Lap-Band® from a Personal Perspective

This is a letter we received from a former patient, giving her personal perspective on achieving weight loss success. She explains how Lap-Band has changed her life and brought her everyday victories.

Lap-Band Before and After San Diego Lap Band

* Results may vary.

My name is Duana, and I had Lap-Band® surgery on May 11, 2011. My story started when I went with my parents to the Lap-Band orientation with my insurance information. I eventually received the insurance approval, but it was a long road to get it done. I almost gave up, but Dr. Gertsch and Dr. Martinez (from the Gastric Banding Center) never did. I would not be where I am today without them.

Before I had my surgery, I was 349.5 pounds. I am now 194 pounds, a size 14, and getting smaller! The first seven days after my surgery, I lost 20 pounds, and the weight loss just kept going. I did the surgery for my health, because I was borderline diabetic. I had to take two water pills a day and wore clothing in sizes 26 to 28.*

When I would go to places like Sea World, I would have to stop every 10 to 15 minutes to rest because my back would be hurting. Now that I have lost 156 pounds, I walk a lot without needing to stop and rest along the way. My kids have to catch up with me because I am walking too fast.*

Before the surgery, when I would go to theme parks, I was too big for the rides. I was told I was too fat and could not go on them with my kids. Now I go on amusement park rides with no problems, and no one looks at me as if I am too fat for them.*

I am very happy with this procedure, and I love my doctor for all they have done for me. Everyone at the Gastric Banding Center cares for the patients and does not judge them. I would do the surgery all over again, and I brag about this medical center to all my friends. I even had two friends who also had the procedure done.*

*Results may vary.

Thanks to all who helped me!

To learn more about surgery for successful weight loss, contact our Gastric Banding Center of San Diego. You can attend one of our free seminars which are held daily or you can attend one of our monthly free support group meetings which are held on the second Monday of every month at 6:30 pm. The Gastric Banding Center can be reached at 800-GBC-7103 or 800-422-7103. *Results may vary from person to person.


What to Expect From a Lap-Band® Seminar

Lap Band san Diego LAP-BAND Seminar

Are you interested in transforming your life through Lap-Band® and wondering about our free seminars? *The Lap-Band San Diego seminars are designed as an introduction to the procedure. This first step can be a beneficial one when considering surgical weight loss. Seminar attendance is not mandatory, but there are reasons to consider it, including:*

*Results may vary.

1. Information. At a seminar, our physicians, staff members, and former patients provide the details you need to make an informed decision about the procedure. You will learn benefits and risks. Before attending, you may want to browse our website to find out who is a candidate for weight loss surgery. If you think you are a candidate, a seminar will outline the advantages of this laparoscopic gastric banding procedure, as well as what to expect in terms of weight loss and long-term weight management.

2. Q&A. You have the chance to ask questions at our seminars and to hear questions or comments from other attendees. Since former patients are in attendance, they can also provide valuable insight within the seminar setting. Of course, there will be some inquiries you prefer to make in private. These can be addressed during an individualized consultation with one of our physicians.

3. Resources. We have educational materials for you to take home and review. These resources cover specifics about Lap-Band and its recognition as a minimally invasive and safe medical procedure. There will also be information available about payment options, potential insurance coverage, or financing plans.

4. Family involvement. We know your weight loss journey requires the support of friends and family. They will be more likely to provide this support if they understand the process. So we encourage you to invite a spouse, loved one, or close friend to attend a seminar with you.

5. Common goals. Most individuals who attend our seminars share the goal of freeing themselves from the health complications of obesity. If you have concerns about making a dramatic change, it often helps to attend a seminar and a support group meeting so you can interact with other individuals wishing to improve their quality of life.

Remember, seminar attendance is highly encouraged if you have an interest in Lap-Band. To attend the next seminar sponsored by The Gastric Banding Group, please contact us or sign up online for a reservation and location information.

Results may vary from person to person.

Body Contouring for Problem Areas

i-Lipo Body Sculpting

* Results not typical.

As you reach a healthier weight with the Lap-Band®, you may desire a more toned appearance to complement the new you. This is why patients sometimes turn to body contouring options.*

*Results may vary. All medical procedures have risks of complications.

