Jaw Wiring for Weight Loss Literature References

National Library of The abstracts included below were obtained from a search done through the website of the Medicine at http://www.ncbi.nlm.nih.gov To obtain these results Search PubMed for "jaw wiring AND weight loss".


General Conclusions of the Articles Presented Below

Jaw wiring is generally accepted by the medical community as a therapeutically effective method to lose weight.

The only study of jaw wiring on teeth, gums and jaw joints per se shows that this procedure has no permanent harmful effects.

Behavior modification that results in maintenance of weight lost is extremely important.

There are no studies specifically aimed at the harmful effects on the Temporo-mandibular joint of  a long-term "immobilization-rest-immobilization" protocol as utilized by Dr. Rothstein.

Orthodontists seem uniquely reticent and reluctant to provide a service that no other professional can deliver as safely, efficiently and competently.

Bruch, Hilde, M.D.,  EATING DISORDERS Obesity, Anorexia Nervosa and the Person Within 1973, Harper Colophon Books

: Obes Surg 1993 Aug;3(3):261-264 Books

Preoperative Intermaxillary Fixation has no Influence on Weight Loss Induced by Vertical Banded Gastroplasty.

Hedenbro J, Frederiksen S, Jansson O, Jisander S.

Department of Surgery, Lund University, Lund, S-221 85, Sweden.

Surgery is the only therapeutic modality that has shown lasting results in the treatment of morbid obesity. Ability to lose weight by voluntary dieting has been associated with unsatisfactory weight loss after gastroplasty. This report examines the effect of preoperative inter-maxillary fixation (IMF) on weight reduction induced by vertical banded gastroplasty (VBG). Twenty-four patients entered the study and were randomly assigned to either 10 weeks of IMF or 10 weeks on the waiting-list. Patient groups were similar in respect to age, gender and Body Mass Index (BMI). All patients were urged to lose weight preoperatively. Patients in the IMF group lost 18 kg (-12 to -36; median, range) and the waiting list group lost 3 kg (+ 3 to -30) during the 10 weeks prior to surgery. Total weight loss from time of inclusion to 24 months postoperatively was the same in both groups. Our results suggest that weight loss up to 2 years after VBG is not Influenced by short-term preoperative IMF. Although we found no obvious advantage in having patients pre-treated by IMF, our findings indicate that jaw wiring can be used for patients in whom moderate preoperative weight loss is desired without endangering the effect of VBG on body weight development.

PMID: 10757930 [PubMed - as supplied by publisher]

Treatment of obesity.

Bjorntorp P.

Department of Medicine I, Sahlgren's Hospital, University of Goteborg, Sweden.

Current treatment of obesity seems to be focused mainly on the success of losing body weight, which can be achieved, in order of increasingly drastic manoeuvres: by simple nutritional advice; professional follow-up of a negative energy balance; drugs with effects on appetite regulation, energy absorption or expenditure; total seclusion with control of every administered calorie; surgical intervention; or even jaw-wiring. The only treatment of this sort that has been convincingly shown to have long-lasting effects is surgical intervention in the gastrointestinal tract, but this can only be accepted for use in severe cases. Thus, the problem of treatment of moderate obesity is to find an effective therapeutic modality which iss efficient in maintaining a reduced weight. Obesity treatment also seems to have focused too much on the mass of excess body fat, which is not necessarily an indicator of the medical hazards of the condition. It is important to realize that the risk factor clusters following obesity are often efficiently treated by successful reduction of the obese condition. Instead of specific treatment of each of these complications by, for example, multi-pharmacological therapy, a sufficiently efficient obesity treatment would be a preferable substitute. This goal may, if necessary, be achieved by treatment with a single drug with a useful therapeutic profile, including efficiency in the long-term to prevent relapse. Chronic treatment might then be considered acceptable in the same way as chronic pharmacological treatment of hypertension and hyperlipidemia, for example. No drug has as yet proven to have these characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

Management strategies for weight control. Eating, exercise and behaviour.

Caterson ID.

Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.

Obesity is a major health and social problem worldwide for which no single satisfactory treatment exists. Because of the prevalence of the disease, numerous therapeutic strategies have been attempted--often unsuccessfully. Weight loss programmes based on dietary restriction of caloric intake and nutritional education, exercise, surgical (gastroplasty, gastric bypass) and procedural (gastric balloon, waist cord, jaw wiring, liposuction) intervention and pharmacotherapy (appetite suppressants, thermogenic agents, bulking agents) used alone or in combination, have produced weight loss in the short to medium term; however, weight is generally regained on discontinuation of treatment. Behaviour modification programmes appear to offer the highest success rate in the long term. Weight loss is not rapid, although losses of 10 to 15 kg have been achieved after 6 months, and this may be increased when behaviour modification therapy is combined with more aggressive treatments such as severe caloric restriction or jaw wiring. Behaviour modification is particularly beneficial in special patient groups such as the obese elderly, children or adolescents, and disabled patients. Thus, although it appears that each of the treatments developed for the management of obese patients has its place, the cornerstone of therapy for most patients remains a programme of dietary restriction, combined with exercise and behaviour modification.

