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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…

Obese people undergoing gastric banding surgery typically lose up to half of their excess body weight and go on to live more healthy lives. Flickr/puuikibeach.

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.

AAP AAP

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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10 Comments sorted by

  1. Gavin Moodie
    Gavin Moodie is a Friend of The Conversation.

    Adjunct professor at RMIT University

    I don't know, but mightn't lap band surgery be indicated for only some obese people? Mightn't lifestyle changes be indicated for other obese people? If so, I think the article would have been better had it stated this. The article would have been even more informative had it discussed the proportion of obese people for whom lap band surgery is indicated and effective.

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    1. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Gavin Moodie

      I agree Gavin. Some weight loss groups achieve great and lasting success by encouraging lifestyle changes. In my experience, these groups may be reluctant to publicise their success because they're outdone by those who regain their lost weight and they fear the adverse publicity if they put out results, such as 35% of people maintaining long-term weight loss with their support, they'll be lambasted because 65% don't have long-term success (these figures are not accurate, although they're likely to…

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    2. Charis Palmer

      Deputy Business Editor at The Conversation

      In reply to Rosemary Stanton

      Thanks for your valuable contribution Rosemary. I have also added in some details on the NHMRC guidelines Gavin. I couldn't find stats on how many people end up progressing past diet/exercise to surgery, so if anyone knows of any, please let us know.

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  2. Whyn Carnie

    Retired Engineer

    This article has avoided the well known, inconvenient, side effects of lap banding. It is not permanaent and requires the regular adjustment of the band via the "port. Hence those 81% returning. Some patients (1 in 20?) require premature removal due to complications brought about by patient abuse or incorrect installation. The gastric band industry does very well out of these support group articles.

    There are other procedures that work as well with even less subsequent problems, and this type…

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  3. Cheryl Huckel

    Student

    After spending a lifetime of yo yo dieting I've found that by removing sugar from my diet that finally my hunger is under control. I managed a weight loss of 8 kilos in the past year without having to track food or have an exercise plan.

    I'm a carer as well and as Ms Stanton has stated many of us who care use food as a comfort so my weight loss isn't as dramatic as some may expect but at least it is a loss. The times when I've slipped due to stress have had some impact but at least overall there…

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  4. tim mande-jones

    doctor

    Lapbanding should be thought of as an aid to weight loss.It is not a cure for obesity. It can easily be beaten if the patient chooses to drink lots of coke and eat chocolate, so proper diet is also vital component.
    There is also now gastric sleeve surgey where the stomach is thinned to a sleeve. This is more radical surgery but does not require lapband port adjustments and other problems with lapbands.

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    1. Clem Campbell

      Sustainability practioner

      In reply to tim mande-jones

      Are there any results for the number of patients who didn't lose any significant weight or had complications from the surgery.

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    2. Charis Palmer

      Deputy Business Editor at The Conversation

      In reply to Clem Campbell

      Hi Clem, Dr O'Brien said about 5% were considered 'failed' procedures - it's deemed a failure when patients don't lose at least 25% of ther excess weight

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    3. Whyn Carnie

      Retired Engineer

      In reply to Charis Palmer

      Have had a gastric laparoscopy 4 years ago. The surgeon was very thorough in the preop and postop info sessions. If his advisories were followed to best of my ability he guaranteed success. They were, I lost 35Kg over 2 years after 15 wasted years of see-saw trying (I varied from 145Kg to 115Kg) and am now Type II diabetes symptom free, cholesterol normal, free of hypertension, didn't need pending knee replacement, didn't need pending 2nd hip revision, don't snore at night,but best of all I can walk anywhere, climb stairs, work around the house fit into aircraft seats and generally do all the things I did before, making lives of my wife, family and I that much more enjoyable.
      You can fool it, and all those in my cohort who tried would be those 5% failures. Several because they kept on drinking heavily. I was able to have the odd drink throughout and never missed the rest.

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  5. Kaye Hargreaves

    Retired

    I had the Lapband operation in 2003. My surgeon was Mr Stewart Skinner, at The Avenue, working under Prof. O'Brien's auspices. I weighed 165 kg at the time. I developed severe osteo-arthritis in both hips, and my orthopedic surgeon would not operate until I got down to 100 kg. I achieved that by the end of 2010 and had two hip replacement operations in 2011. At the time of surgery I was 87 kg.

    This should go down in history as one of the stunning success stories of the lapband procedure. To give…

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