What You Need to Know About Lap-Band Surgery

By Diana Zuckerman, PhD National Research Center for Women & Families

Posted on | By Diana Zuckerman, PhD

We all know that obesity can kill, and that many weight-loss strategies don’t work for most people over the long-term. Lap-Bands help many people lose weight in the short-term, and health benefits usually coincide with weight loss. For example, blood pressure decreases in the first years after surgery and tends to increase as the patient gains weight back after that. Patients who keep the weight off can reduce their risk of diabetes or heart disease. Whether it will be effective for you mostly depends on why you are overweight, how motivated you are to lose weight, and other personal factors. Whether it is risky for you is more unpredictable.

People who are very obese may want to take a chance on Lap-Band surgery, because being obese is also risky. Do the risks outweigh the benefits for people who are not dangerously overweight? It depends who you ask. The American Heart Association doesn’t think so. Although they want Americans to reduce heart disease by losing weight, they stated in March 2011 that “bariatric surgery should be reserved for patients who have severe obesity” and only when medical therapy has failed and surgery is a safe option.* The Food and Drug Administration (FDA) came to a different conclusion, approving Lap-Bands for people who are slightly obese if they have serious obesity-related illness. For more information on these rulings, click here.

Should you consider a Lap-Band if you are not dangerously overweight? Here’s the information that can help you decide if a Lap-Band is for you, especially if you only want to lose 30-60 pounds.

How does a Lap-Band work?

A Lap-Band around your stomach reduces the room for food so that you feel full after eating very small amounts. If you eat too much, especially too much of certain kinds of food, you will feel nauseous or will vomit. These unpleasant experiences will motivate you to avoid over-eating and will help you lose weight.

I have lost weight many times through various diets, but I can’t keep it off for more than a year. Will a Lap-Band help me lose weight and keep it off?

Most people with Lap-Bands lose weight during the first year. Surprisingly few people lose weight after that, and many start gaining weight again. Some gain and lose weight just like they did when they were on different diets. Despite how difficult it is to eat large amounts of most foods, many people don’t lose weight with a Lap-Band. Approximately one-third of the people with Lap-Bands have them removed and not replaced within 1-5 years, and the percentage is closer to half a few years later. Many of those people end up weighing about the same as they did before surgery.

If you are addicted to eating, a Lap-Band is probably not going to help you lose weight, because you will find foods you can tolerate and you’ll eat too much of those. If you eat too much, it can cause problems.

Can a Lap-Band be dangerous? Can it kill you?

All surgery has risks. Almost all patients will survive Lap-Band surgery, but the risks increase after surgery, even if you are careful about what you eat. Patients have died as a result of Lap-Bands. For example, research shows that weight loss after surgery can increase the risk of sudden death from cardiac arrhythmias. It is important for patients and their families to understand that there are serious risks that may be greater than the likely benefits, especially for patients who are not dangerously obese.

Two serious risks are that 1) the Lap-Band can deteriorate after just a year or two, or 2) cause a perforation in the gastro-intestinal tract, where acids and fecal matter can leak into the abdomen. It can take less than 30 minutes of surgery to get a Lap-Band, but when something goes wrong, patients may need emergency surgery and stay in the hospital for days. That can cost patients tens of thousands of dollars.

What scientific evidence is available that states that Lap-Bands are safe and effective?

Allergan, a company that makes Lap-Bands, provided two studies to the FDA. One is a 3-year study of 178 patients from 18 to 55 years old, who were dangerously obese. The second study has only 149 patients from the new target weight group, who were slightly obese with weight-related health problems. All the patients were 18 to 55 and none had diabetes.They were all studied for one or two years.

Both studies are too short to determine long-term safety or effectiveness.

Why do people have their Lap-Bands removed?

Some people never lose weight from a Lap-Band, so they get the Lap-Band removed after just a few months. Some have terrible side effects, such as nausea, vomiting, or perforation of the gastrointestinal tract, as previously mentioned. Some Lap-Bands slip off or deteriorate, requiring surgery, and the patient may then decide to remove the Lap-Band and not replace it. 