Effect of the Garren-Edwards gastric bubble on gastric emptying.

Velchik MG, Kramer FM, Stunkard AJ, Alavi A.

Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.

The Garren-Edwards Gastric Bubble (GEGB) was introduced in 1984 as an alternative to surgery (jaw wiring, gastrointestinal bypass, vertical banded gastroplasty) for the treatment of morbid obesity in patients who had failed behavior modification therapy or dietary management for weight reduction. Its mechanism of action is unclear and previous reports have not demonstrated any significant consistent alteration in gastric emptying (GE) as measured by radionuclide techniques. Other proposed mechanisms include: placebo, hormonal, mechanical "satiety", behavioral modification, and neuronal. In order to determine the effect of the GEGB on GE, ten obese (mean % overweight = 89%) patients, 27-50 yr old (mean = 36 yr), had solid GE scans before and 5 wk after endoscopic placement of the bubble. GE scans were performed in six patients after removal (12 = wk residence time). The meal consisted of 300 microCi [99mTc]sulfur colloid in the form of a 300 kcal egg sandwich (egg white 248 g, white bread 40 g, butter 6 g; composition = CHO 40:PR 40: FAT 20) with 180 ml deionized water. Images were obtained in the anterior and posterior projections at 15-min intervals for 1 hr (four patients) or 2 hr (six patients) and the %GE (decay corrected geometric mean) was calculated. Unlike other studies involving the GEGB, adjunctive therapy in the form of dieting and behavior modification were not employed in this study. The effect of the GEGB alone in the treatment of obesity has not been previously evaluated. There was a significant (p less than 0.025) delay in gastric emptying at 1 hr (pre-bubble mean % gastric retention = 46%; bubble mean = 57%; n = 10). After removal, GE returned toward baseline (mean % gastric retention = 51%; n = 6) (p less than 0.05) (Student's t-test). The average weight loss was 5.5 lb (n = 10; p less than 0.025). One mechanism of action of the GEGB may be delayed gastric emptying resulting in early satiety and decreased food intake with resultant weight loss

Int J Obes 1989;13(4):521-9 Related Articles, Books, LinkOut

Inpatient-outpatient randomized comparison of Cambridge diet versus milk diet in 17 obese women over 24 weeks.

Garrow JS, Webster JD, Pearson M, Pacy PJ, Harpin G.

Rank Department of Human Nutrition, St Bartholomew's Hospital Medical College, London, UK.

Twenty-two obese women were recruited for a prospective cross-over trial of the effects of either the Cambridge Diet (CD) or 1200 ml milk with iron and vitamin supplements (milk) during a three-week inpatient study, then 20 weeks as outpatients, then a final week as inpatients. Five dropped out, leaving eight who took initially milk and then CD and nine who took CD and then milk. Within each diet group five women had their jaws wired together during the outpatient phase. The four groups (CD/milk, with/without jaw wiring) were initially well matched for age, height, weight and resting metabolic rate (RMR). There was no significant difference (by unpaired t test) between the groups during the initial inpatient phase in rate of weight loss, or N loss/kg weight loss, but patients on CD during days 13-22 had a greater daily N loss than those on milk (2.08 vs 0.28 g N/day, P = 0.02). When the change in weight loss, N loss and N/kg weight loss on changing diet within a patient group was compared by paired t test the patients changing from milk to CD showed no significant change, but patients changing from CD to milk showed a reduced rate of weight loss (0.36-0.23 kg/day; P = 0.012), a reduced N loss (2.02-0.28 g N/day; P = 0.0013) and reduced loss of N/kg (6.26 to 1.02 g N/kg; P = 0.025). During the outpatient phase weight loss was not significantly related to the diet, but patients with jaws wired lost more weight than those without jaw wiring (0.151 vs 0.077 kg/day; P = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)


When to advise surgery for severe obesity.

Garrow JS.

Rank Department of Human Nutrition, St Bartholomew's Hospital Medical College, London, UK.

A typical severely obese patient will have about It is difficult to maintain this degree of dietary restriction over such a long period, and procedures such as jaw wiring or stomach stapling may help in some cases. Mainten50 kg excess weight to lose, which is equivalent to a store of 350,000 kcal. The optimum rate of weight loss in such a patient is about 1 kg/week, which involves an energy deficit of 1000 kcal/day for about a year. ance of weight loss is difficult to achieve and may be helped by fitting a nylon waist cord after weight loss. On theoretical grounds, patients who do not lose weight despite keeping to a properly-designed reducing diet would not benefit from surgery, but in practice this problem does not arise. It is dangerous to resort to surgery for the treatment of severely obese patients who cannot diet by reason of psychiatric disorder.

