Lap Band - Not the Band-Aid You Want?

Laparoscopic adjustable gastric banding, more commonly known as lap band (which Allergan markets as their trademarked LAP-BAND adjustable gastric banding system), has flourished over the last several years, as evidenced by all the billboards I saw while driving in Southern California last week.

As we attempt to deal w/our nation's obesity, those who are in dire straights w/body mass index (BMI) >40kg/m2 and w/o obesity related health problems and those w/BMI >35kg/m2 w/obesity-related health problems qualify for surgery.  In fact, the FDA just approved decreasing the lower limit to just 30kg/m2 in those w/obesity-related health problems this past month based upon a review of 12-24 month data from a prospective 5 year study.

Ironically, in a study published last month in the Archives of Surgery, the long term outcomes from laparoscopic adjustable banding performed between 1994 & 1997 in Europe where the authors started performing these surgeries in 1992 were not so wonderful during the follow up period approximately 12 years after surgery.  In fact, close to a third of the patients experienced band erosion and close to half required removal of the band.  

Granted the study was small w/only 151 consecutive patients followed, of whom only 82 responded to questions.  Furthermore, tremendous experience has been gained since the beginning close to 2 decades ago with over 300,00 patients enrolled in the BOLD database with over 12,000 patients being added monthly per Allergan.  However, results from this 10 year trial won't be available until 2017 at the earliest.  

In the meantime, I should point out that in Europe (where we often look for advanced medicines & surgical procedures now available years before reaching our shores), there has been a shift away from lap bands since 2004 towards the more traditional gastric bypass.  As noted above, this is quite opposite our national experience where Allergan expects to make $220-240M this year.

And just what are those obesity related health problems?  Cancer, diabetes, high blood pressure, heartburn, heart disease, osteoarthritis (typically hips & knees), sleep apnea, stroke, and more.  This also assumes that the patient has failed all reasonable attempts at medical therapy, eg diet & exercise.  But if you think about, the participants of NBC's Biggest Loser are able to lose just as much weight as those who have surgery.  All they (we) have to do is change our lifestyle.  Something easier said than done for most of us.