Plastic surgery after weight loss ga -

Plastic surgery after weight loss ga
Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomised controlled trial. The effects of an intensive lifestyle modification program on carotid artery intima-media thickness: a randomized trial. How to use an article reporting a multiple treatment comparison meta-analysis. The Task Group stated that registered dietitians are best qualified to provide nutritional care, including pre-operative assessment and post-operative education, counseling, and follow-up. Patients are advised to follow a medically supervised diet and exercise plan to augment their weight loss efforts while using the ReShape Dual Balloon and to maintain their weight loss following its removal. The process of digestion is more or less normal. Surgery should only be performed at facilities that are equipped to collect long-term data on clinical outcomes. Moreover, following surgery, patients have to follow a careful diet of nutritious, high-fiber foods in order to avoid nutritional deficiencies, dumping syndrome, and other complications. Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults A Meta-analysis. Pujol Gebelli et al (20110 stated that laparoscopic gastric plication is a new technique derived from sleeve gastrectomy. 9, Author Audio Interview. US Preventive Services Task Force. 7 %). The evidence for the mini gastric bypass has come from a single investigator, thus raising questions about the generalization and validity of the reported findings. Note: Most Aetna HMO and QPOS plans exclude coverage of surgical operations, procedures or treatment of obesity unless approved by Aetna. Cazzo et al (2014) stated that non-alcoholic fatty liver disease (NAFLD) is common among subjects who undergo bariatric surgery and its post-surgical improvement has been reported. However, distension of the pouch, slippage of the band and entrapment of the foreign material by the stomach have been described and are worrisome. 2 %, and 59. , biliopancreatic diversion (BPD)) result in the greatest amounts of weight loss, hybrid procedures are of intermediate effectiveness (e. 4 % (average of 3. Aetna considers open or laparoscopic short or long-limb Roux-en-Y gastric bypass (RYGB), open or laparoscopic sleeve gastrectomy, open or laparoscopic biliopancreatic diversion (BPD) with or without duodenal switch (DS), or laparoscopic adjustable silicone gastric banding (LASGB) medically necessary when the selection criteria listed below are met. Although the long-term effectiveness of weight reduction programs has been questioned, the Institute of Medicine (1995) has reported the substantial short-term effectiveness of certain organized physician-supervised weight reduction programs. Systematic review: an evaluation of major commercial weight loss programs in the United States. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Once the device is placed in the stomach, patients may experience vomiting, nausea, abdominal pain, gastric ulcers, and feelings of indigestion. 0 % versus 0 %). 9 %) and anastomotic problems (8. To determine weight loss outcomes for popular diets based on diet class (macronutrient composition) and named diet. Bariatric surgery as a treatment for type-2 diabetes in persons with a BMI less than 35. The trend towards use of Roux-en-Y and away from loop gastric bypass was based on sound surgical experience of multiple surgeons with large series of patients. The role of energy expenditure in the differential weight loss in obese women on low-fat and low-carbohydrate diets. Laparoscopic RYGB is a less invasive approach that results in a shorter hospital stay and earlier return to usual activities. Effect of a free prepared meal and incentivized weight loss program on weight loss and weight loss maintenance in obese and overweight women: a randomized controlled trial. There is established evidence that medical supervision of a nutrition and exercise program increases the likelihood of success (Blackburn, 1993). DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. Since post-surgical biopsy is not widely available and has a significant risk, calculation of NAFLD fibrosis score is a simple tool to evaluate this evolution through a non-invasive approach. The small bowel is then divided, and the end going to the cecum of the colon is connected to the short stump of the duodenum. The duodenum is divided just beyond the pylorus. The characteristics of eligible branded dietary programs are reported in eTable 1 in the Supplement. A moderate-protein diet produces sustained weight loss and long-term changes in body composition and blood lipids in obese adults. 1 %). GRADE confidence in indirect estimates: 12-month weight loss eTable 12. It is unclear what benefit there is from a temporary reduction in weight. The percentage of EWL (% EWL) for LGP varied from 31. CPB 0039 - Weight Reduction Medications and Programs. The reduced capacity of the pouch and the restriction caused by the band diminish caloric intake, depending on important technical details, thus producing weight loss comparable to vertical gastroplasties, without the possibility of staple-line disruption and lesser incidence of infectious complications. g. For adults aged 18 years or older, presence of persistent severe obesity, documented in contemporaneous clinical records, defined as any of the following. Oxidative stress was measured by concentration of hydroperoxides (CEOOH) in liver tissue. , San Clemente, CA) to treat obesity without the need for invasive surgery. No mortality was reported in these studies and the rate of major complications requiring re-operation ranged from 0 % to 15. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. The Task Group recommended to decide on a case-by-case basis whether to proceed with surgery in patients who are unable to lose weight. The data were collected and analyzed pre- and post-operatively. Publication bias assessed via funnel plots—Atkins versus moderate micronutrient diets: 6-month weight loss eFigure 5. Obesity makes many types of surgery more technically difficult to perform and hazardous. These procedures are not for cosmesis but for prevention of the pathologic consequences of morbid obesity. These investigators presented a case report of a 29-year old female with a maximum BMI of 50. Although easier to perform than the RYGB, it has been shown to create a severe hazard in the event of any leakage after surgery, and seriously increases the risk of ulcer forrmation, and irritation of the stomach pouch by bile. This new device is intended to facilitate weight loss in obese adult patients by occupying space in the stomach, which may trigger feelings of fullness, or by other mechanisms that are not yet understood. A randomized controlled trial of a commercial Internet weight loss program. Fobi, is a modification of gastric bypass surgery. Significant weight loss was observed with any low-carbohydrate or low-fat diet. The gastric restrictive procedures include vertical banded gastroplasty accompanied by gastric banding which attempt to induce weight loss by creating an intake-limiting gastric pouch by segmenting the stomach along its vertical axis. BMI greater than 35 in conjunction with any of the following severe co-morbidities. Even if the patient has not been able to keep weight off long-term with prior dieting, the patient may be able to lose significant weight short term prior to surgery in order to improve the outcome of surgery. The authors concluded that the results demonstrate that significant sampling variability exists in class 2 and 3 obese individuals undergoing screening liver biopsies for NAFLD. Combining weight-loss counseling with the Weight Watchers plan for obese breast cancer survivors. Dietary guidelines for Americans: 2010. Difference in mean weight loss at 6 and 12 months across all diet brands with 95% credible intervals when restricted to low risk of bias studies eTable 10. Difference in mean weight loss at 6 and 12 months across all diet classes with 95% credible intervals when restricted to low risk of bias studies eTable 5. Quiz Ref ID Despite potential biological mechanisms explaining why some popular diets should be better than others, recent reviews suggest that most diets are equally effective, 2, 5, 6 a message very different from what the public hears in advertisements or expert pronouncements. Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women. The authors concluded that routine liver biopsy documented significant liver abnormalities in a larger group of patients compared with selective liver biopsies, thereby suggesting that liver appearance is not predictive of NASH. The effects of a commercially available weight loss program among obese patients with type 2 diabetes: a randomized study. 6 % with NASH, 48. Therefore, the appropriateness of obesity surgery in non-compliant patients should be questioned. Roux-en-Y Gastric Bypass (RYGB) and Vertical Banded Gastroplasty (VBG). Therefore, the evidence supports the overall superiority of RYGB over VBG in safety and efficacy for bariatric surgery. Complications were noted in 9. Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Pories et al (1995) reported 57. A synthetic band is placed around the stomach opening to keep it from stretching. Branded diets and weight loss in overweight or obese adults: a network meta-analysis. We reviewed bibliographies of review articles and eligible trials, and searched the registries of ClinicalTrials. 3 mins without any intra-operative complications. It is thought that these patients lose restriction because of the dilated gastrojejunostomy and thus overeat. We contacted the named diet companies and individuals working in the field of obesity and weight management to identify additional or unpublished trials. 4 %). An assessment by the Institute for Clinical Systems Improvement (ICSI, 2005) found that large studies have shown that RYGB may result in weight loss of 60 % to 70 % of excess weight. All of the published literature has been limited to descriptive articles, case series, and a prospective non-randomized controlled study. Gastric bypass surgery has been used to treat morbid obesity and its co-morbidities, and IIH has recently been considered among these indications. Using a network meta-analytic approach, we assessed the relative effectiveness of different popular diets in improving weight loss. It is meant to be temporary and should be removed 6 months after it is inserted. 9 %, 41. This supports the practice of recommending any diet that a patient will adhere to in order to lose weight. JAMA 2014-09-02, Vol. Liver biopsy remains the gold-standard for diagnosing NASH. The report stated that the incidence of gastric sleeve dilatation appears to be an uncommon event, but the evidence is far from conclusive at this point. Our analyses adjusted for behavioral support and exercise. 9, 10. 6 kg), and median BMI of 33. A total of 85 publications were identified, and after initial appraisal, 17 were included in the final review. 3 %, 55. The mean operative time was 87. Intragastric balloon is intended to reduce gastric capacity, causing satiety, making it easier for patients to take smaller amounts of food. Quiz Ref ID Network meta-analysis facilitates comparison of different diets using all available randomized clinical trial (RCT) data. They stated that further prospective randomized studies with control groups and a larger number of participants are lacking within the published studies to date. Hospital stay varied from 0. Peri-operative data were collected from each study and recorded. The gastric bypass operation can be modified, to alter absorption of food, by moving the Roux-en-Y-connection distally down the jejunum, effectively shortening the bowel available for absorption of food. Biliopancreatic Diversion (BPD) (Jejunoilieal Bypass, Scorpinaro Procedure) and Duodenal Switch (DS) Procedures. 7 %, and 49. 1 % of the patients. In 2008, Loewen and Barba evaluated the injection of morrhuate sodium as sclerotherapy to decrease the diameter of the gastrojejunostomy anastomosis following gastric bypass. Network diagrams for randomized controlled trials investigating weight loss among diets, categorized by diet class eFigure 3. The authors concluded that the published Class IV evidence suggested that bariatric surgery may be an effective treatment for IIH in obese patients, both in terms of symptom resolution and visual outcome. In 13 patients both pre- and post-operative CSF pressures were recorded, with an average post-operative pressure decrease of 254 mm H(2)O. After a waxing and waning course and various medical treatments, the patient underwent laparoscopic Roux-en-Y gastric bypass surgery with anterior repair of hiatal hernia. An assessment of laparoscopic RYGB by the BlueCross BlueShield Association Technology Evaluation Center (BCBSA, 2005) stated that among available bariatric surgical procedures, RYGB appears to have the most favorable risk-to-benefit ratio, and that the overall risk-to-benefit ratio of laparoscopic RGBY is similar to that of open RGBY. Factors such as blood glucose control, hypertension, etc. A total of 242 patients underwent open and laparoscopic RYGBP from 1998 to 2001. Dieting and the development of eating disorders in obese women: results of a randomized controlled trial. Laparoscopic RGBY had a higher rate of postoperative anastomotic leaks than open RGBY (3. 6 % versus 1. Because it is impossible to provide a placebo diet in a clinical trial, eligible control diets included wait-listed controls, no specific assigned diet, or competing dietary programs. 3 and a 5-year history of severe headaches and moderate papilledema due to IIH. A retrospective review was performed of this group, including chart review, follow-up data with weight checks, and telephone interview findings. Effects of two weight-loss diets on health-related quality of life. Screening for obesity in adults: recommendations and rationale. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. A low-carbohydrate as compared with a low-fat diet in severe obesity. This physician-supervised nutrition and exercise program must meet all of the following criteria. The authors concluded that bariatric surgery for weight loss is associated with alleviation of IIH symptoms and a reduction in intracranial pressure. Named or branded (trade-marked) weight loss programs are broadly available to the general public, providing structured dietary and lifestyle recommendations via popular books and in-person or online behavioral support. Nondieting versus dieting treatment for overweight binge-eating women. Exercise was defined as having explicit instructions for weekly physical activities and simply dichotomized when differences between varying degrees of exercise frequencies appeared to have negligible effects. The Task Group also recommended a pre-operative assessment for micronutrient deficiencies. The outpatient procedure usually takes less than 30 minutes while a patient is under mild sedation. Dietary energy density in the treatment of obesity: a year-long trial comparing 2 weight-loss diets. , RYGB), and restrictive procedures (e. 13 We assigned 1 of 2 summary assessments for each included study: low risk of bias for key domains, allocation concealment, and missing participant data or high risk of bias for key domains. Findings of cirrhosis on frozen section changed the operation from a distal to a proximal RYGBP. Minimal standards in these areas are set by the institution and maintained under the direction of a qualified surgeon who is in charge of an experienced and comprehensive bariatric surgery team. Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials. It is a prospective cohort study which evaluated patients immediately before and 12 months following Roux-en-Y gastric bypass (RYGB). The two groups were similar in age, gender, and BMI. A Multidisciplinary Care Task Group (Saltzman et al, 2005) conducted a systematic review of the literature to to provide evidence-based guidelines for patient selection and to recommend the medical and nutritional aspects of multi-disciplinary care required to minimize peri-operative and post-operative risks in patients with severe obesity who undergo weight loss surgery. 12. GRADE overall confidence in estimates: 12-month weight loss eTable 13. g. Recent advances in laparoscopy have renewed the interest in gastric banding techniques for the control of severe obesity. The National Institutes of Health Consensus Statement (1998) states that all smokers should be encouraged to quit, regardless of weight. Weight, protein, fat, and timing of preloads affect food intake. This method entails encircling the upper part of the stomach using bands made of synthetic materials, creating a small upper pouch that empties into the lower stomach through a narrow, non-stretchable stoma. 2, 3 Low-carbohydrate diets may drive weight loss due to a higher intake of protein, which may induce a stronger satiating effect than fats and carbohydrates. g. One patient required replication 4 days post-operatively due to obstruction at the site of the last knot. Weight-loss diets modify glucose-dependent insulinotropic polypeptide receptor rs2287019 genotype effects on changes in body weight, fasting glucose, and insulin resistance: the Preventing Overweight Using Novel Dietary Strategies trial. , the VBLOC device, also known as the Maestro Implant or the Maestro Rechargeable System). Lifestyle Behaviors Nutrition Obesity Shared Decision Making and Communication Treatment Adherence Diet. The 1st patient in the GCP group required re-operation and plication reduction owing to gastric obstruction. Network diagrams for randomized controlled trials investigating change in BMI among branded and common diets. Reduced-calorie diet program supervised by dietician or nutritionist. A randomized trial of a low-carbohydrate diet for obesity. Key differences between this analysis and recent joint guidelines from the American Heart Association (AHA), American College of Cardiology (ACC), and The Obesity Society (TOS) eFigure 1. Weight loss with self-help compared with a structured commercial program: a randomized trial. Some have advocated use of the DS procedure in the super-obese (i. The total weight loss from surgery can be enhanced if it is combined with a low-calorie diet. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. The mean excess weight loss at 1, 3, 6, 9, and 12 months after surgery was 21. Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs reduced carbohydrate diets. Dedicated dietitians can help patients during their pre-operative education on new dietary requirements and stipulations and their post-surgical adjustment to those requirements. 9 mins (average of 79. After institutional review board approval, 2 methods were used to achieve laparoscopic gastric volume reduction. ), an endoluminal fastener and delivery system used to tighten esophageal tissue. Huang et al (2012) noted that the laparoscopic adjustable gastric band has been widely accepted as 1 of the safest bariatric procedures to treat morbid obesity. Many claims have been made regarding the superiority of one diet or another for inducing weight loss. The results of the first cases where this technique has been applied in this hospital were presented. Although patients can have increased frequency of bowel movements, increased fat in their stools, and impaired absorption of vitamins, recent studies have reported good results. Regarding long-term adverse events, the rates of reoperation (9. According to the recommendations by the expert panel, potential candidates for bariatric surgery should be referred to centers with multi-disciplinary weight management teams that have expertise in meeting the unique needs of overweight adolescents. No restrictions were placed on these searches, including the date of publication. 0 %, respectively), while the rate of incisional hernia is higher for open RGBY than laparoscopic RGBY (9. Of the total, 889 proved potentially relevant for full-text review and 59 articles that reported 48 RCTs of 11 branded diets proved eligible (eFigure 1 in the Supplement ). Laparoscopic adjustable gastric banded plication was performed using 5-port surgery. The most progressive form of NAFLD is NASH. Histology showed fatty liver in 92. Diet classes were established by macronutrient content ( Table 1 ). However, because of variations in the results and the complications that tend to arise from port adjustment, alternative procedures are needed. Surgery for obesity, termed bariatric surgery, includes gastric restrictive procedures and gastric bypass. eMethods. These researchers planned for 120 patients to be randomized 2:1 to multiple full-thickness plications within the gastric pouch and stoma using the StomaphyX device with SerosFuse fasteners or a sham endoscopic procedure and followed up for 1 year. 0 %) may be higher for laparoscopic RGBY than for open RGBY (6. The assessment found that the estimated mortality rate was low for both procedures, but somewhat lower for laparoscopic surgery than open surgery (0. Weight loss prior to surgery makes the procedure easier to perform. Effects of hypocaloric diet, low-intensity resistance exercise with slow movement, or both on aortic hemodynamics and muscle mass in obese postmenopausal women. Establishing which of the major named diets is most effective is important because overweight and obese patients often want to know which diet results in the most effective weight loss. Requirement for Physician Supervision of Program Documented in Medical Record. The average age of the patients was 45 years and all but 4 patients were women. Aetna considers open or laparoscopic vertical banded gastroplasty (VBG) medically necessary for members who meet the selection criteria for obesity surgery and who are at increased risk of adverse consequences of a RYGB due to the presence of any of the following co-morbid medical conditions. The study also found that sleeve gastrectomy was associated with more severe complications than LASGB. The pre-operative surgical preparatory regimen should include cessation counseling for smokers. According to the available literature, patients who have this procedure seldom experience any satisfaction from eating, and tend to seek ways to get around the operation by eating more. 71 kg greater weight loss than the Zone diet at 6-month follow-up. Difference in mean decrease in BMI at 6 and 12 months across diet classes with 95% credible intervals eTable 14. The authors concluded that LGP has the potential of being an ideal weight loss surgery for adolescents, resulting in excellent weight loss and minimal psychological disruption. Comparison of the effects of four commercially available weight-loss programmes on lipid-based cardiovascular risk factors. , affect surgical risk. Obesity surgery is not indicated for persons with transient increases in weight (Collazo-Clavell, 1999). There is active collaboration with multiple patient care disciplines including nutrition, anesthesiology, cardiology, pulmonary medicine, orthopedic surgery, diabetology, psychiatry, and rehabilitation medicine. Once in place, the balloon device is inflated with a sterile solution, which takes up room in the stomach. The CMS decision memorandum found that short-and-long-term mortality associated with both LASGB and RYGB were low (less than 2 %) in this younger age group. 