The Geisinger Obesity Institute (GOI) seeks to enhance the quality and quantity of research related to obesity within the Geisinger Health System by providing a system-wide focal point for all researchers, clinicians and trainees interested in the issues related to obesity and by establishing the necessary resources to support obesity research in epidemiology, clinical research and translational/molecular research.
Gastric bypass surgery is an effective therapy for extreme obesity. Although the safety and potential efficacy of this procedure is well established, some patients may regain variable amounts of weight after a short period of rapid weight loss and remain extremely obese.
There are many phenotypic, genetic, environmental and behavioral reasons for this. Our studies attempt to identify pre-operative factors associated with weight loss outcomes after surgery.
Morbid obesity is often associated with many different co-morbidities such as type 2 diabetes, hypertension, cardiovascular disease, stroke, sleep apnea and gallbladder disease. Research has shown that many of these co-morbidities can be reduced through bariatric surgery. For example, evidence suggests that the rearrangement of the intestines during bariatric surgery and the change in physiological mechanisms can possibly result in remission of type 2 diabetes within days of surgery. Our research aims to better understand these mechanisms to help better predict post-surgery outcomes.
National and state estimates regarding the health impact of maternal and pediatric obesity are staggering. Maternal and pediatric obesity prevention and treatment research in Geisinger Health System involves the Janet Weis Children's Hospital, Pediatrics, Women's Health, Maternal and Fetal Medicine, Center for Clinical Innovations, Obesity Institute, eHealth, Strategic Industry Partnerships, Genomic Medicine Institute, Environmental Health Institute and Center for Health Research.
Our research focuses on the genetic, molecular, social and behavioral contributors to obesity, and supports our work with community and public health partners, schools and parents to prevent and reduce childhood obesity with a strong focus on the first 1000 days of life beginning with conception. We are re-engineering care to improve screening, tailoring preventive counseling, and using systems design to direct families to multi-disciplinary, treatment programs when indicated. We are training primary care providers and support staff to use motivational interviewing skills, utilizing tele-health, apps, and electronic health records, and coordinating care between clinics and community agencies and schools to help families identify and act on solutions that make healthy, active choices easier.
Body weight is influenced by both genes and environment. Diet, exercise, where one lives and many other environmental factors interact with genes to predispose people to obesity. The Human Genome Project has now allowed scientists to identify obesity genes. Our goal is to discover and validate genetic factors that can cause or influence obesity.
Our research focuses on not only the genetic factors that may affect the onset of obesity, including intergenerational transmission, but also genetic variations associated with better outcomes after bariatric surgery. We hope our research will provide information to improve individualized patient care both for the current obese population and for future generations..
This study directly addresses two important health problems, obesity and fatty liver disease, called non-alcoholic fatty liver disease (NAFLD). Over 70 percent of the adult population in the U.S. are overweight or obese as are 20-25 percent of children and adolescents. Obesity may soon overtake smoking as the leading cause of death in the U.S. About 20-30 percent of obese adults in the U.S. have excess fat accumulation in the liver. About 10 percent of these individuals (2-3 percent of all adults) are estimated to meet current diagnostic criteria for NAFLD. NAFLD can progress to cirrhosis in up to one third of these cases. The incidence of NAFLD increases with an increase in body mass index (BMI). BMI increases in proportion to weight increase. Although NAFLD is the second cause of liver transplantation, weight loss has been shown to improve NAFLD.
Obesity is associated with an increased risk for all-cause mortality. Mortality risk related to obesity is largely associated with cancer and cardiovascular disease. Mechanisms known to contribute to the strong association between obesity and cardiovascular disease include the indirect effects of obesity on known cardiovascular risk factors including hypertension, dyslipidemias and type 2 diabetes and the direct adverse effects of obesity on the homeostasis of the endothelium. Additional mechanisms include the adverse effects of obesity on cardiac structure and function.
The Geisinger Obesity Institute is uniquely positioned to explore the long-term benefits of surgical weight loss and cardiovascular outcomes as a result of its robust clinical bariatric surgery registry, established in 2004 and continuously fed by the electronic health record. A large cohort of surgical patients with follow-up beyond seven years has allowed comparison of long term cardiovascular outcomes with a tightly matched cohort of non-operated control patients with severe obesity. The outcome benefits of bariatric surgery shown in this cohort coupled with the prospective tissue biobanking in conjunction with obesity surgery afford opportunities for translational studies designed to uncover atherogenic-protective mechanisms.