And, some people just get tired of their Lap-Bands because they don’t like such severe limits on what they can eat. They long to have a sandwich or a small bowl of pasta, or to eat a regular meal with their family or friends. As long as you’re losing weight, the restrictions may be tolerable, but may not seem worth it if you stop losing weight or start gaining it back.

Can a Lap-Band prevent a person who is overweight from becoming obese? Can it prevent diabetes or heart disease?

If a person who is overweight can tolerate the restrictions and possible side effects of a Lap-Band for the rest of his or her life, he or she might never become obese. 

Unfortunately, there are no studies to tell us how long the average obese person will keep a Lap-Band, but we know that many patients have their Lap-Bands removed within a few years. It seems logical that a very obese person will be more motivated and more thrilled about losing 60-100 pounds than a slightly obese person will be about losing 30 pounds. 

How much does Lap-Band surgery cost? How much does it cost to remove a Lap-Band?

It usually costs between $15,000-$30,000 to put in a Lap-Band. If there are complications, removal will cost at least that much, if not more.  If you are considering a Lap-Band, find out if your health insurance will pay for the surgery and be sure to find out if it will pay to have the Lap-Band removed. If it does, consider whether you are likely to have as generous an insurance policy a few years from now, when you are most likely to need additional surgery. Many insurance companies will only pay for one Lap-Band surgery, so they will pay to put it in, but not to take it out.

Remember, a Lap-Band will not last forever.  If a patient chooses to keep their Lap-Band as long as possible, eventually it will need to be removed (and patients can pay to replace it). Many do not last 10 years.

If you are financially comfortable and have savings for future surgery if needed, a Lap-Band could be a reasonable choice. Consider the complications if insurance or tight finances are or might become a problem for you.

I’ve seen ads that say a Lap-Band can save your life. Is this true? Is there proof?

It is possible that a Lap-Band could save a person’s life. But, it may not even improve the health of most people who get them. Ads by doctors are usually not regulated to ensure “truth in advertising.”

There are no studies to tell us if most people who get Lap-Bands are healthier or less healthy 5 years later. We also don’t know what percentage of patients die from Lap-Band complications.

What happens when Lap-Bands deteriorate? 

A Lap-Band that deteriorates can kill or seriously harm a patient if it is not removed. We don’t know how long most Lap-Bands will last in the human body before they deteriorate and that is why the FDA is requiring Allergan, which makes Lap-Bands, to do studies to answer those questions. In the meantime, however, Allergan can keep selling Lap-Bands.

Are Lap-Bands especially risky for some people?

Allergan intentionally did not study patients with either a family history or personal history of autoimmune disease, such as rheumatoid arthritis, lupus, MS or scleroderma, because of concerns about the dangers for those patients. We don’t know if FDA will require a warning for autoimmune patients and those with family members with autoimmune diseases, but they should. If the risk was too high to study Lap-Bands for those patients, it’s too high to sell Lap-Bands to those patients.

Is there any reason to think Lap-Bands are less safe for African American or Hispanic women?

African American women and Hispanic women are especially vulnerable to lupus and several other autoimmune diseases. And, there are other racial and ethnic differences that could influence safety. Is the Lap-Band safe for them? There were only 16 Hispanics and 14 African Americans in Allergan’s study, and even fewer other minorities – so we don’t have all the answers. We think the risks of Lap-Bands are likely to be higher for Hispanic and African American women, because of their risk of autoimmune disease.

Read this information carefully and decide what risks you are willing to take. If you are dangerously obese or extremely unhappy with your weight, a Lap-Band could be a reasonable choice for you. 

Many doctors suggest that you think about the eating restrictions that a Lap-Band requires, and make at least one more serious effort to improve your diet and exercise habits. After you have made that effort, if you are still obese, check out what the latest research shows about Lap-Bands and talk to your doctor about whether a Lap-Band is a good choice for you.

 

*Bariatric Surgery and Cardiovascular Risk Factors: A Scientific Statement from the American Heart Association, Circulation, 2011, 123, available online on March 15, 2011.

Article written by Diana Zuckerman, PhD
National Research Center for Women & Families