Lap Band Blog

The Baby Boomer generation is aging and people are living longer today than ever before, a combination that is rapidly changing the composition of the world’s population. While only 10% of people were over 60 years of age in 2000, the United Nations projects that this number will increase to 21% by 2050 [1]. But even as we enjoy increased longevity, a new health crisis is emerging: developed nations are seeing obesity become a leading cause of preventable death [2]. Medical science is making advances in the fight against obesity, with bariatric surgery one of the most powerful weapons in its arsenal. Unfortunately, the tendency has been to discourage older patients from addressing their obesity with surgical methods.

Noting the rapidly aging population, several researchers have taken a closer look at the safety and efficacy of bariatric surgery among patients over the age of 50. A 2006 study among elderly patients in the US concluded that, although “the morbidity and mortality is higher in the elderly, bariatric surgery in the elderly is considered as safe as other gastrointestinal procedures because the observed mortality is better than the expected (risk-adjusted) mortality” [3].

Laparoscopic Adjustable Gastric Band In Older Patients

Two additional studies, whose results are presented below, have found compelling evidence that at least one form of bariatric surgery, laparoscopic adjustable gastric banding (LAGB), is safe and beneficial for older patients:

Craig John Taylor and Laurent Layani, of the Obesity Surgery Centre at John Flynn Hospital in Queensland, Australia, conducted a prospective review on patients aged 60 or older who underwent LAGB between February 2000 and September 2005 [4]. All patients had a BMI greater than 40 or a BMI greater than 33 plus significant co-morbidities.

Rishi Singhal and colleagues, of the Heart of England NHS Foundation Trust, conducted a study which compared the outcome of LAGB in patients aged 50 and older with patients younger than 50 [5]. All patients had a BMI of 40 or above, or a BMI of 35 or above plus comorbidities. The study consisted of 1,335 patients, 1,137 of which were female.

Complications

Complications were few among the older patients, and there were no in-hospital deaths resulting from the LAGB procedure. The patients in the Taylor study, all aged 60+ years, experienced no complications during the LAGB procedure and only three later complications—one band slippage and 2 access port infections—which were all successfully treated. Of the 3 band slippages, 6 pouch dilations, and one band erosion observed among patients in the Singhal study, all but one partial slippage occurred in patients younger than 50 years.

Weight Loss

Both studies found that older patients saw significant weight loss with LAGB surgery. Patients in the Taylor study, who averaged 65.8 years of age, went from an average pre-surgery BMI of 42.2 to an average BMI of 32.9 in the 48 months following the LAGB procedure. Their excess weight loss was 54% after 2 years.

In the Singhal study, patients 50 years or older began with an average preoperative BMI of 43.8 and saw a steady increase in excess percent BMI loss over the following 3 years, from 25.9% at 3 months to 47.3% at 36 months. This weight loss was not significantly different than that experienced by patients younger than 50.

Comorbidities

Although the majority of patients in the Taylor study reported an improvement in obesity-related comorbidities, many patients continued to use the same amount of medication to treat these conditions even after LAGB. This is a departure from the results of younger obese patients, who generally require significantly less medication after bariatric surgery.

Quality of Life

Perhaps the most interesting aspect of the Taylor study was the look at quality of life. Before surgery, all patients completed the Medical Outcomes Study Short Form-36 (SF-36), a detailed preoperative quality of life assessment known to give valid and accurate results [6]. As might be expected, quality of life as measured preoperatively was lower among the patients than among their peers in the general population. When assessed again a little over two years after undergoing LAGB, the patients had significantly improved scores related to physical functioning, general health, mental health, and energy levels. In particular, nearly half saw improved sleep, 70% experienced an increase in self-esteem, and 72% reported a better outlook on life. And patients’ quality of life wasn’t improved only in relation to their presurgery responses—their mental and physical well-being actually exceeded that of the general population in several respects.

Conclusion: LAGB Safe and Effective For Older Adults

As the percentage of adults over 60 increases in the coming decades, the need for bariatric procedures among this age group will also increase. Fortunately, recent examinations suggest that the effective weight loss, improvement in comorbidities, and increased quality of life known to result from LAGB hold true even among older patients. The patient experience appears to be largely positive as well, with 82% of older patients happy they had undergone LAGB and 91% indicating they would recommend LAGB to other older people. The consensus in the medical community is that age should not be the deciding factor when considering weight loss surgery. Moreover, there are indications that older people experience a significant improvement in quality of life after undergoing LAGB, making their golden years truly a time to enjoy.

