Weight Loss Options

Weight Loss Options


01: Obesity Overview

Obesity is a complex disease caused by many factors. It is not simply the result of “lack of willpower”, but rather a combination of cultural, environmental, genetic, and individual factors:

Genetics

People with an obese parent are much more likely to be obese than those with lean parents. 

Friends & Family

The eating habits and physical activity levels of the people around you have a significant influence on your health behaviors.

Medical Conditions

Some medical conditions and medications can lead to weight gain. 

 

Emotions

Distressing events, major life changes, stress, or boredom can lead to food intake even when you are not physically hungry.

Lifestyle

Increased portion sizes and readily available “junk” food can lead to unhealthy eating habits. Busy schedules and modern conveniences such as cars and elevators make exercise difficult to fit into your daily routine.

With so many causes to obesity, long-term weight loss is extremely difficult to achieve. Most obese people have tried numerous diets and exercise programs, with little long-term success. Keeping the weight off is often a greater challenge. Even when short-term weight loss is achieved, most people regain the lost weight over time.

Moderate weight loss of five to ten percent of initial body weight has been shown to improve many of the adverse health effects of obesity1. In addition, moderate weight loss decreases the risk of developing new obesity-related diseases, such as diabetes2,3.

02: Non-Surgical Treatment

Lifestyle Intervention

The most common approach to treat obesity is lifestyle intervention, including changes in dietary intake and physical activity. While moderate weight loss can often be achieved through dieting, most people regain their lost weight over time4.

Pharmacotherapy

Appropriate pharmacotherapy can help patients achieve about a five to ten percent weight loss in one year. However, if effective, pharmacotherapy must be continued, and rapid weight regain will occur when drug therapy is stopped. Moreover, many patients will begin to regain weight after one year of drug therapy despite continued treatment. Few drugs are currently approved for obesity therapy and only one (orlistat, which blocks the absorption of fat) is approved for long-term use in obese patients in the United States.

 

03: Bariatric Surgery & The AspireAssist

Due to the shortcomings of diet and exercise approaches, bariatric surgery has become recognized as the most effective solution for long-term weight loss. For many patients, bariatric surgery has produced considerable long-term weight loss. This weight loss has important medical benefits, including normalizing blood glucose in patients with type 2 diabetes5, preventing the future development of diabetes6, improving or normalizing blood pressure in patients with hypertension,7,8 improving or eliminating obstructive sleep apnea,9,10,11 decreasing joint pain,12 and improving health-related quality of life13. However, these surgical options also have many potential complications that must be carefully weighed against the potential benefits. The AspireAssist is a breakthrough minimally-invasive therapy that has been shown to provide similar weight loss results, without many of the serious complications of invasive surgery.

 

Gastric Bypass Surgery

The gastric bypass procedure, also known as Roux-en-Y Gastric Bypass, involves the creation of a small stomach pouch by stapling across or completely transecting the stomach. The surgeon then attaches a lower section of small intestine directly to the stomach pouch. Therefore, this procedure reduces the capacity of the stomach from about 1.5 liters to about 30 ml (about the volume of a golf ball) and causes food to bypass most of the stomach and the upper portion of the intestines.

Vertical Sleeve Gastrectomy

Sleeve Gastrectomy procedures reduce the size of the stomach by over 80%. In this procedure, the surgeon staples across and removes most of the stomach, leaving a banana-sized stomach sleeve.

Laparoscopic Adjustable Gastric Banding (LAGB)

Gastric banding, such as the LAP-BAND® and Realize® Band, involves surgically placing an adjustable band around the upper stomach.

The AspireAssist

The AspireAssist is different from invasive surgical methods. The device can be placed during a short outpatient procedure under conscious sedation, so general anesthesia is not required. If desired, it can be removed at any time through a similar 15-minute procedure, with no permanent changes to the gastrointestinal anatomy. With the AspireAssist, there are no extreme or sudden changes to the foods you can eat or drink. Instead, successful patients gradually learn healthy behaviors though the accompanying lifestyle counseling program.

04: Compare Options

Use the chart below to learn more about the important differences between the AspireAssist and invasive bariatric surgeries. If you have not been able to successfully maintain weight loss through diet and exercise changes, but do not want to undergo an invasive bariatric surgery, the AspireAssist might be the right choice for you.

