Inclusion Criteria:
\- Inclusion criteria for patients
* Age \>18 years
* Morbid obesity defined by a BMI ≥ 40 kg/m2
* Prediabetes or diabetes with HbA1C between ≥ 5.7 % OR
* Fasting plasma glucose \> 5.6 mmol/l (\> 100 mg/dl) (no caloric intake for at least 8 hours) OR
* Random plasma glucose \> 11.1 mmol/l (\> 200 mg/dl)
* Informed consent
Inclusion criteria for RYGB-FMT intervention donors
* Sustained total weight loss of ≥30% ≥12 months after RYGB surgery
* HbA1c \< 6.5% without insulin treatment or oral antidiabetic medication
* Age \>18 years
* Informed consent
Inclusion criteria for LEAN-FMT intervention donors
* Normal weight (BMI ≥ 20 to \< 25 \>18 years
* Informed consent
Exclusion Criteria:
Exclusion criteria for patients
• Non-Compliance
* Insulin dependent diabetes mellitus, treated with GLP-1 agonists or poorly controlled on oral antidiabetic medications (HbA1C \> 8%)
* Use of any weight loss medication or participation in a weight loss program
* History of recent body weight change (defined as body weight loss or body weight gain of ≥ 5 kg within the two months preceding study enrolment).
* Use of immunosuppressive medication or immune modulators (glucocorticoids, methotrexate, tacrolimus, cyclosporine, thalidomide, interleukin-10 or -11) within the last three months preceding study enrolment.
* Congenital or acquired immunodeficiencies.
* Anatomical reconstruction of the nutrient passage (i.e. hemicolectomy, resection of small bowel, gastrectomy, sleeve gastrectomy, gastric bypass surgery, biliopancreatic diversion, fundoplication etc) or cholecystectomy.
* Chronic diarrhoea
* History of serious chronic disease including malignancy, rheumatic heart disease, endocarditis, or valvular disease (due to risk of bacteremia)
* Any condition, based on clinical judgment that may make study participation unsafe
* Pregnancy or Breast Feeding
Exclusion criteria for RYGB-FMT intervention donors
* Intake of pre-, pro- or antibiotics within \< 3 months before study entry
* Use of immunosuppressive medication or immune modulators (glucocorticoids, methotrexate, tacrolimus, cyclosporine, thalidomide, interleukin-10 or -11) within the last three months preceding study enrolment.
* Congenital or acquired immunodeficiencies.
* Chronic or acute infectious diseases (specified under 6.2.1)
* Drug abuse
* Anatomical reconstruction of the nutrient passage other than surgical RYGB configuration (i.e. hemicolectomy, resection of small bowel, fundoplication, LSG-to-RYGB transformation etc) or cholecystectomy.
* History of recent body weight change (defined as body weight loss or body weight gain of ≥ 5 kg within the two months preceding study enrolment).
* Chronic diarrhoea or steatorrhea or acute gastrointestinal infection within ≤ 3 months before study entry.
* History of serious chronic disease including malignancy, chronic kidney disease (eGFR \< 60 ml/min), heart failure (NYHA ≥ III).
* Any further condition, based on clinical judgment that may disqualify the candidate as an appropriate donor.
Exclusion Criteria for Lean-FMT Intervention Donors • History of overweight or obesity in the past (BMI \> 25 kg/m2)
• History of recent body weight change (defined as body weight loss or body weight gain of ≥ 5 kg within the two months preceding study enrolment).
• HbA1C \> 6.5% or treatment with insulin or oral anti-diabetic medication.
• Use of any weight loss medication or participation in a weight loss program
• Use of immunosuppressive medication or immune modulators (glucocorticoids, methotrexate, tacrolimus, cyclosporine, thalidomide, interleukin-10 or -11) within the last three months preceding study enrolment.
• Congenital or acquired immunodeficiencies.
• Chronic or acute infectious diseases (specified under 6.2.1)
• Drug abuse
• Anatomical reconstruction of the nutrient passage (i.e. hemicolectomy, resection of small bowel, fundoplication etc) or cholecystectomy.
• Chronic diarrhoea or acute gastrointestinal infection within ≤ 3 months before study entry.
• History of serious chronic disease including malignancy, chronic kidney disease (eGFR \< 60 ml/min), heart failure (NYHA ≥ III).
• Any further condition, based on clinical judgment that may disqualify the candidate as an appropriate donor.