Matt Papa

Matt Papa, PhD, is a research scientist at Washington University School of Medicine. Matt closely follows the current scientific findings related to obesity and weight loss, and is empathetic to those who struggle with their weight. He strives to present relevant scientific research in layman’s terms, in the hope that his articles will help to educate and inform the public. He often gives away a promotional coupon for Nutrisystem and a discount coupon code for BistroMD.

References:

1. United Nations. World population prospects: the 2000 revision highlights. New York: United Nations; 2001. p. 14–5.

2. Washington Post, March 10, 2004; Page A01.

3. Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72(10):865–9.

4. Taylor CJ, Layani L. Laparoscopic adjustable gastric banding in patients > or =60 years old: is it worthwhile? Obes Surg. 2006; 16(12):1579–83.

5. Singhal R et al. Age ≥50 Does Not Influence Outcome in Laparoscopic Gastric Banding. Obes Surg. 2009; 19:418-421.

6. Ware JE, Sherbourne CD. The MOS 36 item Short-Form Health Survey (SF-36): Conceptual framework and item selection. Medical Care 1992; 30: 473-83.

Guest post by Matt Papa

Of the nearly 24 million Americans that have diabetes, the majority are type 2, a disorder where the body is unable to properly use or make enough insulin [1]. If left untreated, type 2 diabetes can lead to severe and even life-threatening complications including heart disease, stroke, high blood pressure, blindness, kidney disease and amputation. While there are several risk factors associated with developing type 2 diabetes, research shows that 90% of all people with this particular type of diabetes are either overweight or obese [2].

A recent meta-analysis published in the March 2009 issue The American Journal of Medicine examined the results from more than 620 studies involving one form or another of bariatric surgery. The analysis found that bariatric surgery is an overall powerful treatment option in helping to improve or even resolve the clinical manifestations associated with type 2 diabetes in obese people.

Differences Between the Types of Bariatric Surgery

Currently, there are several types of bariatric surgery that are typically performed on obese patients. Laparoscopic adjustable gastric banding, gastric bypass and biliopancreatic diversion/duodenal switch procedures are the most commonly performed types of bariatric surgery. These procedures are usually performed on those who have been defined as morbidly obese, which is having a body mass index (BMI) of more than 40 kg/m2 or more than 35 kg/m2 with the presence of obesity-related comorbidities [3].

In laparoscopic adjustable gastric banding surgery, an inflatable tube is placed around the stomach to limit food intake. The diameter of the tube, which determines the degree of stomach restriction, can be adjusted by the addition or removal of saline through a tube that is placed right beneath the abdominal wall. In gastric bypass surgery, a portion of the stomach is removed and reconnected to a lower part of the small intestine. The restrictive and malabsorptive nature of gastric bypass results in a smaller stomach and less overall food absorption within the small intestine. Finally, the biliopancreatic diversion/duoduenal switch procedure is very similar to the gastric bypass surgery, except for the fact that a larger portion of the small intestine is bypassed resulting in a greater malabsobsorption.

Two Meta-Analyses Reach Similar Conclusions

A previous meta-analysis of 134 studies conducted in 2004 and published in the Journal of the American Medical Association had similar results to a larger, more recent meta-analysis. In the earlier study, the use of bariatric surgery was found to resolve type 2 diabetes in patients who underwent either laparoscopic adjustable gastric banding, gastric bypass or biliopancreatic diversion/duodenal switch procedures in 48%, 84% and 98% of patients, respectively [4].

The purpose of the second analysis was to further explore these earlier findings and update the meta-analysis to include additional studies conducted since 2004. As such, the second meta-analysis study was designed to evaluate all studies on gastric banding, gastroplasty, gastric bypass, and biliopancreatic diversion/duodenal switch procedures published between January 1, 1990 and April 30, 2006. The analysis examined weight loss and resolution of diabetes by procedure in the total patient population as well as in those with diabetes alone.

