Original article
Improvement in comorbid illness after placement of the Swedish Adjustable Gastric Band

https://doi.org/10.1016/j.soard.2008.04.006Get rights and content

Abstract

Background

Obesity and its related comorbid illnesses have become a national health priority. We report comorbidity and quality of life (QoL) data after weight loss with gastric banding using the Swedish Adjustable Gastric Band (SAGB).

Methods

Data were collected prospectively for 838 consecutive morbidly obese patients who underwent laparoscopic adjustable gastric banding (LAGB) between January 2001 and July 2007. Patients were followed-up by a multidisciplinary team consisting of a surgeon, physician, dietician, and exercise consultant, all of whom were involved in the evaluation of clinical outcomes. Continuous data were reported as mean ± SD; categorical data were reported as number and percentage. Patients served as their own controls.

Results

Respective preoperative mean age, weight, and body mass index (BMI) were 44 years (range 16–76), 122 kg (range 86–240), and 44 kg/m2 (range 35–86), respectively. SAGB implantation was accomplished by the pars flaccida technique with no conversion to an open procedure. Mature follow-up data were available for 35% of patients at 24 months and 21% at 36 months. In the total cohort of 838 patients, BMI (mean ± SD) decreased to 32 ± 5 kg/m2 and 32 ± 7 kg/m2 at 24 months and 36 months, respectively. Percentage excess weight loss (%EWL) (mean ± SD) was 32% ± 14% (n = 506), 47% ± 15% (n = 461), 52% ± 16% (n = 291), and 54% ± 23% (n = 175) at 6, 12, 24, and 36 months, respectively (P < .001). There were 545 patients identified with comorbid illness at >6-month follow-up. After a median follow-up of 13 months (range 6–36 months), resolution and/or improvement of comorbidities was as follows: type 2 diabetes mellitus, 79%; metabolic syndrome, 78%; hypertension, 67%; dyslipidemia, 66%; gastroesophageal reflux, 66%; asthma, 57%; arthritis/joint pain, 70%; polycystic ovarian syndrome, 48%; and depression, 57%. There was a significant improvement in QoL (as measured by the Short Form-36 Health Survey [SF-36]), bringing patients' QoL to a level consistent with that of community norms in all 8 domain scores. Of 342 patients surveyed with the Beck Depression Inventory (BDI-II), a statistically significant improvement in depressive mood was also observed (P < .001).

Conclusion

Weight loss achieved by use of the SAGB provides a dramatic reduction in many serious comorbid illnesses as well as improvement in the psychosocial wellbeing of morbidly obese patients.

Introduction

Obesity is one of the most serious public health challenges facing the Western world [1], [2]. Not only are obesity (body mass index [BMI] 30–39.9 kg/m2) [3] and morbid obesity (BMI ≥40 kg/m2, or ≥35 kg/m2 with 2 or more comorbidities) [3] independent health risks, they contribute to the development of numerous serious medical conditions that, each year, are responsible for more than 2.5 million deaths [4]. These illnesses are divided into those associated with the metabolic consequences of obesity and those directly related to the mechanical consequences of excess weight [5]. Once an individual becomes obese, the relative risk of developing comorbidities of obesity becomes dramatically greater [6], [7], [8], [9]. Risk of type 2 diabetes mellitus (T2DM), for example, has been shown to increase approximately 40-fold as BMI increases from <23 kg/m2 to >35 kg/m2[10], [11]. Individuals who are only 20% overweight have an 8-fold increased risk of hypertension [7], [12]; and approximately 40% to 50% of those with a BMI ≥30 kg/m2 are likely to develop dyslipidemia [2], [6], [7], [13].

Morbid obesity in combination with its comorbidities is an onerous disease [9], [14], [15]. Perhaps the most serious health hazard for the obese patient is the likelihood of developing the metabolic syndrome, a combination of T2DM, impaired glucose tolerance, dyslipidemia, hypertension, central obesity, and an increased incidence of cardiovascular events, which can dramatically threaten the patient's longevity and ability to participate in activities of daily living [14], [16], [17], [18], [19].

Surprisingly, a high proportion of morbidly obese patients presenting for weight-loss surgery are not aware of the full complement of comorbid conditions that contribute to their overall poor health and, frequently, to an unsatisfactory quality of life (QoL). In our bariatric surgery population, for example, approximately 20% to 30% of new patients were not previously aware of their prediabetic state before examination at our center. Such a deficiency in what should be regular screening for comorbidities in the obese and morbidly obese suggests an inadequate level of attention to their overall health—an undue burden carried by these populations that may result in undertreatment of their obesity-related comorbidities [20], [21], [22], [23].

Weight loss after bariatric surgery, including laparoscopic adjustable gastric banding (LAGB), has a major positive impact on obesity-related illness [24], [25], [26], [27], [28] and QoL [29], [30], [31], [32]. The aim of this article is to review weight-loss findings and health benefits, in terms of improvement or resolution of comorbid illnesses and improvements in QoL, in our current cohort of patients with >6-month follow-up after placement of the Swedish Adjustable Gastric Band (SAGB) (Ethicon Endo-Surgery, Inc., Cincinnati, OH; Johnson and Johnson Medical, Inc., Livingston, United Kingdom).

Section snippets

Patient selection and data collection

Patients selected for surgery qualified for LAGB under standards defined by the 1991 NIH Consensus Conference Statement on Gastrointestinal Surgery for Severe Obesity [28]. Weight-loss and comorbidity data were collected prospectively. Ideal body weight was determined at baseline by the 1983 Metropolitan Life Insurance Company table formula for weight and height [33]. Percentage excess weight loss (%EWL) was calculated as the difference between the baseline absolute weight and the weight at

Preoperative patient characteristics

Between January 2001 and July 2007, 838 consecutive patients underwent laparoscopic placement of the SAGB in our bariatric surgery clinic. In this population, 81% (679) were female and 19% (159) were male (Table 1); the mean age was 44 years (range 16–76 years). The mean presurgical weight was 122 kg, with a mean excess weight (EW) of 60 ± 39 kg, and a preoperative mean BMI of 44 kg/m2.

The prevalence of comorbid illness in the population eligible for weight-loss surgery is shown in Table 1. Of

Discussion

The prevalence of the disease burden we have encountered is quite similar to that reported by Buchwald et al. [19] in their 2004 meta-analysis of the worldwide bariatric surgery literature. A preponderance of females usually seeks bariatric surgery, possibly due to a greater awareness of poor health, surgery's aesthetic effects, and cognizance of the treatment options available. Although the average age of patients is typically in the early forties, a growing number of adolescents and an older

Conclusion

LAGB using the SAGB is an effective method for achieving and maintaining substantial weight loss in the majority of morbidly obese patients undergoing bariatric surgery. After gastric banding, morbidly obese patients experience marked weight loss in addition to a reduction of the major comorbid conditions that not only threaten their lives but significantly impair their daily QoL. There is widespread evidence that the intentional weight loss achieved with SAGB surgery leads to dramatic

Disclosures

The research was supported by an unrestricted research grant from Ethicon Endo-Surgery. Drs. A. Brancatisano and R. Brancatisano are consultants for Ethicon Endo-Surgery. Dr. A. Brancatisano's expenses for the symposium were paid by Ethicon Endo-Surgery, Inc., the manufacturer of the Realize Band (also known as the Swedish Adjustable Gastric Band). Ms. S. Wahlroos has no commercial associations that might be a conflict of interest in relation to this article.

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