Obesity Surgery

, 19:3

Successful Multi-Intervention Treatment of Severe Obesity: A 7-year Prospective Study with 96% Follow-up

  • Rudolf Steffen
  • Natascha Potoczna
  • Norman Bieri
  • Fritz F. Horber
Research Article

Abstract

Background

No long-term, high participation study of the outcome of bariatric surgery has examined how a multi-intervention approach to the treatment of severe obesity can achieve and sustain weight loss after an initial bariatric procedure.

Methods

We employed a multi-intervention treatment that combines adjustable gastric banding with intensive follow-up to support patient life-style change and use of an algorithm allowing reoperation—to bypass, if necessary—in the event of complications. Four hundred four severely obese patients with an average BMI = 42.6 at the outset had initial AGB surgery and were followed with a high rate of face-to-face consultations for 7 years. Seventy-five percent of the patients retained a gastric band throughout the study. Weight loss, complications, and comorbidities were studied, and quality of life was assessed using Bariatric Analysis and Reporting Outcome System (BAROS).

Results

Three hundred eighty-eight (96%) patients completed the 7-year follow-up. Average BMI reduction at 5 years was 28% and remained stable through year 7, at which the mean excess weight loss was 61%. The preoperative prevalence of metabolic syndrome, 59.7%, decreased to 13.3% at 7 years and was abolished for patients with more than 40% loss of initial BMI. Similar changes were seen for all components of metabolic syndrome. More than 60% of patients had a “good” or higher BAROS score; 10.1% were considered failures. Patients converted to gastric bypass, and those retaining gastric bands throughout the study had very similar outcomes.

Conclusions

Long-term, multi-intervention treatment of severe obesity can achieve and preserve weight loss and thus improved quality of life and sustained reduction or disappearance of all components of metabolic syndrome, for a high proportion of severely obese patients with preoperative BMI between 35 and 55.

Keywords

Severe obesity Gastric banding Metabolic syndrome Quality of life BAROS Long-term outcome Multi-intervention strategy 

