A number of readers have sent me e-mails in recent days with inquiries about obesity surgery. The heightened interest in the subject seems to stem from news reports about a pharmaceutical company, Allergan, which has asked the Food and Drug Administration to modify its existing policy on surgical procedures for the purpose of weight loss. For now, the FDA considers operations of this kind to be appropriate only for patients with a body mass index (B.M.I.) of 40 and above, or 35 and above in cases where so-called “comorbidities” exist, meaning other serious health issues often connected with obesity, like diabetes and hypertension, among others.
Allergan has requested to lower the current standards to let less obese people qualify for a specific surgical procedure known as “Lap-Band” operation. Allergan is one of the makers of devices used in the surgery. The company claims that its studies have shown “significant success in all measures of weight loss” for patients who were taking advantage of its products.
If Allergan’s request were granted, it would lower significantly the B.M.I. threshold for qualifying Lap-Band users. This means that literally millions more Americans would be eligible for weight loss surgery, which would be a great gain for the company, especially if insurance coverage becomes available for the procedure.
Having surgery to treat severe obesity, of course, is not new. Other types of bariatric surgery have been around for some time and are now routinely in use as a last resort for people who seem unable to lose weight any other way. Compared to gastric bypass surgery, a.k.a. Roux-en-Y gastric bypass (where the size of the stomach is permanently reduced to the size of a small pouch, which is then connected to the intestine), or gastric sleeve resection, (where the stomach is reduced to the size of a narrow tube), gastric banding is far less invasive, less complicated, less costly – and it is also reversible.
As the term, “banding,” suggests, a small band made of silicon is placed around the upper part of the stomach, which causes it to form a pouch, also known as “stoma.” This pouch can obviously hold much less food than the entire stomach. The idea is that the stoma registers as being full long before the entire stomach fills up. Patients, so the hope is, will stop eating sooner and, over time, will lose weight.
Banding technology has undoubtedly improved in recent years. Gastric bands no longer come only in one-fits-all sizes but are now adjustable and can be better monitored to ensure proper functioning. The Lap-Band system by Allergan is said to be one of these advanced devices.
Another great advantage of gastric banding over other types of bariatric surgery is that it does not interfere as significantly with the absorption of nutrients. Still, any form of metabolic surgery is a drastic step to take. Most complications may not be caused by the technology. Of far greater concern are the eating- and lifestyle habits of patients after they had the surgery. Post-operative care is a most crucial part of the equation. This includes counseling and strict dietary guidelines. It matters greatly that these are carefully followed, especially in the immediate aftermath of the procedure. When food intake is significantly reduced, it is even more important that the diet is of high quality to ensure sound nutrition. But patients are often confused not only about the quantities but also about the kind of foods they can eat. Although initial weight loss occurs in most cases, many continue to struggle with weight management over time.
All types of bariatric surgeries are performed on the assumption that they can mechanically force people to restrict their food intake. Think about this for a moment: We are basically putting a physical padlock on people’s digestive organs to keep them from overeating. It may be true that for some this is the only way to escape obesity and other diseases. But if operating for the purpose of weight loss turns into an everyday commodity, like cosmetic surgery, people may see it as an easy way out from having to watch their diet and lifestyle. The technology may give us the tools, but the incentives to work for the improvement of our health and quality of life may be reduced even more.
Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun.”
