Menus Subscribe Search

Follow us


How Should We Evaluate Lap-Band Candidates?

• July 15, 2011 • 9:38 AM

Allergan lowers BMI requirement and raises questions about its effectiveness and appropriateness.

You’ve tried Atkins, South Beach and Nutrisystem. You’ve enlisted the help of a personal trainer, busted your butt at your gym’s boot camp and sweated it out in Bikram yoga. Desperate to trim inches, you’ve even bought into gimmicky weight-loss pills, fasting and cleanses. But the stubborn scale still tells you that you’re overweight.

Where should you turn now? If you have a body mass index of 30 or higher (a man standing at 5’9″ and weighing in at 203 pounds) and one weight-related medical condition (high blood pressure, diabetes, etc.), you now qualify for quick and easy gastric bypass surgery. (Click here to calculate your BMI.)

In February, the Food and Drug Administration announced that Allergan, the maker of the Lap-Band Adjustable Gastric Banding System, can market the medical procedure for a person with a BMI of 30, lowered from the former requirement of 40. This opens the device’s market to 26.4 million more Americans; 45.6 million Americans, or 1 in 7, now meet criteria for the Lap-Band surgery. In short, it’s moved from the last hope of the morbidly obese to a sort of lifestyle choice for the plump.

With the device already advertised on billboards across the country (with the phone number 1-800-GET-THIN), this widening of the market begs the question: How should potential patients for weight-loss surgery be evaluated? A body of academic research finds that this evaluation should include both the waist and the mind.

Gastric Surgery
The most common form of gastric bypass surgery is Roux-en-Y gastric bypass, in which a surgeon clips off part of the stomach to create a smaller pouch. This tinier tummy becomes the way station between the passage where chewed food enters and the small intestine, while the larger part of the stomach is sewn shut.

The Lap-Band does not require the removal of any part of the digestive system, and, unlike stomach stapling, it’s reversible. A surgeon makes a few incisions in the abdominal wall and inserts an adjustable band – think of a pants belt — around the upper wall of the stomach. Depending on how tight or how loose the band is pulled, a person’s stomach is restricted to anywhere from about half of a cup to six cups of food.

That relative ease comes at a price.

A February 2011 study in the Archives of Surgery reported that both gastric bypass and adjustable bypass banding surgeries are generally safe and have similar complication rates when performed at “high-volume centers by expert surgeons,” although Lap-Band did have more occurrences where a second surgery was required.

But the researchers concluded that Roux-en-Y gastric bypass surgery had “a better risk-benefit profile” than the Lap-Band, in large part because it is more effective: Roux patients lost 64 percent of their excess weight during their first year post-procedure, compared to Lap-Band’s 36 percent.

The Lap-Band is not a foolproof weight-loss device. The failure rate (defined as failure to achieve a certain percentage of weight loss or a particular BMI) ranges from 10 percent to 20 percent during the first several years after surgery. That rate grows the longer the band is in place.

The Lap-Band’s less-invasive nature and ability to be reversed gives it a less serious air than other forms of gastric bypass surgery, but it also comes with the risk of various, albeit rare, complications, such as band erosion, pouch dilation, band slippage and an inflamed esophagus. And, like any aggressively marketed medical device, with awareness comes notoriety when something goes dramatically wrong, as when four Southern Californians died after their Lap-Band surgery.

And then there are issues with nutrition post-procedure. Some who have had the Lap-Band develop an intolerance to meat, particularly red meat.

Whether the band is the best solution for the obese, it remains a reasonable one. A recent 14-year long study in the Journal of Obesity that tracked the health of 200 formerly obese Germans who had gastric banding in 1995 found the operation to be “a safe and efficient procedure when performed by an experienced surgeon using a standardized operation technique.” The authors stressed the importance of a standardized follow-up procedure to ensure a healthy recovery, greater weight loss and fewer conditions such as diabetes or hypertension.

Mind and Body
While the Lap-Band can provide a solution for weight loss, the procedure may not solve all of an obese person’s problems. More than 28 percent of potential bariatric surgery patients have been reported to have a lifetime history of a major depressive disorder. Lifestyle habits, such as a poor diet and a lack of exercise, are not immediately solved with the Lap-Band.

Weight-loss surgery is less successful when people exhibited binge eating habits and poor eating habits linked to psychological problems. For more effective weight loss, a person’s psychological profile and relationship with food needs to be analyzed for eligibility and for the best post-operation results. Obesity can be a psychological problem, and having weight loss surgery serves to treat the consequences of psychological problems, rather than unearthing and treating the emotional reasons that people overeat.