Invasive vs. Noninvasive Contouring

Liposuction and tummy tucks are two well known plastic surgery procedures for body shaping, but these invasive techniques involve anesthesia, recovery, and interrupted activities. Fortunately, there are alternatives.*

We offer noninvasive laser contouring that features short treatments, generally immediate results, and usually no downtime. *Commonly treated areas include places prone to fat deposits, such as the waist, thighs, hips, and upper arms.* Before body contouring, you may want to be at or close to your post-surgical goal weight. Certain medical conditions may also prevent you from receiving the treatment. *To find out if you’re a candidate, simply check with your physician.*

*Results may vary. All medical procedures have risks of complications.  Consult your doctor.

Reducing Inches with i-Lipo

The i-Lipo laser contouring is an effective and affordable alternative to traditional liposuction. Clinical studies have verified the laser’s capabilities, and it has FDA approval. An i-Lipo body sculpting laser generally provides immediate results and is safe when administered by qualified staff. Since it is noninvasive, work and activity schedules are not usually affected. The time commitment is also manageable. As with any procedure, you’ll want to gain the information you need before scheduling treatment.*

During the technique, a low level laser stimulates the body to shrink its own fat cells. *This procedure has gained popularity because it generally triggers fat elimination without pain. The i-Lipo laser contours and creates a measurable loss of inches in targeted areas.*

*Results may vary. All medical procedures have risks of complications.  Consult your doctor.

Advanced Weight Loss Services

Fitness and nutrition are key components to losing and maintaining weight and a trim body. If you decide to integrate advanced body contouring, the i-Lipo laser technique can be a viable alternative to invasive procedures.*

At Lap-Band San Diego we take a multidisciplinary approach to weight loss, providing a range of resources. If you’re interested in i-Lipo, please contact the Gastric Banding Medical Group for a consultation.*

*Results may vary. All medical procedures have risks of complications.  Consult your doctor.


A Healthy Pregnancy After Lap-Band

12 Jul 2013 LAP-BAND Procedure

If you’re an overweight woman who is planning to have a child in the future, the Lap-Band® procedure can be an important step in preparing for a safe, healthy pregnancy. Lap-Band surgery may lead to significant weight loss and the reduction of obesity complications. Here are some points to consider to have a healthy pregnancy after Lap-Band. *

  • You need 12-18 months of “me” time. We recommend waiting at least one year after the procedure before trying to get pregnant. Dedicate this time period to concentrating on your own weight loss, as the body adjusts to the Lap-Band. Preferably, before becoming pregnant, you will have reached a healthy weight. *
  • In some cases, weight loss can enhance fertility. Being significantly overweight may affect hormone levels and fertility. As the weight comes off, fertility could improve. It is important to remember that your smaller stomach may not absorb oral contraceptives as well, meaning you should consider alternative forms of contraception. *
  • A healthier weight may mean fewer complications. Pregnancy with obesity carries risks. Excessive weight is associated with specific health concerns as you carry a child. Achieving a healthy weight with Lap-Band can alleviate the worries over pregnancy complications related to obesity. *
  • Congratulations! Let us know you’re pregnant. Your obstetrician is vital to the health of your baby. You’ll also want to contact your Lap-Band San Diego physician when you receive the good news. During this time, you will need to gain some weight. Your band can be loosened, allowing you to follow your obstetrician’s recommendations concerning nutrition and food intake. Because the Lap-Band is adjustable, it does not prevent a baby from receiving nourishment from its mother. The band should also support more gradual weight increases. *
  • Think weight loss after baby. Once your bundle of joy arrives, talk to your medical providers about the best time to make adjustments for weight loss. These can usually be performed while breastfeeding, if you continue eating nutrient-rich foods for your little one *

A healthy pregnancy is the top priority. Contact Lap-Band San Diego if you need more information as you start or add to your family.

*Results may vary. All medical procedures have risks of complications.  Consult your doctor.


Weight Loss Success After LAP-BAND

* Results may vary from person to person.

The road to optimal weight loss and improved health can begin with the LAP-BAND® procedure, which may lead to gradual and safe weight reductions. * We believe the average patient may lose more than 20 pounds throughout the year after surgery, with approximately two-pound decreases each week. These losses generally continue over time, so patients at five years post-surgery generally lose an average of 60% of their excess weight! Lap-Band weight loss occurs because the device limits the amount of food the stomach can hold, creating a feeling of fullness with smaller portions.*

* Results may vary from person to person.

