Stomach Restricting Surgery Poised to Expand
… thanks to an FDA advisory committee which voted in favor of changing the guidelines for using Allergan’s Lap-Band device. The New York Times has the story:
A federal advisory panel Friday endorsed an expansion of the use of Allergan’s Lap-Band stomach-restricting device to patients who are less than severely obese.
The vote could pave the way to double the number of Americans who qualify for weight-loss surgery. And it could eventually lead to making other types of weight-loss surgery available to those who are not quite as heavy.
…The advisory committee to the Food and Drug Administration voted 8 to 2 that the benefits of Lap-Band surgery exceeded the risks for patients in the lower range of obesity. It voted 8 to 2 that the device was safe, and 8 to 1, with one abstention, that the device was effective.
…A person who is 5 feet, 5 inches with hypertension must weigh at least 210 pounds to qualify for surgery now. Under the proposal endorsed by the committee, that person would have to weigh only 180 pounds.
…Allergan, which is known mostly for Botox, hopes that expanding use of the Lap-Band to less obese adults — and also eventually to teenagers — will spur sales. Sales of its obesity products, mostly Lap-Band, fell 4 percent to $182.4 million in the first nine months of this year, a decline the company attributed to the weak economy. But obesity products make up only 5 percent of Allergan’s overall product sales.
Shares of Allergan rose 52 cents, to $68.80 in regular trading Friday. The shares rose 3 percent, to $70.89 in after-hours trading, following the panel’s vote.
Lately, I’ve been of two minds regarding weight loss surgery. On the one hand, it’s certainly not a cure-all (ask Carnie Wilson about that). In addition, it’s expensive, invasive, and has the potential for complications/side effects (including chronic malnutrition). On the flip side, procedures have improved and, in truth, surgery has the best (or at least the best-documented) record of success of all weight/fat loss approaches. There are plenty of people with stories like Tammy Miller’s – so it’s tough to condemn it from a practical perspective (however much I’d like to…).
Still, I find the Times story a tad creepy. While people should be free to make their own medical decisions, it’s not hard to forsee a future where surgical weight loss is hyped just like fat loss supps are. The financial incentives are too compelling, as this 2009 article makes clear:
Venture capital firms are increasingly backing bariatric ASCs, and the two makers of surgical devices for gastric banding procedures are engaged in “fierce competition,” a formula that’s turning a “once-controversial weight-loss procedure into the next big thing in elective surgery,” according to a recent Wall Street Journal report.
“We are just at the beginning of major marketing campaigns for laparoscopic banding by two very large medical device companies, and I think it’s going to have very potent affects on healthcare and ASCs and on how we treat obesity surgery,” says Dr. Sasse. “In a few years’ time, the idea that 100 million Americans qualify for outpatient laparoscopic band weight-loss procedures that are safe, private, non-invasive, effective, easy and relatively affordable will be much more accepted.”
…Dr. Sasse follows up by noting that primary care physicians need to be brought into the care loop, because that’s where the “marketing” of a weight-loss surgery program begins.
“Bariatric surgeons have to teach primary care physicians about what they offer and about the vocabulary for talking to their patients about this issue without sounding judgmental,” he says. “Some patients might be angry and defensive, but others will be very, very receptive.
Patients need to come before profits… but this certainly isn’t always the case, and I’m afraid that changing the criteria could muddy the waters even more.
December 9, 2010
Stomach Restricting Surgery Poised to Expand – http://blog.ultimatefatburner.com/2010/1…
December 10, 2010
This is a topic I have been doing some research on. Our Dr. told my wife on her last visit that she should consider the surgery because of an increasing fatty liver issue.
First off my wife has been trying to loose weight {unsuccessfully) for twenty years. She has no willpower, dosn’t like vegetables, eats by taste not by nutrition. She has brought this on herself.
I have tried (unsuccessfully) to help her for the past 10 years. With no progress past a few pounds here and there, which she just puts back on. I really don’t think she can handle the surgery or the aftermath.
I’m really in a fix. The Dr. said if she dosen’t do something her life will be shortened, but if she has the surgery I think her life will be miserable.
I have been married for 33 years and don’t want to loose her before I have to. I also don’t want her to have more pain and suffering from the surgery.
December 10, 2010
It’s not an easy decision to make. In the end, the surgery enforces some of the lifestyle changes that people need to make; and it creates a sort of “window of opportunity” by enhancing appetite control/regulation. But it’s not likely to change a habit of “eating by taste” or make vegetables more appealing. And – as Carnie Wilson’s story demonstrates – poor eating habits and overall orientation towards food can ultimately derail the results. She’s still better off than she was (212 lbs. vs. 300 lbs.), but her story is still a cautionary tale.
In the end, however, the odds of experiencing some success are in your wife’s favor. That’s no guarantee, of course – however you run the stats, it bites for the ones who end up on the wrong side of them. To take a hypothetical example, if a procedure offers a 90% chance of success, that means 90 out of 100 people undergoing it will come out of it just fine. If you’re one of them, life is good. If – on the other hand – you’re one of the 10 – well, it sucks to be you.
So in the end, you’ll have to choose your poison. Run the various scenarios (including “do nothing”) and their likely outcomes, and make the best decision the two of you can make with no regrets.
FWIW, losing someone before you have to isn’t always a sudden process. So your choices aren’t necessarily “premature death” vs. “prolonged pain and suffering from the surgery.” There may be prolonged pain and suffering (not to mention surgery) before the death part kicks in, too. Depends on how the fatty liver progresses – it may be harmless… or it could progress into cirrhosis ( see: http://digestive.niddk.nih.gov/ddiseases/pubs/nash/ ). I’m sorry to be morbid, but I’ve had to watch two people die only after prolonged declines… which, IMHO, is worse for both the victims and their loved ones.
You might want to look into a newer, “incisionless” technique that may reduce recovery time and complications: http://www.news-medical.net/news/2009/02/22/46103.aspx Non-surgical, clinic-based alternatives that provide a lot of support and behavior modification (like this one: http://rfoweightloss.med.ucla.edu/body.cfm?id=32 which has a well-documented success rate) might be worth looking into as well.
December 11, 2010
Thanks Elissa. I appreciate your advice, suggestions and links. We will be looking over the info and making a decision at the first of the year.
I really appreciate you taking the time to answer. I have seen the decline of some family members after bouts with terrible diseases. I really don’t want to see it with my wife.
December 28, 2010
Hi,
Great post, I think that stomach restricting surgery should the last option when it comes to weight loss.
cheers.