Patients must learn risks, benefits before choosing weight loss surgery

The controversy about the use and marketing of the Lap-Band device for weight loss underscores the need for those considering surgical options to carefully understand the potential risks as well as benefits before deciding on surgery.

“Gastric surgery patients can often have a great outcome, but the operation is not something to be taken lightly,” says Dr. Brian Smith of UC Irvine Medical Center’s bariatric surgery service. “Any major surgery has risks and it’s important that patients understand them.”

In December, the Food and Drug Administration accused the 1-800-GET-THIN marketing company of underplaying serious risks in its billboard, radio and television advertising for Lap-Band surgery. Last week, Allergan, the maker of the Lap-Band, announced that it would no longer sell their product to clinics associated with this campaign. Since then, several Los Angeles-area clinics have said they will stop offering the surgery while they review their practices.

“We’re in an era when people increasingly want to see responsible surgery,” Smith says. “It’s important that they speak to their doctor to understand the short-term and long-term ramifications of each kind of bariatric surgery.”

While adjustable gastric banding may be the least invasive surgery, Smith says the traditional gastric bypass or the laparoscopic sleeve gastrectomy may be better options for some people.

“We want patients to be empowered to make the right decision,” he says. That empowerment comes from choosing the right doctor and fully discussing all surgical options.

The Bariatric Surgery Center Network of the American College of Surgeons web site allows potential patients to search for surgery centers that have met the highest standards for weight loss procedures, including UC Irvine Medical Center.

Earlier this year, Medi-Cal, California’s version of Medicaid, okayed payments for sleeve gastrectomy and Medicare is expected to consider approving the procedure this spring. Private insurers may follow. In a September 2011 article in the Annals of Surgery, Dr. Ninh T. Nguyen, UC Irvine’s chief of gastrointestinal surgery, and colleagues from Massachusetts General Hospital, found that the procedure’s safety and effectiveness fits between that of banding and bypass.

Weight loss is slower than with the gastric bypass, but tends to be faster than with the gastric banding procedure.  Overall weight loss is comparable to gastric banding.

Though gastric banding continues to grow in popularity, Nguyen told the Orange County Register last year that it is not a cure-all:

“The biggest misconception is thinking that once you have the band, that’s it. Everything is going to be easy,” [says] Nguyen.

The band won’t work, he emphasizes, unless it’s paired with a healthy lifestyle. Because the band limits the quantity you can eat at one time, what you eat better contain the right ratio of protein, carbohydrate and fat.

“You can still fail, and we have seen it.”

Nguyen says gastric band patients normally lose 40 percent of their excess weight within a year. He sees a 16 percent failure rate, defined as someone who loses less than 20 percent of his or her excess weight.

- John Murray / UCI Health