2 % (10) with StomaphyX versus 3. e. A total of 11 relevant publications (including 6 individual case reports) were found, reporting on a total of 62 patients. The median duration of the diet intervention across trials was 24 weeks (interquartile range, 16-52 weeks). g. If this goal is achieved, further weight loss can be attempted, if indicated through further evaluation. 9 %, 31. Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women. The Fobi pouch, developed by California surgeon Mathias A. Difference in mean decrease in BMI at 6 and 12 months across diet brands with 95% credible intervals eTable 15. The authors concluded that this treatment modality should be further investigated prospectively to analyze the rate of headache improvement with weight loss, the amount of weight loss needed for clinical improvement, and the possible correlation with improvement in papilledema. By not exploring the full range of potential comparisons in a statistically and methodologically rigorous fashion, these reviews could have missed important benefits of specific diets or their compositions. The modifications to gastric bypass surgery are designed to prevent post-surgical enlargement of the gastric pouch and stoma. GRADE confidence in direct estimates: 12-month weight loss eTable 11. The authors concluded that as previously reported by studies in which post-surgical biopsies were performed, RYGB leads to a great resolution rate of liver fibrosis. The intragastric balloon (also known as the silicone intragastric balloon or SIB) has been developed as a temporary aid for obese patients who have had unsatisfactory results in their clinical treatment for obesity and super obese patients with higher surgical (Fernandes et al, 2004). Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A to Z Weight Loss Study: a randomized trial. , person meets the criteria for treatment of obstructive sleep apnea set forth in. Description of dietary programs eTable 2. A fatty liver is heavy, brittle, and more likely to suffer injury during surgery. A decision memorandum from the Centers for Medicare and Medicaid Services (CMS, 2006) concluded that the evidence is sufficient that open and laparoscopic RYGB is reasonable and necessary for Medicare beneficiaries who have a BMI greater than 35 and have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. Candidates for obesity surgery should begin a weight reduction diet prior to surgery. A total of 13 patients were operated on (7 women). Weight reduction reduces the size of the liver, making surgical access to the stomach easier. For our branded diet analysis, we made a visual assessment of funnel plots for publication bias for direct comparisons that included 10 or more studies. A decision memorandum from the Centers for Medicare and Medicaid Services (CMS, 2006) concluded that open or laparoscopic BPD with or without DS are reasonable and necessary for Medicare beneficiaries. The aim of this study was to determine the role of routine liver biopsy in managing bariatric patients. The Roux-en-Y modification of the loop bypass was designed to divert bile downstream, several feet below the gastric pouch and esophagus to minimize the risk of reflux. Enrollment was closed prematurely because preliminary results indicated failure to achieve the primary efficacy end-point in at least 50 % of StomaphyX-treated patients. The assessment noted that, due to limited evidence and poor quality of the trials comparing each pair of procedures, these conclusions should be viewed with caution. Lifestyle intervention in overweight individuals with a family history of diabetes. JAMA 2014-09-02, Vol. Accessed July 30, 2014. For the 9 patients who underwent AP, the 6- and 12-month endoscopic evaluations demonstrated comparable-size plications over time, except for in 1 patient, who had a partially disrupted fold. Ideally patients selected for surgery should have no major perioperative risk factors, a stable personality, no eating disorders, and have lost some weight prior to surgery. Risk of bias versus quality assessment of randomised controlled trials: cross sectional study. In addition, the intragastric balloon has been associated with potentially severe adverse effects, including gastric erosion, reflux, and obstruction. Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record at each visit. When available, we used P values for group differences to derive the standard deviation of change from baseline. 3 % of their total body weight). Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Adjustable Silicone Gastric Banding (LASGB), Sleeve Gastrectomy, Biliopancreatic Diversion (BPD) and Duodenal Switch (DS) Procedures. For maximal benefit, dieting should occur proximal to the time of surgery, and not in the remote past to reduce surgical risks and improve outcomes. , adjustable gastric banding) result in the least amounts of weight loss. These investigators performed a comprehensive literature search using the following databases: MEDLINE, EMBASE, PubMed, Scopus, Web of Sciences, and the Cochrane Library. L. Smoking cessation is especially important in obese persons, as obesity places them at increased risk for cardiovascular disease. Patients should be encouraged to remain non-smokers after weight loss surgery to reduce the negative long-term health effects of smoking. 9, Author Audio Interview. The CTAF assessment reported that the results of multiple case series and retrospective studies have suggested that sleeve gastrectomy as a primary procedure is associated with a significant reduction in excess weight loss. One non-randomized controlled clinical study that reported positive results reported that results were not maintained after gastric balloon removal (Ramhamadany et al, 1989). 7 %, 54. In a prospective study, Zeinoddini (2014) evaluated safety and effectiveness of LGP on adolescents. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. Both groups had a similar prevalence of cirrhosis. Randomized trial of a multifaceted commercial weight loss program. Long-term weight loss after diet and exercise: a systematic review. The primary efficacy end-point was reduction in pre-RYGB excess weight by 15 % or more excess BMI (calculated as weight in kilograms divided by height in meters squared) loss and BMI less than 35 at 12 months after the procedure. The authors concluded that laparoscopic gastric plication is a new surgical technique which gives equivalent short-term results as vertical gastrectomy. It is not known whether the benefits of obesity surgery in children and adolescents outweigh the increased risks. The panel recommended the Roux-en-Y gastric bypass method of surgery over the simpler, newer technique of implanting an adjustable gastric band since gastric bands are less effective and younger patients would probably need replacement as they age. 9 %), and a somewhat higher rate of bleeding (4. 0 % versus 4. 7 % with isolated steatosis and just 7.


