CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A obesidade mÃrbida à uma doenÃa muito freqÃente nos dias de hoje. O paciente obeso mÃrbido apresenta importantes alteraÃÃes fisiolÃgicas e anatÃmicas, alÃm de comorbidades de grande significado clÃnico, particularmente cardiovasculares, respiratÃrias e metabÃlicas, exigindo do mÃdico anestesiologista pleno conhecimento dessas peculiaridades, para que possa realizar uma abordagem segura, tendo em vista que os procedimentos cirÃrgicos tÃm sido cada vez mais constantes nesse grupo de indivÃduos. O objetivo deste estudo clÃnico, prospectivo e nÃo aleatÃrio, foi avaliar os efeitos da administraÃÃo do agente agonista &#945;2 adrenÃrgico clonidina, como fÃrmaco coadjuvante de tÃcnica anestÃsica padronizada para cirurgia da obesidade em 36 pacientes que pertenciam ao grupo de obesidade mÃrbida do Hospital UniversitÃrio Walter CantÃdio. Foram distribuÃdos em dois grupos: o primeiro grupo composto por 25 pacientes recebeu clonidina administrada em infusÃo contÃnua na dose de 2 mcg/kg de peso ideal, iniciada dez minutos antes da induÃÃo anestÃsica e mantida em seguida, na dose de 0,4 a 0,7 mcg/kg/h de peso ideal, tendo sido descontinuada no inÃcio do fechamento da aponeurose; o segundo grupo composto por 11 pacientes, nÃo recebeu a infusÃo do agente agonista, entretanto todo o restante da tÃcnica anestÃsica foi igual. As principais variÃveis avaliadas foram a pressÃo arterial sistÃlica e diastÃlica, a freqÃÃncia cardÃaca, o Ãndice bispectral (BIS), a concentraÃÃo expirada de sevoflurano (CESEV), a sensaÃÃo de dor, o mini-exame do estado mental (MEEM) e os nÃveis glicÃmicos. Quanto aos dados demogrÃficos, nÃo houve diferenÃa entre os dois grupos estudados. Com relaÃÃo aos parÃmetros hemodinÃmicos, houve aumento da pressÃo sistÃlica e diastÃlica no momento da incisÃo cirÃrgica no grupo controle (P < 0,05). NÃo houve diferenÃa na funÃÃo cognitiva. Foi verificada uma melhor analgesia pÃs-operatÃria no grupo clonidina (P< 0,05). NÃo houve diferenÃa significativa no comportamento glicÃmico no perÃodo peri-operatÃrio quando foram analisados os dois grupos, porÃm quando se analisou apenas os pacientes do grupo clonidina, observou-se que nos nÃo diabÃticos, ocorreu um aumento significativo da glicemia durante o perÃodo intra-operatÃrio (P < 0,05), no entanto, sem ultrapassar o valor de 200 mg/dl. Houve maior controle hemodinÃmico intra-operatÃrio com a utilizaÃÃo da clonidina. O grupo clonidina apresentou um despertar mais rÃpido ao final da cirurgia e tambÃm obteve melhor analgesia no perÃodo pÃs-operatÃrio. O uso do fÃrmaco nÃo interferiu com o retorno das funÃÃes cognitivas. Em baixas doses, a clonidina nÃo determinou alteraÃÃes nos nÃveis glicÃmicos no perÃodo peri-operatÃrio, entretanto, nos pacientes diabÃticos em que o agonista foi administrado, observou-se um melhor controle da glicemia, o que nÃo foi demonstrado nos pacientes nÃo diabÃticos. Os pacientes dos dois grupos nÃo apresentaram efeitos adversos. / Morbid obesity is very frequent nowadays. The morbidly obese patient presents important anatomical and physiological changes, and comorbidities of great clinical significance, particularly cardiovascular, respiratory and metabolic demands of the physician anesthesiologist must be aware of these peculiarities, so you can make a safe approach, considering that the surgical procedures have been increasingly appearing in this group of individuals. The objective of this clinical, prospective and not randomized, was to evaluate the effects of administration of the &#945;2-adrenergic agonist clonidine as an adjunct to drug standardized anesthetic technique for obesity surgery in 36 patients who belonged to the group of morbid obesity at the university hospital . Were divided into two groups: the first group of 25 patients received clonidine administered by continuous infusion at a dose of 2 mcg / kg ideal body weight, which started ten minutes before induction of anesthesia and then maintained at a dose from 0,4 to 0,7 mcg / kg / h of ideal weight, having been discontinued in the early closure of the aponeurosis and the second group of 11 patients did not receive the infusion of the agonist, however the rest of the anesthetic technique was equal. The main variables evaluated were systolic and diastolic blood pressure, heart rate, bispectral index (BIS), the expired concentration of sevoflurane, pain sensation, the mini-mental state examination (MMSE) and levels glucose. With regard to