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Gonzalez-Campoy J.M.,Minnesota Center for Obesity
US Endocrinology | Year: 2016

The number of publications about obesity has increased geometrically over the past couple of decades. The knowledge that adipose tissue is an endocrine organ gave birth to the field of bariatric endocrinology. The concept that adipose tissue may become diseased, and thus contribute to the genesis of metabolic disorders, including hyperglycemia, dyslipidemia, hypertension, male hypogonadism, and cardiovascular disease, constitutes adiposopathy. The goals of treatment for people with overweight and obesity are to decrease the burden of fat mass (adiposity), and to treat adiposopathy (i.e. to return adipose tissue function to normal). As a society, we must overcome the social, political and economic obstacles that prevent patients with overweight or obesity from gaining access to needed medical care.

Kelly A.S.,University of Minnesota | Bergenstal R.M.,International Diabetes Center at Park Nicollet | Gonzalez-Campoy J.M.,Minnesota Center for Obesity | Katz H.,Allina Hospitals and Clinics | Bank A.J.,United Heart and Vascular Clinic
Cardiovascular Diabetology | Year: 2012

Background: Glucagon like peptide-1 (GLP-1) receptor agonist treatment may improve endothelial function via direct and indirect mechanisms. We compared the acute and chronic effects of the GLP-1 receptor agonist exenatide vs. metformin on endothelial function in patients with obesity and pre-diabetes.Methods: We performed a randomized, open-label, clinical trial in 50 non-diabetic individuals (mean age 58.5 ± 10.0; 38 females) with abdominal obesity and either impaired fasting glucose, elevated HbA1c, or impaired glucose tolerance (IGT) who were randomized to receive 3-months of exenatide or metformin. Microvascular endothelial function, assessed by digital reactive hyperemia (reactive hyperemic index: RHI), C-reactive protein (CRP), circulating oxidized LDL (oxLDL), and vascular cell adhesion molecule-1 (VCAM-1) were measured at baseline and 3-months. Seven subjects with IGT participated in a sub-study comparing the effects of pre-administration of exenatide and metformin on postprandial endothelial function.Results: There were no differences for the change in RHI (Δ exenatide: 0.01 ± 0.68 vs. Δ metformin: -0.17 ± 0.72, P = 0.348), CRP, oxLDL, or VCAM-1 between exenatide and metformin treatment. Triglycerides were reduced more with exenatide compared to metformin (Δ exenatide: -25.5 ± 45.7 mg/dL vs. Δ metformin: -2.9 ± 22.8 mg/dL, P = 0.032). In the sub-study, there was no difference in postprandial RHI between exenatide and metformin.Conclusions: Three months of exenatide therapy had similar effects on microvascular endothelial function, markers of inflammation, oxidative stress, and vascular activation, as metformin, in patients with obesity and pre-diabetes.Clinical trials registration: This study is registered on http://www.clinicaltrials.gov/: NCT00546728. © 2012 Kelly et al.; licensee BioMed Central Ltd.

Kelly A.S.,University of Minnesota | Gonzalez-Campoy J.M.,Minnesota Center for Obesity | Rudser K.D.,University of Minnesota | Katz H.,Allina Hospitals and Clinics | And 3 more authors.
Journal of Clinical Hypertension | Year: 2012

The authors hypothesized that carvedilol controlled-release plus lisinopril combination therapy (C+L) would increase endothelial function and decrease oxidative stress to a greater extent than hydrochlorothiazide plus lisinopril combination therapy (H+L) in obese patients with hypertension. Twenty-five abdominally obese patients (aged 54.4±7.3 years; 14 women) with hypertension/prehypertension were enrolled in a 7-month (two 3-month treatment periods separated by a 1-month washout), randomized, double-blind, controlled, crossover clinical trial comparing C+L vs H+L. Endothelial function, measured by digital reactive hyperemic index (RHI), circulating oxidized low-density lipoprotein (oxLDL), 8-isoprostane, and asymmetric dimethylarginine (ADMA) were obtained at baseline, post-period 1, post-washout, and post-period 2. Analyses were adjusted for baseline measurements by analysis of covariance, with robust variance estimation for confidence intervals and P values. C+L treatment compared to H+L treatment significantly improved RHI (0.74, 95% confidence interval, 0.31-1.19, P=.001). This difference persisted after adjustment for the change in systolic blood pressure. No significant treatment differences were observed for oxLDL, 8-isoprostane, or ADMA. These data provide evidence that independent of blood pressure-lowering, C+L therapy improves endothelial function to a greater extent than H+L therapy. Levels of oxidative stress were not significantly different between treatments, suggesting that other mechanisms may be responsible for the improvement in endothelial function. © 2011 Wiley Periodicals, Inc.

Weber M.A.,New York University | Black H.R.,New York University | Garber J.,Beth Israel Deaconess Medical Center | Gonzalez-Campoy J.M.,Minnesota Center for Obesity | And 4 more authors.
Endocrine Practice | Year: 2012

Collaborations between physicians, particularly those in academic medicine, and industries that develop pharmaceutical products, medical devices, and diagnostic tests have led to substantial advances in patient care. At the same time, there is a strong awareness that these relationships, however beneficial they may be, should conform to established principles of ethical professional practice. Through a writing committee drawn from diverse disciplines across several institutions, the Association of Clinical Researchers and Educators (ACRE) has written a code of conduct to provide guidance to physicians in observing these principles. Our recommendations are not intended to be prescriptive or inflexible, but rather to be of assistance to physicians in making their own personal decisions on whether, or how, to be involved in research, education, or other collaborations with industry. Copyright © 2012 AACE.

Gonzalez-Campoy J.M.,Minnesota Center for Obesity | Richardson B.,Minnesota Center for Obesity | Richardson C.,Minnesota Center for Obesity | Gonzalez-Cameron D.,Minnesota Center for Obesity | And 8 more authors.
International Journal of Endocrinology | Year: 2014

Obesity, is a chronic, biological, preventable, and treatable disease. The accumulation of fat mass causes physical changes (adiposity), metabolic and hormonal changes due to adipose tissue dysfunction (adiposopathy), and psychological changes. Bariatric endocrinology was conceived from the need to address the neuro-endocrinological derangements that are associated with adiposopathy, and from the need to broaden the scope of the management of its complications. In addition to the well-established metabolic complications of overweight and obesity, adiposopathy leads to hyperinsulinemia, hyperleptinemia, hypoadiponectinemia, dysregulation of gut peptides including GLP-1 and ghrelin, the development of an inflammatory milieu, and the strong risk of vascular disease. Therapy for adiposopathy hinges on effectively lowering the ratio of orexigenic to anorexigenic signals reaching the the hypothalamus and other relevant brain regions, favoring a lower caloric intake. Adiposopathy, overweight and obesity should be treated indefinitely with the specific aims to reduce fat mass for the adiposity complications, and to normalize adipose tissue function for the adiposopathic complications. This paper defines the principles of medical practice in bariatric endocrinology - the treatment of overweight and obesity as means to treat adiposopathy and its accompanying metabolic and hormonal derangements. © 2014 J. Michael Gonzalez-Campoy et al.

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