Obesity is a serious problem in America and in my practice. Obesity predisposes to type II diabetes, high blood pressure, and high cholesterol. It also increases stress on joints and worsens arthritis. Nevertheless, losing weight for most patients is very difficult. Dietary modification and exercise have been the most proven weight loss techniques, but many patients can not adhere to a strict exercise and diet regimen.

More recently, surgical treatments for weight loss have offered an alternative for patients who have not lost weight with diet and exercise. Though these treatments seemed promising, until now there have been no rigorous randomized trials comparing surgical treatments to diet and exercise.

The most recent issue of the Annals of Internal Medicine features a trial in which mild to moderately obese patients were randomized to receive medication aimed at weight loss, and intensive diet and exercise counseling versus laparoscopic gastric banding. Gastric banding involves surgically placing a small belt around the stomach which can be adjusted to different lengths to constrict the stomach and promote satiety. Because it is placed laparoscopically (with scopes through small incisions) it involves a much faster recovery than gastric bypass and is frequently done as an outpatient.

The study showed that the patients treated surgically had more weight loss and better quality of life than those treated medically, after being followed for two years. This is the strongest evidence so far that surgical approaches to weight loss are effective. That’s encouraging news for patients who have struggled for years unsuccessfully with diet and exercise.