Benotti P, Wood GC, Argyropoulos G, Pack A, Keenan BT, Gao X, Gerhard G, Still C. The Impact of Obstructive Sleep Apnea on Nonalcoholic Fatty Liver Disease in Patients with Severe Obesity. Obesity. 2016; 24(4): 871-877.
Hunsinger M, Wood GC, Still C, Petrick A, Blansfield J, Shabahang M, Benotti P. Maximizing weight loss after Roux-en-Y Gastric Bypass may Decrease Risk of Incident Organ Cancer. Obes Surg. 2016; 1-6. doi: 10.1007/s11695-016-2206-0
Lent MR, Bailey-Davis L, Irving BA, Wood GC, Cook AM, Hirsch AG, Still CD, Benotti P, Franceschelli-Hosterman J. Bariatric surgery patients and their families: Health, physical activity and social support. Obesity Surgery. 2016. [Epub ahead of print].
Lent MR, Vander Veur SS, Peters JC, Herring SJ, Wyatt HR, Tewksbury C, Wojtanowksi AC, Hill JO, Foster GD. Initial weight loss goals: have they changed and do they matter? Obesity Science & Practice. 2016. doi: 10.1002/osp4.45
Lee C, Wood GC, Lazo M, Brown T, Clark J, Still C, Benotti P. Risk of Post-Gastric Bypass Surgery Hypoglycemia in Nondiabetic Individuals: A Single Center Experience. Obesity. 2016; 24(6): 1342-1348. doi: 10.1002/oby.21479
Peyer K, Welk G, Bailey-Davis L, Chen S. Relationships between County Health Rankings and child overweight and obesity prevalence: a serial cross-sectional analysis. BMC Public Health. 2016; 16(1): 404.
Lingren T, Thaker V, Brady C, Namjou B, Kennebeck S, Bickel J, Patibandia N, Ni Y, Van Driest S, Chen L, Roach A, Cobb B, Kirby J, Denny J, Bailey-Davis L, Williams MS, Marsolo K, Solti I, Holm IA, Harley J, Kohane IS, Savova G, Crimmins N. Developing an algorithm to detect early childhood obesity in two tertiary pediatric medical centers. Appl Clin Inform. 2016; 7(3): 693-706.
Nau C, Glass T, Ellis H, Schwartz B, Bailey-Davis L, Kress AM, Hirsch A, Pollak J. Exploring the forest instead of the trees: An innovative method for defining obesogenic and obesoprotective environments. Health & Place. 2015; 35: 136-146.
Petrick A, Benotti P, Wood GC, Still CD, Strodel WE, Gabrielsen J, Rolston D, Chu X, Argyropoulos G, Ibele A, Gerhard GS. Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients. Obes Surg. 2015; 25(12): 2368-75 doi 10.1007/S11695-015-1707-6.
Petrick AT, Still CD, Wood CG, Vitunac MA, Plank M, McGrail L, Strodel WE, Gabrielsen JD, Rogers J, Benotti P. Feasibility and Impact of an Evidence-Based Program for Gastric Bypass Surgery. J Am Coll Surg. 2015; 220(5): 855-62.
Nead K., Li A., Neupane B., Gustafsson S., Butterworth A., Engert J., Davis A., Hegele R., Miller R., den Hoed M., Khaw K., Kilpelainen T., Wareham N., Edwards T., Hallmans G., Varga T., Kardia S., Smith J., Zhao W., Faul J., Weir D., Mi J., Xi B., Quinteros S., Cooper C., Sayer A., Jameson K., Grontved A., Fornage M., Sidney S., Hanis C., Highland H., Haring H., Heni M., Lasky-Su J., Weiss S., Gerhard G., Still C., Melka M., Pausova Z., Paus T., Grant S., Hakonarson H., Price R., Wang K., Scherag A., Hebebrand J., Hinney A., Biobank Japan, AGEN-BMI, GIANT Consortium, Franks P., Frayling T., McCarthy M., Hirschhorn J., Loos R., Ingelsson E., Gerstein H., Yusuf S., Beyene J., Anand S., Meyre D. A Systemic Review and Meta-Analysis With Evidence from Up to 331,175 Individuals. Hum Mol Genet. 2015; 24(12): 3582-94.
