Since posting this article, JK has spent two years examining full-time the issues of diet, and the diabetes and obesity pandemics.  A dietary treatment has been developed in Canada with a high rate of success which combines the New Atkins diet with alternate day fasting.  The results have been excellent.  Click on link for more information at Atkins diet obesity, diabetes and watch the video on diabetes by Dr. Jason Fung, at section 3 on Part 8 Videos political YouTube. 

One last point, a proof that diet works.  Bariatric surgery forces the patient to fast for the first couple of months.  Ninety percent of the patient cure their diabetes within the first month (before significant weight loss).  Following Dr. Fung's program can accomplish the same without surgery.

There are several currently practiced methods of operating to reduce the size of the stomach or the duodenum (part of the small intestines where must of the nutrients are absorbed).  The use of a silicone band is the most commonly used method.  Bariatrics:  a branch of medicine that deals with the control and treatment of obesity and allied diseases. 

Bariatric Surgery

A Systematic Review and Meta-analysis

JAMA. 2004;292:1724-1737.

Context  About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery.

Objective  To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea).

Data Sources and Study Selection  Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations.

Data Extraction  A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22 094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8).

Data Synthesis  A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality ( 30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients.

Conclusions  Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

There is a gradual increase in the ability to eat larger portions.  With this ability returning, the problem behavior returns.  Fortunately for the majority the loss of weight at 2 years is maintained at 5.  Serious complications run about 20%.

--JK. 

Long-Term Results of Laparoscopic Adjustable Gastric Banding for the Treatment of Morbid Obesity, Obesity Surgery, Vol 12, Number 4, August 2002. 

Long-Term Results of Laparoscopic Adjustable Gastric Banding for the Treatment of Morbid Obesity.  763 patients have been enrolled. Sex ratio was 22% male/78% female. Mean age was 34 years, and mean preoperative BMI was 42 kg/m². Results:The follow-up rate was 90%, and the minimum follow-up time was 4 years. The average BMI after 4 years was 30 kg/m². Early complications were: gastric perforation 4 (0.5%); large bowel perforation 1 (0.1%); bleeding 1 (0.1%); and conversion to open 10 (1.3%). Late complications were: erosion 7 (0.9%); total food intolerance 59 (8%); access port problems 20 (2.5%); re-operations 80 (11.1%); death 1 (0.1%). Conclusion: Long-term results of LAGB have been rarely reported, although publications on the procedure are copious. Our long-term data found that BMI evolution is good, the complication and re-operation rates are acceptable and the overall long-term results of the Lap-Band® system are good.   

An eight year study (same journal, June 2003) had similar results:  Mean excess weight loss was 59.3% after 8 years, if patients with band loss are excluded. BMI dropped from 46.8 to 32.3 kg/m². 5% of the patients had the band removed because of complication including slippage. 

Lap Band adjustable gastric banding system: the Italian experience with 1863 patients operated on 6 years. Surgery, Endoscopic, 2003, Mar, 17(3):409-12

Weight loss has been evaluated at the following intervals: 6, 12, 24, 36, 48, 60, and 72 months, with BMI 37.9, 33.7, 34.8, 34.1, 32.7, 34.8, and 32,

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