Lap Band Surgery

Weight Loss Surgery Factsheet

OVERVIEW

• Metabolic and bariatric surgery, the treatment of morbid obesity and obesity-related diseases and conditions, limits the amount of food the stomach can hold, and/or limits the amount of calories absorbed, by surgically reducing the stomach’s capacity to a few ounces
• Candidates for bariatric surgery have a body mass index (BMI) of 40 or more, or a BMI of 35 or more with an obesity-related disease, such as type 2 diabetes, heart disease or sleep apnea
• An estimated 205,000 people with morbid obesity in the U.S. had bariatric surgery in 2007
• About 15 million people in the U.S. have morbid obesity; only 1% of the clinically eligible population is being treated for morbid obesity through bariatric surgery
• Bariatric surgery costs an average of $17,000 - $25,000; Insurance coverage varies by provider
• Bariatric surgery can improve or resolve more than 30 obesity-related conditions, including type 2 diabetes, heart disease, sleep apnea, hypertension and high cholesterol
TYPES OF BARIATRIC SURGERY
• Gastric Bypass
o Stomach is reduced from size of football to size of golf ball
o Smaller stomach is attached to middle of small intestine, bypassing the section of the small intestine (duodenum) that absorbs the most calories
o Patients eat less because stomach is smaller and absorb fewer calories because food does not travel through duodenum
• Laparoscopic Adjustable Gastric Banding
o Silicone band filled with saline is wrapped around upper part of stomach to create small pouch and cause restriction
o Patients eat less because they feel full quickly
o Size of restriction can be adjusted after surgery by adding or removing saline from band
• Bilio-Pancreatic Diversion with Duodenal Switch
o Similar to gastric bypass, but surgeon creates sleeve-shaped stomach
o Smaller stomach is attached to final section of small intestine, bypassing the duodenum
o Patients eat less because the stomach is smaller and absorb fewer calories because food does not travel through the duodenum
• Vertical Sleeve Gastrectomy
o Emerging procedure
o Approximately 85% of the stomach is removed, leaving a sleeve-shaped stomach
o No published studies on long-term results
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BARIATRIC SURGERY: RISKS VS. BENEFITS

The federal government (AHRQ) and studies report significant improvements in safety 6,7
Risk of death from bariatric surgery is about 0.1%
Morbidly obese individuals who have bariatric surgery increase their longevity, as compared to those who do not have surgery
Patients can improve life expectancy by 89% 8
Patients can reduce their risk of dying by 30% - 40% 9,10
Morbidly obese patients who have surgery dramatically reduce their risk of dying from an obesity-related disease, as compared to those who do not have surgery
Risk of death from diabetes down 92%, from cancer down 60% and from coronary artery disease down 56% 10

LONG-TERM EFFECTIVENESS OF BARIATRIC SURGERY
In general, bariatric surgery patients experience their maximum weight loss 1-2 years after surgery and maintain a substantial weight loss, with
improvements in obesity-related conditions, for years
Patients may lose 30% - 50% of their excess weight 6 months after surgery and 77% of their excess weight as early as 12 months after surgery 11
• Long-term studies show up to 10-14 years after surgery, morbidly obese patients who had surgery maintained a greater weight loss and more favorable levels of diabetes, cholesterol and hypertension, as compared to those who did not have surgery 3,12
ADOLESCENTS AND BARIATRIC SURGERY
• As obesity rates rise in the U.S., an increasing number of adolescents (12-17 years old) are receiving bariatric surgery, an estimated 349 in 2004 7
• Bariatric surgery has been performed on morbidly obese adolescents for more than 10 years; doctors are gaining more experience with surgery for this age group
• Long-term efficacy and impact remains unknown, but is a topic of ongoing research
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FOLLOW-UP CARE
• Bariatric surgery is considered a tool to help morbidly obese patients lose weight, to be used in conjunction with changes in eating and exercise habits
• Research shows that bariatric surgery patients who keep all doctors appointments for at least 3 years after surgery lost an average of 24% more weight, as compared to those who skipped appointments 13
• Studies show that bariatric surgery patients who attend support groups maintain about 20% - 30% greater excess weight loss as compared to patients who do not attend support groups 14,15,16
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1 Dixon, JB et al. Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes. JAMA 2008; 299(3): 316-323.
2 Schauer, PR et al. Effect of Laparoscopic Roux-en-Y Gastric Bypass on Type 2 Diabetes Mellitus. Nutrition in Clinical Practice. 2004: Vol. 19, No. 1, 60-61.
3 Pories, WJ et al. Who Would Have Thought It: An Operation Proves to Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus. Ann Surg 1995:222(3):339-352.
4 Torquati, Alfonso, MD, MSCI, FACS, Wright, Kelly, MD, FACS, Melvin, Willie, MD, FACS, and Williams, Richard, MD, FACS. “Effect of Gastric Bypass Operation on Framingham and Actual Risk of Cardiovascular Events in Class II to III Obesity.” Journal of the American College of Surgeons. Vol 204, No. 5, May 2007.
5 Rasheid, Sowsan et al. Gastric Bypass is an Effective Treatment for Obstructive Sleep Apnea in Patients with Clinically Significant Obesity. Obes Surg 2003; 13, 58-61.
6 Buchwald H, et al. Bariatric Surgery: A Systematic Review and Meta-analysis. JAMA 2004; 292 (14): 1724-38.
7 Agency for Healthcare Research and Quality (AHRQ). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. January 2007.
8 Christou, NV et al. Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Ann Surg 2004;240: 416–424.
9 Sjöström, Lars. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N Engl J Med 2007; 357:741-52.
10 Adams TD. Long-Term Mortality after Gastric Bypass Surgery. N Engl J Med 2007; 357:753-61.
11 Wittgrove, AC, et al. Laparoscopic Gastric Bypass, Roux-en-Y: Technique and Results in 75 Patients With 3-30 Months Follow-up. Obesity Surgery 1996: 6, 500-504.
12 Sjöström, Lars, et al. Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery. N Engl J Med 2004; 351: 2683-2693.
13 Gould JC. Impact of routine and long-term follow-up on weight loss after laparoscopic gastric bypass. Surg Obes Relat Dis 2007 Nov-Dec; 3(6):627-30.
14 Song Zirui, et al. Association between support group attendance and weight loss after Roux-en-Y gastric bypass. SOARD 2008 (4): 100-103.
15 Orth, WS. Support Group Meeting Attendance is Associated with Better Weight Loss. Obes Surg 2008 (18): 391-394.
16 Elakkary, Ehab, et al. Do Support Groups Play a Role in Weight Loss After Laparoscopic Adjustable Gastric Banding? Obes Surg 2006; 16, 331-334.