Evidence-Based Treatment for a Patient with Severe Obesity_Chinese Journal of Evidence-Based Medicine

Authors：

LIANG Yongkang , YANG Jianjun ,  WANG Bing

Department of General Surgery, Ninth People’s Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai 200011, China;

Corresponding author：

WANG Bing, Email: wingping01@126.com

Keywords：

Evidence-based treatment; Severe obesity; Bariatric surgery; Laparoscopic adjustable gastric band

DOI：

10.7507/1672-2531.20110143

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To formulate an individualized evidence-based treatment for a patient with severe obesity.
Methods 　According to the PICO (patient intervention comparison outcome) principle, the evidence was collected and critically assessed after the clinical issues were put forwarded. The patient’s preference was also taken into account in the decision making process.
Results 　Nine clinical guidelines, eight systematic reviews or meta-analyses and three randomized controlled trials (RCTs) were included. According to the data from the included studies and patient’s special condition, a reasonable surgical treatment regime was made to reduce the weight, relieve all kinds of complications and improve the life quality which were all regarded as the expected target. After one year’s follow-up, the patient’s weight reduced by 20 kg, and some obesity-related co-morbidities such as sleep apnea syndrome and hyperlipoidemia were also improved significantly.
Conclusion 　The laparoscopic adjustable gastric band is an effective operation for severely obese individuals. This procedure can not only achieve weight loss, but also improve some obesity-related co-morbidities.

Citation： LIANG Yongkang,YANG Jianjun,WANG Bing. Evidence-Based Treatment for a Patient with Severe Obesity. Chinese Journal of Evidence-Based Medicine, 2011, 11(7): 841-844. doi: 10.7507/1672-2531.20110143 Copy

1.	1 Tsigosa C, Hainerb V, Basdevant A, et al . Management of obesity in adults: European clinical practice guidelines. Obes Facts , 2008, 1(2): 106-116.
2.	2 SAGES Guidelines Committee. SAGES guideline for clinical application of laparoscopic bariatric surgery. Surg Endosc , 2008, 22(10): 2281-2300.
3.	3 Mechanick JI, Kushner RF, Sugerman HJ, et al . American association of clinical endocrinologists, the obesity society, and american society for metabolic & bariatric surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract , 2008, 14 (Suppl 1): 1-83.
4.	4 Logue J, Thompson L, Romanes F, et al . Management of obesity: summary of SIGN guideline. BMJ , 2010, 24(340): c154.
5.	5 Fried M, Hainer V, Basdevant A, et al . Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg , 2007, 17(2): 260-70.
6.	6 Guidelines for laparoscopic and open surgical treatment of morbid obesity. American Society for Bariatric Surgery. Society of American Gastrointestinal Endoscopic Surgeons. Obes Surg , 2000, 10(4): 378-379.
7.	7 International Pediatric Endosurgery Group. IPEG guidelines for surgical treatment of extremely obese adolescents. J Laparoendosc Adv Surg Tech A , 2009, 19(Suppl 1): xiv-xvi.
8.	8 Society for Surgery of the Alimentary Tract. SSAT patient care guidelines. Surgery for obesity. J Gastrointest Surg , 2007, 11(9): 1219-1221.
9.	10 Colquitt JL, Picot J, Loveman E, et al . Surgery for obesity. Cochrane Database Syst Rev , 2009, 15(2): CD003641.
10.	11 Maggard MA, Shugarman LR, Suttorp M, et al . Meta-analysis: surgical treatment of obesity. Ann Intern Med , 2005, 142(7): 547-559.
11.	12 Buchwald H, Estok R, Fahrbach K, et al . Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery , 2007, 142(4): 621-635.
12.	13 Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg , 2004, 14(9): 1157-64.
13.	14 Buchwald H, Avidor Y, Braunwald E, et al . Bariatric surgery: a systematic review and meta-analysis. JAMA , 2004, 292(14): 1724-1737.
14.	15 Buchwald H, Estok R, Fahrbach K, et al . Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med , 2009, 122(3): 248-256.
15.	16 Tice JA, Karliner L, Walsh J, et al . Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med , 2008, 121(10): 886-893.
16.	17 Garb J, Welch G, Zagarins S, et al . Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg , 2009, 19(10): 1447-1455.
17.	18 Chapman AE, Kiroff G, Game P, et al . Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery , 2004, 135(3): 326-351.
18.	19 Solomon H, Liu GY, Alami R, et al . Benefits to patients choosing preoperative weight loss in gastric bypass surgery: new results of a randomized trial. J Am Coll Surg , 2009, 208(2): 241-245.
19.	20 Swenson BR, Saalwachter Schulman A, Edwards MJ, et al . The effect of a low-carbohydrate, high-protein diet on post laparoscopic gastric bypass weight loss: a prospective randomized trial. J Surg Res , 2007, 142(2): 308-313.
20.	21 Savastano S, Di Somma C, Angrisani L, et al . Growth hormone treatment prevents loss of lean mass after bariatric surgery in morbidly obese patients: results of a pilot, open, prospective, randomized, controlled study. J Clin Endocrinol Metab , 2009, 94(3): 817-26.
21.	郑成竹, 李际辉. 中国肥胖病外科治疗指南（2007）.中国实用外科杂志, 2007, 27(10): 759-62.

