Last month an FDA advisory panel recommended lowering the B.M.I. requirements for gastric lap bands from 35 to 30. Now some doctors say this could turn the serious procedure into another quick-fix weight-loss method. Saw that one coming, didn't you?
According to current guidelines, the surgery is appropriate for people who haven't had success losing weight through diet and exercise if their BMI is 40 or above, or 35 and above if they have health problems like diabetes or hypertension. The New York Times reports that Allergan, which makes the Lap-Band, wants to lower those numbers to 35 for those with no health problems, and 30 for those with health complications, which wouldn't have to be as severe. A company executive estimated that 27 million American have a BMI of 30 to 35 with at least one associated health condition.
One obvious problem with these new guidelines: Doctors have recently admitted B.M.I. is bullshit. One member of the panel, Dr. John G. Kral, argued that this is precisely why the requirements should be lowered. "The B.M.I. criterion is so seriously flawed," he said. "Removing this barrier of this idiotic number in itself would be an important step."
However, other doctors are expressing concerns about allowing more people to undergo lap band surgery because there's no research proving that the operation's long-term health benefits for slightly obese patients outweigh the risks. In a Times op-ed, Diana Zuckerman, President of the National Research Center for Women and Families, offered a disturbing account of how the F.D.A. originally approved Inamed's Lap-Band for the extremely obese based on a study of only 200 people. The company was required to perform a more extensive follow-up study, but after the company was bought by Allergan — surprise! — it was never competed. You'll also be shocked to learn that the study Allergan is using to back up its latest request involved only 149 patients who had lap bands for one to two years.
Many people say lap band surgery has significantly improved their health or even saved their lives. (For first-hand accounts, just read through the comments on a recent post about the procedure's costs.) When performed by a reputable doctor, patients prepare for months with psychological evaluations, therapy, and diet and exercise programs. But Eric Oliver, a political science professor at the University of Chicago and author of the book Fat Politics: The Real Story behind America's Obesity Epidemic, says that lowering the threshold may lead to more people electing to have the surgery when it won't benefit their health. He tells Women's eNews, "What I worry about is, to what extent is bariatric surgery becoming a form of cosmetic surgery?"
That definitely seems to be the underlying message of lap band ads that run across the country, which are the only commercials for general surgery. The ads really aren't any different from Weight Watchers or Jenny Craig commercials.
Which is a problem, because those ads are designed to make weight loss look easy. The commercials focus on "before and after" photos rather than the health problems that would lead to a doctor suggesting the surgery. Though many people get cosmetic surgery purely to lose weight, Dr. Wendy Scinta of The American Society of Bariatric Physicians, warns lap band surgery is far more serious. The Society recently condemned the F.D.A. advisory panel's decision, and Dr. Scinta says the surgery should be used only as a last resort.
Though the surgery should be available to patients whose doctors have deemed it medically necessary, the motives behind the push to open the surgery to less-obese people are highly suspect. The Times notes Allergan also makes Botox, and the company made the request to the F.D.A. after sales of its obesity products fell 4% in 2010. Making people thinner won't necessarily make them healthier, but convincing people who just want to lose weight that they need a medical intervention will make Allergan richer.
Panel Votes to Expand Surgery for Less Obese [NYT]
Playing With The Band [NYT]
Lap-Band Critics Decry Excess Rhetoric on Weight [Women's eNews]
Bariatric Physicians Question FDA Recommendations to Lower BMI Requirements For Lap-Band Surgery [PR Newswire]
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