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Comment on: Long-term outcomes and experience of laparoscopic adjustable gastric banding: one center’s results in China
860
X. Z. Liu et al. / Surgery for Obesity and Related Diseases 11 (2015) 855–860
Editorial comment
Comment on: Long-term outcomes and experience of laparoscopic adjustable gastric banding: one center’s results in China This is a beguiling paper. Of greatest interest are the thoughtful insights into the attitude toward obesity and bariatric surgery in China. Like everywhere that western culture has touched, obesity is surging in China. It dates back, very clearly, to the introduction of McDonalds and computers, and is compounded by the 1 child rule and by the burgeoning wealth in this huge country. It is now a major health issue for millions of people. This paper describes a small series from Shanghai, possibly the most exciting city in the world. It is small, but it is a start along the road to eventual acceptance of bariatric surgery for millions of Chinese. It is well known that the metabolic effects of obesity come in at lower body mass index (BMI) in Asians than in Caucasians. This is reflected in the use of a BMI over 35 as “high BMI”. The relative success in what in the United States would be low BMI patients is also of interest, as this is an area where the band may play an increased role in the developed world. The results in these patients are quite good, especially as they had virtually no regular follow-up, and probably only 3 adjustments in the first year, based on the described protocol. I found it fascinating that in this low BMI cohort, the weight loss at 10 years was the same for band patients as bypass patients the same surgeons have cared for. I believed the description of the social deprivations faced by young Chinese women with a BMI of 35, a number that is almost the new normal in the West.
The complication rates are consistent with those published from other low volume centers and reflect both relative inexperience and the infrequent assessment of the patients in the clinic, a situation made more difficult due to patients travelling from all parts of China and paying in cash, because there is no coverage for bariatric surgery in China. They also include quite a few patients who asked to have their band removed when they were happy with their weight loss. We should congratulate these authors on an earnest attempt to describe their early experience in bariatric surgery in China. Perhaps, with more such reports, the government may provide funding for bariatric surgery in their country, surgery that will be needed on a large scale in the future, as surely as the sun rises every morning.
Disclosures The authors have no commercial associations that might be a conflict of interest in relation to this article. George Fielding, M.D. Professor of Surgery NYU School of Medicine New York
X. Z. Liu et al. / Surgery for Obesity and Related Diseases 11 (2015) 855–860
Editorial comment
Comment on: Long-term outcomes and experience of laparoscopic adjustable gastric banding: one center’s results in China This is a beguiling paper. Of greatest interest are the thoughtful insights into the attitude toward obesity and bariatric surgery in China. Like everywhere that western culture has touched, obesity is surging in China. It dates back, very clearly, to the introduction of McDonalds and computers, and is compounded by the 1 child rule and by the burgeoning wealth in this huge country. It is now a major health issue for millions of people. This paper describes a small series from Shanghai, possibly the most exciting city in the world. It is small, but it is a start along the road to eventual acceptance of bariatric surgery for millions of Chinese. It is well known that the metabolic effects of obesity come in at lower body mass index (BMI) in Asians than in Caucasians. This is reflected in the use of a BMI over 35 as “high BMI”. The relative success in what in the United States would be low BMI patients is also of interest, as this is an area where the band may play an increased role in the developed world. The results in these patients are quite good, especially as they had virtually no regular follow-up, and probably only 3 adjustments in the first year, based on the described protocol. I found it fascinating that in this low BMI cohort, the weight loss at 10 years was the same for band patients as bypass patients the same surgeons have cared for. I believed the description of the social deprivations faced by young Chinese women with a BMI of 35, a number that is almost the new normal in the West.
The complication rates are consistent with those published from other low volume centers and reflect both relative inexperience and the infrequent assessment of the patients in the clinic, a situation made more difficult due to patients travelling from all parts of China and paying in cash, because there is no coverage for bariatric surgery in China. They also include quite a few patients who asked to have their band removed when they were happy with their weight loss. We should congratulate these authors on an earnest attempt to describe their early experience in bariatric surgery in China. Perhaps, with more such reports, the government may provide funding for bariatric surgery in their country, surgery that will be needed on a large scale in the future, as surely as the sun rises every morning.
Disclosures The authors have no commercial associations that might be a conflict of interest in relation to this article. George Fielding, M.D. Professor of Surgery NYU School of Medicine New York