A 12-month study analyzed the pre-surgical and post-surgical eating behaviors of 129 recipients of the Lap-Band. Although the prevalence of binge-eating disorder, uncontrolled eating and night-eating syndrome dropped from 14 percent, 31 percent and 17.1 percent, respectively, to 3.1 percent, 22.5 percent and 7.8 percent, other eating problems cropped up. Binge-eating disorder is often a side effect of emotional eating, or ”eating in response to a range of negative emotions such as anxiety, depression, anger, and loneliness to cope with negative affect.”

Researchers found that a high level of psychological distress accompanied a loss of control over one’s eating ability, and the consumption of small amounts of food over an extended period of time — “grazing” — became the coping mechanism for participants whose bodies do not allow them to binge eat as they had pre-surgery. Individuals feeling a loss of control over their eating habits may be more inclined to avoid clinical follow-up post-surgery.

Ranesa McNally, therapist, gastric bypass patient and author of Gastric Bypass Surgery: The Psychological Journey, writes that gastric bypass surgery is not a quick fix and requires an overhaul of a patient’s perspective.

“Those who succeed long term tend to be those individuals who fully understand that an entire lifestyle change is necessary; this is not as simple as changing eating habits,” she writes. “This also means looking at how food has played a part in one’s upbringing, when exactly one began struggling with the weight, the social and cultural implications related to obesity, as well as the role food plays in social settings. Also to be examined is one’s outlook regarding exercise, the ability to follow directions and issues of control,”

Allergan requires a psychological evaluation before prospective Lap-Banders go under the knife. Allergan is not involved in the evaluation, said Cathy Taylor, the company’s director of corporate communications.

“Allergan is not involved in the psychological evaluation – we do not develop the questions nor do we provide input,” she said. “Allergan is only the manufacturer of the Lap-Band System, so we don’t manage the psychological evaluation. The psych department of the hospital/surgeon office is responsible for development of the psychological evaluation.”

Dr. Mafa R. Kamal, a psychiatrist at Good Samaritan Hospital in Los Angeles, screens potential Lap-Band patients before they can be considered to have the procedure. He said that the hospital is not choosing as many patients for the procedure as it did in the past, but that if a patient is morbidly obese, the hospital will authorize the surgery because it could save their life.

“After having the surgery, a lot of patients are not willing to change their life patterns,” he explained. “They think that if they do the surgery, they’re going to be slim, but they discover that actually they’re not going to have new friends or a new personality. After surgery, many patients don’t want to exercise or stop eating junk food. They want to do what they want to do. The surgery is risky, and there are complications. Some patients are not going to be compliant with anything.”

Deciding to have the Lap-Band inserted into your body to restrict your food intake is a tough call. One study warns that “we must remember that idiopathic morbid obesity probably is the result of a complex metabolic and psychological disturbance in the fine-tuned chain of events that governs the intake of food.” Although some may call psychological screening before bariatric surgery prejudicial, a surgeon must ensure that a patient is ready to deal with the consequences of the Lap-Band procedure. The Lap-Band’s consequences can be positive when a person has a healthy psychological profile: self-esteem and improved body image can increase with weight-loss surgery.

For some people, weight-loss surgery has given them a start at living a new, healthy life. Jasmine Myers, author of the blog Eat Move Write, said that she was facing death before she had Roux-en-Y gastric bypass surgery six years ago.

“Six years ago, all I could see ahead of me was a long dark tunnel. Today, I am healthy,” Myers said. “I enjoy hiking, walking, and working out with my husband. I have a blog dedicated to pursuing my own healthy lifestyle. And, children are no longer an impossibility. They are an eventuality. I am not just existing now. I am alive.”

For other recipients of weight loss surgery, the ordeal gave them temporary relief but didn’t reach the roots of psychological issues that drive them to overeat. One 46-year-old woman who had the surgery three years ago told me that it has been a struggle to adapt to eating less after decades of overeating.

“When I first had the Lap-Band, I was excited and enthusiastic about my weight loss prospects,” she said. “Now I feel trapped, and my mind hasn’t caught up with my body. I still overeat, and the food stacks up in my esophagus.”

Food can be an addiction, and cutting the ties from the drug of food does not necessarily rehabilitate someone’s emotional health. Now the floodgates have opened for almost 50 million Americans with the lowering of the BMI requirement, Allergan should thoroughly analyze the mental health of potential Lap-Band recipients. Even though the Lap-Band is reversible, its psychological consequences can leave scars.

Taylor Orr
Taylor Orr currently works in marketing and public relations for a Santa Barbara-based nonprofit organization. She earned a bachelor's in global studies with minors in professional editing and French from UCSB, and graduated in 2009. During her undergraduate career, she worked for environmental coalitions on campus and wrote for the Montecito Journal and Santa Barbara Fitness Magazine.

More From Taylor Orr

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

December 20 • 10:28 AM

Flare-Ups

Are my emotions making me ill?


December 19 • 4:00 PM

How a Drug Policy Reform Organization Thinks of the Children

This valuable, newly updated resource for parents is based in the real world.