demographics, there was no difference between the two groups. With respect to hemodynamic parameters, an increase of systolic and diastolic blood pressure at the time of surgical incision in the control group (P <0.05). There was no difference in cognitive function. It was observed a better postoperative analgesia in the clonidine group (P <0.05). There was no significant difference in glycemic levels in the peri-operative when they examined the two groups, but when we examined only patients in the clonidine group, we observed that in nondiabetic patients, there was a significant increase in blood glucose during the intraoperative (P <0.05), however, not to exceed 200 mg / dl. There was greater intraoperative hemodynamic control with the use of clonidine. The clonidine group showed a more rapid awakening at surgery and also achieved better analgesia in the postoperative period. The use of the drug did not interfere with the recovery of cognitive function. At low doses, clonidine did not cause changes in glucose levels in the perioperative period, however, in diabetic patients in which the agonist was administered, there was a better glucose control, which was not demonstrated in nondiabetic patients. Patients in both groups showed no adverse effects.

Introduction: Obesity is a major health problem that affects an individual's overall health. Bariatric metabolic surgery is most important and has permanent impact on weight loss in comparison with conservative therapy. The downside is that it often leads to a row nutritional deficiencies requiring long-term supplementation. Object: The aim of the thesis is to map the intake of nutrients in the diet of bariatric patients six months and one year after the procedure. The research is primarily focused on the intake of vitamin D and calcium in diet, vitamin D, parathyroid hormone and calcium levels are also evaluated. Marginally, laboratory values are assessed prior to surgery as deficiencies are known to occur before surgery. Methodology: The research sample consists of 30 respondents who are six months (M6) and one year (Y1) from the procedure. Micronutrients are evaluated from three-day dining records recorded by respondents for at least one week. The research laboratory data was used from the medical information system of the hospital information system. The evaluation parameters for vitamin D-25 (OH)D (limit level was established to > 30 ng/ml). To assess the parathyroid hormone concentration, a minimum limit is set to 1.58 pmol/l, calcium 2.00-2.75 (mmol/l). We were wondering if the profile of...

Hyperproinsulinemia is associated with type 2 diabetes (T2DM) and obesity and is a predictor for future coronary heart disease. This thesis examines the effect of bariatric surgery on glucometabolic status including insulin and proinsulin responses after meal. Further we explored longitudinally the effects of bariatric surgery on glucose, insulin and proinsulin secretion as well as lipids, liver enzymes and magnesium concentrations. We explored by a standardised meal test the postprandial dynamics of proinsulin and insulin and effects on glucose and lipids in patients treated with gastric bypass (RYGBP) surgery and in patients treated with bileopancreatic diversion with duodenal switch surgery (BPD-DS). Comparisons were made to morbidly obese patients and normal weight controls (NW). RYGBP surgery markedly lowers fasting and postprandial proinsulin concentrations although BMI was higher compared to NW-controls. BPD-DS surgery induces a large weight loss and normalises postprandial responses of glucose, proinsulin and insulin and markedly lowers triglycerides. We evaluated non-diabetic morbidly obese patients who underwent bariatric surgery followed-up for up to four years after surgery. Long-term follow-up showed that RYGBP surgery is not only characterized by markedly and sustained lowered BMI but also lowered concentrations of proinsulin, insulin, ALT and increased HDL-C possibly via reduced hepatic insulin resistance. We also examined how magnesium status is affected by bariatric surgery as magnesium has been shown to be inversely related to glucose and to insulin resistance. The serum magnesium concentrations increased by 6% after RYGBP and 10% after BPD-DS. In summary, RYGBP and BPD-DS surgery results in marked weight loss, alterations in insulin and proinsulin dynamics, lowered fasting and postprandial proinsulin concentrations and improved glucometabolic and magnesium status.