A total of 621 studies with 125,246 patients were included in the second meta-analysis. The average age of those included in the studies was 40.2 years, which ranged from the youngest patient at 16 years old to the oldest patient at 65 years old. The majority of the patients were female (80%) and approximately 10.5% had undergone previous bariatric surgeries. Furthermore, the average body mass index (BMI) of the patients was 47.9 kg/m2, which is defined as morbidly obese, and 22.3% had type 2 diabetes.

Which Bariatric Procedure Was More Effective For Weight Loss And Diabetes Resolution?

In the total study population, greater weight loss was seen in those undergoing the biliopancreatic diversion/duodenal switch procedure followed by the gastric bypass, gastroplasty and laparoscopic adjustable gastric banding, respectively. Total excess weight loss was found to be 53.8% at less than two years after surgery and 59% after two years or more of follow-up post-operatively. In the study population that had type 2 diabetes at the start of each study, the total excess weight loss was 67.1% at less than two years following surgery and 58% after two years or more following surgery.

In all of the 621 studies included in the analysis, 86.6% of patients had their diabetes improved or resolved following bariatric surgery. Of these patients, 78.1% had complete resolution of their type 2 diabetes. Resolution was greatest in those that underwent a biliopancreatic diversion/duodenal switch procedure (95.1 %), followed by the gastric bypass (80.3 %), gastroplasty (79.7 %) and laparoscopic adjustable banding (56.7 %) procedures. Resolution of diabetes was associated with significant decreases in insulin levels, hemoglobin HgA1c concentration (a form of hemoglobin that is used to measure levels of blood glucose over the course of time) and fasting blood glucose levels following surgery.

Weight and Diabetes: A Total Cause and Effect?

While this study clearly demonstrates that weight loss following bariatric surgery can both improve and resolve the symptoms associated with type 2 diabetes, there is strong evidence that the relationship between excess weight and diabetes is not that of cause and effect. In fact, an observation made in other studies is that type 2 diabetes was totally resolved in some patients within days after the bariatric surgery, before there was any significant weight loss [5,6,7]. This finding suggests that weight loss is not the only factor responsible for the resolution of type 2 diabetes. It appears that the hormonal and biochemical alterations in the gastrointestinal system brought about by bypass surgery influence directly the development of type 2 diabetes.

The results presented in this meta-analysis demonstrated the powerful effect of bariatric surgery in treating type 2 diabetes. The authors of the study conclude that randomized clinical trials that compare bariatric surgery to medical therapy are necessary to complete in order to determine which course of treatment is best for reducing the complications associated with type 2 diabetes in morbidly obese patients.

Matt Papa, Ph.D. has a special interest in the field of obesity treatment. Obesity is recognized as a major risk factor for cardiovascular disease – Matt’s research field for the past eight years. In his web site, Matt presents the latest scientific research on a variety of weight loss-related topics, writes reviews about weight loss diets and offers a savings coupon for Medifast, a doctor-recommended diet.

References

1. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.

2. Mokdad, A, Bowman, B, Ford E, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286:1195-1200.

3. National Institutes of Health Consensus Development Panel. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115:956-961.

4. Buckwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724-1737.

5. Pories W, Swanson M, MacDonald K, et al. Who would have thought of it ? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339-352.

6. Pories W, Albrecht R. Etiology of type II diabetes mellitus: role of the foregut. World J Surg. 2001;25:527-531.

7. Hickey M, Pories W, MacDonald K, Jr., et al. A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut? Ann Surg. 1998;227:637-643.

Those considering weight loss surgery or those who have already undergone it need to be aware of the nutritional deficiencies caused by this procedure. Nutritional deficiencies are common to all malabsorptive bariatric surgeries and occur in some restrictive types, too. However, they can often be prevented by standard multivitamin supplementation [1].

This article provides information on protein, vitamin, iron, and calcium deficiencies that can occur post-operatively and is based on a number of relevant studies including the scientific review study published in the journal of Obesity Surgery by Dr. Richard Bloomberg.

Why does nutritional deficiency occur after weight loss surgery?

The small intestine is the place where nutrients from the food are mainly absorbed. It is also the place where the pancreatic and bile enzymes mix with the food and facilitate absorbance of fat-soluble vitamins like A, D, E, and K.

In bariatric surgeries that work mainly through malabsorption like biliopancreatic diversion with or without duodenal switch (BPD-DS, BPD) and those that work with both malabsorption and restriction, like gastric bypass, a major part of the small intestine is bypassed. This is the major reason why deficiencies occur, apart from the fact that the overall intake of food is lowered post-surgery and that some people cannot tolerate certain types of nutrient-rich food like milk and other dairy products.

