Bariatric Surgery for Morbid Obesity: Tehran Obesity Treatment Study (TOTS) Rationale and Study Design

Abstract

BackgroundObesity is a major health concern in the Middle East and worldwide. It is among the leading causes of morbidity, mortality, health care utilization, and costs. With bariatric surgery proving to be a more effective treatment option for overweight and obesity, the need for systematic assessment of different procedures and their outcomes becomes necessary. These procedures have not yet been described in detail in our region.ObjectiveWe aim to undertake a prospective study evaluating and comparing several surgical bariatric procedures in an Iranian population of morbid obese patients presenting to a specialized bariatric center.MethodsIn order to facilitate and accelerate understanding of obesity and its complications, the Tehran Obesity Treatment Study (TOTS) was planned and developed. This study is a longitudinal prospective cohort study in consecutive patients undergoing bariatric surgery. TOTS investigators use standardized definitions, high-fidelity data collection system, and validated instruments to gather data preoperatively, at the time of surgery, postoperatively, and in longer-term follow-up.ResultsThis study has recruited 1050 participants as of September 2015 and is ongoing.ConclusionsThis study will ensure creation of high-level evidence to enable clinicians to make meaningful evidence-based decisions for patient evaluation, selection for surgery, and follow-up care.

Dietary macro- and micro-nutrients intake adequacy at 6th and 12th month post-bariatric surgery

“…This study was conducted in accordance with the framework of the Tehran obesity treatment study (TOTS), an ongoing single-institution prospective study initiated in March, 2013 [25]. In our retrospective study, 161 severely obese subjects with the body mass index (BMI) ≥40 kg/m2 or 40 < BMI ≥35 kg/m 2 with at least one or more obesity-related co-morbidities undergoing BS during 2015 to 2016 were selected from the Tehran Obesity Treatment Center, 103 patients were not eligible to participate according to the exclusion criteria ( Fig.…”

Severe fatal protein malnutrition and liver failure in a morbidly obese patient after mini-gastric bypass surgery: Case report

“…She was referred to our obesity clinic to be considered for bariatric surgery, as part of the Tehran Obesity Treatment Study [9]. Her past history was significant for diabetes since 5 years ago, dyslipidemia, hypothyroidism, and a history of nephrolithiasis.…”

Nonalcoholic Fatty Liver Disease and Liver Fibrosis in Bariatric Patients: Tehran Obesity Treatment Study (TOTS)

“…This study was a baseline evaluation of the Tehran Obesity Treatment Study (TOTS), which is an ongoing prospective bariatric cohort commenced in March 2013. A detailed study protocol for TOTS is available elsewhere (18). Briefly, after providing written informed consent, morbidly obese patients undergo laparoscopic Roux-en-Y gastric bypass, mini-gastric bypass, or sleeve gastrectomy by a single surgical team and are followed postoperatively.…”

“…Biopsies were taken from the left liver lobe, percutaneously with a 16-gauge Tru-Cut needle (BARD-Max core, Covington, GA, USA), and right liver lobe by wedge biopsy under laparoscopic guidance. This approach ensured that enough tissue would be obtained for evaluation and provided specimens for future molecular and immunohistochemical studies (18). An experienced liver pathologist blinded to baseline characteristics and laboratory data of patients assessed all biopsies using hematoxylin and eosin, Masson's trichrome, and iron staining.…”