Stomach surgery may have a role in moderate obesity

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For adults who are mildly to moderately obese, gastric banding—a popular, minimally invasive type of weight loss surgery—appears to be more effective in reducing weight and improving health and quality of life than behavioral modification plus drug therapy, Australian investigators report.

Current guidelines for weight loss surgery include only patients who are severely obese. However, “revision of those guidelines” can only occur once data from people with mild to moderate obesity are gathered, Dr. Paul E. O’Brien, of the Alfred Hospital, Melbourne, and colleagues note in the Annals of Internal Medicine.

They therefore recruited 80 such patients with body mass indexes (BMIs) of 30 to 35, who had comorbid conditions, severe physical limitations, or psychosocial problems related to their obesity, and who had made prior attempts to reduce weight.

Forty patients were randomized to diet, exercise, and treatment with the weight loss drug, orlistat, over a 6-month period. Physicians saw each patient every 2 weeks during the first 6 months, then every 4 to 6 weeks, during which they continued to advise lifestyle changes.

The other 40 subjects underwent gastric banding. These patients were also seen every 4 to 6 weeks. Thirty-nine patients in the surgery group and 33 in the nonsurgical group completed the 2-year study.

After 6 months, both groups had lost the same amount of weight (13.8 percent), according to the report.

After 2 years, patients who underwent gastric banding had an average loss of 21.6 percent of their initial weight and 87.2 percent of their excess weight.

However, the nonsurgical group showed progressive weight gain after 6 months. By the end of 2 years, they maintained an average loss of 5.5 percent of their initial weight and 21.8 percent of their excess weight.

At 2-year follow-up, those who underwent gastric banding had significant improvements in all eight domains of a standard health and quality of life questionnaire, while the behavioral therapy group had improvements in only three domains.

Drs. Thomas A. Wadden and Adam Gilden Tsai, from the University of Pennsylvania in Philadelphia, co-authors of a commentary on the study caution that more data are needed on long-term outcomes and costs to determine which patients with mild to moderate obesity would benefit most from surgery.

Additionally, they state, “We need to expend far more resources on preventing these individuals, particularly children, from becoming obese.”

SOURCE: Annals of Internal Medicine May 2, 2006.

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