Getting a Grip on Obesity

By Loretta Grantham
Palm Beach Post Staff Writer
Sunday, November 12, 2006
Many patients pondering weight-loss surgery, such as Margaret Kendall, say the thought of slicing, stapling and rerouting their digestive system is more than they can stomach.
“I consider gastric bypass to be the last straw,” says Kendall, referring to the procedure that accounts for about 70 percent of U.S. bariatric surgeries (and the choice of Carnie Wilson and Al Roker, celebrities who went public with their decision).
But at 315 pounds, the Royal Palm Beach teacher was desperate. She’d tried so many diets, she says, that the letter she wrote to her insurance company outlining her weight-loss attempts was six pages long.
Kendall, 46, attended a JFK Medical Center seminar on the LAP-BAND® System, an adjustable silicone ring that’s placed around the upper portion of the stomach to limit food intake and boost fullness.
“As soon as I heard about the reversibility and the less invasive feature of the band, I was interested,” she says. “But my primary thing was that it didn’t have anything to do with the intestines. When they said that, I got a lot more comfortable.”
So comfortable, in fact, that she’s having a LAP-BAND® System implanted this month, joining an increasing number of people who’re willing to accept slower initial weight loss in exchange for a less drastic operation that doesn’t alter their anatomy.
“The LAP-BAND® System has gone from 0 to approximately 25 percent of bariatric operations in about five years,” says Dr. Philip Schauer, president of the American Society for Bariatric Surgery. “That’s pretty rapid. It definitely has found a niche.”
The Lap-Band® System, developed by Inamed (which was acquired by Allergan in April), received FDA approval in June 2001 and is the only gastric band used in the United States. Its name comes from “laparoscopic banding,” which means the device is designed to be implanted with instruments passed through small cuts in the abdomen rather than through a full incision.
Rocker wife and reality TV matriarch Sharon Osbourne was an early success story after getting a band in 1999 at Cedars-Sinai Medical Center in Los Angeles during FDA trials. She lost 125 pounds and has regained just 15.
Although the LAP-BAND® System is relatively new in the United States and still gaining acceptance by initially wary insurance companies, gastric banding (there are other versions beside the LAP-BAND® System) has been popular in Europe for more than a decade.
Studies vary, but in general, LAP-BAND® System patients drop about 45 percent of their excess weight the first year after surgery. Patients who have gastric bypass, which involves stapling off a small pouch from the rest of the stomach and attaching it to the small intestine (therefore “bypassing” some intestine and decreasing calorie absorption), lose as much as 70 percent the first year.
Schauer, director of bariatric surgery at the Cleveland Clinic in Ohio, likens the choice to picking stocks: The higher-yield procedure carries more risk.
Dr. Andrew Larson at JFK Medical Center in Atlantis, however, doesn’t think the risk is worth it. Research shows that after seven years, both surgeries achieve comparable results — 51 percent of excess weight for bands and 55 percent for bypass.
“The operation is quicker,” he says, referring to the LAP-BAND® System. “You don’t have to cut the stomach, you don’t have to cut the small intestine, you don’t have to cut anything. This eliminates complications caused by leakage at the connections. Remember there are two connections with the bypass, and both of them have to heal properly. Also when you reroute the bowel, you create potential blockages down the road, and that’s a lifelong concern.”
Larson, who’s been at JFK for two and a half years, is trained in gastric bypass but only does LAP-BAND® System.
“If somebody’s 100 pounds overweight, is a long-term difference of 5 pounds or so enough to justify a much higher surgical risk?” he says.
John Hoffmann, however, was more than 200 pounds overweight. The Boynton Beach construction project manager chose the bypass on the advice of a surgeon at the Cleveland Clinic in Weston.
“He recommended that I have it because with the bypass you don’t absorb as many calories,” says Hoffmann, 41, who had the operation in April and is down 170 pounds from his top weight of 432. “He thought it would be a better choice for me because I’m more of an emotional eater.”
LAP-BAND® System critics say patients can cheat the band — in other words, indulge in large quantities of high-calorie soft foods such as milkshakes — because it only restricts the opening to the stomach, which remains its original size.
“You have to be careful with patient screening,” says registered nurse Patricia Specian, bariatric surgery program coordinator at Wellington Regional Medical Center, which plans to start offering the LAP-BAND® System next summer. (JFK and West Boca Medical Center are the only hospitals currently using the band in Palm Beach County and the Treasure Coast.)
“If you’re someone who can’t say no, then the LAP-BAND® System isn’t going to work for you,” she says. “You could eat all day long. If you have gastric bypass, you experience dumping syndrome, and that holds you back.”
Specian is talking about the nausea, cramps, vomiting and heart palpitations that occur when some bypass patients eat foods that are high in sugar or fat. Most people who resort to weight-loss surgery hope they get the unpleasant syndrome, which is a strong deterrent to overeating. But there’s no guarantee.
Robert Grant, president of Allergan Medical, a division of the company that makes the LAP-BAND® System, says that despite the criticism, “there’s no evidence that the device is less effective for ‘sweet eaters’ and ‘bingers.’ ”
But it’s important, he adds, “that a patient is fully informed about post-surgery dietary requirements, lifestyle changes and band adjustments to achieve an optimal outcome.”
In short: You can’t gobble vats of chocolate pudding and drop pounds.
Bariatric psychologist Melodie Moorehead, who works with JFK patients, stresses that neither procedure is foolproof.
“It’s natural, when you’ve fought obesity your whole life, to come in and want magic,” says Moorehead, whose main office is in Fort Lauderdale. “But part of the help we give patients is the awareness that the band is just the beginning, and many changes have to take place.”
Schauer says the American Society for Bariatric Surgery doesn’t formally recommend either procedure, leaving the decision up to patients and their doctors.
“The LAP-BAND® System is definitely an effective and safe weight-loss procedure that’s less invasive with a lower rate of major complications,” he says. “It’s an important tool in a toolbox that includes changes in exercise and eating habits.”
Regina Ortega, 37, a Royal Palm Beach bookkeeper who lost 150 pounds after bypass surgery two years ago, echoes Schauer’s analogy. (She chose bypass, she explains, “because I was afraid I’d end up convincing the doctor to loosen the band so I could eat more.”)
“Gastric bypass is a tool, just like the band,” she says. “Whether you reroute your body with the bypass or you strap your stomach with a LAP-BAND® System, you still have to learn new coping skills because you can’t turn to food.”
Staff researcher Angelica Cortez contributed to this story.