Roesch S., Styer A., Wood G., Kosak Z., Seiler J., Benotti P., Petrick A., Gabrielsen J., Strodel W., Gerhard G., Still C., Argyropoulos G. Perturbations of Fibroblast Growth Factors 19 and 21 in Type 2 Diabetes. PloS One. 2015; 10(2): E0116928. http/www.ncbi.nlm.nih.gov/pmc/articles/PMC4321834/pdf/pone.0116928.pdf
Hayes S, Stoeckel N, Napolitano MA, Collins C, Wood GC, Seiler, J, Grunwald HE, Foster GD, Still CD. Examination of Beck Depression Inventory-II Factor Structure Among Bariatric Surgery Candidates. Obes Surg. 2015; 25(7): 1161.
Lent MR, Vander Veur S, Mallya G, McCoy TA, Sanders TA, Colby L, Rauchut Tewksbury C, Lawman HG, Sandoval B, Sherman S, Wylie-Rosett J, Foster GD. Corner store purchases made by adults, adolescents and children: items nutritional characteristics and amount spent. Public Health Nutr. 2015; 18(9): 1706-1712.
Gessert C., Waring S., Bailey-Davies L., Conway P., Roberts M., VanWormer J. Rural Definition of Health: A Systematic Literature Review. BMC Public Health. 2015; 15 (378): 1-14. doi: 10.1186/s12889-015-1658-9.
Psek W, Stametz RA, Bailey-Davis L, Davis D, Darer J, Faucett WA, Henninger DL, Sellers DC, Gerrity G. Operationalizing the Learning Health Care System in an Integrated Delivery System. EGEMS (Wash DC). 2015; 3(1): 1-11. doi; 10.13063/2327-9214.1122
Nau C, Glass T, Ellis H, Schwartz B, Bailey-Davis L, Kress AM, Hirsch A, Pollak J. Exploring the forest instead of the trees: An Innovative Method for Defining Obesogenic and Obesoprotective Environments. Health Place. 2015; 35:136-146.
Lu W, Ching Cheng Y, Chen K, Wang H, Gerhard GS, Still CD, Chu X, Yang R, Parihar A, O’Connell JR, Pollin TI, Angles-Cano E, Quon MJ, Mitchell BD, Shuldiner AR, Fu M. Evidence for Several Independent Genetic Variants affecting Lipoprotein (a) Cholesterol Levels. Hum Mol Genet. 2015; 24(8):2390-2400.
Hayes S, Stoeckel N, Napolitano MA, Collins C, Wood GC, Seiler J, Grunwald HE, Foster GD, Still CD. Examination of Beck Depression Inventory-II Factor Structure among Bariatric Surgery Candidates. Obes Surg. 2015; 25 (7): 1155-1160.
Hayes S, Napolitano MA, Lent MR, Wood GC, Gerhard GS, Irving BA, Argyropoulos G, Foster GD, Still CD. The Effect of Insurance Status on Pre- and Post-operative Bariatric Surgery Outcomes. Obes Surg. 2015; 25(1): 191-4.
DiStefano JK, Kingsley C, Wood GC, Chu X, Argyropoulos G, Still CD, Done SC, Legendre C, Tembe W, Gerhard GS. Genome-wide Analysis of Hepatic Lipid Content in Extreme Obesity. Acta Diabetol. 2015; 52(1): 373-382.
Nau C, Schwartz BS, Bandeen-Roche K, Liu A, Pollak J, Hirsrch A, Bailey-Davis L, Glass TA. Community socio economic deprivation and obesity trajectories in children using electronic health records. Obesity (Silver Spring). 2015; 23(1): 207-212.
Apovia CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, Ryan DH, Still CD: Pharmacological Management of Obesity: An Endocrine Society Practice Guideline. J Clin Endocrinol Metab. 2015; 100(2): 342-362.
Schwartz BS, Bailey-Davis L, Bandeen-Roche K, Hirsch AG, Pollak J, Glass TA. Attention deficit disorder, stimulant use, and childhood body mass index trajectory. Pediatrics. 2014; 133(4): 668-76. PMID: 24639278
Lawman HG, Polonsky HM, Vander Veur S, Abel M, Sherman S, Bauer KW, Sanders T, Fisher JO, Bailey-Davis L, Ng J, Van Wye G, Foster GD. Breakfast patterns among low-income, ethnically-diverse grade school children in an urban area. BMC Public Health, 2014; 14(1): 604. PMID: 24928474
Gerhard GS, Benotti P, Wood GC, Chu X, Argyropoulos G, Petrick A, Strodel WE, Gabrielsen JD, Ibele A, Still CD, Kingsley C, DiStefano J. Identification of Novel Clinical Factors Associated with Hepatic Fat Accumulation in Extreme Obesity. J Obes. 2014.
