The US Food and Drug Administration (FDA) has ruled to lower the body mass index (BMI) requirements for weight loss surgery using the Lap-Band adjustable gastric banding system.
This decision confirms the recommendation made by an FDA advisory panel in early December 2010 to lower patient eligibility requirements of lap-band surgery to include people with a BMI of 30 with at least one obesity-related health problem, such as type 2 diabetes, heart disease, high blood pressure, or sleep apnea.
With the approval of these new lap-band eligibility guidelines, it essentially doubles the number of potential patients who qualify for this weight loss procedure.
Prior to this announcement, the lap-band was limited to people with a BMI of at least 40 with no related health problems or a BMI of at least 35 with one or more obesity-related health problems.
It has been nearly ten years since the lap-band was approved by the FDA for marketing in the United States. Since that time, it has helped hundreds of thousands of morbidly obese patients get control of their eating, lose weight, and improve both their health and quality of life.
The lap-band surgery involves placing an adjustable gastric band around the top portion of the stomach and filling it with saline so that it tightens to restrict food intake. The procedure does not involve cutting or removing a portion of the stomach nor does it involve cutting and rerouting of the small intestine.
Although the placement of the gastric band creates a new, smaller food pouch, the body’s normal anatomy stays intact and the digestive tract continues to digest foods naturally. The gastric band can be removed if medically necessary, allowing the stomach to return to it’s normal state.
The lap-band procedure was developed as an alternative to gastric bypass surgery, a type of weight loss surgery that permanently alters the gastrointestinal tract. The gastric bypass has been very effective in treating morbidly obese individuals, but for some the extent of the procedure is too drastic.
With gastric bypass, the normal stomach is separated and stapled to create a smaller stomach pouch, a new stomach opening is formed as the new stomach pouch bypasses the pyloric valve (muscle regulating normal stomach outlet), and the small intestine is divided and reattached to bypass a portion of the digestive system which absorbs calories and nutrients from food.
Weight loss results with the lap-band are somewhat comparable to gastric bypass over the long-term, although initial weight loss occurs at a slower rate. The average weight loss period for gastric bypass is about 18 months, while the lap-band weight loss period is an average of three years. To achieve maximum results, however, patients must follow the dietary recommendations and limit daily caloric intake.
The lower BMI requirements for lap-band surgery will allow many obese individuals to get weight loss help sooner rather than later and help them avoid the health consequences associated with morbid obesity. What must be stressed, however, it that surgical intervention is not a quick fix for losing weight. Long-term weight management requires follow-up care and permanent changes in eating behaviors.
The lap-band cost is typically $14,000 to $20,000, which is much less than the $25,000 to $35,000 it costs for gastric bypass. Both procedures are commonly included as approved options under health plans that provide benefits for weight loss surgery. The newer gastric sleeve surgery or more drastic duodenal switch are not covered by many insurance plans.
What remains to be seen, however, is if and when the insurance companies that currently cover lap-band surgery will lower their eligibility requirements to coincide with the FDA ruling.