Obesity Surgery

, Volume 19, Issue 1, pp 47–55 | Cite as

Visceral Adipose Tissue Loss and Insulin Resistance 6 Months after Laparoscopic Gastric Banding Surgery: A Preliminary Study

  • Joan F. CarrollEmail author
  • Susan F. Franks
  • Adam B. Smith
  • David R. Phelps
Research Article



Increased visceral adipose tissue (VAT) is thought to be a risk factor for cardiovascular and metabolic diseases. There are only limited data on whether VAT loss after laparoscopic gastric banding surgery (LGBS) is related to risk factor reduction. This study determined whether improvements in risk markers, in particular insulin resistance, were related to VAT reduction at 6 months after LGBS (T2).


Thirty-four LGBS patients and 17 normal weight controls underwent initial and T2 testing. Fasting venous blood samples were taken to evaluate glucose, insulin, hemoglobin A1c, lipids, C-reactive protein (CRP), and hormone profiles. Insulin resistance was estimated using the homeostasis model assessment (HOMA) index. VAT was measured using CT techniques. Data were analyzed using repeated measures ANOVA and regression analysis.


Results at T2 showed that patients had significant improvements in body composition, HOMA, and hemoglobin A1c. There were also reductions in plasma renin activity and leptin, and increases in ghrelin and GLP-1. Reductions in VAT were significantly correlated with reductions in insulin, HOMA, and glucose. While high density lipoprotein cholesterol, triglycerides, CRP, and the apolipoprotein A1/B ratio were also improved, VAT reduction was significantly correlated only with an increased apolipoprotein A1/B ratio.


These data indicate that 6 months after LGBS there were significant improvements in many cardiovascular and metabolic risk markers. However, VAT reduction was most strongly associated with reductions in insulin resistance. Body weight loss was not associated with markers of improved insulin sensitivity.


Laparoscopic gastric banding surgery Visceral adipose tissue Insulin resistance HOMA Leptin Ghrelin 



The authors gratefully acknowledge the expert technical assistance of Darice Yoshishige, B.S., in the completion of hormone assays. Support by NIH grants H75/CCH224064, HL04297, HL64913.


