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
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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.
KeywordsLong-term weight loss LAGB Class I obesity Metabolic syndrome RCT
Conflict of Interest Disclosure Statement
The Centre for Obesity Research and Education (CORE) at Monash University receives grants from Allergan Inc and Applied Medical for research and educational support. The grants are not tied to any specified research projects and the grantors has no control of the protocol, analysis and reporting of any studies.
Dr. Wendy Brown received an Honorarium from Allergan to attend a Surgical Advisory Panel in London in 2009.
Dr Paul O’Brien has written a patient information book entitled "The Lap-Band Solution: A Partnership for Weight Loss" which is given to patients without charge but some are sold to surgeons and others for which he receives a royalty. He is employed as the National Medical Director for the American Institute of Gastric Banding, a multicenter facility, based in Dallas, Texas, that treats obesity predominantly by gastric banding.
The study has been funded by a research grants from Monash University and from Inamed Health, manufacturer of the Lap-Band system. Equipment, devices and products were provided by Inamed Health, Novartis, manufacturer of Optifast and Applied Medical and US Surgical, manufacturers of laparoscopic disposable equipment.
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