Weight Maintenance.
Once a target weight is reached, many Lap-Band patients maintain their results. During the longest study to date of the procedure, more than 3,000 patients were followed for 10 to 15 years. The study results, published in January, found that a significant number of participants maintained their losses beyond a decade, making the procedure a long-term method for substantial weight loss. *

* Results may vary from person to person.

Lifestyle and Lap-Band.
Though the surgery is integral to this success, behavioral and dietary changes also play a role in dramatic weight loss after Lap-Band. You must be open to following lap band dietary guidelines, such as eating high protein meals and avoiding snacks. Exercising regularly can also encourage the body to shed weight sooner. Your physician will let you know when to start exercising after surgery. You’ll be encouraged to get active at least four times a week, incorporating both cardio and strength training. Fortunately, most of the weight lost following Lap-Band is excess fat. You keep more of the lean muscle you need for a healthy metabolism and fitness.*

* Results may vary from person to person.

Aftercare and Support.
At Lap-Band San Diego, we offer excellent aftercare and programs for continued success. Life after Lap-Band does require smart choices. However, with education and support groups, you’ll have the tools for life changing reductions in weight and obesity-related health complications. * Please contact us for more information about the Lap-Band Procedure.

* Results may vary from person to person.

Lap-Band Surgery – there are no words to express my gratitude.

25 Apr 2013 LAP-BAND News

To the team at Gastric Banding Medical Group:

San Diego Lap Band Surgery

* Results may vary from person to person.

There’s no words to express my gratitude. What is one year of life worth that you would have lost to obesity, embarrassment, humiliation, loneliness, fear, poor health… and how do you thank the people who gave you a MULTITUDE of years back. Years full of confidence, joy, energy, new opportunities, new relationships, new self-esteem, new goals. Again, I couldn’t possibly thank you enough.*

My name is Adrianne Kozlik and I had the lap-band procedure done, I believe, in 2009. I was upwards of 270 lbs. I had tried everything. I cried constantly. I was on severe depression medication. My husband was distant and stayed out at night more and more often. I used to watch the pretty skinny girls walk around the mall as a slinked myself into the “plus sized” stores and cried in the dressing room of every one of them. I was winded walking up one flight of stairs. I couldn’t cross my legs. I couldn’t see my collar bones. I couldn’t lay on my stomach. Then came the silver lining…*

LAP-BAND Suergery in San Diego

* Results may vary from person to person.

Since the surgery, I have lost 140 lbs and currently weigh a healthy, happy 130. I went from a size 22 pant, to a size 6. I’m surfing again – something I had put away when I hit 200 lbs…I thought I had put it away forever. I’m painting again because I feel inspired. I’m loving again because I feel worthy of love. The husband I had when I got the surgery eventually divorced me about six months after the surgery because he claimed I wasn’t losing the weight fast enough and I wasn’t even trying. That kicked me into high gear. I was determined to let NOTHING stop me gaining my life back… and nothing did. In fact, when I lost my first 100 lbs, my gift from my friends was to sponsor me on a 5k mud run obstacle course, which I finished (although slowly!), but I finished. I had never felt so good. I broke down in tears…and then had a couple beers 🙂 You and this life-saving procedure did that for me.*

I’ve maintained my weight for about a year now, so I wanted to show you some pictures of me now and the new life and support team of friends and family I have with me that have helped me through the entire process. I hope my story helps some other poor soul contemplating this procedure. It absolutely saved my life. It absolutely saved the quality of my life. It was, by far, the best thing I’ve ever done for myself. Again, there are no words to thank you all.*

Here’s to you continuing to make new lives…cheers!

Adrianne Kozlik

p.s. If there’s any way you can forward me the picture you took of me prior to my lap-band surgery that would be great… most of my friends STILL don’t believe I ever weighed that much 🙂

* Results may vary from person to person.

i-Lipo Body Sculpting Procedure Zaps Fat

i-Lipo Body Sculpting

* Results may vary from person to person.