Types of nutritional deficiencies that may occur after Roux-en-Y, BPD, and BPD-DS

Protein deficiency

Protein deficiency, though occurring in gastric bypass patients, is seen at fairly high levels in BPD and BPD-DS patients. In a study in which questionnaires were answered by 858 BPD patients, it was found that protein deficiency was so severe in 3.7% of the patients that they had to be admitted to the hospital and 6% of them had to undergo revision surgery [2].

Dolan and colleagues examined patients that had undergone BDP with and without duodenal switch and found that both BPD and BPD-DS patients have 18% chance of presenting hypoalbuminemia [3], a condition where protein (albumin) levels in blood serum are too low. Fortunately, as several studies have shown, dietetic counseling and increased protein intake can lower the risk of protein deficiency.

Iron deficiency

Iron deficiency occurs in all bariatric surgeries, be it restrictive or malabsorptive. As shown in the illustration, the duodenum and the proximal jejunum are the main sites of iron absorption and bypassing these sites results in anemia.

RYGBP patients experience iron deficiency that tends to increase over the years, whereas in BPD and BPD-DS patients, conclusive evidence is yet to surface on whether the levels of serum iron and ferritin are affected over the years.

Vitamin B12 and Folate deficiency

A study by Halverson and colleagues demonstrated that a third of gastric bypass patients had vitamin B12 deficiency (<250 pg/ml) and 63% of them had folate deficiency (<3 ng/ml), despite being on a multi-vitamin regimen [4]. This can occur in patients even if they don’t have vitamin deficiency pre-operatively.

Rhode and colleagues experimented with different doses of B12 ranging from 100 ug to 600 ug and concluded that a dose of at least 350 ug needs to be administered to maintain a serum level of >150 pmol/L [5].

Calcium and Vitamin D deficiency

Calcium and vitamin D deficiencies are more frequently seen in malabsorptive weight loss surgeries than in restrictive. The duodenum and the proximal jejunum primarily absorb calcium, while vitamin D is absorbed by the jejunum and the ileum. Hence, bypassing these sites results in a lack of these nutrients.

When the body falls short of vitamin D, there is more production of the parathyroid hormone which results in release of calcium from bone, leading to bone loss and osteoporosis in the long term. Calcium and vitamin D deficiency occur at a rate of 10% and 51% respectively in distal Roux-en-Y patients [6]. There is a probability of postoperative metabolic bone disease developing in gastric bypass patients as a result of these deficiencies.

BPD patients too showed low levels of calcium and vitamin D: 57% of 170 patients studied showed a lack of vitamin D a year after surgery and 63% after four years [7].

Thiamine (Vitamin B1) deficiency

Thiamine deficiency is not a common nutritional consequence of bariatric surgery. However, the combination of reduced food intake, frequent vomiting, and malabsoption can sometimes cause this deficiency.

The resolution of thiamine deficiency is comparatively easy and quick. Intravenous or intramuscular thiamine doses of 50/100 mg/day have been shown to restore nutrient levels as early as one day after the administration. It is worth mentioning that administering glucose and other carbohydrates to a thiamine-deficient person can be dangerous, as thiamine is vital in carbohydrate metabolism [8].

Other fat-soluble vitamin (A, E, and K) deficiencies

While vitamin E and K deficiencies are not clinically significant in post-operative patients that receive supplementation, 61% of patients who had undergone either BPD or BPD-DS were found to have low levels of vitamin A [3], notwithstanding an 80% compliance rate with a multi-vitamin diet.

Other deficiencies

Zinc and magnesium deficiencies in gastric bypass patients have not been studied extensively. And in BPD patients with or without the duodenal switch, one study showed zinc deficiency in 50% of the patients in four years of follow-up. This level remained static and did not increase over the years [7]. But another study pinned zinc deficiency at only 10.8% of patients [2]. Magnesium, chromium, vanadium, and copper deficiencies are usually not seen in people going through bariatric surgery.