Bakgrund: I Sverige är övervikt och fetma ett folkhälsoproblem. Detta tenderar till att bli allt större vilket kan ge en ökad risk för bl.a. hjärt- och kärlsjukdomar samt diabetes typ 2. En allmänsjuksköterska möter överviktsopererade patienter varhälst i vårdsektorn hon/han arbetar. Därför är det viktigt att känna till hur dessa människor upplever sin nya vardag för att på bästa sätt kunna erbjuda dem en optimal, hälsofrämjande vård. Syftet: Syftet med denna studie var att belysa människors upplevelser av vardagen efter en överviktsoperation. Metod: En självbiografisk kvalitativ studie baserat på sju böcker. Resultat: Ur analysen av datamaterialet identifierades tre huvudteman ”Ett bättre liv”, ”Kroppsliga och själsliga besvärligheter” samt ”Den nya livssituationen” samt nio subteman vilka alla belyser individers upplever av vardagen efter en överviktsoperation. Diskussion: Individer som genomgår en överviktsoperation har svårt att anpassa sig till sin nya livsstiuation trots att de samtidigt upplever ett stort välbefinnade över att bland annat ha nått sitt mål. Ett förändrat bemötande från omvärlden är ibland svår att hantera vilket leder till en osäkerhet inför den egna kroppen och kroppsuppfattning. För sjuksköterskan är det viktigt att förstå att förändringen efter en överviktoperation inte endast är fysisk utan även i allra högsta grad psykisk. Slutsats: För att livsstilsförändringen ska fortgå efter en överviktsoperation krävs att individen känner meningsfullhet i sin nya situation. Genom utbildning, inför och efter det kirurgiska ingreppet, är det lättare att leva med denna livsstilsförändring. Med tanke på att livet kan förlängas med tio år genom kraftig viktreducering och därmed även frånvaro av överviktsrelaterade sjukdomar, bör ämnet om hälsobefrämjande åtgärder för fetmadrabbade individer inkluderas i sjuksköterskans grundutbildning. / Background: Overweight and obesity is a public health problem in Sweden. This tends to become larger and may increase the risk of cardiovascular diseases and diabetes type 2. A general nurse meet patients who had undergone bariatric surgery wherever in the health sector, she/he is working. Therefore, it is important to know how these people feel about their new living in order to offer them an optimal health care. Aim: The aim of this study was to highlight people's experiences of everyday life after obesity surgery. Method: An autobiographical qualitative study based on seven books. Result: The analysis of the data identified three main themes; "A better life", "The physical and emotional discomforts” and "The new life situation” together with nine subthemes that illustrates how individuals experience their everyday lives after an bariatric surgery. Discussion: For individuals who undergo bariatric surgery has it been difficult to adapt the new life situation, even though they often experience a feeling of well-being as well as a feeling of that they have reached their goal. The changed attitude from the ‘outside world’ is sometimes difficult to manage. This leads to uncertainty about the own bodie and body image. As a nurse, it is important to understand that the difficulties after bariatric surgery are not only physical but also a mental distress and discomfort. Conclusion: To achieve that the new lifestyle should proceed after bariatric surgery it requires that the individual feel meaningfulness in their new situation. Through training before and after surgery, it is easier to live with this change. Given that life can be extended with ten years due to severe weight reduction and thus the absence of sequelae, it may be recommended that education of health promotion among obesity affected individuals should be included in the nurse’s education.

Importance: Childhood and adolescent overweight and obesity have more than tripled over the past two decades. Bariatric surgery is becoming more common for adolescents. Currently, there are few studies that describe outcomes after bariatric surgery in adolescents and no studies that describe nutritional behaviors that predict sustained weight loss in this population post-surgery. Objective: To describe pre-surgery dietary intake in adolescents who underwent a sleeve gastrectomy between 2011 and 2013 at an outpatient pediatric weight loss clinic. This study specifically aims to determine whether there is a correlation between fruit and vegetable intake before surgery and weight loss post-surgery in adolescents. Design, Setting, and Participants: The participants in this study received the sleeve gastrectomy procedure. Patients were between the ages of 13-17 years old and had a BMI between 35 kg/m2 to 60 kg/m2. All patients had undergone extensive counseling and assessment by a team of medical professionals (pediatrician, psychologist, exercise physiologist, nurse, and dietitian) for at least six months before surgery. Weekly number of servings of fruits and vegetables, cups of sweetened beverages (separated as fruit juice or soda), servings of fried foods eaten, and meals eaten from or at restaurants as reported at the initial consultation were collected and analyzed. Results: The mean age of participants (n=11) was 17.1 ± 1.51 years. Mean servings of vegetables consumed at baseline was 7.32 ± 4.38 servings per week and mean weekly consumption of fruits was 6.0 ± 4.16 servings per week. There were no statistically significant correlations between baseline fruit (p = 0.50) and vegetable (p = 0.44) consumption with weight (kg) lost six months after surgery. Conclusion: While the relationship between fruit and vegetable consumption with weight lost six months post-surgery failed to reach significance, there was a trend such that patients who consumed more servings of fruits and vegetables at baseline had lost more weight at 6 months. It is interesting to note that none of the patients in the study consumed the recommended daily servings of fruits or vegetables at baseline in accordance with the USDA guidelines. A longer study may reveal a more significant relationship between dietary patterns before surgery and changes in weight after surgery.

