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
"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
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
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.