Wood CG, Gerhard GS, Benotti P, Petrick AT, Gabrielsen JD, Strodel WE, Ibele A, Rolston DD, Still CD, Argyropoulos G. Preoperative use of increntins is associated with increased diabetes remission after RYGB surgery among patients taking insulin: A retrospective cohort analysis. Ann Surg. 2014; 261(1): 125-128.
Lent MR, Napolitano MA, Wood GC, Argyropoulos G, Gerhard GS, Hayes S. Foster GD, Collins CA, Still CD. Internalized weight bias in weight -loss surgery patients: psychosocial correlates and weight loss outcomes. Obes Surg. 2014; 24(12): 2195-9.
Hirsch AG, Wood GC, Bailey-Davis L, Lent M, Gerhard G, Still CD. Collateral Weight Loss in Children Living with Adult Bariatric Surgery Patients: A Case Control Study. Obesity (Silver Spring). 2014; 22(10): 2224-9. PMID: 24989939
Gabrielsen J, Petrick A, Ibele A, Wood GC, Benotti P. A novel technique for wound protector deployment and efficient following Laparoscopic sleeve gastrectomy. J Gastrointest Surg. 2014; 18(9): 1678-82.
Parihar A, Wood GC, Chu X, Jin Q, Argyropoulos G, Still CD, Shuldiner A, Mitchell BD, Gerhard GS. Extension of GWAS Results for Lipid-related Phenotypes to Extreme Obesity Using Electronic Health Record (EHR) Data and the Metabochip. Front Genet. 2014; 5: 222.
Hsiao PY, Mitchell DC, Wood GC, Jensen GL, Still CD, Hartman TJ. The Association of Dietary Patterns and Weight Change in Rural Older Adults 75 years and older. J Nutr Gerontol Geriatr. 2014; 33(4): 357-75.
Still CD, Wood GC, Strodel W, Petrick A, Gabrielsen J, Ibele A, Irving B, Seiler J, Benotti P, Celaya MP, Blackstone R, Gerhard GS, Argyropoulos G. A probability score for preoperative prediction of type 2 diabetes remission following RYGB surgery. The Lancet Diab & Endocr. 2014; 2(1): 38-45.
Still CD, Wood GC, Chu X, Manney C, Strodel W, Petrick A, Gabrielsen J, Mirshahi T, Argyropoulos G, Seiler J, Yung M, Benotti P, Gerhard GS. Clinical factors associated with weight loss outcomes after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring). 2014; 22(3): 888-94.
Bailey-Davis L, Virus A, McCoy TA, Wojtanowski A, Vander Veur SS, Foster GD. Middle school student and parent perceptions of government-sponsored free school breakfast and consumption: A qualitative inquiry in an urban setting. J Acad Nutr Diet. 2013; 113: 251-257.
Bailey-Davis L. Situated learning in the local food movement. Adult Education Research Conference Proceedings. 2013.
Gerhard, GS., Styer, AM., Wood, GC., Roesch, SL., Petrick, AT., Gabrielsen, J., Strodel, WE., Still, CD., Argyropoulos, G.: A role for fibroblast growth factor 19 and bile acids in diabetes remission after Roux-en-Y gastric bypass. Diabetes Care. 2013; 36(7); 1859-64.
Gerhard, GS, Chu, X, Wood, GC, Gerhard, GM, Benotti, P, Petrick, AT, Gabrielsen, J, Strodel, WE, Still, CD, Argyropoulos, G. Next-generation sequence analysis of genes associated with obesity and nonalcoholic fatty liver disease-related cirrhosis in extreme obesity. Human Heredity. 2013; 75(0): 144-51.
Gerhard GS, Styer AM, Strodel WE, Roesch SL, Yavorek A, Carey DJ, Wood GC, Petrick AT, Gabrielsen J, Ibele A, Benotti P, Rolston DD, Still CD, Argyropoulos G. Gene expression profiling in subcutaneous, visceral and epigastric adipose tissues of patients with extreme obesity. Int J Obes (Lond). 2013; 38(3): 371-378. doi: 10.1038/ijo.2013.152.