America's obesity ̒epidemic̕, coupled with increasing use of biomedical technologies in healthcare, has helped usher in new technoscientific methods to medically manage the bodies of overweight and obese individuals. Potential patients now have several surgical options to choose from in efforts to lose weight and (potentially) improve health outcomes, including gastric bypass, sleeve gastrectomy, and gastric banding; this research focuses on the gastric band, an implantable and adjustable silicone device designed to restrict the amount of food consumed. This study involves: in-depth interviews with predominantly female gastric banding patients, medical practitioners, bariatric surgeons, and representatives from the two U.S.-based biomedical firms that manufacture the gastric band; a multi-site ethnography examining the patient experience and the clinical encounter; and content analysis of scientific and non-scientific texts. Through this mixed methodological approach, this study charts the band's evolution and the complex forces guiding its design, development and adoption, and draws attention to the ways in which gendered assumptions enter into the pre- and post-surgical space with repercussions for patient care. Findings suggest that patients̕ decision-making process is shaped by - and shapes - multiple social, political, economic, and regulatory contexts. As a contested and unstable technology, the band's efficacy and ̒foreignness̕ is continually both challenged and reaffirmed by a diverse arena of social actors with a vested interest in the bariatric surgical space. These actors construct the band's role in the obesity epidemic in oppositional ways, affecting its use and perceived misuse: the depiction of the band as a safe, less invasive and - most significantly - removable technology helps drive its use, directing some patients away from other options - specifically, the anatomically changing gastric bypass procedure - portrayed as unnatural and extreme, though simultaneously more effective. While the band's reversibility represents freedom over technology and control over their bodies, it also reflects patients̕ struggle for both autonomy and desire for technological assistance in managing their weight. However, despite patients̕ attempt to assert themselves as active agents, the gastric band emerges as a disciplinary weight loss technology which serves to reinforce the perceived need for clinical intervention in the care and treatment of obesity. This study contributes to our understanding of the possibilities and limitations offered by biomedical technologies, and the ways in which humans resist, comply or are ambivalent toward their adoption and use.

Bakgrund: År 2014 utfördes 6,800 bariatriska operationer i Sverige med syfte att minska individers vikt och förbättra välbefinnandet. Studien utfördes för att beskriva patienters subjektiva erfarenheter av processen efter operation och förankrades i Dorothea Orems egenvårdsteori.   Syfte: Syftet var att beskriva patienters erfarenheter efter bariatrisk kirurgi.   Metod: En systematisk litteraturstudie som utgick från Forsberg och Wengströms (2013) metodologi.   Resultat: Resultatet presenterades som ett övergripande tema: En önskan om att återfå hälsa genom viktminskning, med sex tillhörande kategorier. Många av deltagarna beskrev att erfarenheter efter bariatrisk kirurgi överlag var positiva. De upplevde också att relationen till mat förändrades. Självkänslan samt sociala och fysiska förmågor förbättrades. Några upplevde svårigheter att anpassa sig efter operationen vilket påverkade deras erfarenheter negativt.   Slutsats: Många av dem som genomgick bariatrisk kirurgi ökade sin livskvalitet på många sätt. Utöver det kirurgiska ingreppet som förminskar magsäcken behövdes ytterligare åtgärder i form av livsstilsförändringar och egenvård. Ett ansvar som till stor del låg hos individen själv, dessutom fanns också ett ansvar hos sjukvårdspersonalen, att uppmärksamma vilken hjälp patienten kunde komma att behöva i den fortsatta hälsoprocessen och stötta dem i detta. / Background: In 2014, there were 6,800 bariatric surgeries performed in Sweden, in order to reduce an individual's weight and improve well-being. This study was conducted to describe the patients' subjective experiences of the process after surgery and were anchored in Dorothea Orem's self-care theory.   Aim: The aim was to describe patients' experiences after bariatric surgery.   Method: A systematic literaturereview emanated from Forsberg and Wengström’s (2013) methodology.   Result: The results are presented with an overarching theme: A desire to regain health through weight loss, and six associated categories. Experience after bariatric surgery was described by many of the participants generally positive. The most common experience was that the relationship with food changed. For many of the participants there was an improvement in both self-esteem and social and physical abilities. Some experienced difficulties adjusting after surgery which affected their experience negatively.   Conclusion: Most people who underwent bariatric surgery increased their quality of life in many ways. In addition to the surgical procedure that reduces the stomach, most of them needed additional measures in terms of lifestyle changes and self-care. A responsibility that largely lay with the individual himself, though even healthcare professionals have a responsibility in the subsequent care.

