Gastric Bypass: Most Effective Weight Loss Surgery?
Study Shows Patients Lose More Weight With Gastric Bypass Surgery
Lap-Band Manufacturer Responds
Cathy Taylor, senior manager of corporate communications at Allergan Inc., writes in an email to WebMD, “This is a single-center study, not a randomized, double-blind, and multi-center clinical trial, and the study’s conclusions are not in line with the vast findings from the published literature. The LAP-BAND System procedure is inherently safer than gastric bypass, given bypass is an invasive procedure... In addition, the medical literature supports that at five years, which is the measure of sustainable weight loss, weight loss achieved with the Lap-Band System is on par with weight loss achieved from gastric bypass. In terms of resolution of diabetes, a landmark study published in JAMA in 2008 found that gastric banding also helps resolve diabetes over time.”
Gastric Bypass vs. Sleeve Gastrectomy
For the second study, researchers in Taiwan recruited 60 moderately obese patients (BMIs between 25 and 35) who had poorly controlled type 2 diabetes. They randomly assigned half the patients to get a gastric bypass. The other half had a sleeve gastrectomy, which involves surgically removing a portion of the stomach, creating a small “sleeve” of stomach about as wide as a garden hose. In this procedure there is no bypass of the small intestine.
After 12 months, twice as many patients in the gastric bypass group (93%) saw their diabetes resolve compared to those who had sleeve gastrectomies (47%). The bypass group also lost more weight, had lower blood glucose levels, and had better total and LDL cholesterol levels than the gastrectomy group, a finding that surprised researchers.
“In some previous studies, sleeve gastrectomy was found to have equal efficacy in weight reduction to gastric bypass for morbidly obese patients,” says study researcher Wei-Jei Lee, MD, PhD, a surgeon at Min-Sheng General Hospital.
Lee says that in her study, rerouting food around the duodenum (a portion of small intestine) appeared to make the difference.
“In type 2 diabetes, the duodenum may play a role in insulin resistance. Therefore, duodenum exclusion by surgery might help in reducing insulin resistance,” Lee says.
Choosing Weight Loss Surgery
In light of these results, doctors say it’s important for patients to go into any weight loss surgery clear-eyed and armed with information.
“What I try to explain to everybody is that a band is a diet with a seatbelt, there’s no metabolic weight loss component to it at all,” says Mitchell Roslin, MD, chief of bariatric surgery at Northern Westchester Hospital in Mount Kisco, N.Y. “You put a seatbelt around the stomach.”
Often significant weight loss, by itself, will improve diabetes.
To the extent that people lose weight with Lap-Band, Roslin says, they may see their diabetes improve. But weight loss with Lap-Band tends to be slower than it is with a bypass and in the long term may not be as substantial.