Weight Loss and Dietary Intake After Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass

Brolin, Robert E.; Robertson, Lisa B.; Kenler, Hallis A.; Cody, Ronald P.

doi:10.1097/00000658-199412000-00012

Cited by 317 publications

(232 citation statements)

References 16 publications

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“…The presence of a rapid and a slow phase of weight reduction following gastric bypass has been well documented [26]: this profile is due mainly to the pattern of energy intake, which is extremely low in the early postoperative period and, then, progressively increases up to 1 year after surgery [13,26,27]. Our results clearly indicate that, besides energy intake, other factors can influence weight loss at different phases of the process.…”

Section: Discussionsupporting

confidence: 63%

The effect of insulin on cardiac autonomic balance predicts weight reduction after gastric bypass

et al. 2005

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Aims/hypothesis: The aim of this study was to assess the predictive role of autonomic reactivity in body weight loss induced by gastric bypass. Methods: A group of 22 morbidly obese subjects, who were due to undergo a gastric bypass, were submitted, before surgery, to a euglycaemic-hyperinsulinaemic clamp, during which a continuous recording of the ECG was performed. The effect of insulin on cardiac autonomic balance was evaluated by performing power spectral analysis of heart rate variability. The low-to-high frequency ratio was calculated before and during the clamp and its modifications were expressed as % delta low-to-high frequency ratio (%Δ L: H). Results: Preoperative %Δ L: H showed a significant (p=0.0009, r 2 =0.43), positive relationship to the reduction of body weight, measured 1 year after surgery and expressed as % excess weight loss (% EWL). Preoperative BMI was also significantly (p=0.0009, r 2 =0.43) negatively related to the 12-month % EWL. In a multiple regression analysis, %Δ L: H remained a significant (p=0.003), independent predictor of body weight loss, even when preoperative BMI or age, % fat mass, insulinaemia and glucose disposal were taken into account. Conclusions/ interpretation: The best correction of excess body weight was achieved by those obese subjects who had a preserved capacity to shift their cardiac autonomic balance towards a sympathetic prevalence in response to an euglycaemichyperinsulinaemic clamp. Further studies are needed to elucidate the mechanisms through which the autonomic nervous system influences weight reduction.

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Section: Discussionsupporting

confidence: 63%

The effect of insulin on cardiac autonomic balance predicts weight reduction after gastric bypass

et al. 2005

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“…One of the RCTs that they did include used a horizontal, unbanded gastroplasty 85 and therefore should have been excluded. Four other RCTs comparing vertical banded gastroplasty with gastric bypass [86][87][88][89] as well as three retrospective series [90][91][92] and the SOS cohort trial 17 all found gastric bypass to cause greater weight loss than gastroplasty. One study not cited by either report found an equivalent weight loss between vertical banded gastroplasty and gastric bypass when patients were allowed to choose the operation, but the drop-out rate (15% seen at 5 y) was excessive.…”

Section: Resultsmentioning

confidence: 99%

Evidence-based medicine reports on obesity surgery: a critique

Sugerman

Kral

2005

Int J Obes

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OBJECTIVE:To evaluate evidence in recent authoritative 'Evidence-Based Medicine' (EBM) reports on surgery for severe obesity. METHODS: Focused review of Index Medicus citations and authors' own databases of publications on surgery for obesity, . RESULTS: EBM criteria for assessment of strength of evidence requiring randomized controlled studies (RCTs) in these reports are inappropriate for evaluating invasive treatments such as surgery, which have robust physiological effects, are difficult to reverse and may have more serious side effects than the drug studies for which the criteria were promulgated. Flaws in these reports include omissions of important studies demonstrating improvements in comorbidity, factual errors in descriptions of operations and faulty analyses of outcomes of laparoscopic approaches. There are misinterpretations of cited papers, and inclusion of obsolete operations as well as a study generated during the 'learning curve' of an avowed complex procedure. CONCLUSION: EBM analyses of surgical modalities affecting access to care require relevant evaluation criteria, true peer review and expert consultation. Authors' claims of objectivity by invoking use of evidence-based criteria applicable to drug treatment and other easily reversible forms of therapy are questionable. Decisions based on flawed EBM reports may adversely affect access to care for millions of severely obese patients.

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“…A significant increase in energy intake over time has been reported among bariatric surgery patients. 42,43 In the SOS study, self-reported intake was almost halved during the first 6 months postsurgically, from about 2900 to 1500 kcal per day, but increased to about 2000 kcal per day over the next 6 years. 14 These data suggest that surgical patients have difficulties to adhere to the postoperative diet.…”

Section: Discussionmentioning

confidence: 99%

Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study

et al. 2007

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Objective: To examine trends and effects of weight loss treatment on health-related quality of life (HRQL) in the severely obese over 10 years. Design: Swedish obese subjects (SOS) intervention study is a controlled, longitudinal trial of the health effects of weight loss in the severely obese. Subjects: A total of 655 of 851 surgically treated and 621 of 852 conventionally treated obese men (body mass index, BMIX34) and women (BMIX38) who completed 10 years of the study. Measurements: HRQL was assessed before treatment and after 0.5, 1, 2, 3, 4, 6, 8 and 10 years. Results: HRQL change during the 10-year observation period largely followed phases of weight loss, weight regain and weight stability. Improvements and deteriorations in HRQL were associated with the magnitude of weight loss or regain, except regarding anxiety. Peak improvements in the surgical group were observed during the first year of weight loss, whereas the weight regain phase (mainly between 1-and 6-year follow-up) was accompanied by a gradual decline in HRQL. The period from 6-to 10-year follow-up was characterized by relatively stable observations in both weight and HRQL. At 10 years, net gains were noted in all HRQL domains compared to baseline. Comparisons of treatment effects on HRQL in the surgical vs conventional group after 10 years showed significantly better outcome in the surgical group on current health perceptions, social interaction, psychosocial functioning and depression, whereas no significant differences were found for overall mood and anxiety. Long-term results of the study suggest that a maintained weight loss of about 10% is sufficient for positive long-term effects on HRQL, a limit that was reached in about two-thirds of the surgically treated patients who completed 10 years of the study. Conclusion: Long-lasting weight reduction in the severely obese has a general long-standing positive outcome on HRQL. Bariatric surgery is a favorable option for the treatment of severe obesity, resulting in long-term weight loss and HRQL improvements in a majority of patients. However, difficulties among some surgical patients to control and maintain weight loss over time should not be ignored. Future research should study if the long-term efficacy of bariatric surgery may be further enhanced by implementing lifestyle modification techniques in the postoperative management of patients.

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Weight Loss and Dietary Intake After Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass

Abstract: ObjectiveThe purpose of this study was to learn whether preoperative eating habits can be used to predict outcome after vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB).Background Summary

Cited by 317 publications

References 16 publications

The effect of insulin on cardiac autonomic balance predicts weight reduction after gastric bypass

The effect of insulin on cardiac autonomic balance predicts weight reduction after gastric bypass

Evidence-based medicine reports on obesity surgery: a critique

Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study

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