Lynn C

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 Not sure where I belong or what I'm doing....just wandering back hoping to figure some stuff out. 

27 June 2010

ASMBS: Gastric Banding Gets Low Marks

ASMBS:  Gastric Banding Gets Low Marks

LAS VEGAS -- Adjustable gastric banding achieves only modest weight loss, and even that benefit deteriorates over time in most patients, a Dutch surgeon said here.

 

Five years after surgery, about two thirds of patients maintained 25% excess weight loss. At 10 years the success rate dropped to less than a third (31%).

 

Using 40% excess weight loss as the standard resulted in a five-year success rate of about 50%, which declined to 20% at 10 years, Edo Aarts, MD, reported at the American Society of Metabolic and Bariatric Surgery meeting.

Control of obesity-related comorbid conditions deteriorated similarly over time.

"If you perform adjustable gastric banding, you must realize that this is not the final solution, most of the time, for your patients," said Aarts, of Rijnstate Hospital, Amhem, The Netherlands.

Reviewing the history of adjustable gastric banding, Aarts noted that initial results were encouraging when the procedure was introduced in the early 1990s. Gastric banding achieved good results with respect to excess weight loss and was associated with a low risk of morbidity and mortality.

The five-year results have been mixed, as some studies showed durable weight loss and others deterioration of initial benefits. Because of the procedure's relatively recent introduction, little information has accumulated regarding the long-term results with adjusted gastric banding, Aarts said.

Rijnstate Hospital has the most active bariatric surgery program in The Netherlands, he continued. Surgeons perform more than 800 procedures annually, and more than 3,000 patients have undergone laparoscopic adjustable gastric banding.

Aarts and colleagues evaluated results in 201 patients who had laparoscopic adjustable gastric banding procedures during 1995 to 2003. All the patients had rigorous follow-up at three-month intervals during the first year and then annually thereafter. As a result, 99% of the patients had complete follow-up data, which spanned an average of 9.6 years.

The patients had a mean baseline age of 37, and women accounted for three fourths of the cohort. Baseline body mass index averaged 46 kg/m², and 20% of the patients met the definition of super obese. Excess body weight averaged 83 kg.

Using excess weight loss >25% to define treatment success, Aarts and colleagues found that adjustable gastric banding was successful in about 80% of patients during the first three years, followed thereafter by a steady decline to 64% at 5 years and 31% at 10 years.

When treatment success was defined as band in place and excess weight loss >40%, the success rate was 70% at one year, 64% at three years, 50% at five years, and 20% at 10 years.

A third of patients had undergone reoperation after five years, increasing to 53% at 10 years. The incidence of band removal increased from 0.5% at one year to 11% at five years and 35% at 10 years. Conversion to Roux-en-Y gastric bypass accounted for half of all reoperations.

Control of diabetes, hypertension, and gastroesophageal reflux disease all deteriorated significantly (P<0.01) over time. In particular, the incidence of new-onset diabetes and hypertension increased during follow-up, as did the proportion of patients requiring acid-suppression therapy.

On the basis of the results, surgeons at the Dutch center have begun to re-evaluate their use of adjustable gastric banding for treatment of obesity. What role, if any, the procedure will play in the future has yet to be determined, said Aarts.

Primary source: American Society of Metabolic and Bariatric Surgery
Source reference:
Aarts E et al. "Disappointing results in the long run after gastric banding." ASMBS 10. Abstract PL-118.

Does the band fail the person or the person fail the band. I know I'm fairly intelligent. I understand the priciples of the band and how it works, I have access to good food and high quality medical care and yet my band dilated my stomach. Some will tell you that is my fault... peer reviewed studies will tell you there is a basic flaw with the band as a weight loss tool. More to come.

www.ncbi.nlm.nih.gov/sites/entrez

http://www.aace.com/pub/pdf/guidelines/Bariatric.pdf

So, I did a ton of research, talked to a bunch of band to sleeve revisions and decided that this is the road for me. I had a meeting with my doctor and we discussed all the good, bad and ugly and I'm in.

Insurance approval came through (Yay CIGNA!!) and I have  a surgery date of 9/7 - just 16 days away.  I'm scared and excited. I'm praying that the sleeve will be what I had wanted the band to be - fingers crossed, chickens swinging - everybody wish me a complication free surgery.

It will nice to get on with life!

