Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents

O'Brien, Paul Edmond; Sawyer, Susan Μ; Laurie, Cheryl; Brown, Wendy A.; Skinner, Stewart; Veit, Friederike; Paul, Eldho; Burton, Paul R.; McGrice, Melanie; Anderson, M. Robin; Dixon, John

doi:10.1001/jama.2010.81

Cited by 339 publications

(230 citation statements)

References 40 publications

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“…These findings suggest that when no information is provided about the means through which weight is lost, people assume that the individual lost weight through dieting and exercise, and this is despite the fact that surgery is the most effective method of weight loss for obese individuals. 18,19 In this study, no difference in judgments of warmth was found among any of the conditions. Although there is some evidence that obese individuals are seen as being friendly and warm, 26 these characteristics are not as strongly associated with obesity as are some other characteristics (such as, lazy, sloppy and incompetent).…”

Section: Discussionmentioning

confidence: 48%

“…Weight-loss surgery, such as gastric bypass surgery, is the most effective treatment available for weight loss among obese individuals, 18,19 and the use of weight-loss surgery has dramatically increased over the past decade. 3 Of particular relevance to the present research, a study of obese patients undergoing gastric restriction surgery for morbid obesity indicated that 59% of patients requested the surgery primarily for social reasons, such as embarrassment, and only 10% were obtaining surgery primarily for medical reasons.…”

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confidence: 99%

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Changes in weight bias following weight loss: the impact of weight-loss method

Fardouly

Vartanian

2011

Int J Obes

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Background: Many obese individuals lose weight to reduce weight stigma; however, little is known about whether other people's attitudes actually improve towards obese individuals after they have lost weight, and whether changes in attitudes depend on the method of weight loss. This study examined changes in people's perceptions of an obese target who had lost weight through diet and exercise or through surgery. Method: Participants (N ¼ 73) initially viewed an image of an obese woman or a thin woman (control condition), and were asked to indicate their perceptions of the target with respect to the target's behaviors (for example, how often she exercises), as well as some personality characteristics (for example, lazy, sloppy and competent). Participants then viewed a more recent image of the target in which she had lost weight, and were informed that the target had lost weight through diet and exercise or through surgery, or were not provided with any explanation for the weight loss. Participants once again indicated their impression of the target on the same measures. Results: Regardless of the method of weight loss, all targets were rated as eating more healthily, exercising more, and being more competent and less sloppy after having lost weight. Participants also rated the target as less lazy when they learned that she had lost weight through diet and exercise, or when no information was provided about the method of weight loss; the target who lost weight through surgery, however, was not seen as being any less lazy after losing weight. Conclusion: These findings indicate that perceptions of obese individuals can in fact improve after they have lost weight, but that this might depend on the method of weight loss.

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Section: Discussionmentioning

confidence: 48%

mentioning

confidence: 99%

Changes in weight bias following weight loss: the impact of weight-loss method

Fardouly

Vartanian

2011

Int J Obes

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“…1 It is one of the most powerful medical interventions available. 2,3 It induces and maintains a substantial weight loss. 4 However, despite widespread use, there is only limited understanding of how the LAGB achieves this weight loss.…”

Section: Introductionmentioning

confidence: 99%

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Burton

Brown

2011

Int J Obes

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Laparoscopic adjustable gastric banding (LAGB) has rapidly emerged as a popular bariatric procedure because of its safety, efficacy, durability and adjustability. Despite widespread use, there is limited understanding of how it induces weight loss. Previously, it has been classified as a restrictive procedure, physically limiting the patient to a small meal that subsequently slowly empties into the distal stomach. However, the tiny pouch of stomach created above the LAGB appears to be unable to accommodate even the smallest of meals. Therefore, the key mechanism has been hypothesized to be the induction of satiety via, as yet, undefined pathways. The critical question remains: what are the key physiological changes that lead to satiety and weight loss? In successful LAGB patients, a consistent intraluminal pressure at the level of the LAGB of 26.9±19.8 mm Hg is observed. Studies using semi-solid swallows combined with intraluminal pressure recordings have demonstrated that semi-solid transit across the resistance of the LAGB is mediated by repeated esophageal peristaltic contractions (mean 4.5±2.9) that produce episodic flow, interspersed by reflux events. Failed transit results in obstruction and regurgitation, whereas dilatation of the supraband stomach induces severe and intolerable reflux. Overall gastric emptying does not appear to be significantly altered following LAGB. Focused investigations have shown that the supraband stomach is empty of an ingested meal 1-2 min after intake ceases. Considerable progress has been made in understanding the mechanical physiological effects of the LAGB on esophageal and proximal gastric function. These have been correlated with patient outcomes and sensations. On the basis of recent data, it appears that the LAGB activates the peripheral satiety mechanism without physically restricting the meal size. Therefore, it should not be classified as a restrictive procedure. The precise mechanism of weight loss with the LAGB remains to be delineated.

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“…[8][9][10][11][12] Laparoscopic adjustable gastric banding (LAGB) has not been approved by the US Food and Drug Administration for patients younger than 18 years. Although early results with LAGB have indicated that it is safe and effective, [13][14][15][16] long-term outcomes have not yet been reported for adolescents.…”

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confidence: 99%

Trends and Outcomes of Adolescent Bariatric Surgery in California, 2005–2007

Jen

Rickard²,

Shew³

et al. 2010

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:There has been a dramatic increase in the use of adolescent bariatric surgery. However, previous studies were unable to distinguish laparoscopic versus open procedures. Furthermore, the use of laparoscopic adjustable gastric banding (LAGB) has not been studied on a population level. WHAT THIS STUDY ADDS:The rate of LAGB increased sevenfold from 2005 to 2007 with a corresponding decrease in the rate of laparoscopic Roux-en-Y gastric bypass. Furthermore, white adolescents represented only 28% of those who were overweight but accounted for 65% of the procedures.abstract OBJECTIVE: The goal of this study was to evaluate trends, and outcomes of adolescents who undergo bariatric surgery. PATIENTS AND METHODS: RESULTS:Overall, 590 adolescents (aged 13-20 years) underwent bariatric surgery in 86 hospitals. White adolescents represented 28% of those who were overweight but accounted for 65% of the procedures. Rates of laparoscopic adjustable gastric banding (LAGB) increased 6.9-fold from 0.3 to 1.5 per 100 000 population (P Ͻ .01), whereas laparoscopic Roux-en-Y gastric bypass (LRYGB) rates decreased from 3.8 to 2.7 per 100 000 population (P Ͻ .01). Self-payers were more likely to undergo LAGB (relative risk [RR]: 3.51 [95% confidence interval: 2.11-5.32]) and less likely to undergo LRYGB (RR: 0.45 [95% confidence interval: 0.33-0.58]) compared with privately insured adolescents. The rate of major in-hospital complication was 1%, and no deaths were reported. Of the patients who received LAGB, 4.7% had band revision/removal. In contrast, 2.9% of those who received LRYGB required reoperations. CONCLUSIONS:White adolescent girls disproportionately underwent bariatric surgery. Although LAGB has not been approved by the US Food and Drug Administration for use in children, its use has increased dramatically. There was a complication rate and no deaths. Long-term studies are needed to fully assess the efficacy, safety, and health care costs of these procedures in adolescents.

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Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents

Abstract: ANZCTR Identifier: 12605000160639.

Cited by 339 publications

References 40 publications

Changes in weight bias following weight loss: the impact of weight-loss method

Changes in weight bias following weight loss: the impact of weight-loss method

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Trends and Outcomes of Adolescent Bariatric Surgery in California, 2005–2007

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