AspireAssist   Adjustable Gastric Banding   Gastric Bypass   Sleeve Gastrectomy

Excess Weight Loss
(first year)14

 

Excess Weight Loss
(first year)15

 

Excess Weight Loss
(first year)15

 

Excess Weight Loss
(first year)16*

Serious Complications
(Buried Bumper, n=24)22

 

Serious Complications
(Includes slippage / dilation, erosion, obstruction, death)17**

 

Serious Complications
(Includes staple line failure, leaking, bleeding, obstruction, marginal ulcer, death)17**

 

Serious Complications
(Includes staple line failure, bleeding, postoperative strictures, death)17**

Average Procedure Time

 

Average Procedure Time18

 

Average Procedure Time18

 

Average Procedure Time18

Anatomical Changes

 

Anatomical Changes

 

Anatomical Changes

 

 

Anatomical Changes

Percutaneous
Procedure Type

 

Laparoscopic
Procedure Type

 

Laparoscopic
Procedure Type

 

 

Laparoscopic
Procedure Type

Reversible

 

Reversible

 

Not Reversible

 

 

Not Reversible

 

 

 

Length of Time in
Hospital or Clinic
(on average)

 

Length of Time
in Hospital or Clinic
(on average)18

 

Length of Time
in Hospital or Clinic
(on average)18

 

Length of Time
in Hospital or Clinic
(on average)18

No Vomiting or
Dumping Syndrome

 

Regurgitation / vomiting is
common initially21

 

Sugary Foods can
cause dumping

 

 

No Vomiting or
Dumping Syndrome

Gradually learn
healthy behaviors

 

Very small meals,
no drinking with meals
(~200ml or <1 cup)19

 

Very small meals
(~200ml or <1 cup)20

 

Very small meals
(~200ml or <1 cup)20

Aspire Assist   Adjustable Gastric
Banding

Excess Weight Loss
(first year)14

 

Excess Weight Loss
(first year)15

Gastric Bypass   Sleeve Gastrectomy

Excess Weight Loss
(first year)15

 

Excess Weight Loss
(first year)16*

 
Aspire Assist   Adjustable Gastric
Banding

Serious Complications
(Buried Bumper, n=24)22

 

Serious Complications
(Includes slippage / dilation, erosion, obstruction, death)17**

Gastric Bypass   Sleeve Gastrectomy

Serious Complications
(Includes staple line failure, leaking, bleeding, obstruction, marginal ulcer, death)17**

 

Serious Complications
(Includes staple line failure, bleeding, postoperative strictures, death)17**

 
Aspire Assist   Adjustable Gastric
Banding

Average Procedure Time

 

Average Procedure Time18

Gastric Bypass   Sleeve Gastrectomy

Average Procedure Time18

 

Average Procedure Time18

 
Aspire Assist   Adjustable Gastric
Banding

Anatomical Changes

 

Anatomical Changes

Gastric Bypass   Sleeve Gastrectomy

Anatomical Changes

 

 

Anatomical Changes

 
Aspire Assist   Adjustable Gastric
Banding

Percutaneous
Procedure Type

 

Laparoscopic
Procedure Type

Gastric Bypass   Sleeve Gastrectomy

Laparoscopic
Procedure Type

 

 

Laparoscopic
Procedure Type

 
Aspire Assist   Adjustable Gastric
Banding

Reversible

 

Reversible

Gastric Bypass   Sleeve Gastrectomy

Not Reversible

 

 

Not Reversible

 
Aspire Assist   Adjustable Gastric
Banding

 

Gastric Bypass   Sleeve Gastrectomy

 

 
Aspire Assist   Adjustable Gastric
Banding

Length of Time in
Hospital or Clinic
(on average)

 

Length of Time
in Hospital or Clinic
(on average)18

Gastric Bypass   Sleeve Gastrectomy

Length of Time
in Hospital or Clinic
(on average)18

 

Length of Time
in Hospital or Clinic
(on average)18

 
Aspire Assist   Adjustable Gastric
Banding

No Vomiting or
Dumping Syndrome

 

Regurgitation / vomiting is
common initially21

Gastric Bypass   Sleeve Gastrectomy

Sugary Foods can
cause dumping

 