I used to be so good at updating this stuff. Time to get back to it. My upper GI revealed circumfrential pouch dilation. My doc wanted to take the band out but I'm kinda attached to it so he agreed to a total unfill, six weeks of tiny meals and then another upper GI. At that time I'll need to decide what to do next. If the dilation is improved I could leave the band or have it repositioned, but I would live in fear that the next wrong bite could cause a serious complication. I could have the band removed and go it alone - I can tell you right now, no way in hell that will work. 

I can revise to a different procedure. I've been leaning toward this option. I know that I don't want a malabsorptive procedure and I've done well with restriction only so I've started researching the sleeve. So far I'm liking what I see but I have lots of questions for my doc when I go back. They have started the paperwork though so if I do decide on the sleeve I will already have insurance pre approval - kinda scary. I'll update when I know more

So last October I had a .5 cc fill - I went back to my surgeon at 6 mo to do a check up due to my gain last year and he took out .2 cc due to some reflux issues I've been having. What a relief. Its funny for a veteran bandster I should have know that I was a tad to tight but the symptoms that are now gone 3 days after my unfill were so subtle that I was inclined to ignore them or blame myself for them.  So beware of new/increased reflux, night cough, puddling sensation when drinking and small pains when eating (not overeating).

Owing to the fact that I'm almost 5 years out and I am having reflux (although its almost disappeared in the last 3 days) I am scheduled for an upper GI on 5/24/10. Keeping my fingers crossed that the band is still A OK!! Wish me luck, I'll update when I know more.

Lynn

I lost 103 lbs and then got complacent. I didn't have an unfill but I only had about 2 cc in my 4 cc band, I just got lazy. I put 26 lbs back on over the course of one year.  I was so scared to go to my yearly but figured that was the only way to make a new start.

In October 2009 I went back to my nut/surgeon at 220 lbs vrs the 197 they has last seen. I got a .5 cc fill and over the next two months yo-yo'd from 220-226. In January I went back to Atkins - dropped down to 215 and then went on vacation. Right back up to 225. 

The band has helped me lose over 80lbs but now I have to be much more aware and strict than in those first couple years post op.  I have been following my low carb lifestyle for three weeks now and I'm down to 213 so yes it can be done. You just need to find what works for you and stick with it. Without my band - I'd be back at 300 in a heart beat

So in September of 2008 I found this neat little gadget on a Hungry Girl email - the Fitbit. Sounded like a mini Bodybugg with the features I wanted. It was small, discreet and tracked sleep habits as well as activity. Hubby pre-ordered for my Christmas 2008 gift.  Turns out that development, debugging and manufacturing took a bit longer than expected to produce a perfect product.

I got my Fitbit last week and I can tell you the wait was worth it. This thing is fun, easy and very motivational. It is worn clipped to your clothing and in a wrist band at night. I clip it to the center of my bra, you can't see it and I can't tell its there. It uses a bunch of fancy technology to keep an accurate record of - steps, distance traveled and exertion. During sleep mode it records when you were restless and when you slept peacefully.

There web site (which is free) allows you to customize your goals for steps, calories, etc and also provides a very user friendly food log (I've used them all and this one is the easiest IMO). Now I have a real time evaluation of calories burned vs. calories eaten. I love my Fitbit.

www.fitbit.com

Centrum Complete Chewable (Flintstones Complete)

Serving Size 1 Tablet   Each Tablet Contains  % Daily Value

Calories 5  

Total Carbohydrate 1g <1%†

   Sugar <1g *

Vitamin A 3,500 IU (29% as Beta-Carotene) 70%  (3000 IU)

Vitamin C 60 mg 100% (same)

Vitamin D 400 IU 100% (same)

Vitamin E 30 IU 100% (same)

Vitamin K 10 mcg 13% (none)

Thiamin 1.5 mg 100%  (same)

Riboflavin 1.7 mg 100% (same)

Niacin 20 mg 100%  (15 mg)

Vitamin B6 2 mg 100%  (same)

Folic Acid 400 mcg 100% (same)

Vitamin B12 6 mcg 100% (same)

Biotin 45 mcg 15%  (40 mcg)

Pantothenic Acid 10 mg 100% (same)

Calcium 108 mg 11% (100 mg)

Iron 18 mg 100%  (same)

Phosphorus 50 mg 5% (100 mg)

Iodine 150 mcg 100% (same)

Magnesium 40 mg 10% (20 mg)

Zinc 15 mg 100% (12 mg)

Copper 2 mg 100% (same)

Manganese 1 mg 50%  (none)

Chromium 20 mcg 17% (none)

Molybdenum 20 mcg  27% (none)

Flintstones also contains 10mg sodium & 38mg Choline

+ Percent Daily Value based on a 2,000 calorie diet. 