Hum Nutr Appl Nutr 1987 Feb;41(1):38-46 Related Articles, Books, LinkOut

A cross-sectional cost/benefit audit in a hospital obesity clinic.

Pacy PJ, Webster JD, Pearson M, Garrow JS.

A cross-sectional survey was made of the 25 men and 127 women attending a hospital obesity clinic over a period of 6 weeks. Among the men the mean (+/- s.d.) age was 37 (+/- 14) years, weight 115.2 (+/- 25.4) kg, height 1.70 (+/- 0.09) m, and Quetelet's index 39.6 (+/- 6.4) kg/m2. Among the women the corresponding values were 41 (+/- 15) years, 102.2 (+/- 22.3) kg, 1.60 (+/- 0.07) m, and 40.3 (+/- 9.2) kg/m2. The most common reasons for wishing to lose weight among both men and women was to improve appearance, shortness of breath and pain in weight-bearing joints. About one-third of the patients tested had raised fasting plasma triglyceride levels. Only one had tests indicating hypothyroidism, and two were hyperthyroid. None of these characteristics predicted how long the patient would continue to attend the clinic. Weight loss was calculated according to the duration of attendance at the clinic, and the method of treatment. Two men and 15 women were treated by jaw-wiring, and the remainder by dietary advice alone. No anorectic or thermogenic drugs were used. Among men treated by diet alone the mean weight loss after 1-3 months, 4-6 months, 7-12 months and greater than or equal to 13 months attendance was 5.0 +/- 6.2 kg, 12.4 +/- 11.0 kg, 12.4 +/- 10.2 kg and 13.0 +/- 5.2 kg respectively. Two men treated by jaw-wiring had lost 23.9 and 57.9 kg.(ABSTRACT TRUNCATED AT 250 WORDS)
Aust N Z J Surg 1985 Apr;55(2):163-7 Related Articles, Books, LinkOut

Jaw wiring in the treatment of morbid obesity.

Ramsey-Stewart G, Martin L.

Fourteen patients originally presented with hyperphagia and intractable morbid obesity have had maxillomandibular fixation (MMF) applied in an effort to control their obesity. In 10 patients who were massively obese or considered poor risk candidates for surgical control of their obesity, MMF was applied with the aim of reducing the obesity to a level where a surgical gastric restrictive bariatric procedure could be safely carried out. Eight of these patients had been rejected for surgical control of obesity elsewhere and two were edentulous. Five of these patients after successful weight loss over periods from 16 to 40 weeks (mean percentage overweight lost 84.8, range 39-150) safely underwent a gastric restrictive procedure. All five patients have had continuous weight loss after bariatric surgery. Two patients requested removal of MMF 1 and 2 weeks after application. The remaining three patients, who were candidates for surgery, after successful weight loss over periods from 12 to 28 weeks (mean percentage of overweight lost 45, range 38-50) decided not to proceed with surgical control. All have subsequently regained the lost weight. Four originally morbidly obese patients, who had had a previously successful gastric restrictive procedure followed by weight loss, requested MMF in an effort to lose further weight. Over periods from 8 to 16 weeks three of the four had further weight loss (mean percentage of overweight lost 18.3, range 5-30). After removal of MMF all four patients regained some weight. In only one was there a significant maintenance of weight lost during MMF.(ABSTRACT TRUNCATED AT 250 WORDS)

Postgrad Med J 1984;60 Suppl 3:27-36 Related Articles, Books, LinkOut

The surgical treatment of obesity.

Wastell C.

Surgery for obesity has developed continuously since it was introduced in 1956. The early idea of small intestinal bypass has been refined to the point that the majority of surgeons agree that about 45 cm of small bowel should be left in continuity, 30 cm of jejunum and 15 cm of ileum. Providing care is taken to given dietary supplements plus a high protein, low fat, low oxalate and high calcium diet, together with a ready response to severe liver damage by treatment of bacterial infection in the bypassed loop, this operation or one of its variants appears to be reasonably safe. But it is nevertheless followed by significant and undesirable side effects. Wiring the jaw is effective in producing weight loss and has the advantage of simplicity and cheapness. Unfortunately when the suffer is released weight is gained in all cases. Gastric operations designed to reduce the size of the proximal stomach to a paltry 50 ml are of two types--gastric bypass in which the small and otherwise closed pouch is drained into the small bowel and gastroplasty in which a 9 mm stoma drains the pouch into the distal stomach. There is much to commend gastroplasty and reports so far do not indicate such a large number of late complications as with jejuno-ileal bypass. This surely is where the future of surgery in this condition lies.

