The Relationship of Eating Behaviors, Hunger Control, and Physical Activity to Weight Loss and Quality of Life in Laparoscopic Adjustable Gastric Banding Patients

The prevalence of morbid obesity is increasing at an alarming rate worldwide and is becoming a major public health problem in the United States. Because of the failure of conventional weight loss therapies for morbid obesity, the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) recommends surgical therapy as the only intervention associated with long-term success [1]. Laparoscopic adjustable gastric banding (LAGB) has been steadily increasing in popularity since approval by the FDA in 2001. Successful weight loss with the LAGB is defined as greater than 50 percent of excess weight loss (EWL). Early studies on the effectiveness of the LAGB were encouraging, with most studies reporting the average percentage of EWL over 50 percent and a low incidence of complications. A systematic review of 4594 studies published worldwide involving 28,980 gastric banding patients found an average EWL of 56 percent with the most significant weight loss occurring in patients with a BMI of > 40kg/mm2 [2]. A recently published retrospective analysis of 2,090 banding patients found a mean EWL of 52.9 percent at 5 years postoperatively. However, a review of individual studies show more inconsistent outcomes, with percentages of EWL ranging from less than 30 percent to as much as 70 percent [3]. Two recently published studies found the majority of patients failed to achieve the benchmark of 50 percent of EWL at 2 and 3 years postoperatively [4]. A number of studies have reported improved quality of life (QOL) after gastric banding surgery [3,5-8]. A study by Freys et al. [9] reported a significant improvement in QOL in 73 banding patients but reported a high number of complications (38%) that resulted in reoperation. A more recent study by Clough et al. [10] reported marked improvement in physical, mental, emotional and social QOL in gastric banding patients over the age of 60 although they experienced less excess weight loss than their younger cohorts.