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Improvement or Resolution of Comorbidities
Overview
Weight loss accomplished through behaviour modification such as diet and exercise, and pharmacotherapy is often not sustained and often results in patients returning to an overweight or obese state. This leads to an increased risk of certain co morbidities such as heart disease, diabetes, hypertension, sleep apnea and increased cholesterol.1
Treating obesity often results in improvements or resolution of comorbidities. The Gastric Band in particular has been associated with improvement or resolution of co morbid conditions, such as: 2,3
- Diabetes Type 2
- Obstructive Sleep Apnea
- Hypertension
- Asthma
- GERD
- Lipid Disorders/High Cholesterol
- Metabolic Syndrome
- Osteoarthritis
- Depression
- Infertility
- Urinary Stress Incontinence
A study published in 2005 in the American Journal of Surgery reported that, at 36 months after Gastric Band procedure the following percentage of improvements or resolution of co morbidities were seen, (n=163 patients with greater than or equal to 18 months follow-up)4:
- GERD—87% (usually immediately post surgery)
- Asthma—81.8%
- Diabetes—66%
- Dyslipidemia—63.5%
- Hypertension—48%
- Sleep apnea—33%
An earlier study found that 4 years after Gastric Band procedure, the rates of resolution/improvement of comorbiditites were: hypertension 58%/42%, diabetes 75%/8%, dyspnea 85%/12%, arthralgia 52%/24%, reflux 79%/11%, self-esteem 45%/39%, and general physical performance 58%/33%. The researchers also noted improvements in stress incontinence, sleep apnea, peripheral edema, and regulation of menstruation 5.
Gastric Band procedure for weight loss is effective in managing the broad range of health problems experienced by obese individuals 5.
Diabetes Type 2
Resolution of co morbidities References:
1.Obesity in the U.S. American Obesity Assocation.http://www.obesity.org/subs/fastfacts/obesity_US.shtml.
2.Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25:2:358-363.Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547-559.
3.Ahroni JH, et al., Laparoscopic adjustable gastric banding: weight loss, co-morbidities, medication usage and quality of life at one year. Obes Surg. 2005;15:641-647.
4.Spivak H, et al., Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure. Am J Surg. 2005;189:27-32.
5.Frigg A, Peterli R, Peters T, Ackerman C, Tondelli P. Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding. Obes Surg. 2004;14:216-223.
6.Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Management of Obesity in Diabetes, S77-80. Available at: http://www.diabetes.ca/files/cpg2008/cpg-2008.pdf.
7.Centers for Disease Control and Prevention Web site. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2005. Available at: http://www.cdc.gov/diabetes/pubs/factsheet05.htm. Accessed June 20, 2007.
8.Dixon JB, et al., Adjustable Gastric Banding and Conventional Therapy for Diabetes Type 2: A Randomized Controlled Trial, JAMA 2008;299(3):316-323
9.Ponce J, Haynes B, Paynter S, et al. Effect of Lap-Band-induced weight loss on Diabetes Type 2 mellitus and hypertension. Obes Surg. 2004;14:1335-1342.
10.Littner M, Alessi C. Obstructive sleep apnea: asleep in our consciousness no more. Chest. 2002;121: 1729-1730.
11.Fritscher LG, et al., Obesity and obstructive sleep apnea-hypopnea syndrome: the impact of bariatric surgery. Obes Surg. 2007;17:95-99.
12.Morgenthaler TI, et al., Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29:1031-1035.
13.Dixon JB, et al., Sleep disturbance and obesity: changes following surgically induced weight loss. Arch Intern Med. 2001;161:102-106.
14.Ong KL, et al., Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension. 2007;49:69-75.
15.Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med. 2007;175:661-666.
16.Dixon JB, O’Brien PE. Gastroesophageal reflux in obesity: the effect of Lap-Band placement. Obes Surg. 1999;9:527-531.
17.Clearfield MB. The national cholesterol education program adult treatment panel III guidelines. J Am Osteopath Assoc. 2003;103:S1-S5.
18.Gordon C. McCarter GC. Wrestling the beast: obesity, metabolic syndrome, diabetes, and related disorders Medscape. 2006; http://www.medscape.com/viewprogram/5352
19.American Obesity Association Web site. Health effects of obesity. Available at: http://obesity1.tempdomainname.com/subs/fastfacts/Health_Effects.shtml. Accessed April 20, 2007.
20.American Society for Reproductive Medicine Web site. Patient’s fact sheet: weight and fertility. Available at: http://www.asrm.org/Patients/FactSheets/weightfertility.pdf.
Accessed June 20, 2007.
21.Agbaje IM, et al., Insulin dependant diabetes mellitus: implications for male reproductive function. Hum Reprod. 2007;1-7 [epub ahead of print].
22.Sugerman HJ. The pathophysiology of severe obesity and the effects of surgically induced weight loss. Surgery for Obesity and Related Diseases. 2005;109-119.
23.Dixon JB, et al., Pregnancy after Lap-Band surgery: management of the band to achieve healthy weight outcomes. Obes Surg. 2001;11:59-65.
24.The American Urogynecologic Society Web site. Female urinary stress incontinence: overview. Available at http://www.augs.org/i4a/pages/index.cfm?pageid=208. Accessed on May 16, 2007.
25.Carroll JF. Lap Band gastric bypass surgery improves insulin resistance. The American Physiological Society Web site. Available at: http://www.the-aps.org/press/journal/07/29.htm. Accessed June 20, 2007.