Gastric bypass surgery and laparoscopic adjustable gastric banding are two commonly performed bariatric procedures in the United States, but each has different profiles for risk and effectiveness. Few studies have explored the factors that might lead patients to proceed with one procedure over another. In the Journal of the American College of Surgeons, a study was conducted to investigate the reasons why obese patients choose one type of weight loss operation over another. First author Caroline M. Apovian, MD, FACP, FACN, and colleagues studied 536 adults who had either gastric bypass (297 patients) or gastric banding (239 patients).
A Deeper Look
According to the results, diabetes status played an important role in decision-making for patients who were choosing between gastric bypass and laparoscopic adjustable gastric banding procedures. Those with diabetes were more likely to proceed with gastric bypass surgery. “This could be the result of patients and their physicians understanding that obesity causes type 2 diabetes, and that gastric bypass surgery can be life-saving and restore normal glucose levels,” says Dr. Apovian. Other patients who were more likely to select gastric bypass over the laparoscopic banding procedure included those who wanted greater weight loss and those willing to assume a higher mortality risk to reach their ideal weight.
BMI appeared to play a smaller role in the decision-making process for patients choosing between bariatric surgeries. “Psychological and emotional issues appear to influence surgery decisions,” Dr. Apovian says. “It’s important to consider the patient’s individual preferences and what matters most to them.” In addition, the study found that patients reporting more uncontrolled eating were more likely to undergo laparoscopic banding than gastric bypass. It is possible that these patients chose laparoscopic banding because the surgery is reversible while gastric bypass typically is not.
A Complicated Decision
Although the mortality risk associated with bariatric surgery is much lower than that of other potentially life-saving surgeries for other health issues, mortality is an important aspect to consider when patients decide between weight loss surgeries. “Decisions on which bariatric surgery patients select are complicated,” says Dr. Apovian. Christina C. Wee, MD, MPH, FACP, who was the principal investigator of this NIH-funded study and senior author, adds that “it’s important for patients talk to their surgeons about their values, weight loss goals and concerns, such as aversion to risk, the level that obesity has adversely affects their quality of life, and their potential challenges to losing weight, including their eating behaviors. This information will help surgeons better guide their patients in choosing a weight loss operation.”
Readings & Resources (click to view)
Apovian CM, Huskey KW, Chiodi S, et al. Patient factors associated with undergoing laparoscopic adjustable gastric banding vs Roux-en-Y gastric bypass for weight loss. J Am Coll Surg. 2013:217;1118-1125. Available at: http://www.sciencedirect.com/science/article/pii/S1072751513010181.
Nguyen NT, Masoomi H, Magno CP, et al. Trends in use of bariatric surgery, 2003-2008. J Am Coll Surg. 2011;213:261- 266.
Nguyen NT, Nguyen B, Gebhart A, Hohmann S. Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg. 2013;216:252-257.