No, this is not my line.
“The LAP-BAND Solution: A Partnership in Weight Loss” is the title of a book by Australian surgeon Dr Paul O’Brien which I read with interest when one of my patients found it in a library and showed it to me.
Since the start of 2007 I have been doing public talks on the myths and facts about weight loss.
The key question I ask people at those talks is this…
What would you advise someone who wanted to lose a SIGNIFICANT amount of weight LONG-TERM?
By which I mean, what actually works to lose >10% of bodyweight for >5 years.
People will come back with all sorts of answers.
I’d love to be able to say it was some sort of psychological intervention, but I can’t (more on this later.)
The fact is that the only research-PROVEN answer is an operation.
There are a few types of stomach operations for weight loss, also known as bariatric surgery, but to my mind they fall into two camps; ones that irreversibly rearrange the gut in some way, and ones that leave your insides intact and put in some sort of stomach banding instead.
The commonest operation of the first type is called gastric bypass surgery, and it is popular in the US.
The most well-known of the gastric banding type is LAP-BANDing (TM), and it is the most popular in Australia.
In “The LAP-BAND Solution” Dr Paul O’Brien is described as one of the originators of this device, and has extensive experience in academic, research, and professional areas of obesity and bariatric surgery.
The book therefore promised to be an authoratitive text, and also very pro-LAP BAND(TM). It was both of these.
It is also fairly readable which is a nice bonus too.
The best bit about finding people who have one solution to a problem, is to listen to what they say about other suggested solutions. They will tend to be scathing.
Here’s what Paul O’Brien says about drugs…
The long-term efficacy is poor and the long-term safety is unknown … the average weight loss after 1 year of orilistat [Xenical] is about 7 lb (3 kg) and for sibutramine [Meridia or Reductil] is 10 lb (4.5 kg) … these results are just not good enough.
Here’s what he has to say about weight loss by dieting and lifestyle modification…
The commercial weight-loss centers have made fortunes by promising excellent weight loss through various twists on the “lifestyle” methods, and their constant advertisements always show the classic “before and after” pictures. Invariably, the “äfter” picture is only a few months after. They do not show the “after” pictures at 5 years.
A recent comprehensive review of all the high-quality scientific studies of the options for weight control has found that there is no evidence of a durable effect from any current lifestyle intervention methods for obesity.
The only problem with this statement is that the review he refers to is in fact from 1997. Not exactly ‘recent’ in my opinion.
Still, the last 11 years haven’t proven any better studies that I am aware of either.
[The approach I recommend has not been proven in the research, and since there is no pill or expensive program, ie no money in it, I very much doubt the required multi-year studies will ever be done.]
However, my patient was already losing weight without surgery.
She gave the book to me for an entirely different reason.
She pointed out that the book talks about patients with a LAP-BAND(TM) learning to eat in an entirely different way – a way that mimics many (but not all) of the things I recommend in my non-surgical, non-dieting approach.
This is really interesting.
What if surgery is merely an extreme way to change someone’s eating behaviors?
I don’t think that is all of the effect, but I certainly think it is some of it, and maybe all of the long-term lasting results.
Why would I say this?
Because I have worked with people who lost weight with surgery, but then gained much of it back again. Their results didn’t last, and I then teach them the additional changes.
Every method of weight loss reports some successes.
Some of people even keep the weight off long-term.
A few become celebrities (eg Biggest Loser winners) and their new life then depends upon keeping the weight off. That might help as motivation.
But I think there are another group of people who discover a few other tips and habits that give them the success they need – effortlessly.
I think they discover, albeit accidentally, the non-dieting method that naturally thin people live unconsciously and automatically.
If you are over-weight enough to qualify for surgery, then it certainly is worth pursuing. In the US you might need to push to get access to LAP-BAND(TM) because apparently insurance companies are still trying to avoid paying for this, but I agree with Dr O’Brien that it is a better option than gastric surgery, if for no other reason than it is entirely reversible.
But also know that you can make many of the same changes without surgery, and all for free!
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[If you are in my home town of Adelaide, then you can get the Adelaidean-only emails with the same audio here instead.]
-Dr Martin Russell