring). 2009 May;17(5):911-7
references.pmid: 19396071
references.citation: Clin Liver Dis. 2007 Feb;11(1):141-54, ix-x
references.pmid: 17544976
references.citation: Cell Biochem Biophys. 2007;48(2-3):97-102
references.pmid: 17709879
references.citation: J Am Coll Surg. 2002 May;194(5):557-66; discussion 566-7
references.pmid: 12022597
references.citation: J Lipid Res. 2005 Jul;46(7):1369-79
references.pmid: 15834118
references.citation: Diabetes Care. 2009 Apr;32(4):567-74
references.pmid: 19171720
references.citation: J Clin Endocrinol Metab. 2005 Feb;90(2):813-9
references.pmid: 15585553
references.citation: Int J Obes (Lond). 2009 Jan;33(1):54-66
references.pmid: 19050672
references.citation: Int J Obes (Lond). 2009 Jan;33(1):173-80
references.pmid: 19050676
references.citation: Obesity (Silver Spring). 2009 May;17(5):889-94
references.pmid: 19396068
references.citation: Obesity (Silver Spring). 2009 May;17(5):924-8
references.pmid: 19396073
references.citation: Obes Res. 2004 Aug;12(8):1197-211
references.pmid: 15340100
references.citation: Int J Gynaecol Obstet. 2008 Dec;103(3):246-51
references.pmid: 18768177
references.citation: World J Surg. 2009 Oct;33(10):2022-7
references.pmid: 19440652
references.citation: Obesity (Silver Spring). 2009 May;17(5):880-4
references.pmid: 19396066
references.citation: Ann Intern Med. 2009 Feb 17;150(4):243-54
references.pmid: 19221376
references.citation: Ann Surg. 2006 Nov;244(5):715-22
references.pmid: 17060764
references.citation: Ann Surg. 2007 Dec;246(6):1028-33
references.pmid: 18043106
references.citation: Int J Obes. 1988;12(3):191-7
references.pmid: 3391735
references.citation: Surg Obes Relat Dis. 2007 Sep-Oct;3(5):496-502; discussion 502
references.pmid: 17903768
references.citation: Int J Obes (Lond). 2008 Dec;32(12):1752-63
references.pmid: 18982009
references.citation: Obes Surg. 2009 Mar;19(3):287-92
references.pmid: 18937018
references.citation: Nutr Hosp. 2003 Jul-Aug;18(4):189-93
references.pmid: 12884474
references.citation: Ann Surg. 2007 Nov;246(5):780-5
references.pmid: 17968169
references.citation: Nutr Metab Cardiovasc Dis. 2009 Feb;19(2):146-52
references.pmid: 19171470
references.citation: Obes Surg. 2005 May;15(5):670-6
references.pmid: 15946459
references.citation: Am J Med. 2009 Jan;122(1 Suppl):S26-37
references.pmid: 19110085
references.citation: Br J Surg. 2008 Nov;95(11):1375-9
references.pmid: 18844274
references.citation: Exp Biol Med (Maywood). 2001 Dec;226(11):997-1002
references.pmid: 11743135
references.citation: J Clin Endocrinol Metab. 2008 Jul;93(7):2479-85
references.pmid: 18430778
references.citation: Obesity (Silver Spring). 2009 May;17(5):901-10
references.pmid: 19396070
references.citation: J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S89-96
references.pmid: 18987275
references.citation: Diabetes Care. 2007 Jul;30(7):1709-16
references.pmid: 17416796
references.citation: Gastroenterology. 2006 May;130(6):1564-72
references.pmid: 16697719
references.citation: Am J Med. 2007 Oct;120(10):863-70
references.pmid: 17904457
references.citation: Nat Rev Gastroenterol Hepatol. 2009 Jun;6(6):343-52
references.pmid: 19434096
references.citation: Diabetes Care. 2008 Feb;31 Suppl 2:S290-6
references.pmid: 18227499
references.citation: Ann Intern Med. 2005 Jan 4;142(1):56-66
references.pmid: 15630109
references.citation: Scand J Clin Lab Invest. 1995 Jul;55(4):351-7
references.pmid: 7569738
references.citation: J Clin Endocrinol Metab. 2004 Jun;89(6):2583-9
references.pmid: 15181027
references.citation: N Engl J Med. 2007 Aug 23;357(8):753-61