Specifically, performing a loop, rather than a Roux-en-Y, anastomosis to a small gastric pouch in the stomach may permit reflux of bile and digestive juice into the esophagus where it can cause esophagitis and ulceration, and may thus increase the risk of esophageal cancer. In a traditional gastric bypass procedure, surgeons create a smaller stomach by stapling off a large section. The Multidisciplinary Care Task Group recommended the use of patient selection criteria from the NIH Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity, which are consistent with those of other organizations. Moderate carbohydrate, moderate protein weight loss diet reduces cardiovascular disease risk compared to high carbohydrate, low protein diet in obese adults: a randomized clinical trial. The authors recommended routine liver biopsy during bariatric operations to determine the prevalence and natural history of NASH, which will have important implications in directing future therapeutics for obese patients with NASH and for patients undergoing bariatric procedures. These included demographic data, pre- and post-operative symptoms, pre- and post-operative visual field deficits, bariatric procedure type, absolute weight loss, changes in BMI, and changes in cerebrospinal fluid (CSF) opening pressure. 7 % versus 1. Australia has reported that the costs of band adjustments with LASGB has exceeded the costs of the primary LASGB procedure. The authors concluded that laparoscopic adjustable gastric banded plication provides both restrictive and reductive effects and is reversible. Effects of energy-restricted diets containing increased protein on weight loss, resting energy expenditure, and the thermic effect of feeding in type 2 diabetes. A total of 71 patients underwent sclerotherapy at their gastrojejunostomy from July 2004 to August 2006. These investigators enrolled 26 patients from May 2009 to August 2010. Plication of the gastric greater curvature was performed under general anesthetic and by laparoscopy using 3 lines of sutures and with an orogastric probe as a guide. There is a lack of data on the durability of the results with the ReShape Integrated Dual Balloon System. A self-regulation program for maintenance of weight loss. 9, 10, 17, 18, 22 -. However, the assessment found that the profile of adverse events differs between the two approaches. Network diagrams for randomized controlled trials investigating weight loss among branded diets eFigure 4. This team should include experienced surgeons and physicians, skilled nurses, specialty-educated nutritionists, experienced anesthesiologists, and, as needed, cardiologists, pulmonologists, rehabilitation therapists, and psychiatric staff. Garza (2003) explained that the patient should lose weight prior to surgery to reduce surgical risks. In the case of percentage change, we assumed independence. There is rarely a good reason why obese patients (even super obese patients) can not delay surgery in order to undergo behavioral modification to improve their dietary and exercise habits in order to reduce surgical risks and improve surgical outcomes. Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses. However, RYGB is associated with significantly more weight loss, and has become the procedure of choice for obesity surgery. Overall improvement in symptoms of IIH after bariatric surgery was observed in 60 of the 65 patients observed (92 %). One pathologist graded all liver biopsies as mild, moderate or severe steatohepatitis. , persons with BMI greater than 50) because of the substantial weight loss induced by this procedure. It also found that VBG shows substantial weight loss efficacy but less than that for RYGB. Although the basic concept of gastric bypass remains intact, numerous variations are being performed at this time. Of the 6 patients who underwent GCP, the 6- and 12-month follow-up endoscopic examinations demonstrated a durable intraluminal fold, except for in 1 patient, with a partial disruption at the distal fold owing to a broken suture. The patient must be committed to the appropriate work-up for the procedure and for continuing long-term postoperative medical management, and understand and be adequately prepared for the potential complications of the procedure. These programs represent a multibillion dollar industry. The diet was labeled as brand-like when the diet met the definition of a branded diet, but failed to name or reference the brand in the article. Some Aetna plans entirely exclude coverage of surgical treatment of obesity. Primary efficacy outcome was achieved by 22. Ideally, the surgical center where surgery is to be performed should be accomplished in bariatric surgery with a demonstrated commitment to provide adequate facilities and equipment, as well as a properly trained and funded appropriate bariatric surgery support staff. Fridley et al (2011) reviewed the literature on the effectiveness of bariatric surgery for obese patients with idiopathic intracranial hypertension (IIH) with regard to both symptom resolution and resolution of visual deficits. Two reviewers independently extracted data on populations, interventions, outcomes, risk of bias, and quality of evidence. Dramatic improvement in IIH headaches occurred by 4 months post-procedure and was maintained at 1 year, when she reached her weight plateau with a BMI of 35. The most frequently found morbidity was nausea and vomiting. The Roux-en-Y gastric bypass was the most common bariatric procedure performed. Effect of a high-protein, energy-restricted diet on weight loss and energy expenditure after weight stabilization in hyperinsulinemic subjects. 0 %) and wound infections (11. Some physiological explanations regarding the merits of different macronutrient compositions, including variable genetic response to diets with different recommended dietary fat intake, make intuitive sense. Smoking cessation reduces the risk of pulmonary complications from surgery. 7 %). It is often the first step in a 2-stage procedure when performing RYGB or duodenal switch. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. gov and the metaRegister of Controlled Trials. Clinically significant obstructive sleep apnea (i. The report found, on the other hand, that open surgery had higher rates of cardiopulmonary complications (2. GRADE guidelines: 4, rating the quality of evidence—study limitations (risk of bias). Only a few of the reviews of named diets have used rigorous meta-analytic techniques to provide quantitative estimates of how much better one diet is compared with another. Stern. The patient may be able to lose significant weight prior to surgery in order to improve the outcome of surgery. In the study (Ponce et al, 2015), 187 individuals randomly selected to receive the ReShape Dual Balloon lost 14. 312, No. The mini-gastric bypass uses a jejunal loop directly connected to a small gastric pouch, instead of a Roux-en-Y anastomosis. Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning. eTable 1. The technique is safe, feasible, and reproducible and can be used as an alternative bariatric procedure. These studies were from a single group of investigators, raising questions about the generalization of the findings. Many forms of weight loss surgery require patients to take lifelong nutritional supplements and to have lifelong medical monitoring. The connectivity of each network meta-analysis was described using density, which was calculated as the ratio of the number of treatment pairs with head-to-head evidence over the total number of treatment pairs. The BPD was designed to address some of the drawbacks of the original intestinal bypass procedures, which resulted in unacceptable metabolic complications of diarrhea, hyperoxaluria, nephrolithiasis, cholelithiasis and liver failure. The greater and lesser curvatures were approximated to create an intraluminal fold of the stomach. 