Treatment of Mild to Moderate Obesity with Laparoscopic Adjustable Gastric Banding or an Intensive Medical Program
Ann Int Med, Volume 144, Number 9. 625- 634 2 May 2006
Paul E. O'Brien, MD; John Dixon, MBBS, PhD; Cheryl Laurie,
Background: Obesity is a major, growing health problem. Observational studies suggest that bariatric surgery is more effective than nonsurgical therapy, but no randomized, controlled trials have confirmed this
Objective: To ascertain whether surgical therapy for obesity achieves better weight loss, health,and quality of life than nonsurgical therapy
Design: Randomised, controlled trial
Setting: University departments of medicine and surgery and an affiliated private hospital
Patients: 80 adults with mild to moderate obesity (body mass index 30 kg/m2 to 35 kg/m2) from the general community
Interventions: Patients were assigned to a program of very-low-calorie diets, pharmacotherapy and lifestyle change for 24 months (non surgical group) or to placement of a laparoscopic adjustable gastric band (LAP-BAND system, INAMED Health, Santa Barbara, California) (surgical group)
Measurements: Outcome measures were weight change, presence of the metabolic syndrome and change in quality of life at 2 years.
Results: At 2 years, the surgical group had greater weight loss, with a mean of 21.6% (95% CI, 19.3% to 23.9%) of initial weight lost and 87.2% (CI 77.7% to 96.6%) of excess weight lost, while the non-surgical group had a loss of 5.5% (CI 3.2% to 7.9%) of initial weight and 21.8% (CI 11.9% to 31.6%) of excess weight (P< 0.0001). The metabolic symdrome was initially present in 15 (38%) patients in each group and was present in 8 (24%) non-surgical patients and 1 (3%) surgical patient at the completion of the study (P<0.0002). Quality of life improved statistically significantly more in the surgical group (8 of 8 subscores of Short-Form 36) than in the non-surgical group (3 of 8 subscores)
Limitations: The study included mildly and moderately obese participants, was not powered for comparison of adverse events and examined outcomes only for 24 months.
Conclusions: Surgical treatment using laparoscopic adjustable gastric banding was statistically significantly more effective than non-surgical therapy in reducing weight, resolving the metabolic syndrome, and improving quality of life during a 24 month treatment program.
At Healthier Weight Centres we believe that obesity surgery is a fine option for some people but others do very, very well on our medically supervised weight loss programme. Our new revised programme (available from September 2006) places enormous emphasis on weight maintenance.
