Intensive Medical Weight Loss or Laparoscopic Adjustable Gastric Banding in the Treatment of Mild to Moderate Obesity: Long-Term Follow-up of a Prospective Randomised Trial
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Proven short-term effectiveness of obesity therapy should be re-evaluated in the long-term. The objective of this paper is to determine the long-term (10 years) outcome for patients from a randomised controlled trial (RCT).
A RCT in 2002 compared laparoscopic adjustable gastric band (LAGB) for obesity with non-surgical therapy. Follow-up has been conducted at 10 years. Eighty patients (BMI 30–35) were randomised to a non-surgical or a surgical program. Outcome data are available on 37 (92.5 %) of the surgical patients and 27 (62.5 %) of the non-surgical patients at 10 years.
Weight change, the metabolic syndrome, quality of life, adverse events and direct costs of the surgical cohort were the main results of the study. A durable weight loss is present in the surgical group with a mean (SD) 10-year weight loss of 14.1 (7.7) kg (63.4 % EWL), better than the non-surgical group (mean (SD) = 0.4 (10.5) kg; p < 0.001). The metabolic syndrome was reduced from 14 to 4 of the 37 patients who completed 10 years within the LAGB groups. Proximal gastric enlargements occurred in 17 (30 %) of the 57 who had LAGB and removal of the band occurred in 7 (12 %). The annual maintenance costs including additional surgery was AUD $765 per patient per year.
Bariatric surgery with the LAGB can achieve long-term weight reduction which is better than a program of non-surgical therapy. There is also a sustained reduction of the metabolic syndrome. There is a significant maintenance requirement after LAGB.
- Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among us adults, 1999–2010. JAMA. 2012;307:491–7. CrossRef
- World Health Organization. Obesity and overweight fact sheet no 311. 2011.
- Avenell A, Brown TJ, McGee MA, et al. What are the long-term benefits of weight reducing diets in adults? A systematic review of randomized controlled trials. J Hum Nutr Diet. 2004;17:317–35. CrossRef
- Avenell A, Brown TJ, McGee MA, et al. What interventions should we add to weight reducing diets in adults with obesity? A systematic review of randomized controlled trials of adding drug therapy, exercise, behaviour therapy or combinations of these interventions. J Hum Nutr Diet. 2004;17:293–316. CrossRef
- Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37. CrossRef
- Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004;135:326–51. CrossRef
- Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59. CrossRef
- O’Brien P, McPhail T, Chaston T, et al. Systematic review of medium term weight loss after bariatric surgery. Obes Surg. 2006;16:1032–40. CrossRef
- Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445–54. CrossRef
- O’Brien P, McDonald L, Anderson M, et al. Long term outcomes after bariatric surgery: fifteen year follow up after gastric banding and a systematic review of the literature. Ann Surg. 2013;257:87–94. CrossRef
- Cobourn C, Mumford D, Chapman MA, et al. Laparoscopic gastric banding is safe in outpatient surgical centers. Obes Surg. 2010;20:415–22. CrossRef
- O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144:625–33. CrossRef
- Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–23. CrossRef
- Keating CL, Dixon JB, Moodie ML, et al. Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis. Diabetes Care. 2009;32:567–74. CrossRef
- Keating CL, Dixon JB, Moodie ML, et al. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care. 2009;32:580–4. CrossRef
- Picot J, Jones J, Coquitt JL, et al. Weight loss surgery for mild to moderate obesity: a systematic review and economic evaluation. Obes Surg. 2012;22:1496–506. CrossRef
- Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among us adults: findings from the third national health and nutrition examination survey. JAMA. 2002;287:356–9. CrossRef
- Ware J. Sf-36 health survey: manual and interpretation guide. Boston: The Health institute, New England Medical Center; 1997.
- Statistics ABo. National health survey Sf-36 population norms for Australia. 1995.
- Miller K, Pump A, Hell E. Vertical banded gastroplasty versus adjustable gastric banding: prospective long-term follow-up study. Surg Obes Relat Dis. 2007;3:84–90. CrossRef
- Favretti F, Segato G, Ashton D, et al. Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results. Obes Surg. 2007;17:168–75. CrossRef
- Lanthaler M, Aigner F, Kinzl J, et al. Long-term results and complications following adjustable gastric banding. Obes Surg. 2010;20:1078–85. CrossRef
- Naef M, Mouton W, Naef U, et al. Graft survival and complications after laparoscopic gastric banding for morbid obesity—lessons learned from a 12-year experience. Obes Surg. 2010;20:1206–14. CrossRef
- Himpens J, Cadiere GB, Bazi M, et al. Long-term outcomes of laparoscopic adjustable gastric banding. Arch Surg. 2011;146:802–7. CrossRef
- Stroh C, Hohmann U, Schramm H, et al. Fourteen-year long-term results after gastric banding. Journal of Obesity. 2011;2011:128451–7. CrossRef
- Fobi MA. Vertical banded gastroplasty vs gastric bypass: 10 years follow-up. Obes Surg. 1993;3:161–4. CrossRef
- Wolfel R, Gunther K, Rumenapf G, et al. Weight reduction after gastric bypass and horizontal gastroplasty for morbid obesity. Results after 10 years. Eur J Surg. 1994;160:219–25.
- Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50. CrossRef
- Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237:751–6. discussion 757–758.
- Günther K, Vollmuth J, Weißbach R, et al. Weight reduction after an early version of the open gastric bypass for morbid obesity: results after 23 years. Obes Surg. 2006;16:288–96. CrossRef
- Christou NV, Look D, MacLean LD. Weight gain after short- and long-term gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40. CrossRef
- Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52. CrossRef
- Higa K, Ho T, Tercero F, et al. Laparoscopic roux-en-y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7:516–25. CrossRef
- Hall JC, Watts JM, O’Brien PE, et al. Gastric surgery for morbid obesity. The Adelaide study Annals of Surgery. 1990;211:419–27. CrossRef
- O’Brien PE, Dixon JB. Pars flaccida versus perigastric pathways for the placement of the lapband(r) system (abstract). Obes Surg. 2003;13:211.
- Dixon AF, Dixon JB, O’Brien PE. Laparoscopic adjustable gastric banding induces prolonged satiety: a randomized blind crossover study. J Clin Endocrinol Metab. 2005;90:813–9. CrossRef
- Burton PR, Yap K, Brown WA, et al. Changes in satiety, supra- and infraband transit, and gastric emptying following laparoscopic adjustable gastric banding: a prospective follow-up study. Obes Surg. 2011;21:217–23. CrossRef
- Clinical Issues Committee A. Bariatric surgery in class I obesity (body mass index 30–35 kg/m(2)). Surg Obes Relat Dis. 2013;9:e1–e10. CrossRef
- Intensive Medical Weight Loss or Laparoscopic Adjustable Gastric Banding in the Treatment of Mild to Moderate Obesity: Long-Term Follow-up of a Prospective Randomised Trial
Volume 23, Issue 9 , pp 1345-1353
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Long-term weight loss
- Class I obesity
- Metabolic syndrome
- Industry Sectors
- Author Affiliations
- 1. Centre for Obesity Research and Education, Monash University, Melbourne, Australia
- 2. Centre for Obesity Research and Education, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, 3004, Australia