2 % excess weight loss with RYGB at 5, 10, and 14 years, respectively, in a large series with 95 % follow-up. Measured parameters included %EWL, percentage of BMI loss (%BMIL), obesity related co-morbidities, operative time, and length of hospitalization and complications. Pairs of reviewers independently assessed the risk of bias associated with individual trials using the Cochrane Collaboration instrument. Arun et al (2007) stated that NAFLD is a chronic condition that can progress to cirrhosis and hepatocellular cancer. This device should not be used in patients who have had previous gastro-intestinal or bariatric surgery or who have been diagnosed with inflammatory intestinal or bowel disease, large hiatal hernia, symptoms of delayed gastric emptying or active H. 3 % versus 1. They stated that prospective, controlled studies are needed for better elucidation of its role. 7 (median SD, 4. Short-term effects of severe dietary carbohydrate-restriction advice in type 2 diabetes—a randomized controlled trial. Effects of dietary carbohydrate restriction versus low-fat diet on flow-mediated dilation. Accessibility verified August 4, 2014. Regarding performing adjustable gastric banding as an open procedure, the CMS decision memorandum (2006) concluded that the evidence is not adequate to conclude that open adjustable gastric banding is reasonable and necessary and therefore this procedure remains noncovered for Medicare beneficiaries. Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects. A problem with the traditional procedure is that the staples can break down, causing the stomach to regain its original shape -- and patients to start gaining weight again. Furthermore, an improvement was observed in patients where conventional treatments, including neurosurgery, were ineffective. Levin and colleagues (2015) stated that IIH occurs most frequently in young, obese women. Effects of a low carbohydrate weight loss diet on exercise capacity and tolerance in obese subjects. Handley et al (2015) systematically reviewed the effect of bariatric weight reduction surgery as a treatment for IIH. 7 % with normal liver. Analyses were conducted using 6- and 12-month data, with a 3-month window (eg, if a study reported weight loss at 5 months, it was used in the 6-month analysis). Thirty-four (97 %) of 35 patients who had undergone pre- and post-operative funduscopy were found to have resolution of papilledema post-operatively. Shalhub et al (2004) noted that non-alcoholic steatohepatitis (NASH) commonly occurs in obese patients and predisposes to cirrhosis. 2 mins). We categorized dietary treatment groups in 2 ways: using diet classes (moderate macronutrient distribution, low carbohydrate, and low fat) 15 and according to diet brands. 4. e. The CTAF assessment found few comparative studies of sleeve gastrectomy. Oliveira et al (2005) stated that pathogenesis of non-alcoholic fatty liver disease (NAFLD) remains incompletely known, and oxidative stress is one of the mechanisms incriminated. While appropriate surgical procedures for severe obesity primarily produce weight loss by restricting intake, intestinal bypass procedures produce weight loss by inducing a malabsorptive effect. This causes vomiting, which can tear out the staple line and destroy the operation. Summary of risk of bias by diet class and brand eTable 3. BMI exceeding 40 with one or more of the following serious co-morbidities. Difference in mean weight loss at 6 and 12 months across all diet classes with 95% credible intervals when adjusting for baseline weight (overweight to obese vs morbidly obese) eTable 7. Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, Ball GDC, Busse JW, Thorlund K, Guyatt G, Jansen JP, Mills EJ. 4 days). Ji et al (2014) conducted a systematic review of the currently available literature regarding the outcomes of laparoscopic gastric plication (LGP) for the treatment of obesity. Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial. Procedures that are mainly diversionary (e. The negative predictive values from Group 1 liver biopsies for NASH and portal fibrosis were only 83 % and 67 %, respectively. It offered insight into an early time course for symptom resolution, and explored the impact of weight-loss surgery on migraine headaches. Psychological benefits of a high-protein, low-carbohydrate diet in obese women with polycystic ovary syndrome—a pilot study. They must also be able to understand, and be adequately prepared for, potential complications. The assessment concluded that the evidence is not adequate to conclude that open or laparoscopic vertical banded gastroplasty is reasonable and necessary and they are therefore non-covered for all Medicare beneficiaries. Gentileschi et al (2002) systematically reviewed the published literature on open and bariatric laparoscopic obesity surgery and concluded that the available evidence indicates that laparoscopic VBG and laparoscopic RYGB are as effective as their open counterparts. Difference in mean weight loss at 6 and 12 months across all diet classes with 95% credible intervals when adjusting for percentage loss to follow-up (continuous measure) eTable 6. 9. Dietary protein and exercise have additive effects on body composition during weight loss in adult women. Resolution was statistically associated with female gender, percentage of excess weight loss, post-surgical BMI, post-surgical platelet count, and diabetes resolution. Two complications developed: (i) gastrogastric intussusception and (ii) tube kinking at the subcutaneous layer. 3). Pairs of reviewers independently, and in duplicate, extracted the following data items: study setting, type of trial (parallel or factorial), demographic information, experimental interventions, control interventions, exercise information, degree of calorie restriction, degree of behavioral support, and each of the outcomes of interest. This study aimed to determine the evolution of liver disease evaluated through NAFLD fibrosis score 12 months after surgery. Prevalence of NASH was 26 % in Group 1 and 32 % in Group 2. However, they stated that large well-designed studies with long-term follow-up are needed. Operative time ranged from 50 to 117. 7 In the absence of published head-to-head clinical trials of each diet against each other diet, network meta-analysis uses both direct and indirect clinical trial evidence to estimate their relative effects. A 12-week commercial web-based weight-loss program for overweight and obese adults: randomized controlled trial comparing basic versus enhanced features. A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. Reviewers, in pairs, independently screened titles and abstracts of articles and reviewed the full text of any title or abstract deemed potentially eligible by either reviewer. The outlet of this pouch is restricted by a band of synthetic mesh, which slows its emptying, so that the person having it feels full after only a few bites of food. The group with the routine liver biopsies showed a statistically significant larger preponderance of NASH (37 % versus 32 %). Weight loss differences between individual diets were minimal. , Irvine, CA) and the Realize Adjustable Gastric Band (Ethicon Endo-Surgery, Cincinnati, OH). The early weight loss results have been encouraging, with better weight loss in patients who underwent GCP. Improved psychological well-being, quality of life, and health practices in moderately overweight women participating in a 12-week structured weight loss program. A detailed description of the statistical analysis appears in the eMethods in the Supplement. Long-term effects of 2 energy-restricted diets differing in glycemic load on dietary adherence, body composition, and metabolism in CALERIE: a 1-y randomized controlled trial. These researchers investigated the discordance of paired liver biopsies in individuals undergoing gastric bypass. Severely obese persons are at increased risk of surgical complications. Laparoscopic gastric plication was performed in 12 adolescents (9 females and 3 males). Children and adolescents are rapidly growing, and are therefore especially susceptible to adverse long-term consequences of nutritional deficiencies from the reduced nutrient intake and malabsorption that is induced by obesity surgery. Long-term effects of a very low-carbohydrate diet and a low-fat diet on mood and cognitive function. The other end, leading from the gallbladder and pancreatic ducts, is connected onto the enteral limb at about 75 to 100 cm from the iliocecal valve. Six months following the device removal, patients treated with the ReShape Dual Balloon device kept off an average of 9. Aetna considers surgery to correct complications from bariatric surgery medically necessary, such as obstruction, stricture, erosion, or band slippage. One-year follow-up was completed by 45 patients treated with StomaphyX and 29 patients in the sham treatment group. 