BACKGROUND: Obesity is associated with elevated cardiovascular mortality, which may be attributed, in part, to sympathetic nervous system (SNS) activation and an associated poor metabolic profile. We examined the effects of laparoscopic adjustable gastric band (LAGB) on SNS activity and cardiovascular profile when the initial weight loss of 10 , corresponding to the recommendation of clinical guidelines, was reached. METHODS: Direct muscle sympathetic nerve activity (MSNA, microneurography), baroreflex function, and cardiovascular profile were examined before and after a predetermined weight loss of 10 in 23 severely obese nondiabetic individuals. RESULTS: The 10 weight loss was achieved at an average of 7.3+/-1.4 months (range = 1.3-23.3 months). This was associated with significant improvement in office systolic and diastolic blood pressure (BP) (-12mm Hg and -5mm Hg, respectively), a decrease in MSNA (33+/-3 to 22+/-3 bursts per minute), improvement in cardiac (16+/-3 to 31+/-4ms/mm Hg) and sympathetic (-2.23+/-0.39 to -4.30+/-0.96 bursts/100 heartbeats/mm Hg) baroreflex function, total cholesterol (5.33+/-0.13 to 4.97+/-0.16 mmol/L), fasting insulin (29.3+/-2.4 to 19.6+/-1.1 mmol/L), and creatinine clearance (172+/-11 to 142+/-8ml/min). None of the cardiovascular risk improvement related to the rate of weight loss. The change in systolic and diastolic BP correlated with change in waist circumference (r = 0.46, P = 0.04; r = 0.50, P = 0.02, respectively). CONCLUSIONS: The initial 10 weight loss induced by LAGB was associated with substantial hemodynamic, metabolic, SNS, and renal function improvements. Changes in waist circumference appear to be an important factor contributing to BP adaptation after LAGB surgery.