Extent of Obesity Not Strongest Factor for Patients when Choosing Type of Weight Loss Operation

A new study investigating why obese patients choose one type of weight loss operation over another reveals that the main factors influencing decision making are whether patients have type 2 diabetes, how much weight they want to lose, and their tolerance for surgical risk to achieve their ideal weight. Unlike findings from previous studies the patient’s body mass index (BMI), or measure of obesity, does not play a significant role in the decision-making process according to study results published in the December issue of the Journal of the American College of Surgeons.

“BMI alone was not an important determinant, suggesting that patients and their surgeons considered the whole patient and what was important to him or her,” according to principal investigator Christine C. Wee, MD, MPH, associate professor of medicine at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston.

“This finding was reassuring,” said Dr. Wee, who also is associate section chief for research in the Division of General Medicine and Primary Care at Boston’s Beth Israel Deaconess Medical Center, one of the sites where the study was conducted.

However, Caroline Apovian, MD, the lead author of the study, said, “One unexpected and concerning finding was that patients who reported having more uncontrolled eating were actually more likely to undergo the less effective laparoscopic banding procedure than gastric bypass.”

Dr. Apovian is professor of medicine and pediatrics at Boston University School of Medicine and director of Nutrition and Weight Management Center at Boston Medical Center, which served as a second study site. She speculated that patients who have poorer control over their eating patterns choose the banding procedure because it is reversible, and gastric bypass typically is not.

Laparoscopic gastric banding makes the stomach smaller by wrapping a band around part of the stomach. The surgeon can later adjust the band to allow less or more food intake, or even remove the band altogether. Surgeons use small incisions during a laparoscopic procedure. Roux-en-Y gastric bypass, one of the most common bariatric surgical procedure in the U.S.,1 removes part of the stomach and reroutes the digestive tract so that food bypasses most of the stomach, thus limiting absorption of calories. Surgeons perform gastric bypass with either an “open” surgical approach or, more often, a laparoscopic approach.

Gastric bypass produces greater and more sustainable weight loss over time than other weight loss procedures but involves a slightly higher risk of complications, said coauthor Daniel B. Jones, MD, MS, FACS, a bariatric surgeon at Beth Israel Deaconess Medical Center and professor of surgery at Harvard.

At the time of the study, gastric banding was the second most common bariatric procedure, according to Dr. Jones. A newer procedure, laparoscopic sleeve gastrectomy, was uncommon when the operations in the study were performed between June 2008 and October 2011,2 but is now more popular than gastric banding because it generally provides better results, he explained.