Lap-Band Shown Effective for Long-Term Weight Loss

Jan. 18, 2013 -- More than 200,000 weight loss surgeries are performed each year in the U.S.

Several recent studies have questioned the effectiveness and safety of one type, gastric banding, which has led to a decline in its use as patients choose other surgical options.

But the largest and longest study yet of the procedure found that patients followed for up to 15 years maintained significant weight loss -- an average of about 60 pounds.

About half the patients in the study needed additional surgeries to adjust the bands or deal with other complications, but only about 1 in 20 patients opted to have the bands removed.

Researcher Paul O’Brien, MD, of Melbourne, Australia’s Monash University, was a pioneer of the Lap-Band procedure, and his latest study was supported by Allergan Inc., which markets the gastric band system.

He says gastric banding offers an effective, reversible, long-term solution for weight loss as long as patients get good follow-up care and are willing to carefully control the way they eat.

The study is published in the January issue of the Annals of Surgery.

“Placing the band is just the first step in the process,” he says. “Compliance and follow-up are critically important. There are plenty of people out there doing this surgery without a follow-up program for their patients, and they are setting them up for failure.”

The Lap-Band procedure is one of several weight loss surgeries performed in the U.S. and the only one that is easily reversible.

The band is an inflatable silicone ring that is wrapped around the upper part of the stomach to create a pouch the size of a golf ball, which limits the amount of food that can be eaten. The band can be tightened or loosened to increase or decrease the size of the opening to the lower stomach.

The most commonly performed type of gastric bypass surgery also reduces the size of the stomach to that of a golf ball. The surgery also bypasses a section of the small intestine, which limits calorie absorption.

The gastric sleeve procedure involves the surgical removal of a portion of the stomach to create a "sleeve" that connects to the small intestine.

Just a few years ago, gastric banding was widely seen as less risky, less costly, and less invasive than either of the other surgical options, and about half of weight loss procedures in the U.S. involved banding.

But that has changed as the long-term data comparing weight loss surgeries has come in, says Ronald H. Clements, MD, who directs the bariatric surgery program at Vanderbilt University Medical Center in Nashville.

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Yoga shown effective for treating chronic neck pain

Nov. 27, 2012 — According to published estimates, some 20 percent of the population suffers from chronic neck pain caused by a variety of structural dysfunctions in the neck, resulting in impaired quality of life and lost work time. A German study published in The Journal of Pain showed that yoga appears to be an effective treatment for neck pain and provides added benefits of improved psychological well being and quality of life.

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The Journal of Pain is the per-review publication of the American Pain Society.

The mainstay of conservative treatment for neck pain is non-steroidal anti-inflammatory medication, and the evidence of its effectiveness is contradictory while side effects, such as nausea and dizziness, are well known. The authors noted that one type of yoga, called lyengar yoga, has been shown effective in other pain syndromes, including low back pain. This activity uses supportive props and the sequences of postures can be tailored to address an individual's medical problem. No randomized controlled clinical trials have been published to assess the efficacy of lyengar yoga for adults with chronic neck pain.

Researchers at Charité-University Medical Center in Berlin and other sites in Germany and Austria studied 77 volunteer patients. Thirty-eight were assigned to the yoga group and 39 to a group treated with exercise. Unfortunately, the dropout rate was higher than anticipated as 24 subjects withdrew or were lost to follow-up. This reduced the study sample to 25 patients in the yoga group and 28 in self-care exercise. They were asked to complete a standardized questionnaire at the outset of the study, after four weeks, and after ten weeks.

The findings showed there was a significant and clinically important reduction in pain intensity in the yoga group. The authors reasoned that yoga might enhance both the toning of muscles and releasing of muscle tension. Relaxation responses, therefore, could reduce stress related muscle tension and modify neurobiological pain perception. They concluded, based on the study data, that lyengar yoga can be a safe and effective treatment option for chronic neck pain. The study results are consistent with the demonstrated benefits of yoga for treating low back pain.

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