Specific signs and symptoms of protein deficiency:

Hair loss, fatigue, leg swelling

Specific signs and symptoms of common vitamin and mineral deficiencies:

· Calcium: bone pain

· Iron: fatigue

· Zinc: brittle nails

· Vitamin A: inability to see in the dark

· Vitamin E: poor wound healing

· Vitamin K: easy bruising

· Vitamin B1 (Thiamine): numbness and tingling in the hands and feet

· Vitamin B12 (Methylcobalamin): fatigue

Conclusion

Research on the full implications of these nutritional deficiencies and how they can be best resolved is still going on. In what form should a particular supplement be administered? How much of it should be recommended? These are some of the questions that need to be answered. Research has shown that multivitamin supplementation can greatly help in keeping important serum nutrients at acceptable levels. Patient education regarding vitamin supplementation is vital.

Morbidly obese individuals have nutritional deficiencies even before weight loss surgery and these can get further complicated if they are not prescribed the right supplements in the required doses post-surgery. But, in some cases, problems occur despite the individual following a multi-vitamin supplement regimen.

Hence, people thinking of opting for bariatric surgery should bear in mind the nutritional deficiencies and other complications that could face post-surgery. Strict compliance with a long-term multi-vitamin diet is required, and so are regular check-ups.

References

1. Nutritional deficiencies after Roux-en-Y gastric bypass can be prevented by standard multivitamin supplementation. Ledoux S, Larger E. Am J Clin Nutr. 2008 Oct;88(4):1176

2. Marinari GM, Murelli F, Camerini G et al. A 15-year evaluation of biliopancreatic diversion according to the Bariatric Analysis Reporting Outcome System (BAROS). Obes Surg 2004; 14: 325-8.

3. Dolan K, Hatzifotis M, Newbury L et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 2004; 240: 51-6.

4. Halverson JD. Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg 1986; 52: 594-8.

5. Rhode BM, Tamin H, Gilfix BM et al. Treatment of vitamin B12 deficiency after gastric surgery for severe obesity. Obes Surg 1995; 5: 154-8.

6. Brolin RE, LaMarca LB, Kenler HA et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 2002; 6: 195-203; discussion 4-5.

7. Slater GH, Ren CJ, Siegel N et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 2004; 8: 48-55; discussion 4-5.

8. Chaves LC, Faintuch J, Kahwage S et al. A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit. Obes Surg 2002; 12: 328-34.

Matt Papa works at Washington University as a biochemist. He has special interest in the field of obesity treatment and compassion for people who struggle with their weight. His website is about best weight loss programs and diet plans and provides practical information on wide range of diet topics including a review of the Realize My Success website and the cost of lap band at Strax rejuvenation in Florida.

One of the most commonly featured news and science topics that is discussed and debated is the growing epidemic of obesity in America. The prevalence of morbid obesity has grown substantially over recent years, affecting as much as 8% of the population [1]. This translates into almost 1 in 10 Americans that are morbidly obese, which is higher than it has ever been. Morbid obesity, or Class 3 obesity, is linked with premature death, diabetes, and heart disease to mention but a few risks. Furthermore, Class 3 obesity, a life-threatening medical condition that is sweeping through America at alarming rates, affects both social functioning and quality of life in general [2].

However, on the converse side of this, there are clear and distinct correlations between weight loss and a decrease of the negative effects and impact of obesity. This, coupled with the dramatic epidemic of obesity, has caused an increase in attempts to combat obesity. Dietary alterations as well as exercise programs in addition to medications and drug therapies have proven effective in the short-term but not in the long-term [3]. To see the significant medical resolutions to disease, the weight loss must be long term. This is what has led many to consider surgery as an alternative and long-term solution to obesity. The two most popular types of bariatric surgery are gastric bypass and gastric banding.

Bariatric surgery is a surgical procedure on the upper gastrointestinal tract that results in significant weight loss. In order to qualify for any bariatric procedure, according to the guidelines set forth by the National Institutes on Health, a patient must have a BMI of higher than 40 kg/m2. A patient may also qualify if he or she has a BMI of greater than 35 kg/m2 in addition to serious medical comorbidities that are a result of obesity.

Weight Loss

Jeffrey Tice and colleagues from the department of General Internal Medicine at the University of California in San Francisco completed a study where they reviewed retrospectively a number of patients who had undergone either gastric banding or gastric bypass between 1966 and 2007 [4]. This study is the culmination of several studies examining the successes, similarities and differences between the two bariatric surgeries. The participants in the reviewed studies were on average 40 years old and had a beginning BMI of 45 m/kg2. Twenty percent of the participants were males, and 80% were females.