Gorden A, Yang R, Yerges-Armstrong LM, Ryan LM, Speliotes E, Borecki IB, Harris TB, Chu X, Wood GC, Still CD, Shuldiner AR, Gerhard GC. Genetic Variation at NCAN Locus Is Associated with Inflammation and Fibrosis in Non-Alcoholic Fatty Liver Disease in Morbid Obesity. Human Heredity 2013; 75(1): 34-43.
Kumashiro N, Beddow SA, Vatner DF, Majumdar SK, Cantley JL, Guebre-Egziabher F, Fat I, Guigni B, Jurczak MJ, Birkenfeld AL, Kahn M, Perler BK, Puchowicz MA, Manchem VP, Bhanot S, Still CD, Gerhard GS, Petersen KF, Cline GW, Shulman GI, Samuel VT. Targeting pyruvate carboxylase reduces gluconeogenesis and adiposity and improves insulin resistance. Diabetes. 2013; 62(7): 2183-94.
Parikh M, Hetheringon J, Sheth S, Seiler J, Ostrer H, Gerhard G, Wood GC, Still CD. Frequencies of Obesity Susceptibility Alleles among Ethnically and Racially Diverse Bariatric Patient Populations. SOARD. 2013; 9(3): 436-441.
Rinella ES, Still CD, Shao Y, Wood GC, Chu X, Salerno B, Gerhard GS, Ostrer H. Genome-wide association of single nucleotide polymorphisms with weight loss outcomes after Roux-en-Y Gastric Bypass surgery. J Clin Endocrinol Metab. 2013; 98(6): E1131-E1136.
Gessert CE, Waring S, Conway P, Bailey-Davis L, Roberts M, VanWormer J. Do rural and urban elders define “health” differently? Gerontologist. 2012; 52: 711.
Matzko M, Argyropoulos G, Wood GC, Chu X, McCarter R, Still C, Gerhard G. Association of Ghrelin Receptor Promoter Polymorphisms with Weight Loss following Roux-en-Y Gastric Bypass Surgery. Obes Surg. 2012; 22(5): 783-790.
Wood GC, Chu X, Manney C, Strodel W, Petrick AT, Gabrielsen J, Seiler J, Carey DJ, Argyropoulos G, Benotti P, Still CD, Gerhard GS. An Electronic Health Record-Enable Obesity Database. BMC Med Inform Decis Mak. 2012; 12(45).
Gerhard G, Chokshi R, Still C, Benotti P, Wood GC, Freedman-Weiss M, Rider C, Petrick A. The influence of iron status and genetic polymorphisms in the HFE gene on the rick for postoperative complications after bariatric surgery: a prospective cohort study in 1,064 patients. Patient Saf Surg. 2011; 5(1).
Kumashiro N, Erion D, Zhang D, Kahn M, Beddow S, Chu X, Still C, Gerhard G, Han X, Dziura J, Petersen K, Samuel V, Shulman G. Cellular Mechanism of Insulin Resistance in Nonalcoholic Fatty Liver Disease. Proc Natl Acad Sci U S A. 2011; 108(39): 16381-16385.
Mirshahi U, Still C, Masker K, Gerhard G, Carey D, Mirshahi T. The MC4R (I251L) Allele is Associated with Better Metabolic Status and more Weight Loss after Gastric Bypass Surgery. J Clin Endocrinol Metab. 2011; 96(12): E2088-E2096.
Still CD, Wood GC, Chu X, Erdman R, Manney CH, Benotti P, Petrick A, Strodel W, Mirshahi UL, Mirshahi T, Carey D, Gerhard G. High Allelic Burden of Four Obesity SNPs Is Associated with Poorer Weight Loss Outcomes Following Gastric Bypass Surgery. Obesity (Silver Spring). 2011; 19(8): 1676-1683.
Samuel V, Beddow S, Iwaski T, Zhang X, Chu X, Still C, Gerhard G, Shulman G. Fasting Hyperglycemia is Not Assoicated with Increased Expression of PEPCK or GGPc in Patients with Type 2 Diabetes. Proc Nat Acad Sci. 2009; 106(29): 12121-6.
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