Br J Med Psychol 1983 Mar;56 (Pt 1):49-56 Related Articles, Books, LinkOut

Locus of control in obesity: predictors of success in a jaw-wiring programme.

Ross MW, Kalucy RS, Morton JE.

One hundred and thirty-three obese women were administered a modified version of the Reid-Ware Locus of Control questionnaire prior to jaw wiring. The factorial structure of the questionnaire was examined, and found to be primarily a unidimensional measure of internal and external locus of control, with two subscales. Total score had greatest predictive validity in terms of the four criteria of success of weight loss while wired, percentage weight loss of wiring weight, weight gain over six months, and compliance with the treatment regime. Twenty items of the scale predicted success on one or more of these criteria of success, and are presented as an abbreviated locus of control scale with a higher degree of validity than the original scale.

Int J Oral Surg 1982 Oct;11(5):292-8 Related Articles, Books, LinkOut

The oral effects of prolonged intermaxillary fixation by interdental eyelet wiring.

Shephard BC, Townsend GC, Goss AN.

The oral effects of prolonged intermaxillary fixation were investigated in 106 severely obese patients who had been jaw wired as an aid to weight loss. The principal complications during fixation were episodes of periodontal pain and tooth mobility (40%). After removal of fixation, the principal sequelae were residual periodontal problems (9%) and mandibular limitation (9%). These findings were confirmed in a subgroup of 11 patients who had detailed measurements made of their periodontal index, oral hygiene index and range of jaw movements. These findings were discussed in relation to other methods of management of obesity.  [Oral surgeons apply the wires by passing the wire between the teeth with great skill and care to try to avoid having the wire damage the gums. Elastics are use to hold the jaws together. Orthodontists are uniquely able to bond brackets to the teeth of the upper and lower jaw and then thread a wire between the upper and lower jaws and control the force being used to hold the jaws together...a far more simple and less invasive/almost harmless procedure when compared to the approach of the Oral Surgeon...Note added by By Dr. Rothstein]

: Br Med J (Clin Res Ed) 1981 Mar 14;282(6267):858-60 Related Articles, Books, LinkOut

Maintenance of weight loss in obese patients after jaw wiring.

Garrow JS, Gardiner GT.

In treatment of obesity restriction of food intake is necessary to achieve good results. Various operations have been devised to prevent patients overeating, but in this study jaw wiring was used to limit food intake. This procedure produces weight loss in obese patients but when the wires are removed the weight is usually regained. This report studied a group of patients whose weight loss was maintained after the wires were removed. A nylon cord fastened round the waist of the patient after weight reduction was found to act as a psychological barrier to weight gain. Seven patients were followed for 4-14 months after removal of jaw wires and regained a mean of only 5.6 kg of the 31.8 kg lost while their jaws were wired. This procedure compares favourably with other treatments for severe obesity.

Int J Oral Surg 1980 Aug;9(4):253-8 Related Articles, Books, LinkOut

Treatment of massive obesity by prolonged jaw immobilization for edentulous patients.

Goss AN.

Twenty massively obese patients who were edentulous in one or both jaws were treated by prolonged jaw immobilization. Dentures were secured under general anaesthesia to the edentulous jaws by various direct wiring methods and the jaws immobilized by interdental wires, where teeth were present, and intermaxillary wires. The wired-in dentures were generally well tolerated with minimal mucosal reaction but with a high incidence of infection around the attachment wires. Patients edentulous in one jaw alone, (11 maxilla, two mandible), managed well and 11 achieved a satisfactory weight loss. The seven patients edentulous in both jaws had considerable difficulty with pain and infection, three having the fixation appliances removed in the immediate post-operative period and only one achieved a satisfactory weight loss. Thus prolonged jaw immobilization is an effective means of treating massively obese patients if they are edentulous in one jaw alone but less so if they are completely edentulous.

: Br J Surg 1979 Nov;66(11):756-61 Related Articles, Books, LinkOut

Gastric reduction for morbid obesity: technique and indications.

Kark AE, Burke M.

The results of gastric reduction for obesity in 12 patients are described. Emphasis is laid on preoperative weight loss, using jaw wiring in 9 patients. The successful outcome of the operation was found to depend on the formation of a small gastric pouch and a narrow gastro-jejunal anastomosis. A constant-sized pouch was achieved by forming the pouch around a 100-ml silicone balloon devised for the purpose. Postoperative results were good in 7 patients, partial success was achieved in 3 patients and there were 2 failures. It is concluded that the procedure will produce successful results provided that a small proximal pouch with a narrow outlet is fashioned in motivated and psychologically well-balanced patients.

YO-YO dieting:   Q and A NY Times article  April 25, 2006 by C. Claiborne Ray


    "We have been told that yo-yo dieting is unhealthy. But is gradual weight loss followed by gradual weight gain really more unhealthy than just staying obese?"  [Read the answer.]


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