The results of this examination demonstrated that weight loss outcomes were more favorable with the Roux-en-Y gastric bypass surgery than with laparoscopic adjustable gastric banding. There was, in fact, a clinically significant difference of 25% greater weight loss with the Roux-en-Y procedure. As Dr Tice, author of the study, explains, this means that for every 4 obese people who choose to be treated with gastric bypass rather than gastric banding, 1 additional patient will be cured of the disease. Other investigators have reported even greater weight loss differences between the two procedures. One study by Bowne et al showed that 100% of patients with type 2 diabetes were cured after Roux-en-Y surgery as opposed to only 49% of gastric banding patients [5].

Complications

The short-term complication rates favor laparoscopic adjustable gastric banding. Procedure length averages just over one hour and hospitalization stay after gastric banding is approximately two days shorter than gastric bypass. And while mortality rates are low for both procedures, they are lower for gastric banding. Rates of complications such as bleeding, perforation, etc were also low for both procedures.

However, the long-term complication rates favor gastric bypass. In other words, laparoscopic adjustable gastric banding is associated with more long-term complications than gastric bypass. Moreover, a higher number of gastric banding patients undergo re-operation than do Roux-en-Y patients.

Patient Satisfaction

Patient satisfaction is a subjective way to measure a surgery’s success. This is because one individual’s definition of successful surgery may differ from another’s. However, 80% of Roux-en-Y patients report being very satisfied with the surgery and the results compared to only 46% of patients who underwent laparoscopic adjustable gastric banding. Of the 20% of Roux-en-Y patients who were not extremely satisfied, none of them said they were not satisfied. The Bowne et al study also demonstrated that almost 20% of laparoscopic adjustable gastric banding patients were, for one reason or another, very dissatisfied with the surgery, some even regretting having had the procedure.

There is no doubt that the obvious benefit of both surgeries is weight loss. However, Roux-en-Y surgery has demonstrated greater long-term benefits in terms of weight loss and weight maintenance than gastric banding. Fifty-one percent of patients having Roux-en-Y surgery had maintained weight loss one year after surgery versus only 35% of patients undergoing gastric bypass [6]. Furthermore only 1 in 24 (4%) Roux-en-Y patients failed to lose any weight at all after the procedure versus the 9 in 26 (35%) of gastric banding patients who lost no weight after the procedure. Need or desire for reoperation was 12% with the Roux-en-Y patients comparing to 15% with the gastric banding patients.

Conclusion

Surgery as a means of weight loss for severely obese patients is a very serious consideration. A weight loss surgery comparison chart can help those who are considering weight loss surgery understand the basic differences between the various procedures performed today. There are potential medical complications and risks as with any surgery. However, many Americans suffering from obesity today simply have no real medical alternative for weight loss that is effective. Currently, both laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass are the most popular choices for bariatric surgery taking several factors into account. Roux-en-Y gastric bypass still is more popular than gastric banding and is considered the standard bariatric procedure for the above reasons [7]. Perhaps the most significant advantage is the greater weight loss.

One year after the procedure (up to five years) resulting weight loss is higher with gastric bypass. While it is difficult to assess clearly which procedure is the best one, as both are effective, it has been predominantly determined that Roux-en-Y gastric bypass is often a better choice for bariatric surgery candidates. Dr Tice concludes that until trials and studies are done to show that laparoscopic adjustable gastric banding is as effective, it is likely that Roux-en-Y will continue to be the bariatric standard for Americans.

References

1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegel KM. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002; 288:1723-1727.
2. Fine JT, Colditz GA, Coakley EH, et al. A prospective study of weight change and health-related quality of life in women. JAMA. 1999;282: 2136-2142.
3. Bennett W. Dietary treatments of obesity. Ann N Y Acad Sci. 1987; 499:250-263.
4. Tice, JA MD, Karliner, L, Walsh, J, Petersen, AJ, Feldman, MD. Gastric Banding or Bypass? A Systematic Review Comparing the Two Most Popular Bariatric Procedures. 2008. The American Journal of Medicine. 2008; 121, 885-893.
5. Bowne WB, Julliard K, Castro AE, et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: a prospective, comparative analysis. Arch Surg. 2006;141:683-689.
6. Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis. 2007;3:127-133.
7. Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14:1157-1164.

