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.
