title: Intensive medical weight loss or laparoscopic adjustable gastric banding in the treatment of mild to moderate obesity: long-term follow-up of a prospective randomised trial.
abstract: BACKGROUND
  Proven short-term effectiveness of obesity therapy should be re-evaluated in the long-term. The objective of this paper is to determine the long-term (10 years) outcome for patients from a randomised controlled trial (RCT).
  
  
  METHODS
  A RCT in 2002 compared laparoscopic adjustable gastric band (LAGB) for obesity with non-surgical therapy. Follow-up has been conducted at 10 years. Eighty patients (BMI 30-35) were randomised to a non-surgical or a surgical program. Outcome data are available on 37 (92.5 %) of the surgical patients and 27 (62.5 %) of the non-surgical patients at 10 years.
  
  
  RESULTS
  Weight change, the metabolic syndrome, quality of life, adverse events and direct costs of the surgical cohort were the main results of the study. A durable weight loss is present in the surgical group with a mean (SD) 10-year weight loss of 14.1 (7.7) kg (63.4 % EWL), better than the non-surgical group (mean (SD) = 0.4 (10.5) kg; p < 0.001). The metabolic syndrome was reduced from 14 to 4 of the 37 patients who completed 10 years within the LAGB groups. Proximal gastric enlargements occurred in 17 (30 %) of the 57 who had LAGB and removal of the band occurred in 7 (12 %). The annual maintenance costs including additional surgery was AUD $765 per patient per year.
  
  
  CONCLUSIONS
  Bariatric surgery with the LAGB can achieve long-term weight reduction which is better than a program of non-surgical therapy. There is also a sustained reduction of the metabolic syndrome. There is a significant maintenance requirement after LAGB.
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Australia. paul.obrien@monash.edu
authors.forename: Paul E
authors.initials: PE
authors.lastname: O'Brien
authors.forename: Leah
authors.initials: L
authors.lastname: Brennan
authors.forename: Cheryl
authors.initials: C
authors.lastname: Laurie
authors.forename: Wendy
authors.initials: W
authors.lastname: Brown
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human