About the author

Working as a biochemist at Washington University, Matt Papa, PhD has worked extensively to present medical, clinical, and research findings related to obesity and cardiovascular disease. In his website he posts the latest findings in obesity research and offers a Medifast coupon discount.

Many of you have been looking into surgeries to help improve yourself regarding your obesity, and there are two that you might not be able to tell the difference between. These surgeries are the Lap Band Surgery, and the Gastric Sleeve surgery. We will first go over the basic definitions of both these surgeries and the basic underlying principles of each surgery. After that we will explain some of the differences between them.

The Lap Band Surgery is available for people who are one hundred pounds overweight or even more, therefore considered to be obese. This surgery is for those who really need to have it done, not just for people trying to lose a few pounds; it’s a last call option for those that have struggled with obesity for years. The Lap Band system is a powerful weight loss tool that helps you on your journey to lose that extra weight. Although the Lap Band system is simple it is also a very advanced gastric binding system. This system works by reducing the amount of food that you can take in at one time, controlling the amount of the food that you can take digest in one meal; so basically you feel full with a smaller amount of caloric intake.

The Lap Band system is an adjustable Gastric Binding System. The name Lap Band comes from the fact that the procedure is a minimal invasive surgery. The technique of this surgery is called laparoscopy, and the silicone device that is placed around the upper part of your stomach called the gastric band.

Now we will learn a little bit more about the Gastric Sleeve.

The Gastric Sleeve is a more invasive surgery then the Lap Band system is, as it basically removes around 2/3 of the stomach. The Gastric Sleeve Surgery is more of a brand new type of surgery in Bariatric Surgery. This surgery is for people who are also severly over weight but it is a more extreme type of bariatric surgery as it is not reversible once done. However, this surgery is also for the people that cannot have the lap band surgery done on them.

During the Bariatric Surgery they remove up to sixty percent of your stomach. That way there is no reason for you to say you have been over eating. Since you stomach will be so much smaller then the normal stomach there is no reason for your weight gain, other then being lazy and not exercising.

With the Bariatric surgery you will have a smaller stomach, which will basically cut your caloric intake by half if not more. Now you should not eat more times during the day, but only during the appropriate meal times.

Both of these systems have its up and it downs, but the overall effect of the surgeries is what you should be focused on. Not only will you lost weight and to begin to feel like you will have the sense of getting your old body back. You will also begin to have a better diet, as you will start eating better because now you have a reason. If you spent the money on one of these surgeries then you should take the full advantage of the service, and do your best to lose weight. Plus many bariatric clinics offer post surgery support to help you achieve your weight loss dreams once and for all!

The differences between the Lap Band and the Gastric Sleeve are huge. In the Lap Band you have a band around the upper part of your stomach which can be adjusted to the size that you need for the moment, and not make such a drastic cut off of weight all at once. The Gastric Sleeve actually removes up to sixty percent of your stomach. That is a big difference if you are unsure if you really want to make that leap as opposed to more gradual weight loss.

Now we have learned a little bit more about these two types of bariatric surgeries and why they are different from each other, but in the end they both should accomplish the same goal; permanent weight loss.

Lap band surgery is a medical technique which helps the obese people reduce their weight. It is always said that lap band surgery should be the last option for reducing weight after one has tried all other available means. It is done laparoscopically and does not require any large cuts on the stomach. A belt or band is inserted through a hole on the uppermost side of the belly, which is tightened later after insertion. As soon as it gets tightened, it divides the stomach into two parts. The upper part of the stomach takes the shape of a relatively small pouch and while eating food it is filled with small amounts of food and therefore the mind gets a signal to stop eating. Consequently, the obese person feels less hungry and eats less amount of food which helps him or her reduce their weight. To get this surgery done the body mass index should be 40 to 60 and the age criterion is to be above 18 years.

Lap band surgery is not unaffordable in terms of expenses, but still the cost varies from country to country. Most of the insurance companies cover Lap band surgery under their medi-claim criteria and cover the cost of it, still it is advisable that once you decide to go for a lap band surgery you much consult your life insurance company and read the policy related to reimbursement extremely carefully.

