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June 20, 2017

How a much-hyped weight-loss surgery failed to fulfill the hype

Daily Briefing

The once-popular lap band surgery is now one of the least performed weight loss procedures—and according to the latest research, it is the least effective, often requiring additional surgeries, Julia Belluz writes for Vox.

Access these key insights on medical weight loss programs

Details on lap band surgery

FDA approved the lap band in 2001 as an adjustable and non-invasive device for weight loss surgery. Unlike other procedures for weight loss—such as the gastric sleeve and gastric bypass—the lap band surgery could be reversed, and did not require cutting a patient's stomach or rerouting a patient's intestines. It also does not cause hormonal or physiological changes to curb hunger, according to Vox.

The procedure involves placing an inflatable band on the upper portion of the stomach to restrict the size of a patient's stomach, and to make patients feel satiated faster—which should help the patient eat less and lose weight, Vox reports.

The device's ease and perceived safety helped it become one of the most common weight-loss procedures, accounting for 35.4 percent of all weight-loss surgeries in 2011, according to data from the American Society for Metabolic and Bariatric Surgery. However, that popularity has waned in recent years in light of safety and effectiveness concerns from doctors, patients, and researchers, Vox reports. In 2015, lap band procedures accounted for roughly 6 percent of all weight-loss operations.

Jim Mitchell, a researcher at the University of North Dakota School of Medicine, said at first the lap-band surgery "looked like it was going to be great," but added "that's one of the reasons you need long-term outcome data [in medicine]."

Research shows lap band surgery is not as effective or safe as other weight-loss options

The latest long-term research has found a large number of patients face medical complications, undergo additional surgeries, and struggle to lose weight after having their first lap band procedure, Vox reports.  

For example, a study recently published in JAMA examined 16 years of Medicare data on lap band re-operations found one in five patients who received the surgery needed an additional operation to remove, replace, or fix the lap band. In comparison, the re-operation rate for gastric bypass and gastric sleeve operations is 3 to 9 percent, according to Vox.

Medicare between 2006 and 2013 spent $470 million for lap band re-operations, which included an average of 3.8 procedures per lap band patient, Vox reports.

Another study published in JAMA in 2016 showed veterans lost less weight when they underwent lap-band surgery than when they had gastric bypass or gastric sleeve surgeries. Further, a systematic review, which pooled results from several studies, showed similar weight loss trends.

Researchers warn against lap ban procedure

Andrew Ibrahim, a University of Michigan researcher involved in the re-operation study, said, "If [he] were a patient and [the findings] were the numbers presented to [him], [he] would have a hard time accepting that risk [with lap band operations] when there are two other alternatives that we know well can be done."

Yoni Freedhoff, a doctor who specializes in obesity, said he "would never recommend" lap band surgery and he "wouldn't wish one on [his] worst enemy."

That said, Freedhoff predicted the procedure would continue to be performed as long as insurers continue to cover the device and patients are willing to pay for it (Belluz, Vox, 5/25).

Key insights on medical weight loss programs

 Key insights on medical weight loss programs

As obesity and its related comorbidities remain top concerns nationwide, many hospitals are considering how to enhance their services to this patient group. Understanding that weight loss demands a comprehensive approach to care, many hospitals have launched non-surgical weight loss programs to support those patients who are not candidates for surgery.

These weight management programs vary greatly in their organization, program offerings, patient referral patterns, payment structure, and marketing strategies, though all aim to help patients lose excess weight. This brief profiles three non-surgical weight loss programs at community and teaching hospitals to identify the variety of services available.

Download the Brief

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