Bariatric surgery not a 'last resort' for diabetics

Weighting game over for obese adults with FDA expansion of LAP-BAND use

Australia was the first in the Asia-Pacific region to recently endorse the LAP-BAND for use in people with a BMI over 35 or a BMI greater than 30 with at least one serious, obesity-related condition. For the first time, adults across the whole obesity spectrum who have failed conventional weight loss measures (diet, exercise and medication) can access this clinically effective, long-term, weight loss option.

According to Professor Paul O'Brien, Head of the Centre for Obesity Research and Education (CORE) at Monash University, Melbourne, broader use of the LAP-BAND among obese adults will have a significant and positive effect on health in Australia and the US.

“We know that serious, obesity-related health complications have already begun by the time a BMI of 30 is reached, which is the lower limit of obesity.1

“The LAP-BAND was previously available to those with a BMI of at least 35 and one serious, obesity-related condition. Until now, obese people with a BMI under 35 who carry significant health risks have had limited options to improve their health when other conventional weight loss measures, such as diet and exercise, have failed,” said Prof O&'Brien.

In Australia, the first LAP-BAND procedure was performed in 1994, and last year more than 11,000 gastric banding procedures were conducted.8 In total, more than 600,000 procedures have been performed internationally.9

“In one of our landmark studies that contributed to the FDA&'s decision to expand the indication for the LAP-BAND, those who had mild-to-moderate obesity (BMI 30-35) showed very clear benefits with the gastric band compared to a matched group who received the best conventional weight loss treatment,” said Prof O&'Brien.

“Obesity is a complex disease. We all have different messages from our brain about food. It is sometimes assumed that those who over-indulge in food must have a lack of self-control. However, the spectrum of pressure to eat can range from minimal to an overwhelmingly persistent hunger that can never be satisfied.

“The FDA announcement is a welcome relief for people struggling to lose weight who want to improve their health and quality of life when other options fail,” Dr Brancatisano said.

“Gastric banding surgery addresses an unmet treatment need and provides effective, sustainable weight loss.

“The broader indication for the LAP-BAND across the whole adult obesity spectrum will allow Australia and the US to lead the way in the fight against obesity,” said Dr Brancatisano.

The FDA approved the laparoscopic adjustable gastric banding (LAGB) procedure for people with a BMI greater than 35, or people with a BMI greater than 30 and at least one serious, obesity-related condition, and who are unable to lose weight through conventional weight loss methods on Wednesday, February 16, 2011.

Landmark Australian research contributed to the FDA&'s approval of the gastric band for use in adults within the lower limits of obesity. A world-first study, conducted at the Centre for Obesity Research and Education (CORE) at Monash University, compared the effectiveness of LAGB to non-surgical treatment (diet, exercise and medication) in obese adults with a BMI between 30 and 35. The research found that LAGB resulted in a loss of 87.2 per cent in excess body weight, compared to 21.8 per cent with non-surgical treatment; a greater reduction in obesity-related health conditions for LAGB; greater improvements in quality of life across all measures with LAGB.10

A second Australian study also conducted at CORE, that formed part of the FDA submission, revealed that gastric banding surgery is five times more likely to reverse type 2 diabetes than simple lifestyle changes.11 The study revealed 20 per cent of average body weight loss with LAGB compared to 1.4 per cent average body weight loss with conventional diabetes care; an 80 per cent improvement to normal limit blood sugar (glucose) levels with LAGB, compared to 20 per cent with conventional diabetes care; a greater reduction in the use of diabetes medication with LAGB and a greater reduction in associated health conditions, including use of blood pressure and lipid lowering medications.

References

  1. Guh DP. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009; 9:88
  2. Kuczmarski MD, Prevelance of Overweight and Weight Gain in the United States. Am J Clin Nutr 1992; 55:495S-502S.
  3. Australian Bureau of Statistics 2008, National Health Survey 2007-08, Cat 4364.0.
  4. Australian Institute of Health and Welfare (AIHW). Weight loss surgery in Australia. Cat. No. HSE 91.
  5. Access Economics 2008. The growing cost of obesity in 2008: Three years on.
  6. World Health Organisation (WHO) 2011. Obesity and Overweight.
  7. Bray G. Medical consequences of obesity. The Journal of Clinical Endocrinology & Metabolism 2004: 89(6); 2583-2589.)
  8. Medicare 2010 data.
  9. Allergan data on file, 2011.
  10. O&'Brien PE, et al. Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents: A Randomised Trial. JAMA 2010: 303:519 -526.
  11. Dixon, JB et al. Adjustable gastric banding and conventional therapy for Type 2 diabetes. JAMA 2008; 316-323.
  12. LAP-BAND AP™ Adjustable Gastric Banding System with OMNIFORM™ Design. Directions for Use. Allergan.
  13. Access Economics. The economic cost of obesity. Diabetes Australia 2006.
  • International Federation for the Surgery of Obesity and Metabolic Disorders
  • The American Society for Gastrointestinal Endoscopy
  • American Society for Metabolic and Bariatric Surgery
  • Obesity surgery society of australia and newzealand
  • Society for surgery of the alimentary