December 19 • 2:00 PM

Where Did the Ouija Board Come From?

It wasn’t just a toy.


December 19 • 12:00 PM

Social Scientists Can Do More to Eradicate Racial Oppression

Using our knowledge of social systems, all social scientists—black or white, race scholar or not—have an opportunity to challenge white privilege.


December 19 • 10:17 AM

How Scientists Contribute to Bad Science Reporting

By not taking university press officers and research press releases seriously, scientists are often complicit in the media falsehoods they so often deride.


December 19 • 10:00 AM

Pentecostalism in West Africa: A Boon or Barrier to Disease?

How has Ghana stayed Ebola-free despite being at high risk for infection? A look at their American-style Pentecostalism, a religion that threatens to do more harm than good.


December 19 • 8:00 AM

Don’t Text and Drive—Especially If You’re Old

A new study shows that texting while driving becomes even more dangerous with age.


December 19 • 6:12 AM

All That ‘Call of Duty’ With Your Friends Has Not Made You a More Violent Person

But all that solo Call of Duty has.


December 19 • 4:00 AM

Food for Thought: WIC Works

New research finds participation in the federal WIC program, which subsidizes healthy foods for young children, is linked with stronger cognitive development and higher test scores.


December 18 • 4:00 PM

How I Navigated Life as a Newly Sober Mom

Saying “no” to my kids was harder than saying “no” to alcohol. But for their sake and mine, I had to learn to put myself first sometimes.


December 18 • 2:00 PM

Women in Apocalyptic Fiction Shaving Their Armpits

Because our interest in realism apparently only goes so far.


December 18 • 12:00 PM

The Paradox of Choice, 10 Years Later

Paul Hiebert talks to psychologist Barry Schwartz about how modern trends—social media, FOMO, customer review sites—fit in with arguments he made a decade ago in his highly influential book, The Paradox of Choice: Why More Is Less.


December 18 • 10:00 AM

What It’s Like to Spend a Few Hours in the Church of Scientology

Wrestling with thetans, attempting to unlock a memory bank, and a personality test seemingly aimed at people with depression. This is Scientology’s “dissemination drill” for potential new members.


December 18 • 8:00 AM

Gendering #BlackLivesMatter: A Feminist Perspective

Black men are stereotyped as violent, while black women are rendered invisible. Here’s why the gendering of black lives matters.


December 18 • 7:06 AM

Apparently You Can Bring Your Religion to Work

New research says offices that encourage talk of religion actually make for happier workplaces.


December 18 • 6:00 AM

The Very Weak and Complicated Links Between Mental Illness and Gun Violence

Vanderbilt University’s Jonathan Metzl and Kenneth MacLeish address our anxieties and correct our assumptions.


December 18 • 4:00 AM

Should Movies Be Rated RD for Reckless Driving?

A new study finds a link between watching films featuring reckless driving and engaging in similar behavior years later.


December 17 • 4:00 PM

How to Run a Drug Dealing Network in Prison

People tend not to hear about the prison drug dealing operations that succeed. Substance.com asks a veteran of the game to explain his system.


December 17 • 2:00 PM

Gender Segregation of Toys Is on the Rise

Charting the use of “toys for boys” and “toys for girls” in American English.


December 17 • 12:41 PM

Why the College Football Playoff Is Terrible But Better Than Before

The sample size is still embarrassingly small, but at least there’s less room for the availability cascade.


December 17 • 11:06 AM

Canadian Kids Have a Serious Smoking Problem

Bootleg cigarette sales could be leading Canadian teens to more serious drugs, a recent study finds.


December 17 • 10:37 AM

A Public Lynching in Sproul Plaza

When photographs of lynching victims showed up on a hallowed site of democracy in action, a provocation was issued—but to whom, by whom, and why?


December 17 • 8:00 AM

What Was the Job?

This was the year the job broke, the year we accepted a re-interpretation of its fundamental bargain and bought in to the push to get us to all work for ourselves rather than each other.


December 17 • 6:00 AM

White Kids Will Be Kids

Even the “good” kids—bound for college, upwardly mobile—sometimes break the law. The difference? They don’t have much to fear. A professor of race and social movements reflects on her teenage years and faces some uncomfortable realities.



Follow us


Don’t Text and Drive—Especially If You’re Old

A new study shows that texting while driving becomes even more dangerous with age.

Apparently You Can Bring Your Religion to Work

New research says offices that encourage talk of religion actually make for happier workplaces.

Canadian Kids Have a Serious Smoking Problem

Bootleg cigarette sales could be leading Canadian teens to more serious drugs, a recent study finds.

The Hidden Psychology of the Home Ref

That old myth of home field bias isn’t a myth at all; it’s a statistical fact.

The Big One

One in two United States senators and two in five House members who left office between 1998 and 2004 became lobbyists. November/December 2014

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.