Quote: "It is also important to note that despite the fact that the majority of patients involved in this review reported improvement in obesity-related co-morbidities, this did not translate to stopping or reducing medication they took following surgery."
The United Nations estimates that the number of people who will be over 60 in 2050 will reach 21% of the world's population, compared with 10% in 2000.
Traditionally, older morbidly obese patients have been discouraged from undergoing weight loss surgery due to a perception that surgery may be both unsafe and unlikely to provide any significant benefits to this group of people.
Since the world's population is aging, it is important to know whether the benefits of bariatric surgery seen in younger patients can be applied to older patients. Two recent studies published in the peer-reviewed journal Obesity Surgery examined whether laparoscopic adjustable gastric banding surgery is a safe and effective treatment option for older obese patients.
The Australian Study: Lap Band in Older Obese People
To better understand how laparoscopic adjustable gastric banding surgery affects people over 60 years of age, a prospective review was conducted of all patients older than 60 years of age who underwent the bariatric surgery at Obesity Surgery Center of John Flynn Hospital in Queensland, Australia between February 2000 and September 2005 .
Patients included in the analysis were those who either had a body mass index (BMI) of greater than 40 kg/m2 or those who had a BMI of greater than 33 kg/m2 accompanied with significant obesity-related co-morbidities. In order to determine the effect of surgery on the quality of life, the patients were required to complete a well-validated, accurate and reproducible quality of life assessment called the Medical Outcomes Study Short Form-36, or SF-36 .
The average age was 65.8 years (ranging from 60 to 72) and the average BMI was 42.2 kg/m2 (ranging from 33 to 54).
Does Lap Band Improve Weight And Quality of Life in Older Patients
Two years after surgery the patients had lost 54% of their excess weight. At 48 months following bariatric surgery, the mean BMI in these patients decreased by 9.3 units. No peri-operative complications were observed. Three late complications occurred (7.5%), which consisted of one band slippage (2.5%) that was treated by laparoscopic band revision and two access-port infections (5%) that required temporary removal. There were no in-hospital deaths.
Prior to the start of the study, the quality of life scores reported by patients were lower in most of the components than other people of the same age from the general (non-obese) population. However, following bariatric surgery, these quality of life scores not only improved but exceeded those of age-matched controls in several components. Specifically, improvement was seen in seven of the eight components of mental and physical well-being, after an average of 27 months following surgery.
A statistically significant improvement in physical functioning, general health, mental health and energy levels was also reported. In nearly half of the patients, sleep improved following surgery. Additionally, 70% of patients reported an increase in self-esteem and 72% reported a better outlook on life. Eighty-two percent reported they were happy that they underwent the procedure and 91% would recommend it to other people.
It is also important to note that despite the fact that the majority of patients involved in this review reported improvement in obesity-related co-morbidities, this did not translate to stopping or reducing medication they took following surgery. In fact, many patients continued to use the same amount of medication after the laparoscopic adjustable gastric banding surgery. This finding is in contrast to decreases in medication requirements seen in younger obese patients following bariatric surgery.
The UK Study: Comparison of Lap Band in Younger and Older Patients
To evaluate the results of laparoscopic adjustable gastric banding surgery in patients older than 50 years as compared to those patients younger than 50 years, an analysis was conducted of all cases of this procedure that were performed at the Heart of England NHS Foundation Trust from April 2003 to November 2007 .
A total of 1,335 patients were included in the analysis with 85.2% (1,137) of them being female. All patients fulfilled the requirements for the surgical treatment of obesity, meaning they had a BMI of equal to or greater than 40 kg/m2 without obesity-related adverse health issues, or a BMI of equal to or greater than 35 kg/m2 associated with obesity-related adverse health issues. For the purpose of study analysis, the patients were divided into two subgroups: those less than 50 years of age or those greater than or equal to 50 years of age.
Weight Loss and Overall Complications Between the Two Groups
For those patients less than 50 years of age, the average weight prior to surgery was 120.7 kg and the average BMI was 43.6 kg/m2. The percentage of weight loss for these patients was 34.9% at one year and 49% at three years.
For the older patient group, the average weight prior to surgery was 118 kg and the average BMI was 43.8 kg/m2. In these patients, the overall percentage of weight loss reached 34.2% at one year and 47.3 % at three years after surgery.
It is obvious from the above results that there was no significant difference in the percentage of weight loss between the two groups. Weight loss surgery worked the same for both groups.
Interestingly, the incidence of pouch dilation, slippage and erosion was higher in the younger group as compared to the older group. One complete slippage with urgent readmission happened in one patient at five months. An additional two partial slippages were observed at 12 and 18 months. Six pouch dilations were also seen between 10 and 24 months in separate patients. All of these cases were in the younger group, except for one partial slippage in the older group. There was one band erosion in the younger group.
Based on the results of these two studies, it appears that laparoscopic adjustable gastric banding surgery in older patients is safe, achieves effective weight loss, improves obesity-related co-morbidities and can lead to a better overall quality of life for patients. As the authors conclude, while improvement in BMI and medication requirements may be more modest in older than in younger patients, denial of surgery based on a lack of benefit or unacceptable risk is unfounded.
1. World population prospects: the 2000 revision highlights. United Nations. New York: United Nations; 2001. p. 14-5.
2. Super P. Age > or =50 does not influence outcome in laparoscopic gastric banding. Singhal R, Kitchen M, Bridgwater S. Obes Surg. 2009 Apr;19(4):418-21. Epub 2008 Jul 10.
3. Australian Health Outcomes Collaboration (AHOC) instrument review: SF-36 Health Survey. Marosszeky N. University of Wollongong May 2005.
4. Obesity, weight loss and bariatric surgery. O'Brien PE, Brown WA, Dixon JB. Med J Aust 2005; 183: 310-4.
About the Author
Matthew Denos, Ph.D. has a special interest in the field of obesity treatment because of its close link to cardiovascular disease, which has been his field of research for the past eight years. On his web site, Matt presents the latest scientific research on obesity-related topics and provides information on some of the best diets to lose weight. Visit his site at www.weightlosstriumph.com cosmetic surgery south florida lap band.
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