DOC News July 1, 2006
Volume 3 Number 7 p. 21
© 2006 American Diabetes Association
Lap Band Compares Favorably to Intensive Medical Management
People struggling with obesity have limited options. Good management withimproved dietary habits, increased physical activity, behavioral therapy, anddrug therapy produces mixed results, often with weight loss that is eventuallyregained over the long term. Malabsorptive bariatric surgery has beenavailable for a long time, with risks and benefits that must be carefullyweighed for each patient.
The advent of laparoscopic gastric banding—a procedure less invasivethan traditional gastric bypass surgery—seems to have significantlytipped the risk/benefit scales. The procedure often can be done with one dayof hospitalization and overall has a low rate of morbidity. But little isknown about the long-term results among people with mild to moderate obesitycompared with an intensive medical managementprogram.
A group of Australian investigators conducted a randomized, controlledtrial of surgical and nonsurgical weight-loss approaches in 80 adults withmild to moderate obesity, with a body mass index (BMI) of 30–35.Participants were assigned to undergo a 24-month program of intensive medicalmanagement that included very-low-calorie diets, drug therapy, and biweeklyvisits to the medical office, or to receive an adjustable gastric band.
At the end of 24 months, members of the surgical group lost an average of21.6% of initial weight and 87.2% of excess weight, a term used mainly bybariatric physicians that refers to how much excess weight above ideal weightwas lost. Those in the nonsurgical group lost an average of 5.5% of initialweight and 21.8% of excess weight. The surgical group had fewer relatedmedical disorders and reported a greater quality of life.
Laparoscopic gastric banding, which has been shown safe and effective inmore severely obese patients, may be considered an option more often for thosewith mild to moderate obesity, the group concludes.
O'Brien PE, Dixon JB, Laurie C, et al.: Treatment of mildto moderate obesity with laparoscopic adjustable gastric banding or anintensive medical program. Ann Int Med 144: 625–633, 2006[Abstract/Free Full Text]
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