Safe, non-surgical laser body sculpting is now available to break down fat and contour the body for generally effective results. The Gastric Banding Center staff is specially trained to provide this relaxing i-Lipo laser procedure. It’s a body sculpting laser that generally takes inches off problem areas, without impacting normal activities. Plus, the effectiveness of this laser treatment has been confirmed through scientific studies. Since laser body contouring is non-invasive, you don’t have to take an anesthetic and there is no down time to lose fat from the waist, hips, thighs and other areas. We all know reducing these areas is difficult even with healthy eating and exercise. Fortunately, the i-Lipo procedure offers an alternative to surgical liposuction. The headline-grabbing i-Lipo equipment is available at the Gastric Banding Center of San Diego, which is currently offering the groundbreaking, fat-zapping procedure at a special low rate for patients. *

* Results may vary from person to person.

Savings on Effective, Non-Invasive Body Contouring

The i-Lipo laser by Chromogenex Technologies LTD contours the body to smaller proportions. With the procedure, you usually experience the removal of excess fat without side effects. The i-Lipo laser technology generally reduces the size of the fat cells, as its beam emulsifies them. As fat cell contents are released and excreted through the lymphatic system, smaller waistlines, thighs, love-handles and hips can be seen after the treatment. With a total of 36 individual laser beams, you rest comfortably on a table while i-Lipo targets the application areas. One session takes 20 minutes. To save on the latest non-invasive body contouring procedure that decreases inches and increases self-confidence, contact us for more information.*

* Results may vary from person to person.

Gastric Banding Center Awarded Special ACS Accreditation

14 Aug 2012 LAP-BAND News

Gastric Banding Center of San Diego Awarded Center of ExcellenceOur outpatient facility, San Diego Ambulatory Care Surgical Center and Gastric Banding Center of San Diego, was awarded a highly respected accreditation through the Bariatric Surgery Center Network (BSCN) of the American College of Surgeons (ACS). This accreditation is only given to surgical facilities that provide superior resources and an optimal commitment to care during lap-band weight loss procedures. This specialized designation is reserved for outpatient centers which are dedicated to performing gastric band surgery according to nationally recognized standards.

Our BSCN accreditation was based on the precise quality of care requirements established by the American College of Surgeons and ASMBS. Bariatric specialists with the ACS network conducted a comprehensive, on-site review of our facilities. During this evaluation, our facility demonstrated its ability to offer a full continuum of high quality care to patients, from preoperative to postoperative bariatric treatments.

On average, U.S. patients lose approximately 60 percent of their excess weight within five years after undergoing LAP-BAND® System procedures. Following the surgery, many patients can effectively control obesity-related health conditions, such as diabetes, high blood pressure and heart disease. Our board certified physicians have extensive experience in weight loss surgery and healthy weight management. We are dedicated to helping patients reach their goals for overall well-being.

With our accreditation we have been designated as a Center of Excellence for Bariatric Surgery. We want the community to be confident in the extensive knowledge and specialized experience of our physicians and staff. We welcome the on-going rigorous evaluation and certification process which is part of maintaining accreditation status as a Center of Excellence. We are dedicated in our commitment to provide the highest quality care possible for our patients.

Results may vary from person to person.


Do You Know the Health Risks of Being Overweight ?

Do You Know the Health Risks of Being Overweight ?

  • Type 2 diabetes
  • Heart disease and stroke
  • Body Mass Index Table
  • Cancer
  • Sleep apnea
  • Osteoarthritis
  • Gallbladder disease
  • Fatty liver disease
  • How can I lower my health risks?
  • Additional resources

Weighing too much may increase your risk for developing many health problems. If you are overweight or obese on a body mass index (BMI) chart, you may be at risk for:

  • Type 2 diabetes
  • Heart disease and stroke
  • Cancer
  • Sleep apnea
  • Osteoarthritis
  • Gallbladder disease
  • Fatty liver disease.

You can lower your health risks by losing as little as 10 to 20 pounds.

Type 2 diabetes

What is it?

Type 2 diabetes used to be called adult-onset diabetes or noninsulin-dependent diabetes. It is the most common type of diabetes in the U.S. Type 2 diabetes is a disease in which blood sugar levels are above normal. High blood sugar is a major cause of early death, heart disease, kidney disease, stroke, and blindness.

How is it linked to overweight?
More than 80 percent of people with type 2 diabetes are overweight. It is not known exactly why people who are overweight are more likely to suffer from this disease. It may be that being overweight causes cells to change, making them less effective at using sugar from the blood. This then puts stress on the cells that produce insulin (a hormone that carries sugar from the blood to cells) and makes them gradually fail.

