Body composition changes following laparoscopic gastric banding for morbid obesity

Abstract

Most reports of outcome following obesity surgery report weight and co-morbidity changes only. We studied body composition changes in 17 adult patients (15 F, 2 M, age 43+/-2 years, range 28-58 years), with morbid obesity (initial BMI 40.4+/-4.9 kg/m(2), range 34.7-48.8) who were managed surgically by laparoscopically inserting an adjustable gastric band. Body composition was studied before and after surgery (mean interval of 909+/-51 days, range 441-1155 days) using anthropometry (abdominal circumference, AC, sum of four skinfold thicknesses, SFSUM), whole-body potassium counting (TBK), in vivo neutron activation analysis total body nitrogen (TBProtein) and whole-body dual-energy ray absorptiometry (total body percent fat TBF%, and total body bone mineral density TBBMD). Weight loss over the study period was 23.4+/-2.5 kg. ( p<0.0003) with an AC reduction of 20.0+/-4.5 cm ( p<0.008). Both SFSUM and TBF% were significantly reduced ( p<0.02 and p<0.0005 respectively). Both TBK and TBProtein after normalization for sex and height, were significantly ( p<0.0054 and p<0.001 respectively) reduced, but the ratio of loss of fat mass to fat-free mass, at 4.4:1 was usual for weight loss, and there was no significant changes in the ratio of potassium to protein. TBBMD, after normalization relative to a young same sex adult, was not significantly changed. In this group of patients, most of the substantial weight loss over a 2- to 3-year period was due to loss of fat mass, with relatively less reduction in the components of fat-free mass. Adjustable laparoscopic gastric banding induces fat loss without significant other deleterious effects on body composition.

Visceral Adipose Tissue Loss and Insulin Resistance 6 Months after Laparoscopic Gastric Banding Surgery: A Preliminary Study

“…Several studies have evaluated post-LGBS abdominal fat loss using dual-energy X-ray absorptiometry (DEXA) or bioelectrical impedance [28][29][30]. These studies demonstrated significant reductions in relative and absolute amounts of abdominal fat [29] or percent body fat [28,30]. However, DEXA is unable to differentiate between subcutaneous and visceral fat so that the resultant measure of abdominal fat is a combination of both depots.…”

“…The present study is unique in that it clearly links improvements in insulin resistance in LGBS patients to VAT loss rather than to weight loss. Several studies have evaluated post-LGBS abdominal fat loss using dual-energy X-ray absorptiometry (DEXA) or bioelectrical impedance [28][29][30]. These studies demonstrated significant reductions in relative and absolute amounts of abdominal fat [29] or percent body fat [28,30].…”

The Bone-Adipose Axis in Obesity and Weight Loss

“…This decrease was apparently not accompanied by changes in parathyroid hormone (PTH), with some authors even evidencing a significant decrease with a concomitant increase in vitamin D [101]. A lack of effect of AGB on BMD or bone mineral content is consistently found in the literature [102,103]. However, a decrease in femoral and trochanter BMD with no significant changes in total BMD has been reported in one study 24 months after AGB [104].…”

Rats Submitted to Gastric Banding are Leaner and Show Distinctive Feeding Patterns

“…1,2 Bariatric surgery with gastric banding induces a substantial weight loss due to a decrease in fat mass with relatively less reduction in the components of fatfree mass, and without significant deleterious effects on body composition. 5,6 In the phase of rapid weight loss that follows gastric banding, there is a preferential mobilization of visceral fat, compared with total and subcutaneous adipose tissue. 7 Restrictive obesity surgery has been shown to result not only in sustained weight loss, but also in improvement in eating behavior.…”