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Study: Gastric band works better than 500-calorie diet

by Nanci Hellmich / USA Today

May 2, 2006

Adjustable gastric banding is much more effective long-term than a very low-calorie diet for people who are about 50 pounds overweight, a study shows.

Medical guidelines support this surgical procedure -- which puts a band around the top of stomach to create a feeling of fullness -- in patients who are extremely obese, about 100 or more pounds over a healthy weight, or those who are almost as overweight and have serious medical conditions, such as type 2 diabetes.

Researchers at Monash University Medical School in Melbourne, Australia, recruited 80 patients who were on average 52 pounds over a healthy weight. Half had the laparoscopic adjustable gastric band surgery.

The other half followed a medical program that included a variety of strategies such as a very-low-calorie diet (500 calories a day) with liquid meal replacements, prescription weight-loss medication and behavioral therapies.

Findings in today's Annals of Internal Medicine:

After six months, both the surgery patients and the low-calorie dieters lost an average of 14% of their starting weight.
After two years, the gastric band patients lost 22% of their starting weight. That was about 87% of their excess weight, or roughly 45 pounds. They also showed marked improvement in their health and quality of life.
At the end of two years, the dieters had regained much of their lost weight but were still 5.5% below their starting weight. They had lost 22% of their excess weight, or about 12 pounds.

Researchers are still analyzing the weight-loss data. "I'm very happy that the gastric band patients are continuing to maintain their weight loss," says lead author Paul O'Brien, director of the university's Centre for Obesity Research and Education. Since the study, he received grants from INAMED Health, maker of the LAP-BAND® System.

In this study, the surgery was as safe as the diet program, but O'Brien notes the procedure does carry risks, and some may need follow-up procedures, such as readjusting the band position. The surgery costs $14,000 to $18,000 in the USA, he says.
Insurance companies vary widely in coverage of gastric banding or gastric bypass, a more complex surgery that creates a much smaller stomach and rearranges the small intestine. Average cost: $26,000. Under certain conditions, Medicare covers both surgeries.

Many surgeons in the USA use gastric bypass because bypass patients lose more weight overall and lose it faster, says Neil Hutcher, president of the American Society for Bariatric Surgery and a surgeon in Richmond, Va.

Thomas Wadden, an obesity expert at the University of Pennsylvania School of Medicine in Philadelphia, says gastric banding "is a very effective procedure, but it's not a rational, cost-effective solution to the epidemic of obesity."

"Because we have limited health-care dollars, we have to decide how best to invest them. Are we going to provide bariatric surgery for a relatively small number of people or instead invest in the prevention of obesity so our children hopefully won't need this surgery?"

Copyright © 2006 USA Today. All rights reserved. Republished with permission.
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