"Gastric Banding" not a stand-alone weight loss solution

Buffalo, NY

Medical Edge from Mayo Clinic
January 8, 2010
DEAR MAYO CLINIC: Lately, I've seen a lot of advertisements for lap band surgery for weight loss. How is this different from bariatric surgery, which I don't hear as much about lately? Does it work? What are the dangers?

ANSWER: Bariatric surgery is a general term used to describe operations that help a person lose weight more consistently and effectively. The two most common types of bariatric surgery performed in the United States are adjustable gastric banding -- sometimes called lap band surgery -- and gastric bypass surgery.

In general, adjustable gastric banding is safe, and serious complications are uncommon. Gastric banding helps people lose weight by restricting the amount of food they can eat. But it's not a stand-alone weight loss solution. For the procedure to be effective, people must be carefully screened to ensure they are good candidates for gastric banding. Follow-up care, along with exercise and healthy eating, also are key to long-term weight loss for people who undergo adjustable gastric banding.

Adjustable gastric banding involves placing a small, inflatable band around the upper part of the stomach to restrict the amount of food that the stomach can hold. The band is filled with fluid that can be added or removed as needed through a small tube (port) placed under the skin. Fluid can be added to constrict the stomach if the band isn't tight enough and allows in too much food. Or, fluid can be removed if the band is too tight and is causing problems such as vomiting.

In gastric bypass surgery, the surgeon staples the stomach to make a small pouch and then connects the pouch to the small intestine, creating a passage (bypass) around most of the stomach, as well as the first section of the small intestine (duodenum).

Both procedures limit the amount of food that can fit in the stomach. Also, after both procedures, people feel full much sooner than normal, which helps decrease the amount of food they eat. One of the noticeable differences between adjustable gastric banding and gastric bypass -- and the one frequently talked about in advertising for gastric banding -- is that gastric bypass surgery usually requires a two-day hospital stay, whereas adjustable gastric banding can be done as an outpatient procedure.

Adjustable gastric banding is a low-risk procedure that's less complex than gastric bypass surgery. But as with any medical procedure, complications are possible. With adjustable gastric banding, complications can include infection of the band or the port, and movement of a portion of the stomach -- that's supposed to be below the band -- up through the band (slippage). The most serious complication associated with adjustable gastric banding is erosion of the band. This occurs when the band works its way inside the stomach, usually as a result of an infection or ulcer. Erosion is very rare, however, occurring in less than 1 percent of gastric banding cases.

Adjustable gastric banding can be an effective way to help people lose weight. It's not for everyone, though. First, if you're considering this procedure, be aware that people who have adjustable gastric banding generally have a slower rate of weight loss than those who have gastric bypass. There's nothing wrong with this, but it is something to consider prior to undergoing the surgery. Average weight loss is about one-third to one-half of a person's excess weight.

Like all bariatric procedures, gastric banding is intended for people who have a body mass index (BMI) of 40 or above or for those who have a BMI between 35 and 40 with a serious weight-related health problem, such as diabetes, high blood pressure or heart disease. In addition, this surgery isn't recommended for people who have certain medical conditions, such as Crohn's disease, large hiatal hernias or connective tissue disorders.

Finally, adjustable gastric banding isn't a cure-all. Follow-up care is critical because all patients need some adjustment of the band after surgery to ensure optimal weight loss. Even after having this operation, patients still need to consistently make good food and exercise choices in order to lose weight. In essence, gastric banding provides people with an opportunity to consistently take in a smaller amount of calories while they're moving forward with the other healthy steps that are necessary to lose weight. -- James Swain, M.D., Gastroenterologic and General Surgery/Director of Bariatric Surgery, Mayo Clinic, Rochester, Minn.

(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to medicaledge@mayo.edu , or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For more information, visit www.mayoclinic.org.)

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Studies underway to determine why obesity surgery thins bones

from Red Orbit

Experts say melting fat from obesity surgery somehow thins bones and even suggest that patients who undergo these procedures might have twice the average person's risk for a fracture, and are more likely to break a hand or foot, The Associated Press reported.

