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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Treating Obesity: Laparoscopic Gastric Banding versus a Nonsurgical Weight Loss Program
2 May 2006 | Volume 144 Issue 9 | Page I-12
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Treatment of Mild to Moderate Obesity with Laparoscopic Adjustable Gastric Banding or an Intensive Medical Program. A Randomized Trial." It is in the 2 May 2006 issue of Annals of Internal Medicine (volume 144, pages 625-633). The authors are P.E. O'Brien, J.B. Dixon, C. Laurie, S. Skinner, J. Proietto, J. McNeil, B. Strauss, S. Marks, L. Schachter, L. Chapman, and M. Anderson.
What is the problem and what is known about it so far?
Surgical treatment of obesity includes a variety of procedures to reduce the size of the stomach so that people feel full after eating small amounts. Studies suggest that surgical treatments can result in substantial weight loss, but few good studies have compared surgical and nonsurgical treatments for obesity. A newer obesity surgery, laparoscopic adjustable gastric banding, involves placing an adjustable band around the stomach. Laparoscopic means that the surgeons perform the procedure through a small cut in the abdomen with a special device that helps them see what they are doing once the device is inside the patient's body. The effectiveness and safety of laparoscopic gastric banding compared with nonsurgical weight loss programs is unknown.
Why did the researchers do this particular study?
To compare weight change and complications after laparoscopic gastric banding with a nonsurgical program.
Who was studied?
80 obese patients with body mass index (BMI) of 30 kg/m2 to 35 kg/m2. Body mass index indicates whether a person is of appropriate weight by dividing a person's weight (in kilograms) by the person's height (in meters2). Normal BMI is between 18.5 kg/m2 and 25 kg/m2. People with BMIs less than 18.5 kg/m2 are underweight, people with BMIs of 25 kg/m2 to 30 kg/m2 are overweight, and people with BMIs of 30 kg/m2 or greater are obese.
How was the study done?
Patients were randomly assigned to treatment with either laparoscopic gastric banding or a nonsurgical program. Nonsurgical treatment involved very-low-calorie diets, weight loss drugs, and behavioral change to improve diet and exercise habits. The researchers measured weight change and the presence of the metabolic syndrome. The metabolic syndrome is a condition in which people have at least 3 of the following abnormalities: overweight, high blood pressure, high triglyceride levels (a bad type of fat in the blood), low high-density lipoprotein cholesterol levels ("good" cholesterol), and high blood sugar levels. People with the metabolic syndrome are at risk for diabetes and heart disease. The researchers also evaluated patients' quality of life and side effects.
What did the researchers find?
After 24 months, patients who had gastric banding lost an average of 21.6% of their initial body weight compared with 5.5% in the nonsurgical group. Before treatment, 15 patients in each group had the metabolic syndrome. After 24 months, 1 patient in the banding group and 8 patients in the nonsurgical group had the metabolic syndrome. Quality of life at 24 months was better in the surgical group than in the nonsurgical group. The study did not find differences in side effects.
What were the limitations of the study?
The study was small and had limited ability to evaluate side effects. In addition, it did not include severely obese patients and evaluated outcomes only after 24 months.
What are the implications of the study?
Laparoscopic adjustable gastric banding resulted in more weight loss and improvements in the metabolic syndrome and quality of life after 24 months compared with nonsurgical treatment that involved very-low-calorie diets, weight loss drugs, and behavioral change. Further study is needed to evaluate long-term outcomes and side effects.
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