Lap Bands, Lap Belts... Are They Effective?

Obesity has become a major health problem worldwide and especially in the western world. The World Health Organization (WHO) estimates that this "globesity" epidemic includes over one billion overweight adults of which at the least 300 million are considered obese. Over two thirds of Americans are overweight and about one third are considered obese. Likewise in 2004, over 6 million Canadians were overweight and over 4.5 million were obese.

Contributing factors include reliance on fast foods, super-sized eating and substituting television and computers for more active pursuits. The enormous surge in obesity has meant a similar surge in obesity-related diseases such as diabetes, heart disease and orthopedic problems.

People who become or remain seriously overweight face a disturbing array of problems including high blood pressure and high blood cholesterol, coronary heart disease, stroke, congestive heart failure, Type 2 diabetes, osteoarthritis, gallstones, low back pain, heartburn, obstructive sleep apnea and some types of cancer, to name a few.

Beyond medical problems, obesity also creates psychological disorders including depression, eating disorders, distorted body image and low self esteem. These issues are aggravated by social norms that place a high value on physical attractiveness and stereotype obese people as lazy or undisciplined.

The causes of obesity are multifactorial and are determined by a combination of genes, metabolism, behavior, culture, and environment. For most people, obesity results from eating too much and not being active enough. Portion sizes continue to increase. Fast-food restaurants encourage customers to "super size" and purchase "value" meals. Further, people eat out more often than in the past and many restaurants offer huge portion sizes.

Less than one-third of American adults report that they do at least thirty minutes of brisk walking or other moderate activity on most days of t he week, and almost half engage in no leisure-time activity at all. Television and other electronic media contribute to obesity through commercials urging people to buy food of low nutritional value, and by encouraging sedentary behavior.

The clinical nutrition research center at the University of Alabama have proposed a number of contributing factors for obesity.

1. Getting too little sleep.

2. Hormones control body weight. Many of today's pollutants affect hormones.

3. More people live and work in temperature-controlled homes and offices, reducing the body's requirement to burn calories staying cool or warm.

4. As people smoke less, they eat more.

5. Many drugs including contraceptives, steroid hormones, diabetes drugs, some antidepressants, and blood pressure drugs can cause weight gain.

6. People gain weight as they age. The world is getting older as a group.

7. There's some evidence that the older a woman is when she gives birth, the higher her child's risk of obesity. Women are giving birth at older and older ages.

8. The environment may create genetic changes that increase obesity.

9. There's some evidence obese people are more fertile than lean ones. If obesity has a genetic component, the percentage of obese people in the population should increase.

10. Obese women tend to marry obese men. To the extent that obesity is genetic, it may become more prevalent.

In a recent study more than 30 percent of respondents cited having dieted between three to five times and a quarter has attempted dieting at least 20 times. 60 percent of respondents regained weight after their diets ended, almost half seeing at least 75 percent of total weight lost return and 20 percent adding more weight than they lost.

Other studies have cited overall diet failure rates as high as 95%. Many nutritionists and obesity researchers believe that diets fail because most are not sustainable. T he more restrictive the diet, the less likely an individual will be to remain faithful to it because in general, people cannot endure extended periods of hunger and deprivation.

Another reason diets may fail is that they neglect to teach dieters new eating habits. Since the weight-loss diet is viewed as a temporary measure with a beginning and an end, at its conclusion, most dieters return to their previous eating habits and often regain the lost weight or even more weight. Those who work with people who are overweight or obese assert that diets do not fail; instead, dieters fail to learn how to eat properly to prevent weight regain.

Faced with years of failure at losing weight through diet and exercise, many obese people are turning to bariatric surgery. The number of weight-loss surgeries has skyrocketed with 205,000 surgeries having been performed in 2007, up from 47,200 in 2001, according to the American Society for Metabolic and Bariatric Surgery.

Bari atric surgery results in a modification of the digestive tract so that less food can be eaten and/or fewer nutrients can be absorbed into the body. There are two main types of bariatric surgery.

(1) Restrictive Operations which alter the size of the stomach by placing a constricting band around it, reducing its capacity from melon-sized to egg-sized. A person who has undergone "lap band" surgery usually cannot eat more than one cup of food at a time.

(2) Gastric By-Pass Surgery where the surgeon removes a portion of the stomach to reduce the size. Then, the first part of the small intestine is bypassed. As a result, the patient can tolerate only small amounts of food and the food that is consumed passes much more rapidly through the digestive tract, reducing the amount of absorbed nutrients.

The average bariatric surgery patient is a woman in her late 30s who weighs approximately 300 pounds. Two-thirds had an average of five obesity-related conditions, incl uding high blood pressure, diabetes and sleep apnea. The average patient spent three years deciding whether to have surgery.

The Consensus Panel of the National Institutes of Health (NIH) emphasizes the need for multidisciplinary care of the bariatric surgical patient to manage problems and address nutrition, physical activity, behavior and psychological needs. In 2004 these recommendations were updated to include persons with a BMI of 30 to 34.9 who have additional medical problems associated with obesity and underscored the need for multidisciplinary pre=operative and post-operative care.

The decision to undergo bariatric surgery should not be made without fully exploring the benefits and the risks. Obesity surgery works successfully for many patients. Typical success rates range from 45-75 percent for stomach bypass and 40-60 percent for gastroplasty. Success rates for bariatric surgery far exceed those for conventional dieting, especially when patients take a dvantage of bariatric support groups or other types of weight loss help.

Surgery was also associated with reductions in diabetes, hypertension, and other co-existing conditions and improvements in health-related quality of life.

However, while bariatric surgery can be dramatically successful, there are significant surgical risks and the results do not always last. According to the Mayo Clinic, there is approximately one death per 200-300 surgeries.

Blood clots, which are more likely to occur in the seriously overweight, have also been associated with this surgery. Surgical intervention issues such as leaking at the staple lines in the stomach or incision hernia are also possible complications. Some patients, especially those who continue to eat sweet or high fat foods, experience "dumping syndrome". Food moves too quickly through the digestive system, resulting in nausea, vomiting, diarrhea, dizziness and sweating. The lowered absorption of food and nutrien ts can lead to vitamin deficiencies, dehydration, gall stones, low blood sugar, kidney stones and intolerance for certain foods. Although not properly labeled a risk, many people who undergo bariatric surgery lose weight very quickly and consequently are left with large amounts of excess skin that cannot be re-absorbed by the body. Also, weight loss is sometimes uneven, leading to excess fat deposits in some areas of the body.

While bariatric surgery can seem like a miracle for the seriously obese, making that "slicing off fat" dream come true, the tragic reality is that for some people, the weight loss is not sustained. A landmark 2006 study showed that the failure rate when all patients are followed for at least 10 years was 20.4%.

How can this happen? It's actually not that difficult. Even when a person's stomach has been banded or surgically altered to reduce the size, it is possible to slowly re-expand the size of the stomach. When a person who undergoes bar iatric surgery does not make the necessary lifestyle changes, they can undo all of the good that was done by the surgery.

The rock bottom reality is that bariatric surgery can give an obese person a fresh start, rapidly improving their health and dramatically accelerating the weight loss process. But, even if it looks like a magic bullet, it's not. The same need to change lifestyle habits apply. The good news is that it may be much easier to make those changes when a person is not facing the uphill battle of needing to lose 100+ pounds allowing one to quickly enjoy much greater physical health and the emotional boost that comes from achieving a better physical appearance.

While there are inherent risks, the consensus is that bariatric surgery is the most effective treatment for severe clinical obesity. However, anyone considering this surgery should recognize that success is fleeting unless there is a serious and long term commitment to changes in lifestyle.