Further research is now under way to see if The Mayo Clinic's finding is significant. But specialists say uncovering long-term side effects from bariatric surgery and how to counter them takes on new urgency as more and more overweight people are electing to try it.

Dr. Shonni Joy Silverberg of Columbia University told last week's annual meeting of The Endocrine Society that these procedures are now being sold as a panacea.

"It is of heightened importance to find the answers to these questions," he said.

And perhaps the only positive thing you'll ever hear a doctor say about too much fat is that obesity actually is considered protective against bone-weakening osteoporosis.

Mayo bone-metabolism expert Dr. Jackie Clowes said overweight people are starting out better than most of us when it comes to staving off osteoporosis.

Therefore, researchers are working towards answering whether those who undergo the procedures really end up with worse bones, or just go through a transition period as their bones adjust to their new body size.

In the United States, some 15 million people are classified as extremely obese (100 pounds or more overweight). With rampant diabetes and other health problems, surgery is fast becoming the preferred treatment.

Options include stomach stapling called gastric bypass to less invasive stomach banding procedures, where patients tend to lose between 15 percent and 25 percent of their original weight — dramatically improving diabetes symptoms.

The American Society for Metabolic and Bariatric Surgery shows that more than 1.2 million U.S. patients have undergone the surgery in the past decade, 220,000 in the last year alone.

Now large National Institutes of Health studies on both adults and teens are underway to find more data on how patients fare many years after the surgeries.

However, doctors know that radical weight loss can speed bone turnover until the breakdown of old bone outpaces the formation of new bone.

A year after gastric bypass, adults' hip density drops as much as 10 percent, raising concern about a common fracture site of old age, according to more recent studies.

And while almost half of peak bone mass develops during adolescence, more research is needed to determine if teen bones react similarly.

The Mayo team is comparing the medical records of nearly 300 adults who've had bariatric surgery with similarly aged Minnesotans who haven't, to see if such changes translate into fractures.

Mayo's Dr. Elizabeth Haglind told the endocrinology meeting that a quarter of the 142 surgery recipients studied so far experienced at least one fracture in the following years. That group had twice the average risk six years after the surgery.

Interestingly, the surgery recipients had three times the risk of hand and foot fractures than their Minnesota neighbors.

Dr. Scott Shikora, president of the bariatric surgeons group, said he was shocked at the numbers because he hasn't seen a significant fracture problem in his own practice.

Shikora estimates about half of surgery patients follow their doctor’s advice to take extra calcium and vitamin D, and other research suggests higher doses may be needed anyway as the obese tend to start out with vitamin D deficiency.

“Don't skip checkups, where doctors monitor bone health, and aggressively treat nutrient deficiencies,” Clowes advised.

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Gastric bypass diet: What to eat after weight-loss surgery

MayoClinic.com

The gastric bypass diet outlines what you can eat and how much after gastric bypass surgery. Find out ways to establish new eating habits for successful weight loss.

What you eat, how you eat and how much you eat changes after gastric bypass surgery — surgery that alters the anatomy of your digestive system to promote weight loss.

With your stomach pouch reduced to the size of a walnut or small egg and portions of your small intestine bypassed, you'll need to follow a specific diet after gastric bypass surgery. A registered dietitian can assist you in creating this gastric bypass diet, which includes what type and how much food to eat with each meal and the required consistency and texture of the food. Closely following your gastric bypass diet promotes healthier weight loss and better nutrition. More >>

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Gastric Bypass Surgery: Are You a Proper Candidate

(MayoClinic.com)
It's always best to lose weight through a healthy diet and regular physical activity. But if you're among those who have tried and can't lose the excess weight that's causing your health problems, weight-loss (bariatric) surgery may be an option. Gastric bypass surgery — one type of bariatric surgery — changes the anatomy of your digestive system to limit the amount of food you can eat and digest. Weight loss is achieved by restricting the amount of food that your stomach can hold and by reducing the amount of calories that are absorbed. Gastric bypass surgery isn't for everyone, however. It's a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle. An extensive and careful screening process determines whether you're a candidate for this surgery.

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