What can you realistically expect in terms of improvement to your health with the Adjustable Gastric Banding and Weight Loss? It is true that some band patients experience the disappearance of high blood pressure, sleep apnea, and other debilitating illnesses. They can potentially experience the permanent remission of other illnesses such as diabetes. But just how is that possible? And how do health improvements with the Adjustable Gastric Banding compare with those of other weight-loss surgical options? Let’s take a look.
Patients seek out bariatric surgery for a variety of reasons, but in my experience it is health concerns that provide the compelling reason why obese individuals may be wise to consider weight-loss surgery. The objective should be improved health, not weight loss just for the sake of weight loss. At the same time, most patients are justifiably concerned about the health risks that naturally accompany procedures such as the gastric bypass. This is why many choose the Adjustable Gastric Banding as a lower-risk alternative. But the question that must be asked is, What about the results?
Improved health following any bariatric operation depends on a number of factors. One of the most obvious is the amount of weight lost. The rapidity of the weight loss also can play a role, and faster is not necessarily better. There is no question that weight loss following gastric bypass is typically faster and more dramatic than it is after the Adjustable Gastric Banding. Those patients who undergo gastric bypass may have a quicker improvement in some of their health problems than patients undergoing the Adjustable Gastric Banding, but at the same time they are somewhat more likely to have other problems related to malnutrition.
Following a gastric bypass, patients may lose as much as 5 pounds or 2 Kilogram per week or more. They tend to lose the majority of their weight during the first six months and then begin to taper off. During this time it is very important to follow a diet with plenty of protein to avoid hair loss and maintain muscle mass. They must also take vitamin B 12 regularly to avoid anemia, since iron cannot be utilized by the body to make red blood cells without vitamin B 12.
For more about Postsurgical Nutritional Deficiencies and important supplements to compensate, read : After Weight Loss Surgery: What Do I Do? What Do I Eat?
Adjustable Gastric Banding patients tend to lose the majority of their weight over a year or two at a slower and steadier rate, usually about a pound to a pound and a half per week. They too need to be on a high-protein diet, but they typically have less trouble maintaining adequate nutrition. Since the stomach is not bypassed, they don’t require B12 supplements. When we look at the results over three to five years, the two procedures actually offer quite similar weight loss outcomes.
With weight loss, both gastric bypass and AGB patients can experience significant improvement in a variety of medical ailments including diabetes, high blood pressure, sleep apnea, reflux, and various back and joint pains. However, weight loss is not a cure-all! Some patients continue to suffer from one or more of these conditions despite losing significant amounts of weight. In other words, there is more to being healthy than just controlling your weight. But, more often than not, for morbidly obese people virtually all health problems become easier to manage once they have lost weight.
Improvement in Diabetes
Diabetes is a complex metabolic illness, characterized by problems processing the simple sugar glucose. Many people still refer to it as “sugar diabetes.” The actual medical term is diabetes mellitus, which differentiates this disease from another illness, diabetes insipidus, a disorder involving excess water loss through the kidneys. In general, when people, including physicians, use the term “diabetes,” they are referring to diabetes mellitus.
What is interesting is how fast this improvement in diabetes can occur following surgical procedures that restrict your ability to eat, such as the AGB Improvement is generally seen long before major weight loss has occurred. For many years diabetes educators have preached to their patients to follow a diet of fewer than 1,800 calories to lower blood sugar. Following the AGB procedure, that is precisely what happens. Patients simply can’t eat they way they used to making it difficult to take in as many calories, so their blood sugar goes down.
Improvement in Hypertension (The Silent Killer)
“Hypertension” is the medical term for what most people call high blood pressure. To grasp the importance of this common condition requires a basic understanding of the cardiovascular system, starting with your heart. The heart is the engine that drives the body. It pumps blood through the lungs where red blood cells pick up oxygen. It then pumps this oxygen-loaded blood out to all areas of the body through a system of vessels, called arteries. As oxygen is delivered to all the tissues, carbon dioxide is picked up and carried back to the heart through a vast network of veins. The blood is immediately sent back through the lungs, where the carbon dioxide is exchanged for oxygen, completing the circuit.
It naturally follows then that losing weight should result in lowering of the blood pressure, and that is what we generally see. As is the case with diabetes, there are many articles in the medical literature documenting this fact. Losing weight with the AGB results in resolution of hypertension in about half of patients, meaning that they are able to get off medication entirely. Nearly three out of four are either resolved or are more easily controlled once they have lost weight.
Like the improvement in diabetes, the reduction in blood pressure often doesn’t take very long. The restricted diet after surgery also tends to restrict both salt and water intake, so we watch the blood pressure closely in the hospital after surgery, then have the patient monitor it closely at home.
Improvement in Sleep Apnea (The Thief in the Night)
Many obese patients report that they are tired all the time. It is easy to pass off this chronic fatigue as the direct result of carrying around all those extra pounds, and that certainly plays a part. But obesity can frequently lead to fatigue by interfering with sleep. A condition known as sleep apnea is quite common among obese patients, and it is often the “thief in the night” that robs you of a good night’s sleep.
