Landmark study highlights long-term success of weight loss surgery

Gastric banding. Image: Paul O'Brien
video describing lap banding procedure.
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A 20-year study by Monash University researchers has demonstrated that lap-band surgery provides substantial weight loss to obese people for at least 20 years.

Obesity is estimated to affect more than a quarter of Australian adults and has now overtaken smoking as the leading cause of preventable deaths.

The study by Monash’s Centre for Obesity Research and Education (CORE) and the Centre for Bariatric Surgery (CBS), demonstrated that patients who had lap-band surgery 20 years ago now weigh an average of 30.1kg less than their initial weight. Lap-band (laparoscopic adjustable gastric band) surgery places an adjustable band around the top of the stomach to reduce appetite.

The study, which examined data from an initial group of more than 8000 people, is believed to be the largest and longest-running of its kind in the world. Its findings were published in the journal Obesity Surgery 10 October 2018.

“These data show that lap-band procedure has the potential to provide an acceptable and cost-effective long-term solution to obesity,” lead author Emeritus Professor Paul O’Brien said.

Obesity is linked to numerous health problems including heart and lung disease, type 2 diabetes, high blood pressure, many cancers, osteoarthritis, psychosocial problems and depression, and reduced life expectancy.

“What we need for people who are obese is durability in weight loss,” Emeritus Professor O’Brien said. “Lifestyle treatments such as diets, exercise and appetite suppressants have been unable to achieve useful benefit in the medium term – three to 10 years – let alone the long-term,” he said.

Prof Wendy Brown (left) doing a lap-
banding procedure

Lap-band patients at CBS were generally treated as day patients, the surgery was simple and safe and in this study there were no deaths related to it, he said. “Whereas obesity is a lethal disease, the surgery can be life-saving.”

In an additional study included in the report, the researchers performed a review of the published literature for all common bariatric (weight loss) surgical procedures at 10 years or more after surgery. They found strong evidence indicating that patients having gastric bypass surgery (where the stomach is divided) had weight loss of around 58% of their excess weight and that those having biliopancreatic bypass (which re-routes the bowel so that food is not absorbed) lost 75% of their excess weight. Excess weight is an estimate of the excess fat in the body.

More limited long-term data supported weight loss after sleeve gastrectomy, which also reduces stomach volume.

“The study demonstrates the long-term effectiveness for bariatric procedures in general, highlighting the urgent need for these procedures to become more available through the public hospital system and with better coverage from our private insurers,” co-author and CORE Director Professor Wendy Brown* said.

All procedures showed a significant need for revisional surgery over time although improvements in surgical techniques and the bariatric devices, and in after-care, had all led to a marked reduction in the need for additional surgery, Emeritus Professor O’Brien said.

A long-term partnership between doctor and patient with attention to eating rules, good nutritional care and exercise and activity was very important, he said.

*Professor Wendy Brown is giving a public lecture on Thursday 18 October 2018 on "Obesity, a serious disease which deserves serious treatment". See more and RSVP.

Reference
O'Brien PE, Hindel A, Brennan L, Skinner S, Burton P, Smith A, Crosthwaite G, Brown W. Long-term outcomes after bariatric surgery: a systematic review and met-analysis of weight loss at 10 ore more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obesity Surgery 2018 https://doi.org/10.1007/s11695-018-3525-0