Failure of adjustable gastric banding: starting BMI of 46 kg/m2 is a fulcrum of success and failure.
ABSTRACT To determine the body mass index (BMI) located at the fulcrum of success and failure in a prospective study conducted at the University of Texas Health Science Center at Houston. On average, our patients whose percentage of excess weight loss (%EWL) was >50% at 1 year had a significantly lower BMI than those with <30% EWL.
We prospectively collected the weight loss data for 430 patients who had had an adjustable gastric band placed. We stratified the %EWL within 1 year for patients with a BMI of 30-59 kg/m2. A line was generated for the %EWL over time for BMI groups of 30-39, 40-49, and 50-59 kg/m(2) and compared with the average %EWL over time. The y-intercepts of the resulting four lines were graphed against the average BMI for each group.
The generated y-intercept line had an R2 of .9237. Using the equation of this line and the known y-intercept for the average, we solved for x, resulting in a BMI of 46 kg/m2. Patients with a BMI <46 kg/m2 had a 50% EWL at 1 year, and those with a BMI >46 kg/m2 had only a 33% EWL at 1 year. The %EWL between the groups was significantly different at all measured intervals (P <.0001).
A BMI of 46 kg/m2 identifies those at high risk of failure to lose a significant percentage of excess weight after adjustable gastric banding and who require closer follow-up. Furthermore, patients who have a BMI >46 kg/m2 should be advised that their weight loss might be suboptimal at 1 year.
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ABSTRACT: Background: This study aimed to describe eating behaviors, food tolerance, and dietary intake after laparoscopic adjustable gastric banding (LAGB); explore associations between these variables; and examine the relationship between diet-related factors and percentage weight loss and quality of life after surgery. Methods: A cross-sectional survey was mailed to subjects who had previously undergone LAGB in Newcastle, Australia. Results: Sixty-seven subjects responded (55 females; mean age 49 – 11.5 years; postoperative body mass index [BMI] 34.5 – 5.4 kg/m 2). Reported average weight loss since surgery was 20.5 – 9.2% (26.6 – 13.0 kg). Restraint (including flexible and rigid control) and disinhibition were higher than community norms and hunger trended toward being lower. The majority of respondents rated their eating ability as good (n = 27, 40.3%) or excellent (n = 15, 22.4%). Median reported energy intake was 4,833 kJ (3,823–5,961) per day. Protein and fat intake as a percentage of daily energy intake was within acceptable distribution ranges, although saturated fat intake exceeded recommendations. Fiber and several micronutrients were below estimated average requirements. BMI at time of surgery and satisfaction with eating ability were significantly associated with reported weight loss after surgery (adjusted R 2 = 0.32, p < 0.001), and satisfaction with eating ability and rigid control were signifi-cantly associated with physical well-being (adjusted R 2 = 0.19, p = 0.001). Conclusions: This study highlights that potential remains to improve aspects of eating behavior, food tolerance, and diet quality in some individuals who have undergone LAGB, and endorses the need for further develop-ment of multifactorial interventions to help optimize a range of diet-related factors after LAGB.Bariatric Surgical Practice and Patient Care. 01/2013; 8(3).
- Surgery for Obesity and Related Diseases 01/2010; 6(5):514-5. · 4.12 Impact Factor
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ABSTRACT: BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a popular choice for patients seeking weight loss surgery. Since behavioural change appears to play a role in weight loss outcomes we postulated that publicly funded patients might not do as well as self-payers. This series examines the effect of public funding versus self-pay on patients undergoing LAGB over 1, 2 and 3 years. METHODS: Consecutive non-randomised cohort series of patient undergoing LAGB over 5 years (September 2003 to December 2008) in a single unit. Age, sex, funding route, body mass index (BMI) and complications were recorded. Per cent excess weight loss (EWL) and the Reinhold criterion for success (proportion achieving 50 % EWL) were assessed. RESULTS: Ninety-nine patients were publicly funded, and 250 patients were self-payers. Initial BMI was significantly higher in publicly funded patients (46.6 vs. 42.3 kg/m(2), p < 0.001) with a higher proportion of males (22.2 vs. 6.0 %, p < 0.001). Mean % EWL was significantly less for publicly funded patients at 1 year (38.1 vs. 53.5 %, p < 0.001) and 2 years (49.6 vs. 64.1 %, p < 0.001), but not at 3 years (59.7 vs. 61.8 %, p = 0.784). Fewer publicly funded patients achieved 50 % EWL at 1 year (24.5 vs. 50.2 %, p < 0.001), but with no significant difference at 2 years (54.8 vs. 67.0 %, p = 0.140) or 3 years (55.2 vs. 66.0 %, p = 0.349). CONCLUSIONS: Self-pay patients initially achieved more % EWL and greater success in reaching 50 % EWL after LAGB, but this difference was not maintained. The results suggest that patient motivation, using self-pay as a surrogate marker, may affect early results, but the operation itself is the main determinant of weight loss at 3 years.Surgical Endoscopy 10/2012; · 3.43 Impact Factor