References

  1. 1.
    Sjöström L, Lindroos AK, Peltonen M, et al. Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.PubMedCrossRefGoogle Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  3. 3.
    DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007;356:2176–83.PubMedCrossRefGoogle Scholar
  4. 4.
    Suter M, Calmes JM, Paroz A, et al. A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg. 2006;16:829–35, Jul.PubMedCrossRefGoogle Scholar
  5. 5.
    Weber M, Müller MK, Michel JM, et al. Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg. 2003;238:827–34.PubMedCrossRefGoogle Scholar
  6. 6.
    O’Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–40, Aug.PubMedCrossRefGoogle Scholar
  7. 7.
    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, Epub 2006 Nov 2.PubMedCrossRefGoogle Scholar
  8. 8.
    Hauri P, Steffen R, Ricklin T, et al. Treatment of morbid obesity with the Swedish Adjustable Gastric Band (SAGB): complication rate during a 12-month follow-up period. Surgery 2000;127:484–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Anwar M, Collins J, Kow L, et al. Long-term efficacy of a low-pressure adjustable gastric band in the treatment of morbid obesity. Ann Surg. 2008;247:771–78.PubMedCrossRefGoogle Scholar
  10. 10.
    Biagini J, Karam L. Ten years experience with laparoscopic adjustable gastric banding. Obes Surg. 2008;18:573–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Melissas J. IFSO guidelines for safety, quality, and excellence in bariatric surgery. Obes Surg. 2008;18:497–500.PubMedCrossRefGoogle Scholar
  12. 12.
    National Institutes of Health Consensus Development Conference Draft Statement. Gastrointestinal surgery for severe obesity 25–27 March. Obes Surg. 1991;1:257–65.CrossRefGoogle Scholar
  13. 13.
    Biertho L, Steffen R, Branson R, et al. Management of failed adjustable gastric banding. Surgery 2005;137:33–41.PubMedCrossRefGoogle Scholar
  14. 14.
    Oria HE, Moorehead MK. Bariatric Analysis and Reporting Outcome System (BAROS). Obes Surg. 1998;8:487–99.PubMedCrossRefGoogle Scholar
  15. 15.
    Baldinger R, Münch R, Steffen R, et al. Conservative management of intragastric migration of Swedish adjustable gastric band by endoscopic retrieval. Gastrointest Endosc. 2001;53:98–101.PubMedCrossRefGoogle Scholar
  16. 16.
    O’Brien PE, Dixon JB. Laparoscopic adjustable gastric banding in the treatment of morbid obesity. Arch Surg. 2003;138:376–82.PubMedCrossRefGoogle Scholar
  17. 17.
    Weiner R, Blanco-Engert R, Weiner S, et al. Outcome after laparoscopic adjustable gastric banding—8 years experience. Obes Surg. 2003;13:427–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Mattar SG, Velcu LM, Rabinovitz M, et al. Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg. 2005;242:610–7, Discussion 618–20.PubMedGoogle Scholar
  19. 19.
    Madan AK, Orth W, Ternovits CA, et al. Metabolic syndrome: yet another co-morbidity gastric bypass helps cure. Surg Obes Relat Dis. 2006;2:48–51.PubMedCrossRefGoogle Scholar
  20. 20.
    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–249.CrossRefGoogle Scholar
  21. 21.
    Potoczna N, Branson R, Kral JG, et al. Gene variants and binge eating as predictors of comorbidity and outcome of treatment in severe obesity. J Gastrointest Surg. 2004;8:971–82.PubMedCrossRefGoogle Scholar
  22. 22.
    Moorehead MK, Ardelt-Gattinger E, Lechner H, et al. The validation of the Moorehead–Ardelt Quality of Life Questionnaire II. Obes Surg. 2003;13:684–92.PubMedCrossRefGoogle Scholar
  23. 23.
    Gould JC, Beverstein G, Reinhardt S, et al. Impact of routine and long-term follow-up on weight loss after laparoscopic gastric bypass. Surg Obes Relat Dis. 2007;3:627–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Shen R, Dugay G, Rajaram K, et al. Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg. 2004;14:514–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Chiolero A, Faeh D, Paccaud F, et al. Consequences of smoking for body weight, body fat distribution, and insulin resistance. Am J Clin Nutr. 2008;87:801–9.PubMedGoogle Scholar
  26. 26.
    Branson R, Potoczna N, Brunotte R, et al. Impact of age, sex and body mass index on outcomes at four years after gastric banding. Obes Surg. 2005;15:834–42.PubMedCrossRefGoogle Scholar
  27. 27.
    Kral JG, Lentes KU, Horber FF. Binge eating as a phenotype of melanocortin 4 receptor gene mutations. N Engl J Med. 2003;349:608–9.Google Scholar
  28. 28.
    Martikainen T, Pirinen E, Alhava E, et al. Long-term results, late complications and quality of life in a series of adjustable gastric banding. Obes Surg. 2004;14:648–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Dargent J. Surgical treatment of morbid obesity by adjustable gastric band: the case for a conservative strategy in the case of failure—a 9-year series. Obes Surg. 2004;14:986–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Naef M, Naef U, Mouton WG, et al. Outcome and complications after laparoscopic Swedish adjustable gastric banding: 5-year results of a prospective clinical trial. Obes Surg. 2007;17:195–201.PubMedCrossRefGoogle Scholar
  31. 31.
    Chevallier JM, Zinzindohoué F, Douard R, et al. Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years. Obes Surg. 2004;14:407–14.PubMedCrossRefGoogle Scholar
  32. 32.
    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.PubMedCrossRefGoogle Scholar
  33. 33.
    van Wageningen B, Berends FJ, Van Ramshorst B, et al. Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg. 2006;16:137–41.PubMedCrossRefGoogle Scholar
  34. 34.
    Mognol P, Chosidow D, Marmuse JP. Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg. 2004;14:1349–53.PubMedCrossRefGoogle Scholar
  35. 35.
    Calmes JM, Giusti V, Suter M. Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg. 2005;15:316–22.PubMedCrossRefGoogle Scholar
  36. 36.
    le Roux CW, Welbourn R, Werling M, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246:780–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Moo TA, Rubino F. Gastrointestinal surgery as treatment for type 2 diabetes. Curr Opin Endocrinol Diabetes Obes. 2008;15:153–8.PubMedGoogle Scholar
  38. 38.
    Pories WJ, MacDonald KG, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10-year follow-up. Am J Clin Nutr. 1992;55:582S–5.PubMedGoogle Scholar
  39. 39.
    Karlsson J, Taft C, Rydén A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31:1248–61. Aug, Epub 2007 Mar 13CrossRefGoogle Scholar
  40. 40.
    Müller MK, Wenger C, Schiesser M et al. Quality of life after bariatric surgery—a comparative study of laparoscopic banding vs. bypass. Obes Surg 2008; May 7, doi:10.1007/s11695-008-9522-y.
  41. 41.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.PubMedCrossRefGoogle Scholar
  42. 42.
    Sjöström L, Narbro K, Sjöström CD, et al. Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.PubMedCrossRefGoogle Scholar
  43. 43.
    Korenkov M, Sauerland S. Clinical update: bariatric surgery. Lancet 2007;370:1988–90.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Rudolf Steffen
    • 2
  • Natascha Potoczna
    • 1
  • Norman Bieri
    • 1
  • Fritz F. Horber
    • 1
  1. 1.Department of Surgery and Internal MedicineKlinik LindbergWinterthurSwitzerland
  2. 2.Private Praxis Dr. SteffenBernSwitzerland

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