What can weight loss do?
You can lower your risk for developing type 2 diabetes by losing weight and increasing the amount of physical activity you do. If you have type 2 diabetes, losing weight and becoming more physically active can help you control your blood sugar levels. Losing weight and exercising more may also allow you to reduce the amount of diabetes medication you take.


Heart disease and stroke

What is it?

Heart disease means that the heart and circulation (blood flow) are not functioning normally. If you have heart disease, you may suffer from a heart attack, congestive heart failure, sudden cardiac death, angina (chest pain), or abnormal heart rhythm. During a stroke, blood and oxygen do not flow normally to the brain, possibly causing paralysis or death. Heart disease is the leading cause of death in the U.S., and stroke is the third leading cause.

How is it linked to overweight?
People who are overweight are more likely to suffer from high blood pressure, high levels of triglycerides (blood fats) and LDL cholesterol (a fat-like substance often called the “bad cholesterol”), and low levels of HDL cholesterol (the “good cholesterol”). These are all risk factors for heart disease and stroke. In addition, people with more body fat have higher blood levels of substances that cause inflammation. Inflammation in blood vessels and throughout the body may raise heart disease risk.

What can weight loss do?
Losing 5 to 15 percent of your weight can lower your chances for developing heart disease or having a stroke. If you weigh 200 pounds, this means losing as little as 10 pounds. Weight loss may improve your blood pressure, triglyceride, and cholesterol levels; improve how your heart works and your blood flows; and decrease inflammation throughout your body.


Body Mass Index Table

To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight. The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.















What is it?

Cancer occurs when cells in one part of the body, such as the colon, grow abnormally or out of control and possibly spread to other parts of the body, such as the liver. Cancer is the second leading cause of death in the U.S.

How is it linked to overweight?
Being overweight may increase the risk of developing several types of cancer, including cancers of the colon, esophagus, and kidney. Overweight is also linked with uterine and postmenopausal breast cancer in women. Gaining weight during adult life increases the risk for several of these cancers. Being overweight also may increase the risk of dying from some cancers. It is not known exactly how being overweight increases cancer risk. It may be that fat cells make hormones that affect cell growth and lead to cancer. Also, eating or physical activity habits that may lead to being overweight may also contribute to cancer risk.

What can weight loss do?
Avoiding weight gain may prevent a rise in cancer risk. Weight loss, and healthy eating and physical activity habits, may lower cancer risk.


Sleep apnea

What is it?

Sleep apnea is a condition in which a person stops breathing for short periods during the night. A person who has sleep apnea may suffer from daytime sleepiness, difficulty concentrating, and even heart failure.

How is it linked to overweight?
The risk for sleep apnea is higher for people who are overweight. A person who is overweight may have more fat stored around his or her neck. This may make the airway smaller. A smaller airway can make breathing difficult, loud (snoring), or stop altogether. In addition, fat stored in the neck and throughout the body can produce substances that cause inflammation. Inflammation in the neck may be a risk factor for sleep apnea.

What can weight loss do?
Weight loss usually improves sleep apnea. Weight loss may help to decrease neck size and lessen inflammation.



What is it?

Osteoarthritis is a common joint disorder. With osteoarthritis, the joint bone and cartilage (tissue that protects joints) wear away. Osteoarthritis most often affects the joints of the knees, hips, and lower back.

How is it linked to overweight?
Extra weight may place extra pressure on joints and cartilage, causing them to wear away. In addition, people with more body fat may have higher blood levels of substances that cause inflammation. Inflammation at the joints may raise the risk for osteoarthritis.

What can weight loss do?
Weight loss can decrease stress on your knees, hips, and lower back, and lessen inflammation in your body. If you have osteoarthritis, losing weight may help improve your symptoms.


Gallbladder disease

What is it?

Gallstones are clusters of solid material that form in the gallbladder. They are made mostly of cholesterol and can sometimes cause abdominal or back pain.

How is it linked to overweight?
People who are overweight have a higher risk for developing gallbladder disease and gallstones. They may produce more cholesterol, a risk factor for gallstones. Also, people who are overweight may have an enlarged gallbladder, which may not work properly.

