Are Lap Bands the Answer to Obesity?

December 9, 2010

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lap bandLast week a U.S. Food and Drug Administration (FDA) advisory panel recommended that Allergan???s Lap-Band weight-loss device be approved for use in patients with BMIs between 30 and 35. While the FDA has not yet approved the move, based upon the panel???s recommendation it???s likely that it will happen.

So is this the end of the obesity problem? Will weight issues become a thing of the past? Hardly, and here???s why.

Lap bands work by constricting a person???s ability to swallow a lot of food at one time, forcing a person to eat smaller bites and more slowly. If they don???t, it can lead to vomiting. The restriction is achieved by placing a band around the entrance to the stomach and then ???tightening??? or ???loosening??? the band by injecting or removing saline solution within it to achieve the desired constraint.

The band is put in place laparoscopically, under general anesthesia, and requires the patient to spend a day in the hospital. After the surgery, follow-up visits every few months are required to manually adjust the saline levels within the band for the first several years. Even after the desired weight loss is achieved, the band remains inside the patient???s body and the port used for the saline adjustments can be felt just under the skin.

Like any surgery, lap band surgery carries risks including possible reaction to anesthesia and infections, as well as an ongoing risk of excessive vomiting, trouble swallowing, and other complications. One patient I met following his surgery had severe infections that required skin grafts and over a year of hospitalization, and other people have died from complications of the procedure.

Another thing to consider: Because the bands have only been in use for about 10 years, it is not yet known if they will need to be removed or replaced over a patient???s lifetime.

Also, weight loss is not a guarantee even with the band. If a patient does not change his or her lifestyle or eating behaviors that led to the weight problem, it is likely to continue or return after the initial weight loss, even with the band in place. Most of the time, the surgery is not accompanied by advice on behavioral modification or counseling for the psychological roles at play in overeating, so the patient is not equipped to deal with these changes.

Finally, there is the cost of the procedure, on average $15,000, which is currently not covered by insurance in most cases.

To me, all of this seems like an unacceptable amount of risk to take if what you are trying to do is lose 30 to 40 pounds, which is about the amount of weight someone with a BMI between 30 and 35 would need to shed.

Earlier in my career, I would often see patients who would come to me to have their bands adjusted after having had the procedure done elsewhere. Over and over what I saw was that the band had not provided the quick and easy weight loss solution they had hoped it would, the core issues that had contributed to their weight problems remained, and that many were unhappy with the results of the surgery, the restriction of their ability to swallow, and how the choice they had made had forever changed their lives.

The truth is a person could lose just as much weight, just as quickly, by following a medically supervised weight loss program that includes a high nutrition, low-calorie eating plan, behavioral modification, physical activity, and counseling to support the healthy lifestyle changes. And all of this could happen minus the risks to one???s health the surgical path includes.

In fact, on The Center for Medical Weight Loss???s program, a person with a BMI between 30 and 35 could reach their goal weight in as little as 8 to 12 weeks!

Of course there are circumstances where I would say having bariatric surgery is medically appropriate, and I do sometimes recommend it. That would be when a patient has a BMI of 35-40 or more, has horribly uncontrolled diabetes or high blood pressure, and has already tried and failed several times to lose the weight with a medically supervised program.

But in most cases, there are better options. So don???t be fooled: Lap band surgery is not a quick or easy fix.

Dr. Michael Kaplan

Founder and Chief Medical Officer

The Center for Medical Weight Loss

See more of Dr. Kaplan???s thoughts on weight loss surgery on Woman???s Day.

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