Lap Banding For Weight Loss in an Aging Population

A United Nations study suggests that approximately 21% of the world’s population will be over 60 years old by the year 2050. Considering the same age group accounted for only 10% of the population just 10 years ago in the year 2000, the needs of these aging citizens will place higher demands on the medical community [1,2]. The higher numbers, combined with the rapid increase of obesity in developed countries, underscores the need for consideration of surgical management for obese members of the 60+ age group. In the past, surgical procedures for older obese patients has been discouraged. However, a look at current statistics mandates further consideration for interventions such as Laparoscopic Adjustable Gastric Banding (LAGB).

John Flynn Hospital in Queensland, Australia examined the impact of LAGB on older patients in a study conducted by Craig Taylor [3]. Taylor contended that LAGB proved to be just as safe for patients over 60 years old as it was for patients younger than 60. Another study from Birmingham, UK conducted by Rishi Singhal and associates produced similar findings [4]. Both clinical studies provide data suggesting that LAGB offers comparable benefits and complications for both age groups. The studies claim lap banding is a viable option to manage obesity in older patients.

Who Participated in the Two Studies
Both studies conducted reviews assessing patients in multidisciplinary fields. In order to be considered in the study, obese patients needed a minimum body mass index of 40. Patients with co-morbidities due to weight were allowed to have a BMI starting at 33-35. Preoperative and postoperative data was collected and compared.

The Australia Study – LAGB in Patients Over 60
At John Flynn Hospital, the study took place from 2000-2005 and focused on 40 individuals aged 60 or older. Quality of life, BMI, medications, weight loss, complications and changes in the quality of life (measured using a questionnaire known as the Medical Outcomes Study Short Form-36 [5]) were documented. Eighty percent of the patients were female.

The UK Study – LAGB in Patients Over 50
The Birmingham study, on the other hand, spanned from April 2003-November 2007, focusing on 334 patients older than 50 within a group of 1335 patients opting for LAGB. Over 85% of patients were female. Patients were placed in two groups. One group was under 50 years of age and the other group was older. Weight loss and complications were the areas of focus.

Weight Loss and BMI Results
The over-60 age group dropped BMI from 42.2 to 32.9 in the Australia study. The mean change in weight went from 261.8 to 204 pounds two years after surgery. That translates into an excess weight loss (EWL) of 54%.

The UK study noted no significant statistical differences in preoperative or postoperative statistics in BMI or weight during any measurement intervals between the below-50 and over-50 age groups. That means that patients lost on average the same weight regardless of their age group.

Specific Complications
No complications due to the procedure occurred immediately following surgery in either study. In the Australia study three patients experienced late complications. Two recovered due to infections related to the access port while one required lap band revision due to slippage.

In the UK study, after five months one patient needed emergency surgery to reposition the band. Between 10-24 months after surgery six patients required treatment for pouch dilatations. One band erosion occurred after 2 years. Interestingly, all of these reported complications were in the under 50 group with the exception of one partial slippage.

Quality of Life
Marked improvement in overall quality of life was recorded in 7 of 8 elements in SF-36 scores dealing with mental and physical well-being. More than two years after surgery, 86% of the older patients rated their general health as much better following LAGB. Higher energy levels, improved mental health and physical functioning and better general health were noted.

Self-esteem was better for 70% of participants while 72% said they had a more positive outlook on life. Forty eight percent of the patients experienced improved sleep. Ninety one percent of those undergoing LAGB said they would recommend the procedure for older people. Eighty two percent of the patients noted they were happy they followed through with the surgery.

Main Points of The Two Studies

Taylor study (Australia)

• Scientific evidence exists to support improved quality of life and significant health benefits for patients over 60 who opt for LAGB. Results of the surgery for older patients are similar to results of patients under age 60.
• Older patients have traditionally been discouraged from having the procedure. It’s possible the perception of surgery not being safe or the benefits not being likely played into that decision [6].
• Surgical options for patients over 60 should focus on the quality of life during their remaining years. The SF-36 is a comprehensive tool measuring physical and mental health correlating to measurement of quality of life. After the lap band procedure, SF-36 scores improved.
• One inconsistent marker compared to younger patients having LAGP was reduction in the need for medication. Many patients in the older group continued using similar medications post surgery while patients in the younger age group experienced a sharp decrease in required medications.

Singhal study (UK)

• An aging population presents a need for safe surgical intervention for weight loss management.
• Bariatric surgery is just as safe as other surgeries for older patients. When choosing surgery these patients live longer than projected mortality without surgery.
• No statistical significant differences in weight loss or BMI between the younger and older group was noted during any measured intervals.
• Complications of slippage, erosion and pouch dilatation was higher in younger patients than in older patients.

Conclusion

The end result in the John Flynn Hospital study overwhelmingly supports the procedure for patients over 60. Lap banding provides greatly improved quality of life due to better physical mobility and a more positive mental outlook. Older morbidly obese patients should be considered for LAGP as a weight management tool. The UK study concluded that it is unacceptable to deny weight loss surgery to older patients. The procedure is just as safe and effective in achieving weight loss for older people and incidences of complications do not increase with age.

References

1. O’Brien and others, Obesity, weight loss and bariatric surgery, Medical Journal of Australia 2005; 183: 310-4. Washington Post, March 10, 2004.

2. Washington Post, March 10, 2004.

3. Craig Taylor, Laurent Layani. Laparoscopic Adjustable Gastric Banding in Patients ≥ 60 Years Old: Is it Worthwhile? Obesity Surgery, 2006; 16: 1579-1583.

4. Rishi Singhal, Mark Kitchen and others. Age ≥50 Does Not Influence Outcome in Laparoscopic Gastric Banding, Obesity Surgery. 2009; 19: 418-421

5. J.E. Ware and C.D. Sherbourne. The MOS 36 item Short-Form health Survey (SF-36): Conceptual framework and item selection, Medical Care 1992; 30: 473-479

6. A. Dhabuwala and others, Improvement in co-morbidities following weight loss from gastric bypass surgery, Obesity Surgery 2000; 10: 428-35.

Matthew Constantin, PhD, is a medical biologist and research fellow in St. Louis, MO at Washington University School of Medicine. His specialized research in cardiovascular diseases relates to his advocacy in promoting natural weight loss treatments. Matt studies the latest scientific findings regarding obesity and publishes articles based on peer-reviewed scientific data on his website where he also posts critical reviews of weight loss programs and offers savings coupons for Medifast.