In a 2019 study of morbidly obese patients by Dr. Dixon and his colleagues from Australia, 59 percent of men and 45 percent of women suffered from various sleep disturbances prior to having AGB surgery. The
group lost an average of 48 percent of their excess body weight during the first year after surgery. Snoring had been a major problem for 82 percent of these patients before surgery, but 12 months later only 14 percent reported that they still had a snoring problem. The incidence of sleep apnea decreased from 33 percent to only 2 percent. Daytime sleepiness fell from 39 percent to 4 percent, and only 2 percent of patients reported poor sleep quality, compared with 39 percent before the surgery. It would be interesting to see the results of a study of the sleeping patterns of their spouses, whose nights are no longer spent nudging their partner and urging them to “roll-over!”
Improvement in the Painful Load
For most people it is hard even to imagine lifting 100 pounds, yet morbidly obese people do that, and often more, without even thinking about it. They have adapted to carrying around far more weight than would seem possible, in large part because the weight has been added over a period of time. Their muscles have gradually enlarged to lift the load, but what about the bones and joints of their skeleton?
Our skeleton is designed to support our own normal weight, with built-in capacity that allows us to lift and strain against considerably more weight over short periods. The problem with obesity is that we can’t put that extra weight aside and let our body rest. The bones and joints are subjected to near maximum stress continuously. Over time the wear and tear on the back, hips, knees, ankles, and feet are predictable.
Back Pain
The spine is the central support for the entire skeleton, and it also provides protection for the spinal cord. The nerves that go to every part of the body exit the column of bones, called vertebrae, through small openings, called foremen. The vertebra are stacked one on top of the other, extending from the end of the torso to the base of the skull. There are 8 cervical (neck), 12 thoracic (chest), 5 lumbar (lower back), and 5 sacral (pelvic) vertebrae. With the exception of the sacral vertebra, which are fused into one solid plate of bone forming the back of the pelvis, each vertebra is separated from the one above and the one below by a firm but spongy cushion called an intervertebral disc.
The bony parts of the spine can withstand tremendous pressure without breaking, in part because the discs compress like a shock absorber. When subjected to extreme pressure, however, a disc can rupture, putting pressure directly on the spinal cord or on one of the nerves. Depending on which disc it is and the severity of the disruption, the result can be neck pain, back pain, leg pain, or even numbness or weakness in one arm or leg. Morbid obesity increases the risk of this type of spine injury because excess weight creates excess pressure on each disc.
Chronic back pain is quite common among obese patients, but most of them don’t have ruptured discs. Their pain is due to the constant strain on the muscles and tendons that support the spine.
Most obese patients with chronic back pain report improvement after losing only 15 to 20 pounds. If the pain is due to a ruptured disc or arthritis in the spine, losing weight may or may not lead to any improvement. These problems may require additional treatment, including even surgery. But if you ask any back surgeon, they will tell you that the results following a spinal operation of any kind are better after the patient has lost weight.
Foot, Ankle, Knee, and Hip Pain
Perhaps no other part of the body takes more punishment than your feet. They must bear every ounce of your weight as they literally “pound the pavement.” Ankle joints are likewise subjected to compression with each step. The knee joints are extremely active, and the surfaces of the bones are protected by only thin wedges of cartilage. The hip joint is also subjected to tremendous stress. Given the mechanics of walking, is it any wonder that these areas of the body are the sites of frequent aches and pains? Add 100 pounds or more to the equation and you have a recipe for major problems.
Researchers have shown that during walking, each pound you weigh results in 4 pounds of pressure on your knee joints. That may not sound like much until you do the math. If you are 100 pounds overweight and take only 3,000 steps per day (less than 2 miles), the total pressure on your knees is a whopping 1.2 million pounds. That’s per day! The result of this crushing load can accelerate arthritis, cartilage deterioration, and disabling pain. In other words, being obese wears out your joints far faster than normal. In sporting terms, it puts you on the sidelines.
Improvement in Gastroesophageal Reflux Disease (GERD)
If you watch television for more than a few minutes, you are bound to see an advertisement for one of a number of medications purporting to eliminate heartburn. That is because heartburn is extremely common, and the sale of these drugs is in the billions of dollars each year. Heartburn, also known as acid reflux, is caused by stomach acid backing up into the esophagus. More often than not this is due to failure of a valve at the lower end of the esophagus that should prevent stomach contents from going up the esophagus.
the AGB is actually quite effective in the management of GERD. It acts as another barrier to the movement of stomach contents up into the esophagus. Most patients are able to stop taking their heartburn medications immediately following surgery, but that is not always the case. In fact, if the band is placed too low, or if it slips down on the stomach, it can actually make symptoms of reflux worse. This is one of the complications of the AGB and will be covered in more detail in the next chapter.
Like all the medical problems discussed here, obesity is a major contributing factor in the development of GERD. In this instance it’s because of the extra pressure on the abdomen, which can literally push stomach contents up into the esophagus. So, when treating patients for GERD, the first thing the gastroenterologist is going to say is, “Lose weight.”