What can weight loss do?
Weight loss — especially fast weight loss (more than 3 pounds per week) or loss of a large amount of weight — can actually increase your chance of developing gallstones. Modest, slow weight loss of about 1/2 to 2 pounds a week is less likely to cause gallstones.


Fatty liver disease

What is it?

Fatty liver disease occurs when fat builds up in the liver cells and causes injury and inflammation in the liver. It can sometimes lead to severe liver damage, cirrhosis (build-up of scar tissue that blocks proper blood flow in the liver), or even liver failure. Fatty liver disease is like alcoholic liver damage, but it is not caused by alcohol and can occur in people who drink little or no alcohol. The National Digestive Diseases Information Clearinghouse (NDDIC) has more information on fatty liver disease or nonalcoholic steatohepatitis (NASH).

How is it linked to overweight?
People who have diabetes or “pre-diabetes” (when blood sugar levels are higher than normal but not yet in the diabetic range) are more likely to have fatty liver disease than people without these conditions. And people who are overweight are more likely to have diabetes (see Type 2 diabetes above). It is not known why some people who are overweight or diabetic get fatty liver and others do not.

What can weight loss do?
Losing weight can help you control your blood sugar levels. It can also reduce the build-up of fat in your liver and prevent further injury. People with fatty liver disease should avoid drinking alcohol.


How can I lower my health risks?

If you are overweight, losing as little as 5 percent of your body weight may lower your risk for several diseases, including heart disease and diabetes. If you weigh 200 pounds, this means losing 10 pounds. Slow and steady weight loss of 1/2 to 2 pounds per week, and not more than 3 pounds per week, is the safest way to lose weight.

To lose weight and keep it off over time, try to make long-term changes in your eating and physical activity habits. Choose healthy foods, such as vegetables, fruits, whole grains, and low-fat meat and dairy products, more often and eat just enough food to satisfy you. Try to do at least 30 minutes of moderate-intensity physical activity— walking— most days of the week, preferably every day. To lose weight, or to maintain weight loss, you may need to do more than 30 minutes of moderate physical activity daily.


Additional resources

National Cancer Institute
NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
Phone: 1-800-4-CANCER ( 1-800-422-6237 )
TTY: 1-800-332-8615

National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Phone: 1-800-860-8747 or (301) 654-3327

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Phone: 1-800-891-5389 or (301) 654-3810

National Heart, Lung, and Blood Institute
NHLBI Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
TTY: (240) 629-3255

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
1 AMS Circle
Bethesda, Maryland 20892-3675
Phone: 1-877-22-NIAMS ( 1-877-226-4267 ) or (301) 495-4484
TTY: (301) 565-2966


As Obesity Surgery Soars, Patients Weigh Which Method is Best

By MARILYNN MARCHIONE, AP Medical Writer. Associated Press. New York:
Jan 1, 2006. pg. 1

As more people abandon New Year’s resolutions to lose weight and turn to obesity surgery, doctors are debating which type is safest and best.

And researchers are uncovering some surprising trends.

The most common method in the United States – gastric bypass, or stomach-stapling surgery – may be riskier than once thought. Yet surgeons still favor it for people who need to lose weight fast because of heart damage or other serious problems.

A gentler approach favored in Europe and Australia – an adjustable stomach band – can give long-term results that are almost as good and with far fewer risks. It may be the best option for children or women contemplating pregnancy, and is reversible if problems develop.

A radical operation – cutting away part of the stomach and rerouting the intestines – is increasingly being recommended for severely obese people. It gives maximum weight loss but also is the riskiest solution.

A large U.S. government study just got under way to compare all three options.

But regardless of which method is used, studies show an inescapable reality: No surgery gives lasting results unless people also change eating and exercising habits.

“The body just has many ways of compensating, even after something as drastic as surgery,” said Dr. Louis Aronne, director of the weight loss program at Weill-Cornell Medical College.

He is president of the Obesity Society, the largest group of specialists in bariatrics, as this field is known. The group’s recent annual conference in Vancouver featured many studies on surgery’s long-term effects.

Obesity is a problem worldwide. About 31 percent of American adults – 61 million people – are considered obese, with a body-mass index of 30 or more. That’s based on height and weight. Someone 5- foot-4 is obese at 175 pounds; 222 does it for a 6-footer.

