A study released today in the Archives of Surgery concludes that a type of weight-loss surgery, laparoscopic adjustable gastric banding, offers relatively poor long-term outcomes in extremely overweight patients.
The findings come a few weeks after guidelines issued by the American Heart Association suggested that weight-loss surgery is an appropriate treatment for those with morbid obesity (defined as having a body mass index [BMI] greater than 40) and the US Food and Drug Administration approved use of an adjustable gastric banding device for patients with a BMI as low as 30 who also have an obesity-related condition, such as type 2 diabetes, hypertension, or sleep apnea.
In the Archives article, lead author Jacques Himpens, MD, of the European School of Laparoscopic Surgery, Saint Pierre University Hospital in Brussels, Belgium, and colleagues assessed 82 patients with morbid obesity, some of whom also had an obesity-related condition, who underwent laparoscopic adjustable gastric banding at least 12 years ago. Study participants reduced their excess weight by 42.8%, going from a mean BMI of 41.57 to 33.79. But the proportion having hypertension, type 2 diabetes, or sleep apnea had increased. Furthermore, 39% had experienced a major complication and 60% had undergone at least one additional surgery. Ultimately, nearly half had the banding device removed. Even so, 60% of patients said they were satisfied with the procedure’s results.
Himpens explains that some people have a misconception about the role of surgery in treating morbid obesity:
“Surgery is not the answer to reducing morbid obesity. Surgery can play a part, but we should be more focused on changing patient behavior—reducing the amount of food eaten at a meal and eliminating snacking.
“The increased proportion of those with the comorbid conditions—that includes people who had diabetes or hypertension when they underwent the procedure and those who developed it during the follow-up due to weight gain—reminds us that the positive effects of banding wear off and these conditions evolve and emerge over time.
“As for why most people feel satisfied after undergoing the procedure, even if they have [the gastric band] removed, I think it is because they do not feel guilty any more. They did something, and if it failed, at least they tried.”