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Improvements or Resolution of Comorbidities
Lipid disorders/High cholesterol
The correlation between atherosclerosis and asymptomatic lipid disorders (hyperlipoproteinemia, hyperlipidemia, dyslipidemia, and hypercholesterolemia) is well documented. Additionally, there is abundant scientific, epidemiologic and clinical evidence that shows that the aggressive treatment of lipid disorders can slow, prevent, or even reverse the progression of atherosclerosis. Therefore, the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) continues to identify elevated LDL cholesterol as the primary target of cholesterol-lowering therapy.17
Therapeutic lifestyle changes, such as reduced intake of saturated fats and cholesterol, increased physical activity, smoking cessation, pharmacologic interventions, and weight management are the most common treatment recommendations.17
For patients unable to effectively manage obesity with diet modification alone, Gastric Band procedure may help achieve this goal. One published study showed that 36 months after Gastric Band procedure, 163 patients showed a 65.5% improvement in dyslipidemia, based upon a comparison of medications (type and dosage) prescribed before surgery and at follow-up. Thirty-six months after surgery, their mean BMI had decreased from 45.2l kg/m2 to 34.9 kg/m2 and their mean %EWL was 47%.4
In another published study, 179 patients who had Gastric Band procedure lost a mean %EWL of 45.7 (+/- 17.1) during the first year and saw major improvements in their hyperlipidemia and a remarkable decline in their medication usage. Weight loss was associated with significant improvements in fasting triglyceride levels and HDL cholesterol levels in 50 subjects with diabetes 1 year after Gastric Band procedure.3
Metabolic SyndromeRelevant Links:
Physician Resources—HyperlipidemiaStandards of Care—Hyperlipidemia
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.