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Clinical Studies and Practice

Weight loss after laparoscopic adjustable gastric band and resolution of the metabolic syndrome and its components

International Journal of Obesity volume 41, pages 902–908 (2017)Cite this article

Subjects

Abstract

Background:

Substantial weight loss in the setting of obesity has considerable metabolic benefits. Yet some studies have shown improvements in obesity-related metabolic comorbidities with more modest weight loss. By closely monitoring patients undergoing bariatric surgery, we aimed to determine the effects of weight loss on the metabolic syndrome and its components and determine the weight loss required for their resolution.

Methods:

We performed a prospective observational study of obese participants with metabolic syndrome (Adult Treatment Panel III criteria) who underwent laparoscopic adjustable gastric banding. Participants were assessed for all criteria of the metabolic syndrome monthly for the first 9 months, then 3-monthly until 24 months.

Results:

There were 89 participants with adequate longitudinal data. Baseline body mass index was 42.4±6.2 kg m−2 with an average age was 48.2±10.7 years. There were 56 (63%) women. Resolution of the metabolic syndrome occurred in 60 of the 89 participants (67%) at 12 months and 60 of the 75 participants (80%) at 24 months. The mean weight loss when metabolic syndrome resolved was 10.9±7.7% total body weight loss (TBWL). The median weight loss at which prevalence of disease halved was 7.0% TBWL (17.5% excess weight loss (EWL)) for hypertriglyceridaemia; 11% TBWL (26.1–28% EWL) for high-density lipoprotein cholesterol and hyperglycaemia; 20% TBWL (59.5% EWL) for hypertension and 29% TBWL (73.3% EWL) for waist circumference. The odds ratio for resolution of the metabolic syndrome with 10–12.5% TBWL was 2.09 (P=0.025), with increasing probability of resolution with more substantial weight loss.

Conclusions:

In obese participants with metabolic syndrome, a weight loss target of 10–12.5% TBWL (25–30% EWL) is a reasonable initial goal associated with significant odds of having metabolic benefits. If minimal improvements are seen with this initial target, additional weight loss substantially increases the probability of resolution.

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Acknowledgements

We acknowledge the kind support of the Royal Australasian College of Surgeons and the National Health and Medical Research Council for supporting GJO and LD in their higher degrees and in completing this research. We thank Ms Cheryl Laurie, Ms Julie Playfair, Mr Stuart Skinner, Mr Gary Crosthwaite, Mr Stephen Blamey and Mr Andrew Smith for their contribution and enthusiasm in recruitment and follow-up of participants and collection of samples.

Author information

Authors and Affiliations

  1. Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia

    G J Ooi, L Doyle, T Tie, J M Wentworth, C Laurie, P R Burton, P E O'Brien & W A Brown

  2. Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia

    G J Ooi, T Tie & W A Brown

  3. Walter and Eliza Hall Institute, Melbourne University, Parkville, Victoria, Australia

    J M Wentworth

  4. Department of Epidemiology, SPHPM, Monash University, Melbourne, Victoria, Australia

    A Earnest

  5. MODI, Monash University, Melbourne, Victoria, Australia

    M A Cowley

  6. Melbourne Pathology, East Melbourne, Victoria, Australia

    K Sikaris

  7. Diabetes Complications Research Centre, University College, Dublin, Ireland

    C W le Roux

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  1. G J Ooi
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Corresponding author

Correspondence to W A Brown.

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Competing interests

GJO, LD, TT, CL, PRB, PEO’B and WAB report being affiliated with the Centre for Obesity Research and Education. The Centre has received funding for research purposes from Allergan and Apollo Endosurgery, the manufacturers of the LapBand. The grant is not tied to any specific research project, and Allergan has no control of the protocol, analysis and reporting of any studies. CORE also receives a grant from Applied Medical towards educational programs. WAB reports financial support for a bariatric surgery registry from the Commonwealth of Australia, Apollo Endosurgery, Covidien, Johnson and Johnson, Gore and Applied Medical and a speaker’s honorarium from Merck Sharpe and Dohme. These are outside of the submitted work. MAC reports grants and personal fees from Novo Nordisk, personal fees and other from Orexigen Therapeutics, outside the submitted work. KS is the Director of Clinical Support Services at Sonic Healthcare; this is unrelated to this work. CWlR has received funding from the Science Foundation Ireland (12/YI/B2480). He also serves on the advisory boards of NovoNordisk and Herbalife and has received speakers fees from Ethicon EndoSurgery. GJO and LD report scholarships from the National Health and Medical Research Council and the Royal Australasian College of Surgeons. PEO’B has written a patient information book entitled ‘The Lap-Band Solution: A partnership for weight loss’, which is given to patients without charge, but some are sold to surgeons and others, for which he receives a royalty. JMW and AE have no other relevant disclosures.

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Ooi, G., Doyle, L., Tie, T. et al. Weight loss after laparoscopic adjustable gastric band and resolution of the metabolic syndrome and its components. Int J Obes 41, 902–908 (2017). https://doi.org/10.1038/ijo.2017.59

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