  1. 1.
    Sturm R. Increases in morbid obesity in the USA: 2000–2005. Public Health 2007;121:492–6.CrossRefGoogle Scholar
  2. 2.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005;294:1909–17.CrossRefGoogle Scholar
  3. 3.
    Zinzindohoue F, Chevallier JM, Douard R, et al. Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Ann Surg. 2003;237:1–9.CrossRefGoogle Scholar
  4. 4.
    Belachew M, Belva PH, Desaive C. Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg. 2002;12:564–8.CrossRefGoogle Scholar
  5. 5.
    Rosenthal RJ, Szomstein S, Kennedy CI, et al. Laparoscopic surgery for morbid obesity: 1,001 consecutive bariatric operations performed at The Bariatric Institute, Cleveland Clinic Florida. Obes Surg. 2006;16:119–24.CrossRefGoogle Scholar
  6. 6.
    Dixon JB, O'Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008;299:316–23.Google Scholar
  7. 7.
    O'Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144:625–33.CrossRefGoogle Scholar
  8. 8.
    Hanusch-Enserer U, Cauza E, Spak M, et al. Improvement of insulin resistance and early atherosclerosis in patients after gastric banding. Obes Res. 2004;12:284–91.CrossRefGoogle Scholar
  9. 9.
    Pontiroli AE, Pizzocri P, Giacomelli M, et al. Ultrasound measurement of visceral and subcutaneous fat in morbidly obese patients before and after laparoscopic adjustable gastric banding: comparison with computerized tomography and with anthropometric measurements. Obes Surg. 2002;12:648–51.CrossRefGoogle Scholar
  10. 10.
    Leichman JG, Aguilar D, King TM, et al. Improvements in systemic metabolism, anthropometrics, and left ventricular geometry 3 months after bariatric surgery. Surg Obes Relat Dis. 2006;2:592–9.CrossRefGoogle Scholar
  11. 11.
    Despres JP. Health consequences of visceral obesity. Ann Med. 2001;33:534–41.CrossRefGoogle Scholar
  12. 12.
    Kahn BB, Flier JS. Obesity and insulin resistance. J Clin Invest. 2000;106:473–81.CrossRefGoogle Scholar
  13. 13.
    Bjorntorp P. “Portal” adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. Arteriosclerosis 1990;10:493–6.CrossRefGoogle Scholar
  14. 14.
    Arner P. Human fat cell lipolysis: biochemistry, regulation and clinical role. Best Pract Res Clin Endocrinol Metab. 2005;19:471–82.CrossRefGoogle Scholar
  15. 15.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.CrossRefGoogle Scholar
  16. 16.
    Cummings DE, Overduin J, Foster-Schubert KE, et al. Role of the bypassed proximal intestine in the anti-diabetic effects of bariatric surgery. Surg Obes Relat Dis. 2007;3:109–15.CrossRefGoogle Scholar
  17. 17.
    Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign IL: Human Kinetics Books; 1988.Google Scholar
  18. 18.
    Smith SR, Lovejoy JC, Greenway F, et al. Contributions of total body fat, abdominal subcutaneous adipose tissue compartments, and visceral adipose tissue to the metabolic complications of obesity. Metabolism 2001;50:425–35.CrossRefGoogle Scholar
  19. 19.
    Ponce J, Haynes B, Paynter S, et al. Effect of Lap-Band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg. 2004;14:1335–42.CrossRefGoogle Scholar
  20. 20.
    Dixon JB, Dixon AF, O'Brien PE. Improvements in insulin sensitivity and beta-cell function (HOMA) with weight loss in the severely obese. Homeostatic model assessment. Diabet Med. 2003;20:127–34.CrossRefGoogle Scholar
  21. 21.
    Busetto L, Tregnaghi A, Bussolotto M, et al. Visceral fat loss evaluated by total body magnetic resonance imaging in obese women operated with laparascopic adjustable silicone gastric banding. Int J Obes Relat Metab Disord. 2000;24:60–9.CrossRefGoogle Scholar
  22. 22.
    Mango VL, Frishman WH. Physiologic, psychologic, and metabolic consequences of bariatric surgery. Cardiol Rev. 2006;14:232–7.CrossRefGoogle Scholar
  23. 23.
    Rubino F. Bariatric surgery: effects on glucose homeostasis. Curr Opin Clin Nutr Metab Care. 2006;9:497–507.CrossRefGoogle Scholar
  24. 24.
    Bennett JM, Mehta S, Rhodes M. Surgery for morbid obesity. Postgrad Med J. 2007;83:8–15.CrossRefGoogle Scholar
  25. 25.
    Biertho L, Steffen R, Ricklin T, et al. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases. J Am Coll Surg. 2003;197:536–44.CrossRefGoogle Scholar
  26. 26.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefGoogle Scholar
  27. 27.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.CrossRefGoogle Scholar
  28. 28.
    Mariani LM, Marini MA, Veneziani A, et al. Morbid obesity: evaluation of metabolic indexes after adjustable silicone gastric banding. Acta Diabetol. 2003;40(Suppl 1):S263–5.CrossRefGoogle Scholar
  29. 29.
    Garrapa GG, Canibus P, Gatti C, et al. Changes in body composition and insulin sensitivity in severely obese subjects after laparoscopic adjustable silicone gastric banding (LASGB). Med Sci Monit 2005;11:CR522–8.CrossRefGoogle Scholar
  30. 30.
    Strauss BJ, Marks SJ, Growcott JP, et al. Body composition changes following laparoscopic gastric banding for morbid obesity. Acta Diabetol 2003;40(Suppl 1):S266–9.CrossRefGoogle Scholar
  31. 31.
    Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord. 1992;16:397–415.PubMedGoogle Scholar
  32. 32.
    Onat A, Avci GS, Barlan MM, et al. Measures of abdominal obesity assessed for visceral adiposity and relation to coronary risk. Int J Obes Relat Metab Disord. 2004;28:1018–25.CrossRefGoogle Scholar
  33. 33.
    Nicklas BJ, Penninx BW, Ryan AS, et al. Visceral adipose tissue cutoffs associated with metabolic risk factors for coronary heart disease in women. Diabetes Care. 2003;26:1413–20.CrossRefGoogle Scholar
  34. 34.
    Hunter GR, Snyder SW, Kekes-Szabo T, et al. Intra-abdominal adipose tissue values associated with risk of possessing elevated blood lipids and blood pressure. Obes Res. 1994;2:563–8.CrossRefGoogle Scholar
  35. 35.
    Williams MJ, Hunter GR, Kekes-Szabo T, et al. Intra-abdominal adipose tissue cut-points related to elevated cardiovascular risk in women. Int J Obes Relat Metab Disord. 1996;20:613–7.PubMedGoogle Scholar
  36. 36.
    Lemieux S, Prud'homme D, Bouchard C, et al. A single threshold value of waist girth identifies normal-weight and overweight subjects with excess visceral adipose tissue. Am J Clin Nutr. 1996;64:685–93.CrossRefGoogle Scholar
  37. 37.
    Despres JP, Lamarche B. Effects of diet and physical activity on adiposity and body fat distribution: implications for the prevention of cardiovascular disease. Nutr Res Rev. 1993;6:137–59.CrossRefGoogle Scholar
  38. 38.
    Hickey MS, Pories WJ, MacDonald KG Jr, et al. A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut? Ann Surg. 1998;227:637–43.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Joan F. Carroll
    • 1
    Email author
  • Susan F. Franks
    • 2
  • Adam B. Smith
    • 3
  • David R. Phelps
    • 4
  1. 1.Department of Integrative PhysiologyUniversity of North Texas Health Science CenterFort WorthUSA
  2. 2.Department of PsychiatryUniversity of North Texas Health Science CenterFort WorthUSA
  3. 3.Laparoscopy Bariatrics and SurgeryFort WorthUSA
  4. 4.Radiology Associates of Tarrant CountyFort WorthUSA

Personalised recommendations