The bottom line: Dr. Campos and his team noted that the patients who underwent gastric bypass: *achieved greater weight loss, *had a higher rate of diabetes remission, * experience greater improvement in their quality of life
The researchers concluded that the gastric bypass surgery might be better than the band.
200 patients with severe obesity underwent gastric banding surgery and half who had gastric bypass surgery.
The subjects who had gastric bypass surgery lost an average of **64%** of their excess weight, whereas the gastric banding patients only lost **36%** of their excess weight.
What’s really striking is the effect gastric bypass had on type 2 diabetes.
76% of the gastric bypass patients with DM experienced remission, compared to 50% of band patients.
After one year 75% of bypass patients who started on insulin no longer needed it; only 17% of the band patients were able to go off insulin.
Band patients had a higher risk of re-operation
A study released published in the February issue of JAMA’s Archives
of Surgery now provides a good comparison between the two main surgical
procedures for weight loss, gastric bypass surgery and gastric band
This is big news, since over 220,000 gastric bypass
and gastric banding surgeries are done in the U.S. every year. The new study
provides consumers and physicians with much more information when they are
deciding which procedure is best.
Currently, insurance companies cover this surgery for
persons with a BMI of 35 or greater who have significant medical issues, or with a
BMI of 40 or greater without health problems. Now the FDA has lowered the BMI requirement to 30 for gastric band surgery after research concluded that it is an effective treatment for obesity in this group, although these
patients are not yet covered by insurance.
So what’s the difference?
In gastric bypass surgery (technically known to clinicians
as Roux-en-Y gastric bypass), the surgeon makes the football-sized stomach much smaller, reducing it to
the size of a small egg. When genuine hunger pangs return about 6 months after surgery, this new
egg-sized stomach (known as a pouch) will help the person to feel full
even after very small meals.
operation bypasses the duodenum, or first part of the small intestine and, for
reasons that are not yet fully understood, brings about significant
weight-friendly changes in the body. First, the surgery increases the metabolism
(the rate at which calories are burned) for several months, and it also makes
hunger pangs disappear for at least 6 months after the operation.
Gastric bypass surgery is
considered by many experts in weight-loss surgery to be a gold standard for
diabetes treatment because the brain becomes content at a lower set point or “happy weight.”
This fine-tuning can actually help change insulin receptors.
The gastric band procedure, on the other hand, is a purely
restrictive solution to weight loss that surgically positions a silicone band near
the top of a person’s stomach. The clinician tightens the band by injecting saline into it. The tighter the band, the smaller the stomach and the smaller the amount of solid food a person can eat at a meal. This method is adjustable and reversible.
Which one is more effective?
Dr. Guilherme Campos, an experienced bariatric surgeon and
researcher out of the University of Wisconsin School of Medicine and Public
Health in Madison, has completed a well-designed study that compared various
measures of success for the gastric band and gastric bypass surgeries.
He looked at 200 patients with severe obesity—all with BMIs
of 40 or greater—half who underwent gastric banding surgery and half who
had gastric bypass surgery. Patients in both groups were matched by sex, race, age, and initial BMI. The differences in the two groups’ outcomes were quite
significant. Interestingly, the subjects who had gastric bypass surgery lost an
average of 64 percent of their excess weight, whereas the gastric banding
patients only lost 36 percent of their excess weight. What’s more, 86 percent of the gastric bypass patients lost
more than 40 percent of their extra weight, compared to just 31 percent of the
What’s really striking is the effect gastric bypass had on type 2 diabetes. Thirty-four subjects in each group had type 2 diabetes mellitus (DM).
At the study’s end, 76 percent of the gastric bypass patients with DM experienced
remission, compared to 50 percent of band patients. After one year of
follow-up, 75 percent of those gastric bypass patients who started the study on
insulin no longer needed it; only 17 percent of the band patients in this
category were able to go off insulin.
Both procedures caused comparable numbers of complications
(15 percent in the gastric bypass group vs. 12 percent in the band group),
although early complications (within the first month after surgery) were higher
in the gastric bypass group (11 percent vs. 2 percent). Band patients,
however, had a higher risk of re-operation (that is, of having to go back into
the OR because the band slipped, etc.). No one died in either group.
The bottom line
Dr. Campos and his team noted that the patients who underwent gastric bypass surgery
- achieved greater weight loss
- had a higher rate of diabetes remission
- experience greater improvement in their quality of life
The researchers therefore concluded that the benefit/risk
profile of gastric bypass surgery might be better than the gastric
But the process of choosing the
best weight-loss surgery procedure is more complex than this. If your BMI meets the weight loss criteria for surgery, I highly recommend that you do extensive research and find a bariatric Center of Excellence, which ensures
that the surgeons and staff have done a large number of these procedures
and follow high standards of practice.