Expanded pool for Lap Bands - Good or ?

[Opti]

WASHINGTON — Cosmetic drug and device maker Allergan Inc. says it has received approval to market its stomach-shrinking Lap-Band to millions more patients who are less obese than those currently using the device.

The Food and Drug Administration expanded approval to patients with a body mass index between 30 and 40 and one weight-related medical condition, such as diabetes. Patients must also have previously attempted other weight loss strategies, like diet and exercise.

Allergan said roughly 37 million American patients meet the new criterion for the device. The adjustable band has been available in the U.S. since 2001.

From an article on MSN.
Is it a good thing or bad thing the approval now OKs people with BMIs 30 to 40? I'm wondering what they consider weight-related conditions?

[thyme4change]

It is good for anyone who owns stock in Allergan.

I don't agree with weight loss surgery - but I'm also in no position to judge. I was blessed with good genetics and parents who stressed good nutritional habits. With no physical or (remarkable) emotional problems, being in the healthy range is something I think about - but the work isn't that hard for me. It must be difficult for people who struggle with the many hurdles that contribute to an unhealthy weight.

[Abby Normal]

I do like the fact that people can choose to do this if they want. However, I think overall it's just another case of "magic beans" and a whole new group of people will think they now have an easy way out. Like I said on the other thread, if you don't change the behavior that got you there, it's not going to do any good long term. Now there are more people that are going to learn that lesson the hard way.

I haven't ever bothered to find stats on just how many people lost weight, and kept it off, with lap bands. But I'd bet there are a fair percentage who gained it back.

[thyme4change]

agilemom - I find that finding stats on any program is difficult. I know that Jenny Craig isn't going to post "3% of people still skinny after 5 years!!!" But, you would think someone, somewhere would compile that information and publish it.

[Abby Normal]

I can see where "weight loss diets" and such would not release stats showing that people have gained weight back. But since lap bands are a medical procedure and regulated by the FDA, I would think that something would be available. I've just never bothered to look since frankly, I don't care. Now I'm curious. Maybe if I have some time today, I'll see if I can find anything.

[chicg]

I wasn't going to comment but I just battled with this myself. I fall into the 30-40 BMI category and have been working with Drs to figure out why I'm not losing weight. I work out at least 5 times a week (5-8 hrs/week) and eat well, track my food, have a wellness coach, bloodwork good, etc. For the most part, a healthy lifestyle and calories in/out is the way to go but for some, body chemistry is messed up and it's not that simple. I fall into the "not fat enough" category to be covered by insurance (so all this testing is paid out of pocket) and often not qualify for weight loss surgeries but I'm overweight enough that people assume I'm lazy, eat junky fried foods and I'm worried about insurance in the future. I did explore lap band surgery and any respectable Dr. puts candidates on a 6+month monitoring program and pre-surgery diet. It's not like you can just walk in, get the surgery and walk out. For anyone that has seriously considered this, you know it's not "just an easy way out" although that's how the public perceives it. I'm sure there are Dr's that will do the surgery on anyone and people that just want a quick fix, but I think the majority of people who have to seriously consider weight loss surgery have honest intentions and just don't know where else to turn.

Most insurance carriers won't cover weight-loss related issues unless your BMI is over 40, which is probably about 75-100lbs over a healthy BMI. Lap band surgery averages $15K-30K with all the pre-surgery labwork, surgery, post-surgery followup, etc. That price alone will keep a lot of people from doing it as a "quick fix", especially if their BMI is under 40 and they're not covered by insurance. Weight-related conditions are high cholesterol, diabetes, high blood pressure.

This all said, I read too many stats where people gain weight back from surgery so overall I'm not a fan (don't know if it's medical or lifestyle why they gain it back) but to those that don't have weight problems (I mean real problems, not just 20lbs), it's really easy to get desperate to find a solution. It's not always as easy as picking carrots over chips, just eating less, etc.

[thyme4change]

Lap band surgery averages $15K-30K with all the pre-surgery labwork, surgery, post-surgery followup, etc.

The guy on NPR said that patients are paying $10k out of pocket for this procedure. I can see how doctors could discount their prices for cash-up-front. If insurance companies aren't going to pay for this, bunches of doctors will prefer to do this surgery on the new group of people.

[Abby Normal]

chicg- It wasn't my intention to imply that everyone who gets is lazy. Nor that is isn't a viable option. I just don't believe it's a good solution for everyone who is obese.

It sounds as though you are already trying to loose weight, exercise and live healthy. If you decide to pursue the band, you are one who would be more likely to be successful since you have already learned the diligence, persistence and patience part.

[chicg]

agilemom - no worries, I didn't mean you implied that and I agree that surgery probably isn't the best option for most. I definitely will not be going that route. It's just frustrating all around, I learned a lot about insurance and treatment for obesity that was a big eye-opener. I do think I live pretty healthy but i know many don't and would just look for that quick fix.

Thyme4change - I don't doubt NPR has much more info then I do, I'm sure some Dr's will charge less for cash out of pocket then what it would cost through insurance, but most of my findings were much more then $10K (total, not just the cost of the surgery) unless you went to Mexico or Central America (I'm not kidding, found more then I wanted to about Mexico discounts in my research). That would include all of the pre-surgery labwork, counseling, post surgery followup, etc. Maybe surgery alone is $10K, which is scary because Drs might be tempted to just do surgery and skip the rest to keep it more affordable. The Dr's office I spoke to wouldn't disclose costs until I came in for a consultation and I never took it that far but it was a big center in Chicago, I looked up patient reviews to get an idea of cost, message boards and cost at other medical places I could find online.