references.pmid: 17715409
references.citation: Gastroenterology. 2007 May;132(6):2253-71
references.pmid: 17498516
references.citation: Am J Med. 2009 May;122(5):435-42
references.pmid: 19375553
references.citation: J Clin Endocrinol Metab. 2008 Nov;93(11):4276-81
references.pmid: 18713823
references.citation: Am J Surg. 1985 May;149(5):656-64
references.pmid: 3887957
references.citation: Obes Res. 2002 May;10(5):408-11
references.pmid: 12006641
references.citation: Endocrinol Metab Clin North Am. 2003 Dec;32(4):915-33
references.pmid: 14711068
references.citation: Diabetologia. 2008 Oct;51(10):1901-11
references.pmid: 18704364
references.citation: J Gastrointest Surg. 2004 Dec;8(8):983-7
references.pmid: 15585385
references.citation: Surg Obes Relat Dis. 2005 May-Jun;1(3):371-81
references.pmid: 16925250
references.citation: Surg Obes Relat Dis. 2008 Jan-Feb;4(1):26-32
references.pmid: 18069075
references.citation: Int J Clin Pract. 2008 Oct;62(10):1474-83
references.pmid: 18681905
references.citation: Am J Med. 2008 Oct;121(10):885-93
references.pmid: 18823860
references.citation: J Clin Endocrinol Metab. 2004 Aug;89(8):4062-8
references.pmid: 15292349
references.citation: Nutr Clin Pract. 2005 Oct;20(5):517-25
references.pmid: 16207692
references.citation: J Clin Endocrinol Metab. 2009 Mar;94(3):884-91
references.pmid: 19106269
references.citation: J Clin Endocrinol Metab. 2004 Jun;89(6):2569-75
references.pmid: 15181025
references.citation: Obes Surg. 2009 Jun;19(6):745-50
references.pmid: 18629594
references.citation: Diabetes Obes Metab. 2008 Dec;10(12):1266-70
references.pmid: 18494809
references.citation: Obesity (Silver Spring). 2009 May;17(5):839-41
references.pmid: 19396062
references.citation: Am J Manag Care. 2008 Sep;14(9):589-96
references.pmid: 18778174
references.citation: N Engl J Med. 2007 Aug 23;357(8):741-52
references.pmid: 17715408
references.citation: JAMA. 2008 Nov 19;300(19):2286-96
references.pmid: 19017915
references.citation: Obes Res. 2004 Aug;12(8):1231-4
references.pmid: 15340105
references.citation: Obesity (Silver Spring). 2006 Aug;14 Suppl 5:242S-249S
references.pmid: 17021375
references.citation: Obes Surg. 2008 Jan;18(1):17-26
references.pmid: 18080721
references.citation: Expert Rev Cardiovasc Ther. 2008 Mar;6(3):391-409
references.pmid: 18327998
references.citation: Obesity (Silver Spring). 2009 May;17(5):885-8
references.pmid: 19396067
references.citation: Curr Treat Options Cardiovasc Med. 2007 Aug;9(4):259-71
references.pmid: 17761111
references.citation: Med Care. 2009 May;47(5):531-5
references.pmid: 19318997
references.citation: J Clin Endocrinol Metab. 2004 Feb;89(2):463-78
references.pmid: 14764748
references.citation: N Engl J Med. 2004 Dec 23;351(26):2683-93
references.pmid: 15616203
references.citation: Am J Surg. 2008 Jan;195(1):94-8
references.pmid: 18082548
references.citation: Diabetes Care. 2009 Apr;32(4):580-4
references.pmid: 19171726
references.citation: Endocr Rev. 2006 Aug;27(5):449-67
references.pmid: 16684901
references.citation: J Gastrointest Surg. 2008 May;12(5):945-52
references.pmid: 17940829
references.citation: Obes Surg. 2007 Jun;17(6):759-63
references.pmid: 17879575
references.citation: Ann Intern Med. 2006 May 2;144(9):689-91
references.pmid: 16670139
references.citation: Diabetes Metab. 2001 Apr;27(2 Pt 2):261-70
references.pmid: 11452220
references.citation: Int J Obes (Lond). 2007 May;31(5):743-50
references.pmid: 17075583
references.citation: Obesity (Silver Spring). 2009 May;17(5):918-23
references.pmid: 19396072
