Obesity represents a worldwide health problem with an increasing incidence among adults. For this reason the University of Bristol started a study named BY-BAND, aimed to compare two commonly surgeries used in practice to treat morbid obesity. Due to the fact that obesity surgery increase the quality of life, this study will compare stomach bypass operation and stomach band operation, in terms of effectiveness and clinical benefit for patients, as until now is not known for sure which type of surgical intervention has a better prognosis.
“Obesity is an increasing health problem in the UK, which is predicted to worsen. Current national guidelines recommend that surgery should be considered for morbidly obese people or for those remaining obese after trying other options. The BY-BAND study will compare two types of operation, gastric bypass and gastric banding, to find out which one has the greater benefits”, said the leader of the study, Professor Jane Blazeby, Upper GI Surgeon.
The main goal of this study is to compare during a period of three years which type of this two surgical interventions will lead to major changes in body weight in a shorter time period and will also better improve the quality of life of obese patients.
The study will include over 700 patients with morbid obesity in randomized trials and for the results to be more objective, researchers will take into account possible complications which may arise at the time of the surgical intervention and in the next three years. One half of patients will be treated with gastric band intervention and the other half with gastric bypass. Due to the fact that none of these two surgical interventions are new, nor in the experimental experimental and both used in the current medical practice, the type of surgical intervention will be randomly decided by researchers. Patients will be asked to answer to a series of questions about their quality of life for the future studies regarding obesity and also asked to donate two blood samples.
Current Types of Morbid Obesity Treatment
Medical interventions for severe clinical obesity include:
(1) Very-low-calorie (or liquid) diet, exercise therapy, lifestyle counseling.
The average medical weight reduction trial using this treatment method is a 10-12 week study with average weight loss of 5.5 pounds.
(2) Use of weight loss drugs in combination with diet and exercise therapy.
In a 4-year study, incorporating the use of obesity drugs, behavior modification, diet and exercise, the final average weight loss was 3 pounds in those who were followed for the four years of the study.
(3) Bariatric obesity surgery (eg. gastric bypass, banding, stomach gastrectomy) with post-operative dietary and exercise regime.
According to most surveys of patients after gastric surgery, the beneficial results of obesity surgery exceed all other treatment methods by a significant margin. Even allowing for weight regain, which typically is much higher among patients after stomach banding than stomach bypass, weight loss after bariatric treatment regularly averages 30-40 percent of initial starting weight. If the patient is well motivated and given lifelong support, the weight loss is usually permanent. Furthermore, improvement of co-morbid conditions is also well-documented. That said, whether bariatric treatment for morbid obesity is a viable treatment option for more than a small minority of the obese population is open to doubt.
Treating morbid obesity without surgery
Todd M. Sheperd, MD, a family physician in Petoskey, Mich., has a couple of morbidly obese patients contemplating bariatric surgery and a couple more who have lost a significant amount of weight as a result of undergoing this procedure. But he’d love to have something else he could offer.
“We would all prefer to find something that worked better than surgery, with no surgical risks,” he said.
More doctors are recognizing that more interventions are needed to treat the swelling ranks of people who have body mass indexes higher than 40. Until recently, though, research in this area - and, therefore, treatment innovations - was lacking.
To fill the gap, two targeted projects have been launched within the past year.
In March, the University at Buffalo School of Public Health and Health Professions kicked off a $5 million, five-year study that will randomize morbidly obese patients to various combinations of behavioral therapy, weight-loss medications and low-calorie diets. The groups will be compared with each other and with a group of bariatric surgery patients.
“Surgery is not a magic bullet for this problem by any means,” said Michael F. Noe, MD, MPH, principal investigator and clinical professor of social and preventive medicine at the University at Buffalo. “It’s essential that alternative nonsurgical approaches to help people who are severely overweight be evaluated.”
For the first phase of this study only two centers from United Kingdom will be included, the University of Southampton and Tauton and in the second phase, eight. Researchers will start to recruit volunteers in April 2012 and the study will be conducted over a period of eight years, until the last patient that is included in the study is monitored for a period of three years. This clinical trial will include obese volunteers until 2015 and the first results will be made public in 2018.
BY ELVIS AUGUSTIN