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With recent advances in obesity surgery, there are now safe, effective, minimally evasive methods of achieving and sustaining significant weight loss. From the perspective of the patient, quality of life (QOL) is arguably the most important outcome measure from a weight-reducing procedure. There are a number of health-related instruments for measuring QOL. The researchers of the current study have been using the Lap-Band system, an adjustable laparoscopically placed gastric band, as the primary surgical method of achieving weight loss since 1994.

Since January 1998, all patients presenting for surgery (n=459) or attending for annual review (n=641) have completed the Short Form-36 (SF-36) health survey questionnaire. The present study reports the results of the analysis of the questionnaires completed over this three-year period, with emphasis on identifying the relationships between change in QOL and the change in weight, comorbidity, and physical capacity.

The questionnaire consisted of eight domain and physical component summary (PCS) and mental component summary (MCS) scores. Scores were analyzed in groups based on time after surgery and compared with community normal (CN) values.

All preoperative mean scores (n=459) were found to be lower than CN values, with greater impairment in the PCS than in the MCS scores. This confirms the significant impairment in QOL suffered by people with a BMI of 35 kg/m2 or greater. After one year, scores were closer to CN scores, and these remained closer for four years. This demonstrates the major and sustained improvement in QOL in these patients after Lap-Band obesity surgery. Preoperative obesity comorbidity, especially physical disability, was the best predictor of poor postoperative SF-36 scores and of improvement in scores at one year. The percentage of excess weight loss at one year was of little predictive value of improved QOL. Age and comorbidity seemed to have played a more dominant role in predicting the degree of improvement of QOL. Comorbidity directly caused by obesity, such as the commonly reported knee, ankle, and foot pain, completely resolves in many cases leading to dramatic improvements in QOL.

Therefore, severely obese subjects were found to have poor health-related QOL as measured by the SF-36 health survey. Lap-Ban surgery for this group has been found to provide a dramatic and sustained improvement in all measures of the SF-36. Improvement is greater in those with greater preoperative disability, and the extent of weight loss is not a good predictor of improved QOL.

J Dixon, M Dixon, P O'Brien. Quality of Life after Lap-Band Placement: Influence of Time, Weight Loss, and Comorbidities. Obes Res 9(11): 713-721 (November 2001) [Correspondence: Dr. John B. Dixon, Monash University Department of Surgery, Alfred Hospital Melbourne 3181, Australia. E-mail: john.dixon@med.monash.edu.au]