I guess that was all my long winded way of saying I think it's fine as long as people take the surgery seriously...Drs and patients. Dr's would already perform at their discretion to BMI 30-40, this really just sounds like more advertising.

[thyme4change]

Dr's would already perform at their discretion to BMI 30-40

Without FDA approval? That's not good.

So, I don't understand. If your calorie count is where it should be, and your food choices are appropriate and you are exercising (this is the proverbial "you" not directly referencing any given person on this thread) and you still aren't losing weight, what does a band do? Does it make it so your calorie count is further restricted, or that it is just easier to stick with the plan, or is there something else that the band does that makes weight loss easier. I was always under the impression that the band was used as a way to restrict calories. (I know very little about this.)

[chicg]

"Without FDA approval? That's not good."

I know...right? I'm not an expert, just spent about a week digging around online and talked to a nurse at the Dr office before realizing it wasn't for me. Nothing was guaranteed but the nurse said I sounded like a good candidate and to come in for an info session, my BMI was 35 with no other weight related health probelms. BMI 40 seemed to be the marker insurance carriers commonly used for coverage, not Drs willing to operate...I don't know where FDA approval came into play. Thing is, a shady Dr will operate on anyone, look how many take plastic surgery too far. That's not to say all plastic surgeons do that, it's just the bad stories resonate more then the good, which I think might be common with bariatric surgery too.

The lap band puts a bad around your stomach, making it smaller, able to hold much less then a normal stomach. I was told it IS reversbile, unlike gastric bypass where they cut a piece out and re-route it (I think, non-medical opinion here). It restricts how much you can eat at a time, you have to eat VERY small quantities of food. It all seemed too drastic to me unless I was much more overweight. I don't know much past that.

EDIT - so curious about this now. I dug more.......seems to be liquids for 4 weeks post surgery then increase in stages, very small meals (like 4oz total) such as 2 oz protein and some veggie. Many foods are to be avoided because they're too hard to digest. No more then 3-4tbsp dairy, etc. Sounds really hard. They do say you get full faster.

[cael]

My mother was going to get this. Went through the counseling program before the surgery and through the dietary support, lost 25ish pounds. Her insurance company then said she wasn't heavy enough to have the procedure and denied her she's really bummed out. Said she was less than ONE BMI point below their limit. I told her to look into whether this change affects her case with the insurance company...

[chicg]

cael - can mom keep up with the diet and see if she can lose more that way? She has good insurance, through my research I discovered my insurance covers nothing for weight-related issues. Good luck to your mom, must have been disappointed but she should be proud she lost some weight.

[cael]

She was really proud of herself, and I was proud of her! I thought she really didn't think she could do it. She's kind of plateaued with it now, I think she's afraid that if she loses more weight she'll be more likely to lose in her appeals process. She does have a fair amount more weight to drop... she was working with an obesity law group (felt great having to use them, lol - she isn't morbidly obese or anything) and she's seeing if she has any more avenues to appeal this. If not, hopefully she can get back on the right track & continue losing the weight. All she did was modify her eating habits and she lost that initial 25lbs, so getting on an exercise program would probably get her some more great results.

[thyme4change]

The lap band puts a bad around your stomach, making it smaller, able to hold much less then a normal stomach.

I understand that - but isn't that just a tool to help you consume less? If you have already learned how to consume an appropriate amount of food, all this does is make it so you can (at least initially) consume a much lower amount of food. Is that safe?

[Mad Dawg Wiccan]

My wife had weight loss surgery almost five years ago. She tried every diet known, did cardio and aerobics five days a week, and just kept gaining weight. When she hit 367 lbs and couldn't walk from her car into her office, she knew she had to do something drastic.
She at first looked into the lap band, which is the least invasive procedure. She couldn't do that because the surgeon her GP referred her to doesn't do them, just the Roux en-Y. The surgeon wouldn't do lap bands because they don't force a person to change their eating habits. It not only forces a person to eat less, but it also forces them to stop eating refined sugars. Eat more than just a few grams of sugar or too much fat, and it makes you horribly ill. With the lap band, you can eat anything you want, no change in diet.
So far, she's down over 165 lbs and still losing. Her diabetes vanished instantly, and her weight-induced asthma about a year later. She says it was the best decision she ever made, and despite all the pain would repeat it yearly if it got her these results. She would probably be dead or at least close to it by now if she hadn't, and she just turned 41.

[chicg]

"I understand that - but isn't that just a tool to help you consume less? If you have already learned how to consume an appropriate amount of food, all this does is make it so you can (at least initially) consume a much lower amount of food. Is that safe? "
Thyme - Even consuming an "appropriate" amount of food for some people still doesn't produce the weight loss results they need, they might need a more drastic tool. And it's not just initially that they have to consume less, people with weight loss surgery have to forever consume significantly lower amounts of food to avoid getting sick and/or gaining weight back.

The nurse I spoke with said lap band diets do require a big change in eating habits, less sugars, less dairy, etc but again, I only spent a few days looking into it. Bariatric surgery is still pretty controversial so I'm sure you can find plenty of true/false info about each option.

Cael, congrats to your wife!

[Opti]

Mad dawg, Good story. The surgery scares me a bit since I've heard of times when its gone badly. The son of someone I know tried it and many problems post surgery including infections that made him housebound. It was reversed and he recovered in 3 to 6 months? I do remember the complications were close to killing him those first few weeks so its not something you want to choose without a lot of thought.