Gastric Bypass Best for Weight Loss, Study Finds

Also better than lap-banding, sleeve surgery at improving, eliminating type 2 diabetes

By Amanda Gardner

 

MONDAY, Feb. 21 (HealthDay News) -- When it comes to shedding pounds and improving or eliminating type 2 diabetes, gastric bypass surgery may be better than other surgical weight-loss procedures, two new studies find.

But obese patients should be careful to choose surgeons who have performed a high volume of these procedures before committing, said Dr. Guilherme M. Campos, lead author of one of two papers appearing in the February issue of the Archives of Surgery.

Gastric bypass and lap-banding are the two most common surgical weight-loss procedures performed in the United States. The former involves stapling the stomach so food has to bypass a section of the small intestine, meaning you get full faster and less food gets absorbed into the gut.

Lap-banding, introduced in 2001, involves separating the stomach into two sections with a band so, simply speaking, eating too much becomes more difficult. "It's a diet with a seatbelt," said Dr. Mitchell Roslin, chief of bariatric surgery at Lenox Hill Hospital in New York City and Northern Westchester Hospital in Mt. Kisco, N.Y.

In a third type of weight-loss procedure, known as sleeve gastrectomy, surgeons remove part of the stomach.

The study led by Campos compared weight loss and diabetes outcomes in 100 patients who underwent gastric bypass surgery with 100 patients who underwent lap-banding. Gastric bypass is considered riskier and more technically demanding than the band.

All patients were morbidly obese (with a body-mass index higher than 40), and 34 in each group had type 2 diabetes.

Although Campos is now an associate professor of surgery at the University of Wisconsin School of Medicine and Public Health in Madison, he conducted the study while at the University of California, San Francisco.

In the bypass group, patients lost an average of 64 percent of their excess weight, vs. 36 percent for those in the lap-banding group. Three-quarters of those undergoing gastric bypass surgery saw their diabetes improve or resolve, vs. only half in the other group.

The average cost of a bariatric surgery is nearly $30,000, according to a recent study from Johns Hopkins University.

Like all surgeries, weight-loss surgery carries its own set of possible risks, including bleeding, blood clots, infection and leaks from sites where body tissues are sewn or stapled together, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. Later complications may include malnutrition, hernias and a tendency in about one in 10 people to regain much of the weight they lost as a result of the procedure.

In Campos' study, roughly equal numbers of patients in each group experienced complications after one year (12 percent in the gastric bypass group compared to 15 percent in the lap-banding group); these included infection, internal bleeding and blood clots, but no deaths. More people in the bypass group had complications right after the surgery. More of those undergoing lap-banding, however, needed repeat surgeries (13 percent vs. 2 percent).

The second study, conducted in Taiwan and led by Dr. Wei-Jei Lee of the Min-Sheng General Hospital, involved randomly assigning 60 obese (but not morbidly obese) patients with type 2 diabetes to receive gastric bypass surgery or sleeve gastrectomy.

Almost all of those undergoing gastric bypass surgery (93 percent) had their diabetes resolved, vs. only half in the other group (these numbers declined to 57 percent and 0 percent after a year).

Those in the gastric bypass group also lost more weight, and there were no serious complications in either group.

There are various theories to explain why gastric bypass may be superior, including one that attributes the success to changes in hormones that control the metabolism of blood sugar.

And certain procedures may still be preferable for certain patient populations, added Roslin, such as bands for patients with lower BMI who don't have so many metabolic challenges.

"Everyone thinks that all weight-loss operations are the same, even the doctors and the surgeons. [But] they're different, and they have different resolutions of comorbidities and probably should be used for different indications," he said.

An editorial accompanying the studies noted the results should be interpreted with caution since longer-term data is not yet available.

Thanks!  Interesting.

I dont think this is new news LOL,

Just some folks are in denial. I think sometimes you have to convince yourself you made the right choice even when you screwed up, just to keep from losing your mind.

I am glad the sleeve is more popular now. Maybe the band will take a back seat now.  At least with the vsg people are assured they have a fair chance of losing something. With the band, you can potentially not lose much of anything even if you do everything right.

I am happy for those the band works for, but I have a lot of band sisters that have not been successful, and it hurts me to see them suffering.

Interesting article.  I've always been amazed at how most diabetics are off insulin and other blood sugar meds within hours to days following rny. 

@ changes in hormones that control the metabolism of blood sugar  The positive outcome for diabetics remains high on the list of why RNY is still considered the gold standard among wls by the bariatrc medicine community.  A few years ago I heard about experiments/ trials taking place to determine its effectiveness in treating type I diabetes.  The portion of the intestines bypassed has shown promise in a reducing the need for devices such as insulin pumps even in the absence of serious obesity.  

@"Everyone thinks that all weight-loss operations are the same, even the doctors and the surgeons. [But] they're different, and they have different resolutions of comorbidities and probably should be used for different indications," The quote drives home the need for patients to know everything about every available procedure when considering wls.  For most folks, there is more to it than resolving obesity. 

The majority of us can be succesful as define by the bariatric medical community on any surgical procedure.  However, we need to select the procedure that best suits our various health conditions; tolerance for negative side effects; and lifestyle. 

This was on the news today. 

Very interesting read.  Makes me love my RNY even more.  I know there are many debates on other less popular procedures being 'better' than RNY, but at the end of the day, the individual patient needs to be happy with their informed decision.  Everytime i sit down for a meal, and realize how full i am after just starting the meal....i dont get frustrated, i smile........at 1.5 years out, i secretly thank God.  I love my RNY :)

Hey - I'm nosy.....

did anything else happen with the idiot co-worker that got the gas face on trying to mess with the newbie RNYer?

The guy who made those comments hasn't said two words to me since then, lol.  And he sits right across from me.  I haven't heard anything else about anyone giving her a hard time or anything. 

*presses the stop button on the CD player, thus ending the MJ tune 'wanna be startin something'*

~sigh~  where is a good fight when you need one??!!!  LOL!

glad homie is on his p's and q's now!

Thanks for the article. I am glad that I made the decision to have RNY. I know too many cases where the band or sleeve wasn't enough and failure was the outcome. I have a good friend who I recently saw that I haven't seen in years. She was amazed when she saw how much I have lost. She then told me that she had gotten the band like a year ago..................................................................... I WAS FLOORED, to say the least. She hadn't lost any weight; to be honest she looked as though she had gained about another 50 or so since I saw her last in 2004. I have so much love for her and it really hurt me to see her like that after hearing that she had gotten the band because it seeems as though she will have to either have another pocedure or just realize that the wieght will never come off. 

I don't wanna guess her weight but if I had to I would say around 350-400. She is a beautiful person and a true friend and I wanna help her so bad, so thankfully she will be moving here in the followng months and I can help her on her journey.