Can You Lose Weight Again With Lap Band After Gaining

In 2008, at only 17 years old, Lindsay Dark-green* decided the merely way she'd get her weight down was through surgery.

At the fourth dimension, Light-green was half-dozen feet alpine and 215 pounds — "overweight," by medical standards, but not "obese." All the same, she heard about the laparoscopic gastric band functioning, one of several common weight loss surgeries, on the radio in Phoenix, Arizona, and was intrigued. "I was a immature person and pretty susceptible," she said. "All I wanted was to lose weight."

After the $16,000 operation, her weight slowly dropped to a "normal" BMI of nigh 180 pounds. But she at present had an eating disorder to argue with. The band made eating painful; she'd frequently feel like someone was screwing her rib cage airtight after meals. To relieve the pressure, she'd vomit.

"I thought if I'm going to throw up no affair what, I might as well eat what I want, and consume as much as I desire," Dark-green, who's at present a corporate wellness worker, said. She'd often opt for bags of Goldfish crackers or bowls of cereal; they injure less than vegetables with fiber, like broccoli. "That's the reverse of what you'd hope of trying to create someone with salubrious eating habits," she added.

Subsequently going into the doctor's office to go her band adjusted four times, Green finally had the device taken out terminal year. Her weight has settled at around 205 pounds. She's relieved she no longer has the band inside her.

Javier Zarracina

Light-green's story, it turns out, is more than the rule than the exception. As the obesity epidemic has surged beyond America, more and more people with weight struggles are turning to weight loss, or bariatric, surgeries as a treatment. Just ever since the lap ring entered the mix in 2001, it's gone from being one of the most common bariatric surgeries to the least. Mounting, longer-term research has emerged showing that lap bands as well ofttimes pb to medical complications and that they're inferior to other obesity surgeries when information technology comes to weight loss.

Nevertheless, of the nearly 200,000 weight loss operations each twelvemonth, some xi,000 of them still involve gastric bands. Researchers are increasingly arguing that'due south also many.

How the lap ring works — and how it fails

The adjustable gastric ring fitted around the stomach to treat obesity.

Peter Gardiner/Getty

First, a quick primer on the three major types of weight loss surgery:

• The first involves restricting the size of the breadbasket, similar the lap ring. The process involves placing an inflatable band effectually the upper portion of the stomach to create a small pouch, and the thought is that people will experience fuller faster, swallow less, and lose weight.
• The second kind interferes with how the body absorbs calories, like the small bowel featherbed, which doctors don't practise anymore.
• The third are combination procedures that are both restrictive and crusade calorie malabsorption or hormonal changes that affect hunger and satiety, similar the gastric bypass and gastric sleeve operations. These operations make the stomach smaller past cut out function of information technology (and in the instance of the bypass, rerouting the intestines). They are now the most popular weight loss surgeries.

When the lap band operation was first canonical past the Nutrient and Drug Assistants in 2001, it was met with a lot of hype: The device seemed like a safe choice for weight loss surgery that could exist adjusted or removed at the patient'south behest. Different the gastric bypass or sleeve operations, information technology didn't involve cutting the breadbasket or rerouting the intestines — and it could be reversed (which helps explain the band'south enduring, albeit more than limited, appeal).

"It looked like it was going to be great," said University of N Dakota School of Medicine obesity researcher Jim Mitchell. "Nobody expected information technology was going to exist problematic."

That ease and perception of relative safety is office of what drew Greenish to the procedure, she said — a quick fix for a difficult trouble.

But over the years, obesity researchers accept been learning that the lap band is anything but: It'due south now articulate that a large number of patients suffer medical complications and require additional surgeries subsequently their initial operation. "That's one of the reasons you need long-term event data [in medicine]," Mitchell said.

In the all-time study we have on but how problematic lap band surgeries can exist, published in JAMA in May, researchers from the University of Michigan looked at 16 years of Medicare data to run across how common "re-operations" were after the outset lap band procedure. These involved everything from removing the ring to replacing it, fixing it, or following the initial procedure with some other weight loss performance (i.eastward., the gastric featherbed). They found twenty percent — or one in five — of the 25,000 lap band patients needed an additional procedure. That's much college than the 3 to 9 percentage re-operation charge per unit for the gastric bypass and gastric sleeve surgeries.

Between 2006 and 2013, Medicare paid $470 million for these procedures. What'southward more, the average number of procedures per lap band patient was a staggering three.eight.

Because the band doesn't cause any physiological or hormonal changes like other bariatric surgeries, patients often struggle with weight loss afterward. They feel the aforementioned hunger sensations they did earlier the surgery, simply they can't eat the aforementioned amount of nutrient. And so they find ways to compensate — like Greenish throwing up subsequently eating. Other doctors told me they've seen patients who routinely drink milkshakes, consume mashed potatoes, or soften their biscuits with gravy so they'll go downward more hands.

In this 2016 JAMA study, looking at the four-year weight alter in veterans who underwent weight loss surgery, the bypass patients lost 27 percentage of their original bodyweight, the gastric sleeve patients lost 17 per centum, and band patients lost only 10 percentage. This systematic review pooled together the results of many studies on different weight loss operations, and also found the same tendency: Ring patients fared the worst when it came to weight loss, and gastric featherbed patients the best.

"If I were a patient," the University of Michigan's Andrew Ibrahim, who studied the re-operation rate of the lap band operation, told me, "and those were the numbers presented to me, I would have a hard fourth dimension accepting that risk [with lap ring operations] when there are ii other alternatives that nosotros know well can exist done."

That'south why some doctors don't refer patients to lap bands anymore. "I would never recommend it," said Yoni Freedhoff, an obesity doctor based in Ottawa. "I wouldn't wish one on my worst enemy."

Other weight loss surgeries are more effective, only doctors will still go along doing the lap band

Fewer and fewer patients are asking for the device, and fewer and fewer doctors are performing the lap band process these days. But despite the concerns about the safety and effectiveness, the lap ring even so accounts for about 6 pct of all weight loss operations: 11,000 of these devices were implanted in patients in 2015, co-ordinate to the American Club for Metabolic and Bariatric Surgery.

That'southward still as well many, Freedhoff says. He noted that the unmarried-payer health organisation in Ontario, Canada, doesn't encompass the band process — though it funds other bariatric operations — and he thinks other payers could move in that direction. (The authors of the May JAMA paper on the lap ring'south charge per unit of re-operations, including Ibrahim, besides ended that insurers should consider discontinuing coverage for the lap band.)

But equally long as there are patients who will pay, doctors will probably keep doing them, Freedhoff said.

Light-green wishes more people contemplating the lap ring were aware of its risks and downsides. She had wanted to remove her band for several years, only had to wait for insurance coverage that could help pes the $5,000 neb for the operation.

Today she'south worried that the heartburn medications she was using to weigh the effects of throwing upwards may have an effect on her os density. She'south also worried virtually whether all those years of being sick and non getting the nutrients her trunk needed will carry long-term wellness consequences.

"I'yard yet settling back in to a normal body," she said, "that doesn't have a weird plastic contraption in there fouling everything up."

*Lindsay's proper noun was changed because she was concerned most her professional image.

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Source: https://www.vox.com/science-and-health/2017/5/25/15659878/weight-loss-surgery-lap-band-evidence

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