 

No Vomiting or
Dumping Syndrome

 
Aspire Assist   Adjustable Gastric
Banding

Gradually learn
healthy behaviors

 

Very small meals,
no drinking with meals
(~200ml or <1 cup)19

Gastric Bypass   Sleeve Gastrectomy

Very small meals
(~200ml or <1 cup)20

 

Very small meals
(~200ml or <1 cup)20

 

Footnotes

*Sleeve Gastrectomy follow-up ranged from 3 to 60 months. **Serious complication rates may be lower in Centers of Excellence. LAP-BAND® is a registered trademark owned by Allergan, Inc. Realize® is a registered trademark of Ethicon Endo-Surgery.

1. Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 1992;16:379-415.

2. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343-1350.

3. Knowler WC, Barrett-Connor E, Fowler SE, et al. Diabetes Prevention Program Research Group.Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.

4. Wadden TA, Foster GD, Letizia KA. One-year behavioral treatment of obesity: comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy. J Consult Clin Psychol 1994;62:165-171.

5. Sugerman HJ, Sugerman EL, Wolfe L, Kellum JM, Schweitzer MA, DeMaria EJ. Risks and benefits of gastric bypass in morbidly obese subjects with severe venous stasis disease. Ann Surg 234:41-46, 2001.

6. Sjostrom CD, Peltonen M, Wedel H, Sjostrom L. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 36:20-25, 2000.

7. Foley EF, Benotti PN, Borlase BC, Hollingshead J, Blackburn GL. Impact of gastric restrictive surgery on hypertension in the morbidly obese. Am J Surg 163:294-297, 1992

8. Carson JL, Ruddy ME, Duff AE, Holmes NJ, Cody RP, Brolin RE. The effect of gastric bypass surgery on hypertension in morbidly obese subjects. Arch Intern Med 154:193-200, 1994.

9. Sugerman HJ, Fairman RP, Sood RK, Engle K, Wolfe L, Kellum JM. Long-term effects of gastric surgery for treating respiratory insufficiency of obesity. Am J Clin Nutr 55:597S-601S, 1992.

10. Barvaux VA, Aubert G, Rodenstein DO. Weight loss as a treatment for obstructive sleep apnea. Sleep Med Rev 4:435-452, 2000.

11. Charuzi I, Ovnat A, Peiser J, Saltz H, Weitzman S, Lavie P. The effect of surgical weight reduction on sleep quality in obesity-related sleep apnea syndrome. Surgery97:535-538, 1985.

12. McGoey BV, Deitel M, Saplys RJ, Kliman ME. Effect of weight loss on musculoskeletal pain in the morbidly obese. J Bone Joint Surg 72:322-323, 1990.

13. Karlsson J, Sjostrom L, Sullivan M. Swedish obese subjects (SOS)–an intervention study of obesity. Two-year follow-up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity. Int J Obes Relat Metab Disord 22:113-126, 1998.

14. Sullivan S, Stein R, Jonnalagadda S, Mullady D, Edmundowicz S. Aspiration Therapy Leads to Weight Loss in Obese Subjects: A Pilot Study. Gastroenterology 2013;145:1245–1252.

15. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;292:1724-1737.

16. Brethauer S, Hammel J, Schauer P. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Related Dis 2009;5:469-475. 

17. Tice J et al. Gastric Banding or Bypass? A Systematic Review Comparing the Two Most Popular Bariatric Procedures. The American Journal of Medicine (2008) 121, 885-893.

18. Shi et al. A Review of Laparoscopic Sleeve Gastrectomy for Morbid Obesity. Obes Surg 2010.

19. Lap-Band:
Website: http://www.lapband.com/en/live_healthy_lapband/months_beyond/lifestyle_guidelines
accessed January 6, 2012.

20. Mayo Clinic Website: http://www.mayoclinic.com/health/gastric-bypass-diet/my00827 accessed January 6, 2012.

21. Realize Band Website: http://www.realize.com/bariatric-surgery-risks-complications.htm, accessed January 6, 2012.

22. Data on file at Aspire Bariatrics.

LAP-BAND® is a registered trademark owned by Allergan, Inc. Realize® is a registered trademark of Ethicon Endo-Surgery.

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