Recent reports address the health benefits of bariatric surgery just as the FDA expands use of the gastric-banding system for weight loss.

Researchers compared laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (GB), the two most common operations performed to treat morbid obesity. At one year, no deaths occurred among 92 RYGB patients or 93 GB patients. Results for RYGB patients outshone those of the GB patients in terms of excess weight lost (64% vs. 36%), resolution of diabetes (76% vs. 50%), and quality-of-life measures. However, the RYGB group had a higher rate of early complications: 11% vs. 2%. The overall rate of complications was similar, occurring in 15% of RYGB patients and 12% of GB patients. GB patients had a higher rate of reoperations (13% vs. 2%).

Despite the conclusion that RYGB has a better risk-benefit profile than GB when performed in high-volume centers by expert surgeons (Arch Surg. 2011;146:149-155), the rate of gastric banding may increase now that the FDA has approved Allergan’s LAP-BAND Adjustable Gastric Banding System in persons with a BMI of 30 to 34 who also have an existing condition related to their obesity. Since its introduction in 2001, the device had been indicated only for persons with a BMI of at least 40, those with a BMI of at least 35 and an existing severe condition related to their obesity, or those who were at least 100 pounds overweight.

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While generally safe, these procedures are not a benign surgery, cautions the American Heart Association (AHA). “Bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present,” Paul Poirier, MD, PhD, and fellow AHA committee members wrote online ahead of print in Circulation.