Federal guidelines say surgery shouldn’t be considered unless someone has tried conventional ways to shed pounds and is at least 100 pounds over ideal weight, or has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure.

More people are meeting those conditions. A decade ago, less than 10,000 such surgeries were done in the United States. That ballooned to 70,000 in 2002 and more than 170,000 in 2005, says the American Society for Bariatric Surgery.

Doctors disagree over which is better: the most popular method, Roux-en-Y gastric bypass, or the adjustable band, which is rapidly gaining fans. Either can be done through a big incision, or laparoscopically with tiny instruments passed through small cuts in the abdomen.

In gastric bypass, a small pouch is stapled off from the rest of the stomach and connected to the small intestine. People eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. They must take protein and vitamin supplements to prevent deficiencies.

The adjustable band has been available in the U.S. only since 2001 but far longer in Europe and Australia where it is dominant. It accounted for 17 percent of U.S. obesity procedures in 2005.

A ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.

Deaths from the procedure are only 0.1 percent compared to about 2 percent for gastric bypass. One recent study of Medicare patients found deaths a year after gastric bypass as high as 3 to 5 percent.

The band’s reversibility makes it a better choice for children, some doctors say.

“It’s becoming more well-known and more accepted. Patients like it because it’s less invasive. It’s an easier surgical procedure. It’s safer,” said Georgeann Mallory, executive director of the bariatric society.

“To me it is a very straightforward decision,” said Dr. Paul O’Brien, director of the Centre for Obesity Research and Education at Monash University in Melbourne, Australia. “I would strongly recommend that the consumer consider the safest effective procedure first,” which is the band, he said.

American doctors have preferred bypass operations because they produce faster, greater weight loss. But new research by O’Brien and others calls that into question.

Combining results on 23,638 patients in 43 published studies, they found that bypasses beat bands for the first three years but were comparable after seven years, with excess weight loss of 55 percent for bypass and 51 percent for bands.

That impressed Dr. Edward Livingston, chief of gastrointestinal surgery at the University of Texas Southwestern Medical Center and chief of bariatric surgery for the Department of Veteran’s Affairs national system.

“I really was not enthusiastic about bands until I came to Dallas from Los Angeles and saw the results from the group that I joined, which where quite good,” he confessed. “What you can accomplish in a year with a gastric bypass you can accomplish in five years with a laparoscopic band.”

Results would improve if Americans copied the Australians and included in the price of the band any future adjustments, Livingston said.

“A key to the success of banding procedures is the followup and working with a patient on their compliance,” he said. “When they come in and they’ve sort of fallen off the wagon, you adjust the band. It really has an amazing effect.”

Bands also appear safer for women attempting pregnancy. Several years ago in Massachusetts, a woman and her 8-month-old fetus died of complications 18 months after gastric bypass surgery. Other pregnancy-related deaths have been reported.

In contrast, another study O’Brien and colleagues presented at the obesity meeting found that pregnancy outcomes for women with stomach bands were comparable to normal-weight women, and better than for obese women without bands.

Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, did a band operation in October for Long Islander Donna Dotzler, who weighed 279 pounds, but wants to do a more drastic surgery for her husband.

“I gave up on New Year’s resolutions maybe five years ago,” said Jim Dotzler, who weighs 479 pounds. “I’m a smart guy. If this were a matter of willpower, I’d have taken care of this a long time ago.”

The operation Roslin has advised for him is BPD, which stands for biliopancreatic diversion, with or without a second procedure called a duodenal switch. Studies show it can cause loss of up to 80 percent of excess body weight for at least as long as 10 years afterward.

Surgeons remove three-fourths of the stomach to leave a sleeve- or banana-shaped organ that is connected to the small intestine, bypassing more of it than a standard gastric bypass does. It can be done in two operations a year apart to reduce its severity and the chances of death, which can be as high as 5 percent.

The “switch” preserves a valve that controls release of food into the intestines from the stomach. These operations account for nearly 5 percent of U.S. obesity surgeries and are growing.

On the horizon are other approaches, like vagus nerve stimulation, to control impulses to eat, and new drugs like rimonabant, which blocks a pleasure center in the brain that makes people want to munch.

“I see the future as combined therapy,” with surgery, medication and other approaches used simultaneously, said Aronne, the obesity society president. “Time will tell what works out best.”

Copyright © Associated Press Jan 1, 2006. Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.



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