The Effects of Gastric Banding in Morbid Obesity on Eating Behavior-A 3-Phase Model

Background and aim: Morbid obesity has been found to be correlated highly with morbidity and mortality. Laparoscopic Adjustable Gastric Banding (LGB), enables a diminished transit of food to the stomach and is considered a pure restrictive operation. It has been found to be a safe and efficient treatment for the long term morbidly obese patient. In this study we have tried to map the change in life style and quality of life, as well as weight reduction, in patients undergoing LGB and to understand if these changes are due only to the restriction imposed by the band, or are there other factors involved. Methods and study design: By using a survey administered to our patients in out-patient clinics. Between the years 1998-2008 a single team of surgeons had operated on over 5000 morbid obese patients. The average age was 38 years (18-67) with average BMI of 44 kg/m2 (35-65). The follow-up on these patients was made on an outpatient clinic basis, where the average time from the operation was in most of them less than 2 years. Results: Using our results, we have formulated a model of eating habits of patients after LGB. The model included 4 different phases of eating habits, each unique in its features. This model has been validated upon more than 500 patients and has shown a significant difference between the formulated phases: ? Phase 1a- (3-6 months post op.) - The patients report an immediate sensation of fullness which enforces them to reduce the quantity and rate of the eating process. ? Phase 1b- (up to 12 months post op.) - The patients are required to selection of the food types which they are able to swallow. Many of the patients report inability to swallow bread, meat and vegetables but can eat dry food such as toast or crackers. ? Phase 2- (less than 2 years post op.) - Most of the patients report inability to eat or drink in the morning and sometimes until the afternoon. ? Phase 3 (more than 2 years post op.) - In this phase the patient's esophagus needs to be activated in order for them to eat or drink. It is achieved by a unique food or drink (hot or cold, salty or sweet etc.) which varies from one patient to the other. Once it is achieved the patient is able to eat and drink more easily for a limited period of time. Conclusions: Based on the results from our model, as well as our clinical experience, we believe that one can interpret our results as those which might imply that the effect of LGB is beyond its restrictive nature, and it involves some cognitive and behavioral changes that are long lasting.