Joslin Diabetes Center’s New Nutrition Guideline For People with Type 2 Diabetes or Pre-Diabetes Who Are Overweight or Obese

The scientific jury is in and the verdict is clear: weight loss is directly related to improved diabetes control. What is also clear is that two out of three people in the U.S. are overweight or obese, resulting in a skyrocketing rate of diabetes.

Joslin Diabetes Center’s approach to nutrition and physical activity has always been to focus on the individual and not dictate a “one size fits all” strategy. This approach has not changed with the creation of Joslin’s new clinical nutrition guideline. Indeed the “Joslin Diabetes Center Clinical Nutrition Guideline for Overweight and Obese People with Type 2 Diabetes, Prediabetes or at High Risk for Developing Type 2 Diabetes” is consistent with Joslin’s care strategy, which emphasizes a personalized approach to diabetes management.

What has changed, however, is an explicit goal of weight loss resulting from increased physical activity and a decrease in the number of calories and carbohydrates a person eats each day. With this goal met, outcomes will include improved insulin sensitivity, better cardiovascular health and a reduction in body fat. The scientific data support this plan. And it is a plan that can be followed because it makes clear what people need to do to achieve their goals.

The best way for people to approach the plan is to work with a registered dietitian (R.D.) for an assessment, review of treatment goals, and an individualized meal plan tailored to meet their needs.

This Joslin guideline, which evolved from a review of the scientific literature, details the following for the major nutrients that provide calories:

Carbohydrate:

• Approximately 40 percent of a person’s daily calories should come from carbohydrate; the total should not be less than 130 gm daily. This is a significant change from previous recommendations that promoted a higher carbohydrate intake. Scientific data show that reducing one’s carbohydrate intake while simultaneously increasing healthier protein and fat choices may be a better approach to weight control. It may also help decrease cardiovascular disease in overweight people with type 2 diabetes.
  • In terms of carbohydrate intake, eating fresh vegetables, fruits, beans, and whole grain foods is preferable to eating pasta, white bread, white potatoes and low fiber cereal.
     
• Fiber intake should be approximately 50 grams daily if that amount can be tolerated; a minimum of 20-35 grams per day is recommended. High-fiber foods include fruits, vegetables, whole grain cereals, breads, nuts and seeds.

For Fat:

• Approximately 30 to 35 percent of a person’s daily calories should come from fat.
  • Mono- and polyunsaturated fats, such as olive oil, canola oil, nuts, seeds and fish (especially those high in omega-3 fatty acids, such as salmon, mackerel, lake trout, herring and sardines)
  • Foods that are high in saturated fat, such as beef, pork, lamb and high-fat dairy products (cream cheese, whole milk) should be eaten in small amounts.
  • Foods that are high in trans fats such as fast foods, commercially baked goods, crackers, cookies and some margarines should be avoided.
     
• Cholesterol intake should be less than 300 mg daily; or less than 200 mg in people with an LDL (“bad”) cholesterol that is more than 100 mg/dL.

Protein:

• Approximately 20 to 30 percent of a person’s total calories should come from protein. This is a higher percentage than recommended in the past. Scientific data reveal that eating more protein helps people feel “full” and thus causes people to eat less calories overall. Protein also helps to maintain lean body mass during weight loss. Examples of protein include fish, skinless chicken or turkey, nonfat or lowfat dairy products and legumes such as kidney beans, black beans, chick peas and lentils.
  • Anyone with signs of kidney disease should consult their provider before increasing the daily amount of protein.

Guidelines for Weight Loss:

• A modest weight loss of one pound every one to two weeks is advised.
• Reducing daily calories should be by 250 to 500 calories; total daily calories should not be less than 1,000 to 1,200 for women and 1,200 to 1,600 for men.
• Weight loss is different for each person and should be continued until a person reaches a target body mass index, or BMI (ask your provider about how to obtain this measurement.
• Meal replacements, such as shakes, bars and ready-to-mix powders that match these guidelines can be helpful for some people. Blood glucose patterns often change with these types of replacements and thus people should monitor their blood glucose.

Guidelines for Physical Activity:

• Physical activity is extremely important to a weight loss plan. A minimum of 150 to 175 minutes of moderate intensity physical activity is recommended. Examples of this include walking, biking, swimming and dancing. A target of 60 to 90 minutes most days of the week is encouraged.
• Physical activity should be a mix of cardiovascular, stretching and resistance activities to maintain or increase lean body mass.