1. 1 Tsigosa C, Hainerb V, Basdevant A, et al . Management of obesity in adults: European clinical practice guidelines. Obes Facts , 2008, 1(2): 106-116.
2. 2 SAGES Guidelines Committee. SAGES guideline for clinical application of laparoscopic bariatric surgery. Surg Endosc , 2008, 22(10): 2281-2300.
3. 3 Mechanick JI, Kushner RF, Sugerman HJ, et al . American association of clinical endocrinologists, the obesity society, and american society for metabolic & bariatric surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract , 2008, 14 (Suppl 1): 1-83.
4. 4 Logue J, Thompson L, Romanes F, et al . Management of obesity: summary of SIGN guideline. BMJ , 2010, 24(340): c154.
5. 5 Fried M, Hainer V, Basdevant A, et al . Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg , 2007, 17(2): 260-70.
6. 6 Guidelines for laparoscopic and open surgical treatment of morbid obesity. American Society for Bariatric Surgery. Society of American Gastrointestinal Endoscopic Surgeons. Obes Surg , 2000, 10(4): 378-379.
7. 7 International Pediatric Endosurgery Group. IPEG guidelines for surgical treatment of extremely obese adolescents. J Laparoendosc Adv Surg Tech A , 2009, 19(Suppl 1): xiv-xvi.
8. 8 Society for Surgery of the Alimentary Tract. SSAT patient care guidelines. Surgery for obesity. J Gastrointest Surg , 2007, 11(9): 1219-1221.
9. 10 Colquitt JL, Picot J, Loveman E, et al . Surgery for obesity. Cochrane Database Syst Rev , 2009, 15(2): CD003641.
10. 11 Maggard MA, Shugarman LR, Suttorp M, et al . Meta-analysis: surgical treatment of obesity. Ann Intern Med , 2005, 142(7): 547-559.
11. 12 Buchwald H, Estok R, Fahrbach K, et al . Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery , 2007, 142(4): 621-635.
12. 13 Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg , 2004, 14(9): 1157-64.
13. 14 Buchwald H, Avidor Y, Braunwald E, et al . Bariatric surgery: a systematic review and meta-analysis. JAMA , 2004, 292(14): 1724-1737.
14. 15 Buchwald H, Estok R, Fahrbach K, et al . Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med , 2009, 122(3): 248-256.
15. 16 Tice JA, Karliner L, Walsh J, et al . Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med , 2008, 121(10): 886-893.
16. 17 Garb J, Welch G, Zagarins S, et al . Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg , 2009, 19(10): 1447-1455.
17. 18 Chapman AE, Kiroff G, Game P, et al . Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery , 2004, 135(3): 326-351.
18. 19 Solomon H, Liu GY, Alami R, et al . Benefits to patients choosing preoperative weight loss in gastric bypass surgery: new results of a randomized trial. J Am Coll Surg , 2009, 208(2): 241-245.
19. 20 Swenson BR, Saalwachter Schulman A, Edwards MJ, et al . The effect of a low-carbohydrate, high-protein diet on post laparoscopic gastric bypass weight loss: a prospective randomized trial. J Surg Res , 2007, 142(2): 308-313.
20. 21 Savastano S, Di Somma C, Angrisani L, et al . Growth hormone treatment prevents loss of lean mass after bariatric surgery in morbidly obese patients: results of a pilot, open, prospective, randomized, controlled study. J Clin Endocrinol Metab , 2009, 94(3): 817-26.
21. 郑成竹, 李际辉. 中国肥胖病外科治疗指南（2007）.中国实用外科杂志, 2007, 27(10): 759-62.

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