Gastric banding and the obesity 'industry'

I am shocked that a research article published on last Wednesday by the Journal of the American Medical Association has been picked up, mixed up and hyped up by mainstream media, suggesting that gastric banding is an appropriate solution for “obese” teenagers. The research is typical of what we are seeing coming from the obesity industry, which is looking to capitalise from the condition.

What the research really found

Given the media hype, we need to look at what the research really tells us. Two groups of teenagers were randomly assigned to either a “lifestyle” group, for exercise and a healthy diet, or a “gastric banding” group, for laparoscopic adjustable gastric banding surgery with the main aim weight loss.

The gastric banding group experienced dramatically more weight loss than the lifestyle group. This is not surprising. I would expect that intrusive surgery resulting in necessary food rationing is far more motivating than the “suggestions and encouragement” regarding dietary changes prescribed to the lifestyle group.

And although the extent of compliance between the groups is not clearly reported in the journal article, it requires little imagination. The reflex of a banded stomach is to vomit if the food is not small and well chewed. Not only does this force malnutrition, there is generally limited opportunity for high calorific intake. Of course vomiting is a vastly different compliance measure than the “intermittent food diaries and food counts used to measure compliance in the “lifestyle” group.

The sample size of the study was hardly robust. Less than 50 participants completed the research trial, meaning that statistically no evaluation of single health problems could be generated. This is important when considering the value of the study’s public health significance, given that the scaremongering associated with the “obesity epidemic” has gained so much momentum by medicalising the problem.

It seems that medicalising obesity somehow justifies culturally sanctioned prejudice on the basis that any intervention is “in their own interests”. Interestingly the study determined that despite the vast difference in weight loss in the gastric banding group, both groups experienced significant improvements in general health.

Further, follow up of weight loss measures were conveniently limited to two years, despite overwhelming evidence in research that suggests significant weight regain occurs from three years post surgery.

Industry promoted research

The study was undertaken by Monash University’s Centre for Obesity Research and Education (CORE). Perhaps not surprisingly, CORE receives an unrestricted research support grant from Allergen, which happens to be Australia’s leading provider of gastric banding equipment.

The lead author and pioneer of the lap banding procedure in Australia is Professor Paul O’Brien, who has previously served on the Allergen Advisory Board. Another author of the study reported consultancy with Allergen and membership of advisory boards that include Allergen, Optifast and Bariatric Advantage - all heavy weights in the weight loss industry.

It seems as though the boundary between commercial methods of weight loss, such as weight loss pills and medical interventions, are becoming blurred. Medicalising obesity to justify surgery creates an instant industry, and there is no shortage of businesses lining up to profit from it. Allergen’s webpage proposes alternative payment options, given the surgery is not covered by Medicare. These include the early release of superannuation savings or bank loans via third party medical finance.

The other side of gastric banding

Gastric banding is framed as a quick fix solution to address obesity. But does it address the real problem? Whether it is compulsive eating, binging due to psychological issues, or poor nutritional education, reducing an individual’s stomach size does not reduce the significance of these factors.

For example, eating disorders are not contraindicated, meaning that many people undertaking gastric banding may have severe psychiatric problems that are contributing to their weight gain or pursuit of thinness. I expect that this is one reason why the weight loss from gastric banding ultimately is short term and generally not sustainable.