BACKGROUND: Previous studies have shown that there are racial disparities in type 2 diabetes (T2DM) remission following bariatric surgery, with African-Americans (AA) in particular experiencing a subsequent relapse. In recent years, some have attributed these findings to racial differences in fasting insulin levels, with AA having higher levels, as increasing evidence for an alternate model of T2DM pathophysiology gains support. In this model, basal hyperinsulinemia is considered a primary event in T2DM disease development, rather than a compensatory response to increased insulin resistance. This study aimed to compare glycemic outcomes after bariatric surgery in different races, namely African-Americans (AA), Hispanic-Americans (HA), and Caucasian-Americans (CA), and to determine whether there were any associated changes in insulin levels and insulin resistance that may lend support to this revised model of T2DM pathophysiology. METHODS: A retrospective medical record review of 1,326 patients (389 AA, 179 HA, and 758 CA) who underwent bariatric surgery at Boston Medical Center (BMC) from 2004 to 2015 was conducted. Baseline characteristics and maximum percent weight loss were compared using one-way ANOVA and Chi-square tests of independence. Changes in mean glycated hemoglobin (HbA1c), insulin levels, insulin resistance (HOMA-IR), and blood glucose levels were analyzed using linear mixed models, overall and by racial group. The same procedures were conducted in both the overall patient population and a T2DM subpopulation. RESULTS: Over an 11-year postoperative observation period, all racial groups underwent a significant decrease in HbA1c (P<0.001) within the first two years following surgery. While HbA1c levels remained stable in CA and HA, they began to rise at 2 years in AA only (P=0.043). Additionally, analyses of covariates, including age at surgery (P=0.005), initial BMI (P<0.001), and maximum weight loss (P=0.049), revealed that all three were significant factors affecting mean HbA1c levels. However, when included in the mixed model, the race x time interaction effect on mean HbA1c remained significant. There was also a significant overall decrease in both insulin and HOMA-IR. When stratified by race, analysis of the T2DM population showed that insulin levels began to increase again by the 2nd year after surgery in AA, while in CA and HA they continued to decrease and subsequently stabilize. Analysis of the total patient population showed that HOMA-IR levels in AA, as well as in CA and HA, continued to decrease at this 2-year time point. Decreases in blood glucose levels after surgery were significant overall (P<0.001), but not significant when stratified by race. CONCLUSIONS: After the initial “metabolic reset” that occurs within the first 2 years after bariatric surgery, during which HbA1c levels normalize in the vast majority of patients, it was observed only in the AA population that there was a steady increase in HbA1c to levels near those recorded at baseline. This coincided with an observation of increasing insulin levels despite decreasing insulin resistance seen in AA only. Our results suggest that current discussions regarding a revised model of T2DM pathophysiology, in which hyperinsulinemia precedes insulin resistance, may help explain the racial disparities in glycemic control observed in both post-surgical and non-surgical contexts of T2DM outcome. However, future prospective studies are needed to further the preliminary results of this study.