14. Bariatric surgery as a treatment for idiopathic intracranial hypertension. The Task Group recommended that smokers should be encouraged to stop, preferably at least 6 to 8 weeks before surgery (Saltzman et al, 2005). Difference in mean weight loss at 6 and 12 months across all diet classes with 95% credible intervals when adjusting for proportion female (continuous measure) eTable 8. The NIH Consensus Conference (1998) states that the combination of a reduced calorie diet and increased physical activity can result in substantial improvements in blood pressure, glucose tolerance, lipid profile, and cardiorespiratory fitness. Both patients were at a high risk and could not undergo another open or laparoscopic surgery to correct the leaks that were not healing. Eleven (92 %) of 12 patients who had undergone pre- and post-operative formal visual field testing had complete or nearly complete resolution of visual field deficits, and the remaining patient had stabilization of previously progressive vision loss. The mini-gastric bypass has not been subjected to a prospective clinical outcome study in peer-reviewed publication. Given the importance of patient compliance in diet and self-care in improving patient outcomes after surgery, the appropriateness of obesity surgery in noncompliant patients should be questioned. Weight loss differences between individual named diets were small. We included RCTs that reported weight loss or BMI reduction at 3-month follow-up or longer. Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: one-year follow-up of a randomised trial. Network diagrams for randomized controlled trials investigating change in BMI among diets, categorized by diet class eFigure 6. Continuous outcomes were most often reported as mean change, but sometimes were reported as preintervention and postintervention measures or percentage change. On July 28, 2015, the Food and Drug administration (FDA) approved the ReShape Integrated Dual Balloon System (ReShape Medical Inc. The weight loss effect is then a combination of the very small stomach, which limits intake of food, with malabsorption of the nutrients, which are eaten, reducing caloric intake even further. Supplement. The Task Group stated that registered dietitians are best qualified to provide nutritional care, including pre-operative assessment and nutritional education and counseling. Fifty-six (92 %) of 61 patients with recorded post-operative clinical history had resolution of their presenting IIH symptoms following bariatric surgery. The authors concluded that early reports with LGP were promising with a favorable short-term safety profile. Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: lighten up randomised controlled trial. In the latter cases, transformations were used to express weight loss and BMI as mean change. Post-operative lumbar puncture opening pressure was shown to decrease by an average of 18. They also relied on aggregating studies comparing one diet with another and did not have the ability to determine the relative performance of diets when they were not directly compared with one another in clinical trials. 8 % of their total body weight) when the device was removed at 6 months, while the control group (who underwent an endoscopic procedure but were not given the device) lost an average of 7. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. The effect of a low-carbohydrate, high-protein diet on post laparoscopic gastric bypass weight loss: a prospective randomized trial. This added to the small number of case reports and retrospective analyses of the successful treatment of IIH with gastric bypass surgery, and brought this data from the surgical literature into the neurological domain. Neither BMI nor liver enzymes predicted the presence or severity of NASH. 1 % versus 2. Search of 6 electronic databases: AMED, CDSR, CENTRAL, CINAHL, EMBASE, and MEDLINE from inception of each database to April 2014. 4 % with follow-up from 6 months to 24 months. 312, No. Combining behavioral weight loss treatment and a commercial program: a randomized clinical trial. CADTH was not, however, able to identify specific thresholds for surgical volume that were associated with better clinical outcomes. GRADE guidelines: 3, rating the quality of evidence. Nevertheless, a 25-mm biopsy specimen without zone 3 cellular ballooning or fibrosis appears adequate to exclude the diagnosis of NASH. A number of studies have demonstrated a relationship between surgical volumes and outcomes of obesity surgery. They stated that additional prospective comparative trials and long-term follow-up are needed to further define the role of LGP in the surgical management of obesity. The Task Group also noted that weight loss surgery is contraindicated in those who are unable to comprehend basic principles of weight loss surgery or follow operative instructions. We searched 6 electronic databases: AMED, CDSR, CENTRAL, CINAHL, EMBASE, and MEDLINE from inception of each database to April 2014. In March 2007, the FDA granted 510(k) pre-marketing clearance to the StomaphyX (EndoGastric Solutions, Inc. Weight loss surgery patients need to learn important new skills, including self-monitoring and meal planning. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. 75 to 5 days (average of 2. Liver cirrhosis was present in 11. 0 % and 2. Body Mass Index as a Criterion for Candidacy for Obesity Surgery. They placed Swedish bands using the pars flaccida method, divided the greater omentum, and performed gastric plication below the band to 3 cm from the pylorus using a single-row continuous suture. It is a reproducible and reversible technique with results and indications still to be validated. 7 years (median SD, 9 years), median weight of 94. View Large Download Diet Classes Based on Macronutrient Composition Table 2. Aetna considers VBG experimental and investigational when medical necessity criteria are not met. 3 %, including 43. Recent data demonstrate that surgeons are moving from simple gastroplasty procedures, favoring the more complex gastric bypass procedures as the surgical treatment of choice for the severely obese patient. 12. This study was poorly reported, failing to discuss inclusion criteria for the trial and adverse events associated with the procedures. NASH was defined as steatohepatitis without alcoholic or viral hepatitis. The loop gastric bypass developed years ago has generally been abandoned by most bariatric surgeons as unsafe. Named diets were identified through the explicit naming of the brand, the referencing of branded literature, or the naming of a brand as funders of an article reporting weight loss outcomes from the diet. For example, dietary programs that did not refer to Atkins but consisted of less than 40% of kilocalories from carbohydrates per day for the duration of study or were funded by Atkins were considered Atkins-like. Random-effects pairwise meta-analyses (using the method by DerSimonian and Laird 19 ) were used to determine direct and indirect associated treatment effects for all network meta-analyses. Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects. Also, the stomach opening that leads into the intestines, which in surgery is made smaller to allow less food to pass through, often stretches as the years go by. Data from each relevant manuscript were gathered, analyzed, and compared. Anderin et al (2015) found that weight loss before bariatric surgery is associated with marked reduction of risk of postoperative complications. More recently, a review of the literature by the Veterans Health Administration Technology Assessment Program (Adams, 2008) found no new literature that would not alter the conclusions of the ANZHSN review. The search strategy is available from the authors upon request. In a sense, this procedure combines the least desirable features of the gastric bypass with the most troublesome aspects of the biliopancreatic diversion. 2 pounds (3. Natural orifice transoral endoscopic surgery (NOTES) techniques for bariatric surgery including, but may not be limited to, the following. Changes in weight loss and BMI varied depending on the reported post-operative follow-up interval. The gray literature search identified 213 additional articles. The assessment found that open and laparoscopic RYGB induces similar amounts of weight loss. The ReShape Dual Balloon device is delivered into the stomach via the mouth through a minimally invasive endoscopic procedure. Bariatric Surgery for the Treatment of Idiopathic Intracranial Hypertension. For example, the Atkins diet resulted in a 1. Brethauer et al (2011) presented the results of a feasibility study using laparoscopic gastric plication for weight loss achieved without stapling or banding. When comparing patients in the 75th with those in the 25th percentile of pre-operative weight loss, the risk of complications was reduced by 13 %. Otherwise, we used the pre- and postintervention standard deviations along with a correlation estimated from studies that reported both change and pre- and postintervention results. 4 % (1) with the sham procedure (p. Consecutive liver biopsies were compared to those liver biopsies selected because of grossly fatty livers. Studies have reported that many patients must undergo another revisional operation to obtain the results they seek. However, it remains unclear if weight loss following LGP is durable in the long-term. A randomized controlled clinical trial comparing short-term (1-year) outcomes of laparoscopic sleeve gastrectomy to laparoscopic RYGB found comparable reductions in body weight and BMI (Karamanakos et al, 2008). 3 pounds on average (6. A Bayesian framework was used to perform a series of random-effects network meta-analyses with meta-regression to estimate the relative effectiveness of diet classes and programs for change in weight and body mass index from baseline. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. Results of the morbidity, mortality and weight loss were presented. Available brands of LASGB include the Lap-Band System (Allergan, Inc. Plication of the greater curvature produces a restrictive mechanism that causes weight loss. Overall, clinical studies have shown that about 40 % of persons who have this operation do not achieve loss of more than half of their excess body weight. The patient must be committed to the appropriate work-up for the procedure and for continuing long-term post-operative medical management, and must understand and be adequately prepared for the potential complications of the procedure. In a prospective, single-center, randomized, single-blinded study, Eid et al (2014) examined the safety and effectiveness of endoscopic gastric plication with the StomaphyX device versus a sham procedure for revisional surgery in RYGB (performed at least 2 years earlier) patients to reduce regained weight. In addition, VBG has a high rate of serious morbidity, including a re-operation rate of up to 30 % from stoma obstruction and staple-line disruption. 9 pounds of the 14. It is associated with a minimal risk of leakage, bleeding, and nutritional deficiency. The aim of this study was to evaluate the role of liver oxidative stress in NAFLD affecting morbidly obese patients. The 48 RCTs included 7286 individuals with a median age of 45. Aetna considers each of the following procedures experimental and investigational because the peer-reviewed medical literature shows them to be either unsafe or inadequately studied. Because the normal flow of food is disrupted, available literature indicates that there is a greater potential for metabolic complications compared to gastric restrictive surgeries, including iron deficiency anemia, vitamin B-12 deficiency and hypocalcemia, all of which can be corrected by oral supplementation. Effects of a low-intensity intervention that prescribed a low-carbohydrate vs a low-fat diet in obese, diabetic participants. We considered 3 weight loss effect modifiers that were modeled as present or absent if they were included in an overall dietary program: calorie restriction, exercise, and behavioral support. Eligible programs included meal replacement products but had to consist primarily of whole foods and could not include pharmacological agents. The published literature was reviewed using manual and electronic search techniques. Vagus nerve blocking (e. The hazards of scoring the quality of clinical trials for meta-analysis. Vertical banded gastroplasty (VBG), a purely restrictive procedure, has fallen into disfavor because of inadequate long-term weight loss. 9 cmH2 O in the 12 patients who had this recorded. 3 pounds they lost. 1 kg (median SD, 14. Self-help weight loss versus a structured commercial program after 26 weeks: a randomized controlled study. Note: The presence of depression due to obesity is not normally considered a contraindication to obesity surgery. For patients in the highest range of body mass index (BMI), the risk reduction associated with pre-operative weight loss was statistically significant for all analyzed complications, whereas corresponding risk reductions were only occasionally encountered and less pronounced in patients with lower BMI. Sampling discordance was greatest for portal fibrosis (26 %), followed by zone 3 fibrosis (13 %) and ballooning degeneration (3 %). For these reasons, it is therefore best for patients to develop good eating and exercise habits before they undergo surgery. The American College of Surgeons (ACS) has stated that the surgeon performing the bariatric surgery be committed to the multidisciplinary management of the patient, both before and after surgery. Patients who have this operation must have lifelong medical follow-up, since the side effects can be subtle, and can appear months to years after the surgery. 7 % of those with NASH. Roux-en-Y gastric bypass as a treatment for gastroesophageal reflux in non-obese persons. 8 % to 74. 1 Debate regarding the relative merit of the diets is accompanied by advertising claiming which macronutrient composition is superior, such as a low-carbohydrate diet being better than a low-fat diet, and the benefits of accompanying lifestyle interventions. Search terms included extensive controlled vocabulary and keyword searches for (RCTs) AND (diets) AND (adults) AND (weight loss). The degree and histopathological discordance is dependent upon zonal location and types of injury. Rationale for Six-Month Nutrition and Exercise Program Prior to Surgery. Diets with at least 2 group or individual sessions per month for the first 3 months were considered as providing behavioral support. Similarly, however, less pronounced risk reductions were found when comparing patients in the 50th with those in the 25th percentile of pre-operative weight loss. By contrast, the liver enlarges and becomes increasingly infiltrated with fat when weight is gained prior to surgery. The claimed advantage of LASGB is the adjustability of the band, which can be inflated or deflated percutaneously according to weight loss