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Growth Hormone Treatment after Weight Loss Surgery Prevents Loss of Muscle Mass E-mail
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Growth hormone treatment for six months after weight loss surgery reduces patientgrowth hormone treatments' losses in lean body mass and skeletal muscle mass, according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

Weight loss surgery techniques, such as gastric banding, have been shown to be effective in reducing body weight and obesity-related diseases, such as diabetes.  Although the results of these procedures are widely beneficial, there are some complications. Following surgery, patients are at risk of losing needed lean body mass and skeletal muscle mass due to the serious complications associated with rapid and sustained weight loss. This new study investigated whether growth hormone treatment could prevent or reduce these losses.

"Besides its more commonly known effect on linear growth during childhood, growth hormone benefits body composition throughout life by increasing muscle mass and reducing fat mass," said Dr. Silvia Savastano, M.D., Ph.D., researcher at University Federico II of Naples in Italy and lead author of the study. "The results of our study show that the use of short-term treatment with growth hormone during a standardized program of low calorie diet and physical exercise is effective in reducing the loss of muscle mass and increasing the loss of fat mass after bariatric surgery."

In this study, Dr. Savastano and her colleagues evaluated women who underwent laparoscopic-adjustable silicone gastric banding surgery and were diagnosed with growth hormone deficiency after the procedure. These women were divided into two groups where both groups participated in a standardized diet and exercise program, but only one group also received growth hormone. After a follow-up period of six months, women receiving growth hormone experienced a significant decrease of fat mass and an increase in lean body and skeletal muscle mass.

"This evidence opens a new frontier for growth hormone therapy in the management of morbidly obese patients," said Dr. Savastano. "However, growth hormone treatment can be costly and a careful cost-benefit analysis that also takes into account the cost of commonly used therapy for management of morbidly obese patients is needed."

Other researchers working on the study include Carolina Di Somma, Francesco Orio, Gaetano Lombardi, and Annamaria Colao of University Federico II of Naples in Italy; and Salvatore Longobardi of Merck-Serono Italia in Rome, Italy.

The article "Growth Hormone Treatment Prevents Loss of Lean Mass after Bariatric Surgery in Morbidly Obese Patients," will appear in the March 2009 issue of JCEM.

About Bariatric Surgery

Bariatric surgery is a term derived from the Greek words: weight and treatment. In simple terms, bariatrics concerns the causes, prevention and treatment of severe overweight, a condition known as obesity. Bariatric operations are major gastrointestinal procedures which alter the capacity and/or the anatomy of the digestive system. Some bariatric procedures are performed using general anesthesia via a midline abdominal incision. Some bariatric surgeons also use laparoscopic surgical techniques, involving smaller instruments connected to cameras through which they view the operational site. Bariatric weight loss surgery fall into three general categories:

  • Restrictive procedures, like Lap Band®, which make the stomach smaller to limit the amount of food intake. Currently, most obesity clinics and bariatric centers favor the Lap Band adjustable gastric banding procedure and the Proximal Roux-en-Y Gastric Bypass.
  • Malabsorptive techniques, which reduce the amount of intestine that comes in contact with food so the body absorbs fewer calories.
  • Combination operations, - such as Roux-en-Y gastric bypass which employ both restriction and malabsorption.  Combination operations reduces stomach capacity and bypasses the upper part of the small intestine, causing a reduction in the number of calories and nutrients which the body absorbs. Stomach bypass operations differ in both how the stomach is sectioned (stapling, banding or gastrectomy), and how much of the duodenum and jejunum are bypassed.

Restriction Operations

There are two types of restrictive operations:
  • Gastric banding ("lapband"). A band of special material is placed around the upper end of the stomach. This creates a small pouch and narrow passage into the rest of the stomach.
  • Vertical banded gastroplasty. This common procedure creates the pouch with both a band and staples.
Restriction Operations are the least commonly performed. They encourage weight loss in two ways:
  • Reduce the amount of food you can eat. We shrink your stomach by creating a small pouch at the top of the stomach where food enters from the esophagus. This makes it impossible for you to each much. At first, the pouch only holds about 1 ounce of food. It expands to hold 2-3 ounces over time.
  • Slow the speed food empties from your stomach. The lower outlet of the pouch is only about 1/4 inch in diameter. Because it's so small, food empties slowly and you feel full longer.

Gastric Bypass Operations

Gastric Bypass Operations are combination operations. That is, they combine both restrictive and malabsorptive techniques:
  • Create a small stomach pouch to restrict the amount of food you can eat.
  • Construct a bypass of the duodenum and other parts of the small intestine to cause malabsorption.
There are two types of gastric bypass procedures:
  • Roux-en-Y Gastric Bypass (RGB). This is the most common bariatric procedure. First, we create a small stomach pouch with staples or a vertical band. This restricts food intake. Then, we attach a Y-shaped section of the small intestine to the pouch to allow food to bypass the first and second segments of the small intestine. This reduces your body's ability to absorb nutrients and calories.
  • DISTAL Gastric Bypass (Duodenal Switch, Biliopancreatic Division). In this procedure, a portion of the stomach is removed. The remaining small pouch is then directly connected to the last portion of the small intestine. The risk for nutritional deficiencies is highest with this procedure.

Comparing the Weight Loss Procedures

  • Patients generally have more success with gastric bypass operations than restrictive procedures.
  • Risks are similar for both restrictive and gastric bypass procedures. Except the risk of nutritional deficiencies for iron, calcium, and Vitamin B12-are higher in patients who undergo gastric bypass operations. Also, there is risk of intestinal leaking.
  • Gastric bypass operations also may cause "dumping syndrome." This is when food moves too fast through the small intestine. It causes nausea, weakness, sweating, faintness, and sometimes diarrhea.

Open Vs. Laparoscopic Surgery 

Open and laparoscopic refer to how abdominal cavity is entered and not the type of surgery being performed. So each type of weight loss surgery may be performed as either an open or a laparoscopic procedure.

When performing open surgery, surgeons create a single incision to open the abdomen for the operation. Typically, for women it is 4 1/2 to 6 inches, and for men, it is 5 1/2 to 7 inches.

With laparoscopic surgery, multiple, small incisions are made in the abdominal wall to accommodate a small video camera and surgical instruments. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them a better view and access to key structures.

Although open surgeries are still more common, most surgeons now offer the less invasive laparoscopic procedure whenever possible since studies show patients who have had laparoscopic weight loss surgery experience:
  • Less pain after surgery
  • Easier breathing and lung function
  • Fewer wound complications such as infection or hernia
  • Quicker return to pre-surgical levels of activity
 
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