Gastric Banding: Cheaper Weight Loss Surgery?

Study Suggests Banding Costs Less in Long Run Than Gastric Bypass

June 28, 2011 (San Diego) -- In people with diabetes, gastric banding is associated with fewer complications and lower costs over the long run than gastric bypass, the most commonly performed surgery for obesity in the U.S., researchers say.

Both procedures reduce the amount of care needed and associated health care costs for people with type 2 diabetes in the months immediately following surgery.

But by four years later, heath care use and costs increased for patients who underwent bypass surgery, while continuing to decline among those who got banding, says researcher Jason Lebowitz, a PharmD candidate at the University of Southern California in Los Angeles.

Allergan Inc., which makes the Lap-Band laparoscopic gastric banding device, funded the research. It was presented here at the annual meeting of the American Diabetes Association.

Experts say the research shows why it’s important for people considering weight loss surgery to understand the trade-offs.

Other studies have shown that bypass surgery appears to help patients lose more weight and may treat diabetes more effectively than banding, says Philip Schauer, MD,professor of surgery at the Cleveland Clinic Lerner College of Medicine. He was not involved with the new work.

Bypass surgery also appears to work well over the long run, he tells WebMD. In a recent study, 89% of people with type 2 diabetes who underwent gastric bypass surgery went into remission and 57% were still in remission after five years.

Bypass may offer more dramatic results because the procedure reroutes digestion, bypassing a portion of the small intestine, he says.

Banding does tend to be safer, at least in the short term: About 1% to 2% of patients have short-term complications, compared to 5% of bypass patients, Schauer says. However, the weight loss from banding procedures is more modest, he says.

"In general, if diabetes is pretty severe, and a patient is on a number of medications, he will need a more powerful procedure such as bypass," Schauer says. "But we’re still trying to understand which procedure works better for which patient. We don't have the right balance defined.”

Lebowitz and colleagues hypothesized that patients' prescription and medical claims might serve as a proxy for how well each procedure performed over the long run.

So they examined prescription claims and other medical records from nearly 2,900 people with type 2 diabetes who underwent weight loss surgery: 2,537 had bypass surgery and 329 had a banding procedure.

In the year before the procedure, people who underwent banding filled an average of 21 prescriptions; by the year afterward, the number had dropped to 16 and by year four, to 13.

In contrast, people who had bypass surgery filled an average of 28 prescriptions in the year before the procedure; by the year afterward, the number had dropped to 19 and by year four, it crept back up to 20.

Weight Loss Surgery Fights Diabetes in Multiple Ways

Researchers Say Changes in Gut Hormones, Along With Weight Loss, May Improve Type 2 Diabetes

June 24, 2011 (San Diego) -- Gastric bypass surgery often helps to improve type 2 diabetes -- even before patients lose a substantial number of pounds, doctors say.

"We used to think bariatric surgery worked for purely mechanical reasons. That is, caloric restriction and decreased nutrient intake were responsible for the improvements in diabetes control," says Lee M. Kaplan, MD, PhD, director of the obesity research center at Massachusetts General Hospital in Boston.

New research shows that physiological changes associated with weight loss surgery, such as changes in gut hormones, may also help to drive diabetes into remission, he tells WebMD.

At a briefing that was sponsored by Ethicon Endo-Surgery, a maker of bariatric surgery products, Kaplan and other leading experts discussed how they are working to understand the mechanisms of weight loss surgical procedures at the tissue, cellular, molecular, and genetic levels.

The goal is to develop less invasive, less risky, and less costly approaches to fighting diabetes, says Philip Schauer, MD,professor of surgery at the Cleveland Clinic Lerner College of Medicine.

Extreme obesity, which affects nearly 24 million adults, or 5.7% of Americans, is associated with more than 30 medical conditions, including type 2 diabetes, coronary heart disease, stroke, hypertension sleep apnea, joint disease, and cancer.

"Bariatric surgery works and works well -- for both obesity and diabetes," Schauer says.

In a recent study, 89% of people with type 2 diabetes who underwent gastric bypass surgery went into remission and 57% were still in remission after five years.

People who were at an early disease stage when they had the surgery were more likely to go into remission, Schauer says. "The first five or 10 years is when you have the best chance of recovery."

Although weight loss surgery is effective, there has been very little adoption of its use, Kaplan says.

Only one in 400 people with severe obesity in the U.S. undergoes bariatric surgery, he says.

The cost of treating diabetes is enormous, Schauer says. A person diagnosed at age 50 can expect to spend $172,000, the equivalent of seven gastric bypass procedures, on the condition.

The researchers don't know when new treatments aimed at the hormonal and genetic roots of diabetes will become available. But at least 12 studies are under way, Schauer says.