references.citation: Future Cardiol. 2005 Jan;1(1):39-59
references.pmid: 19804060
references.citation: Expert Rev Cardiovasc Ther. 2006 Nov;4(6):871-95
references.pmid: 17173503
references.citation: FEBS Lett. 2005 Jul 4;579(17):3487-92
references.pmid: 15953605
references.citation: Int J Clin Pract. 2007 May;61(5):737-47
references.pmid: 17493087
references.citation: Obesity (Silver Spring). 2009 May;17(5):895-900
references.pmid: 19396069
references.citation: Obes Surg. 2004 Jan;14(1):13-5
references.pmid: 14980027
references.citation: Obesity (Silver Spring). 2009 May;17(5):929-33
references.pmid: 19396074
references.citation: Ann Intern Med. 2009 Jan 20;150(2):94-103
references.pmid: 19153412
references.citation: Clin Endocrinol (Oxf). 2007 Nov;67(5):679-86
references.pmid: 17608757
references.citation: J Manipulative Physiol Ther. 2001 Jun;24(5):335-9
references.pmid: 11416824
references.citation: Obesity (Silver Spring). 2009 May;17(5):871-9
references.pmid: 19396065
references.citation: JAMA. 2004 Oct 13;292(14):1724-37
references.pmid: 15479938
references.citation: Diabetes Care. 2009 Mar;32(3):514-20
references.pmid: 19246589
references.citation: Obes Surg. 2008 Oct;18(10):1297-304
references.pmid: 18392897
references.citation: J Clin Endocrinol Metab. 2003 Apr;88(4):1594-602
references.pmid: 12679444
references.citation: Obes Surg. 2008 Mar;18(3):314-20
references.pmid: 18214630
references.citation: Semin Liver Dis. 2008 Nov;28(4):407-26
references.pmid: 18956297
references.citation: Obes Surg. 2009 May;19(5):641-4
references.pmid: 19005734
references.citation: Adv Surg. 2005;39:165-79
references.pmid: 16250551
references.citation: Am Heart J. 2006 Mar;151(3):633-42
references.pmid: 16504625
references.citation: Surg Obes Relat Dis. 2008 May-Jun;4(3 Suppl):S7-13
references.pmid: 18501318
references.citation: Diabetes. 2009 Mar;58(3):718-25
references.pmid: 19074987
references.citation: Obesity (Silver Spring). 2009 May;17(5):863-70
references.pmid: 19396064
references.citation: J Clin Endocrinol Metab. 2008 Nov;93(11):4532-41
references.pmid: 18728164
references.citation: J Clin Endocrinol Metab. 2005 Nov;90(11):6207-13
references.pmid: 16131581
references.citation: J Clin Endocrinol Metab. 2009 Apr;94(4):1329-32
references.pmid: 19174499
references.citation: Ann Hepatol. 2008 Oct-Dec;7(4):364-8
references.pmid: 19034237
references.citation: Expert Rev Cardiovasc Ther. 2008 Mar;6(3):343-68
references.pmid: 18327995
references.citation: Med Clin North Am. 2007 May;91(3):321-38, ix
references.pmid: 17509381
references.citation: J Anim Sci. 2004 Mar;82(3):935-41
references.pmid: 15032452
references.citation: Obes Surg. 2005 Aug;15(7):1017-23
references.pmid: 16105400
references.citation: Surgery. 2007 Jul;142(1):74-85
references.pmid: 17630003
references.citation: Obesity (Silver Spring). 2009 Apr;17(4):619-21
references.pmid: 19322140
references.citation: Int J Obes Relat Metab Disord. 1996 Apr;20(4):338-45
references.pmid: 8680461
references.citation: BMJ. 2007 Dec 8;335(7631):1194-9
references.pmid: 18006966
references.citation: J Surg Res. 2007 Oct;142(2):295-300
references.pmid: 17640666
references.citation: J Clin Endocrinol Metab. 2004 Jun;89(6):2548-56
references.pmid: 15181022
references.citation: Diabetologia. 2007 Aug;50(8):1707-15
references.pmid: 17549449
references.citation: Mol Biol Cell. 2004 May;15(5):2484-91
references.pmid: 15034137
references.citation: Obesity (Silver Spring). 2009 May;17(5):842-62
references.pmid: 19396063
references.citation: Obesity (Silver Spring). 2008 Mar;16(3):615-22
references.pmid: 18239603