Gastric Banding for Patients with a BMI of ≤ 35 kg/m2
Gastric Banding for Patients with a BMI of ≤ 35 kg/m2
Abstract & Commentary
By Richard Peterson, MD, MPH, Clinical Instructor of Surgery, Department of Surgery, USC. Dr. Peterson reports no financial relationships relevant to this field of study.
Synopsis: With additional study, it is reasonable to expect the weight guidelines for gastric banding to be altered to include patients with a BMI of 30-35 kg/m2.
Source: Parikh M, et al. Laparoscopic adjustable gastric banding for patients with body mass index of ≤ 35 kg/m2. Surg Obes Relat Dis. 2006;2:518-522.
Background: Many mild-to-moderately obese individuals (body mass index [BMI] 30-35 kg/m2) have serious diseases related to their obesity. Nonoperative therapy is ineffective in the long term, yet surgery has never been made widely available to this population.
Methods: Between 1996 and 2004, 93 patients with a BMI of 30-35 kg/m2 underwent Laparoscopic Adjustable Gastric Banding (LAGB) with the LAP-BAND. All patients were referred by their primary physician, entered into a comprehensive bariatric surgery program at one Australian center, and were operated on by one surgeon. Data on all patients were collected prospectively and entered into an electronic registry. The study parameters included perioperative age, gender, BMI, presence of co-morbidities, percentage of excess weight loss, and resolution of comorbidities.
Results: The mean age was 44.6 years (range, 16-76), the mean weight loss was 98 kg, and the mean BMI was 32.7 kg/m2 (30-34). Of the 93 patients, 42 (45%) had co-morbidities, including asthma, diabetes, hypertension, and sleep apnea. The proportion of patients in follow-up was 79%, 85%, and 89% at 1, 2, and 3 years, respectively. The mean weight was reduced to 71 kg at one year, 72 kg at 2 years, and 72 kg at 3 years. The mean BMI was reduced to 27.2 ± 2.2, 27.3 ± 3.1, and 27.6 ± 3.7 kg/m2, respectively, and the mean percentage of excess body weight loss was 57.9% ± 24.5%, 57.6% ± 29.3%, 53.8% ± 32.8% at 1, 2, and 3 years, respectively.
Commentary
Parikh and colleagues pose an interesting concept in the treatment of obesity. They referred multiple patients during an 8-year period that, according to current National Institutes of Health (NIH) guidelines, would be ineligible for weight reduction surgery. The patients in this group all had BMI's ≤ 35kg/m2. However, even in this "mild-to-moderately" obese population, obesity-related comorbidities can take their toll on patients. They attempted to determine if use of LAGB would prove beneficial in this set of patients.
The results in this group showed an improvement, if not complete resolution, of associated comorbidities after placement of the band and a concomitant reduction in weight. Parikh et al do discuss that, although the average weight loss of 20-25 kg (44-55 lbs) may not seem like a substantial number to justify the risk of surgery, it is a sustainable loss of weight that they perceive as the ultimate benefit. In this series, the weight loss was sustained for 3 years. This marks a major point in obesity. Patients that present for surgery are typically there as a last resort. Most, if not all patients have lost hundreds of pounds over the course of their lives, but it is sustaining the weight loss that they all grapple with.
The data in this series is also supported in the literature, showing that even with the LAGB, a reduction in Excess Body Weight Loss (EBWL) of approximately 50% has been shown to dramatically improve associated comorbidities. Most series also report a 40%-50% EBWL at one year with the LAGB.
It is the less invasive aspect of the LAGB that is attractive to both patients and surgeons. Parikh et al present that with a BMI of 27 kg/m2 or less, there was virtually complete resolution or improvement in associated comorbidities. They contend that patients who have previously not been considered for surgical therapy of their obesity (BMI 30-35 kg/m2) should be considered, given the efficacy of the procedure.
With additional study, it is reasonable to expect the weight guidelines for gastric banding to be altered to include patients with a BMI of 30-35 kg/m(2).Subscribe Now for Access
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