At the 2nd Diabetes Surgical Summit in 2015, the world’s leading researchers and professionals in the field of diabetes, surgery, and public health gathered to develop new surgical treatment guidelines for diabetes. This summit led to the recommendation of bariatric surgery as an official treatment for type II diabetes, outlining that the surgery be considered for diabetic patients with a Body Mass Index (BMI) of 30, a much lower threshold BMI than that of typical bariatric surgery patients. Despite incontrovertible evidence that bariatric surgery can reverse the progression of diabetes and even cause remission, the physiological mechanisms chiefly responsible for these effects remain controversial. Peer-reviewed published literature was collected to examine the evidence for mechanisms responsible for metabolic improvements following bariatric surgery, especially Roux-en-Y gastric bypass. This review considered the effects of calorie restriction, appetite modulators, incretins, intestinal adaptations, adipose tissue, gut microbiota, bile acid circulation and composition, and psychosocial and behavioral changes on surgery-induced metabolic improvements and sustained type II diabetes remission. Clinical considerations, such as the surgical risks and improved indicators for bariatric surgery were also explored to contextualize the physiological mechanisms under study. The “hind gut hypothesis” emerged as an important overarching mechanism potentially responsible for many of the observed improvements. The more rapid delivery of food to the distal intestine, as well as the delayed mixing of pancreatic, gastric and bile secretions with food, likely contributes to increased nutrient-stimulation of enteroendocrine cells and greater binding of bile acids with their receptors, farnesoid X receptor and TGR5. These changes in food and secretion delivery also appear to positively affect the gut microbiota to support a non-obese microbiota profile. Calorie restriction may be responsible for the early effects of bariatric surgery, including not just a reduction in fat mass but also epigenetic changes to induce β-cell proliferation and increased insulin secretion. However, long-term benefits of bariatric surgery appear to be more closely correlated to enteroendocrine changes, including the surgery-induced changes to levels of appetite modulators that, unlike pure calorie restriction, promote feelings of satiation and reduce rates of diet failure and weight regain. Fat distribution and adipocyte function are also important contributors to both the pathophysiology of obesity-related diabetes and improvements following bariatric surgery. While reductions in BMI and subcutaneous adipose tissue area were not correlated to diabetes remission, reductions in visceral adipose tissue area and enhanced adiponectin secretions were both independent factors associated with diabetes remission. The important role of adipocytes as endocrine organs has emerged as an important field of inquiry. Adipokines, adipocyte hormones, may either promote a pro-inflammatory profile or an anti-inflammatory profile, impacting the development of obesity-related diabetes or diabetes remission, respectively. The findings of this review support the 2nd Diabetes Surgical Summit’s recommendations of proactive bariatric surgery as a treatment for diabetes. The risks of complications and mortality following bariatric surgery are low, whereas the long-term survival after bariatric surgery is improved relative to non-surgical, matched controls. Single-nucleotide polymorphisms associated with obesity and diabetes may serve as early indicators for surgery, and inform both surgical method and follow-up protocols. Despite the benefits of bariatric surgery, only a small number of eligible candidates undergo treatment. In the United States, barriers such as physician and patient perceptions and cost may limit access to surgery. In places that experience a health workforce shortage, there may be no health care professionals or facilities available to perform bariatric surgery. Therefore, while the surgery amazingly causes diabetes remission, one of its greatest benefits may be to continue to inform the mechanisms responsible for metabolic improvements toward developing new pharmacological treatments. In the future, less invasive drug treatments that seek to replicate the effects of bariatric surgery may be more successful in tackling the global obesity and diabetes crisis.

The incidence of obesity is on the rise globally and is associated with many comorbidities, especially type 2 diabetes mellitus (T2DM). Bariatric surgery is the most effective intervention for weight loss and reducing obesity-associated morbidity. The most common bariatric surgeries are roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). RYGB and SG are equally efficacious at long-term reduction of weight in obese individuals and amelioriation of T2DM. Interestingly, the improvement of glucose regulation is noted before weight loss is observed. The most likely mechanism underlying glucose homeostasis after bariatric surgery is hormonal changes in the intestine. Enteroendrocrine changes favorable of an anti-diabetic profile are noted after only a few days of receiving either RYGB or SG surgery. Most consistently, elevated postprandial GLP-1, a potent regulator of appetite and glucose control, is observed in post-bariatric surgery patients. However, data is limited regarding post-prandial GLP-1 levels beyond two years after surgery. This study will address the gap in literature by assessing postprandial elevations of GLP-1 following RYGB or SG for up to five years. We will recruit obese type-2 diabetics from an outpatient bariatric surgery clinic at Boston Medical Center scheduled to receive RYGB or SG and periodically assess postprandial GLP-1 levels to determine if they remain elevated after 5 years. Additionally, we will provide evidence if there is a correlation among changes in postprandial GLP-1, weight loss, and hemoglobin A1c at five years. Our proposed study will help direct researchers to develop safer and more efficacious interventions for obesity and T2DM.