Influence des habitudes alimentaires sur la morbidité chez 645 patients obèses d'une consultation spécialisée. [Effect of eating habits on morbidity in 645 patients at a specialized clinic].

Among 645 obese patients examined at an out-patient clinic for obese patients by physical examination and a computerized questionnaire, two subgroups of patients could be identified according to their nutritional preferences: 177 patients preferred carbohydrates exclusively (group A) and 73 patients fat exclusively (group B). No definite preferences were formulated by the other patients. Among patients under 25 years, only 3 belonged to group B and 49 to group A, while in older patients no significant differences were found. Among patients with BMI less than 30, there were significantly fewer patients from group B than from group A (p = 0.006), while in patients with BMI greater than 30 no significant difference was observed. There were significantly more men in group B than in group A. 57% of the patients of group B complained of physical symptoms related to their obesity, compared to 37% in group A (p = 0.006). 26% of group B suffered from joints and muscles compared to 13% of group A (p = 0.003). Hyperglycemia (greater than 5,6 mmol/l) was found in 21% of group A and in 40% of group B (p less than 0.005). Hypercholesterolemia (greater than 6.5 mmol/l) was found in 20% of group A and in 32% of group B (p less than 0.05). In conclusion, obese patients who prefer fat have more general symptoms related to obesity, more abnormal physical signs, and more frequently have hyperglycemia and hypercholesterolemia than patients who prefer carbohydrates

Predictive factors of binge eating disorder in women searching to lose weight

METHODS: The aim of this study was to detect predictive factors of binge eating disorder (BED) in an out-patient obesity clinic. Eating behaviour, weight history and body composition were assessed in 138 consecutive patients. BED was diagnosed according to the criteria of appendix B of the Diagnostic and Statistical Manual of Mental Disorders. RESULTS: The body mass index (BMI; p < 0.005) and the waist circumference (p < 0.05) were significantly higher in binge patients than in patients without eating disorders. Similar differences were observed between patients who regularly went through weight loss programmes and patients who consulted for the first time. The prevalence of BED increases with the degree of obesity and especially with the number of previous intentional weight loss programmes. A positive and significant correlation was found between the weight cycling syndrome and BMI (p < 0.0001), waist circumference (p < 0.0001) and body fat (p < 0.001). DISCUSSION: The patients with BED present a specific anthropometric profile and a typical behavioural pattern characterized by a higher degree of central obesity and a weight history with a higher number of attempts of weight loss

A 3-year experience with laparoscopic gastric banding for obesity.

BACKGROUND: The introduction of laparoscopic techniques-especially that of gastric banding-and the fact that conservative management does not provide satisfactory long-term results in patients with morbid obesity has resulted in a marked increase in the demand for bariatric surgery in our department since 1995. In this paper, we present our experience during the first 3 years with this approach. METHODS: Data for all patients who had bariatric surgery at our institution were collected prospectively. They were analyzed for the purpose of this study. RESULTS: A total of 150 patients were operated on between December 1995 and December 1998 (37 months). There were 130 women and 20 men, with a mean age of 37.5 years (range, 19-62). The mean initial excess body weight was 102.9% (range, 58-191%), and the mean initial body mass index (BMI) was 44. 6 kg/m(2) (range, 35.1-64.1). A Lapband was used in 101 cases and a SAGB in 47 cases. In two patients in whom conversion was necessary, we performed a vertical banded gastroplasty. Duration of surgery decreased over time from 210 min (first 20 cases) to 73 min (last 20 cases). Six patients (4%) developed major complications, one of whom died. The median duration of postoperative hospital stay was 3 days. The mean follow-up was 17 months. In all, 24 patients (16%) developed late complications, and 22 (14.6%) required reoperation, mainly for band slippage and/or pouch dilatation (14 cases). An incorrect surgical technique used for the first 30 patients (Lapband within the lesser sac) was responsible for more than half of these complications. The mean excess weight loss was 34% at 6 months, 55% at 1 year, and 56% at 2 years. Compared to vertical banded gastroplasty (197 cases between 1981 and 1995), postoperative morbidity was greatly decreased, late morbidity was similar, and weight loss was equivalent. CONCLUSIONS: Laparoscopic gastric banding is followed by a weight reduction that is similar to that observed after vertical banded gastroplasty, with a much lower postoperative morbidity, a shorter hospital stay, and an earlier resumption of normal activities. If these results can be confirmed by long-term follow-up, laparoscopic gastric banding will be confirmed as the restrictive procedure of choice for morbid obesity

Early results of laparoscopic gastric banding compared with open vertical banded gastroplasty.

BACKGROUND: The introduction of laparoscopy and the increasing awareness that surgery is the only efficient long-term treatment for morbid obesity have been followed by an enormous increase in the demand for bariatric surgery. We introduced laparoscopic gastric banding (GB) in 1995, after a 15-year experience with vertical banded gastroplasty (VBG). The aim of this article is to compare the early results of this new technique with those of VBG. METHODS: The charts of all the patients who underwent VBG (group A) between 1981 and 1995 were reviewed. The data for the patients who underwent laparoscopic GB (group B) between December 1995 and March 1998 were collected prospectively. Weight loss was compared between groups. All the complications arising during follow-up in the laparoscopy group were considered for analysis. In the VBG group, the complications during the first 18 postoperative months were taken into consideration. RESULTS: There were 197 patients in group A and 76 patients in group B. The ages and risk factors were similar in both groups, but the mean body weight (116 kg vs. 121 kg, P < 0.01) and the mean body mass index (BMI) (42.7 versus 45.5, P < 0.001) were significantly higher in the laparoscopy group. If the first 30 patients of group B are excluded, duration of surgery was not different between groups. Mortality was similar, but the postoperative morbidity was higher in the VBG group (23.8% vs. 8.0%, P < 0.005). The hospital stay was much shorter in group B. Weight loss was less after 6 and 12 months in group B but was similar after 18-24 months in both groups. During early follow-up as defined in the Methods section, overall morbidity and the need for reoperation were not different between groups. Most complications were noted among the first 30 patients operated on. CONCLUSIONS: Laparoscopic GB takes no longer to perform than VBG once the learning curve is over. It is associated with less postoperative morbidity and a much shorter hospital stay. Weight loss is slower after laparoscopic GB but is similar to that achieved after 18-24 months by VBG. With proper surgical technique, laparoscopic GB can be performed adequately with a very low rate of postoperative and long-term complications. Considering the high incidence of long-term complications after VBG, it is probable that laparoscopic GB will eventually replace VBG as the restrictive procedure of choice for morbid obesity