Lap banding a long-term obesity solution: study

Lap band surgery is an effective long-term measure for managing obesity, according to a 15-year study of thousands of patients who have undergone the procedure.

The study, from Monash University’s Centre for Obesity Research and Education, analysed the results in 3,227 patients who had gastric banding between 1994, when the procedure was first introduced, and 2011.

It found on average patients undergoing the procedure had lost 26kg, or almost half of their excess weight.

The study, published in Annals of Surgery, also included a meta-analysis of all gastric banding studies that included weight loss data at or beyond 10 years.

“It shows, on average, the band patients going out beyond 10 years have lost 54% of their excess weight,” said Dr Paul O’Brien, director of the Centre for Obesity Research & Education & Emeritus Professor of Surgery at Monash University.

About one in four adults in Australia are obese, with the prevalence of the disease increasing rapidly from 8% in 1980 to 23% in 2008.

The National Health and Medical Research Council recommends bariatric surgery should be considered only if nonoperative measures, such as diet and exercise, have failed. And in that case it’s only recommended for patients with a BMI greater than 40, or with a BMI greater than 35 and a number of serious illnesses.

Because obesity is a chronic disease, Dr O’Brien and colleagues write in their paper that any proposed obesity treatment should be expected to demonstrate long-term durability to be considered effective.

“These results show that when you have a significant problem with obesity, a long-term solution is available,” Professor O’Brien said.

He added that there were also important ramifications for the control of type 2 diabetes, which was strongly associated with being overweight. “In obese patients with type 2 diabetes, weight loss after gastric banding can lead to effective control of blood sugar levels without the need for medication in about three-quarters of cases,” Professor O’Brien said.

The patients included in the study had followed the rules of their treating team regarding eating, exercise and activity and committed to returning permanently to the aftercare program.

“It’s a very important part of getting a good result,” Dr O’Brien said, adding that about 81% of patients had continued to return for care. About one in 20 patients had the band removed during the study period.

A review of the effects of bariatric surgery conducted by the Garvan Institute of Medical Research last year found some types or the surgery may cause bone loss, particularly when carried out on young people who have not yet reached their peak bone mass.

“Even though we don’t yet understand all the mechanisms, we can see that the more radical the procedure, the greater the bone loss long-term,” said Malgorzata Brzozowska, an endocrinologist from the Garvan Institute.

Dr O'Brien said while bone health was an important issue to consider after gastric bypass surgery, it wasn’t a problem after lap banding.

“We haven’t found a problem and we’re not expecting a problem with any deficiency because they should absorb food normally,” Dr O'Brien said.

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