The estimated cost of these surgeries in USA range between $15,500 to $30,500 which includes pre operation consultation, hospital charges and post operation medical care and consultation including medical tests, psychological consultation and a regular check and counseling on your food intake and diet. The cost of the same surgery in Mexico is approximately between $8,200 and $10,500 and in European countries; the estimated cost is between $10,800 and $15,400 depending upon the type of hospital one is enrolling. In Canada, the cost of a Lap band surgery ranges between $18,200 and $26,700. Lap band surgery is also done at reasonable prices in countries like India, Brazil and Mexico where the cost is relatively less then European countries.

It is always advisable to ask your doctor to quote the expenses before you finalize one. Countries like Canada can be cheaper in terms of transportation cost if they are closer to you geographically or in Mexico where the travel cost is relatively less in comparison to European countries. These countries have good medical facilities and they perform many of the lap band surgeries. Especially in Canada which provides free health benefits for which a person might be eligible. If the person is insured, then the USA can also be a very good option for such surgery. But if one is not insured and he/she has to bear all the expenses on his/her own then it is always advisable to explore various options available across the globe depending upon your budget.

It is also in the news that USA the cost of the lap band surgery in the USA has decreased because of the increasing number of surgeons practicing weight loss surgeries which has led to more competition and caused the rates to come down and be within reach of everyone. It is also necessary to bring down the cost of this procedure, because obesity and related health problems associated with it are spreading like a pandemic. The fast-food generation has grown older over the years and people of all ages are suffering because of their addiction for oily and greasy food. In this situation, it becomes impertinent to make such procedures affordable so that the maximum number of people around the world have access to the lap band surgery.

There are times in the lives of people suffering from obesity when they they are fed up and just want to desperately get rid of it. This is because of not only the problem and inconveniences which they have in their daily lives, but because of the severe health problems that can be caused due to the imbalance in their bodies. Health problems like diabetes, hypertension, sleep apnea or even heart disorders can be caused by obesity and can make life very difficult. As the patient is already suffering, it becomes vey hard for them to reduce their weight the hard way by going to the gym or dieting.

But technology has introduced solutions which people can use in such situations to change their lives. Two of such solutions are the Lap Band surgery and the slim band surgery. Though very similar in the basic concept, these two are markedly different from each other. Let’s have a look at both of them to see just how different they are.

Lap band is, a gastric binding system, the motive of which is to insert a highly advanced but simple instrument in the patients body, which reduces the size of the stomach, so that it can hold lesser amounts of food at one time. By having a lesser amount of food intake - this results in causing the stomach to hold less food but still enable you to fell full.  Developed after tedious research and development by a company named Allergen, the lap band is a silicone band which is placed around the upper part of the stomach by a form of surgery called Laparoscopy. This band, by reducing the size of the stomach helps the patient in controlling his food intake and thus can help in achieving weight loss which is not only healthy but also sustainable.

The latest version of the lap band is not only adjustable but is also approved by the FDA. These are designed and introduced in the market after extensive testing and thus are guaranteed to be devoid of ay side effects while in prescribed and monitored use. To make the lap band more comfortable, it is manufactured with soft material and is in the form of small sections instead of a uniform ring. These small sections make it flexible, avoiding damage to the internal organs. As these are made of inflatable material, the company insures that all the bands are uniform all over to enable complete covered. Also, due to the high flexibility of the ring, surgeons find it easier to place it, making the surgery safer.

Slim band, is more of a slimming program than a health care procedure. The program can last for up to 4 years and is targeted at people who are looking to reduce their weight without taking the pains of going to gym or dieting. This program is inclusive of the guidance that is provided to the patients by experts like nutritionists, psychiatrists etc. Also, nursing care is provided to patients during the entire duration of the program.

The major portions of the weight loss programs of this company are conducted at their facility in Toronto. But as the patients may be based in other parts of US and of Canada, they provide their service through their various centers. The care and assistance that is provided through out the duration of the program, is charged for at the very start. For instance, if a patient wants to adjust the position of the band for some reason, he may simple go to the assistance centre and get the nurse to do it for him. The process is quite simple and the patient does not have to pay anything for it.

Overall, Lap band and Slim band are very similar is their procedures and motives. But they differ in the core technology used by both of them and the target customers, but at the end of the day both are solutions to help people end their battle with obesity.