People can die from getting lap-bands.
People can have serious, life changing complications from getting lap-bands.
There is no long term research (over 20 years) to support lap-banding in anyone, let alone teenagers, Indigenous communities or people who are merely ‘overweight’ (ie BMI 30).
Finally a surgical resident in the US has spoken out and she was fired from her position at New York University’s Medical Centre as a result.
Dr Neelu Pal has pretty much the same issues with banding that I do – the lack of care after surgery (and by that I mean long term care and follow up) and the lack of comprehensive screening and provision of information before surgery. Pal described the institution where she was employed as ‘a hectic lap-band factory’ where up to 20 patients a day were banded. Pal says ‘I could see what they were trying to do was get as many patients on to the operating tables as possible’. Sort of puts it into perspective doesn’t it? Needless to say, the two surgeons, married couple Drs Ren and Fielding, are paid consultants of Allergan, the leading manufacturer of the gastric band. Can we say conflict of interest? Pal’s allegations were corroborated by a New York State Health Department investigation so it isn’t like she was making this shit up, as critics would like us to think.
The lap-band industry is growing with banding being promoted for groups previously unable to avail themselves of the procedure, such as teenagers and people in the ‘overweight’ BMI designation. A decision by the US FDA regarding marketing the band to teens as young as 14 is currently pending. If approved, manufacturers of the band can target that specific age group. That is to say, they can capitalise on the low self esteem many fat teenagers have and carry out a procedure on those kids that will have life long ramifications.
While banding is considered ‘less invasive and risky than gastric bypass’ there is little long term research pertaining to gastric banding, particularly in the case of teenagers. It is often claimed that banding is preferable because it is reversible, that is, the band can be removed. The hitch to this argument is that people who want their band taken out often cannot afford the costs involved with band removal. Getting the band in Australia (without private health insurance) can cost upward of $10,000 depending what surgeon you use and what hospital you are admitted to, not to mention whether you have any surgical or post surgical complications that require further care. Having the band removed generally costs upward of $5000. No small change.
One long term study of banding in adolescents was launched in 2007 and doesn’t expect to report results until 2012. In the meantime, surgeons world wide are banding teenager at their own discretion. Another study has already shown that over 20% of teens with bands experience ’symmetric pouch dialation’ which in lay terms means the part of the of the stomach above the band (the smaller part) has been stretched, thus allowing the patient to eat more food. This stretching is one of the things banding patients are blamed for as it is seen that the patient obviously ate too much on a regular basis which in turn stretched the upper pouch, allowing more food to be eaten and defeating the ‘purpose’ of the band. This is the reality and it contrasts with the idea that banding somehow sends messages to the brain that the stomach is full and the person is no longer hungry. Working on that premise, people with eating disorders such as Binge Eating Disorder should never be banded as they have specific issues regarding satiety. I personally know more than a few people who exhibit the diagnostic criteria for Binge Eating disorder who have been banded and who were never psychologically screened prior to their banding surgery. These people say they didn’t hide the fact they have an eating disorder from their surgeon, they were just never asked any question pertaining to their psychological state. These questions have to be asked. It is a surgeon’s duty of care to ask these questions. There are no excuses for not doing so.
The article about Neelu Pal asserts there is a ‘dearth’ of long-term data on the outcomes of gastric band surgery and I would agree with that. There are no 20 year studies. There are no 30 year studies. There are no 50 year studies. Until there are it is disingenuous to claim we have any idea about the long term effects of gastric banding. One 10 year study showed that the band failed in almost 30% of patients. That is almost one in three people. About 20% needed a second operation (what exactly the issue with the band was in those cases is not stated). 40% had problems after a decade. That is nearly half of the participants in the study. Half. And yet the claims that banding is safe continue.
One researcher says ‘Bands are definitely safe in the short term and definitely work in the short term’. I would like to know how he defines ’safe’ and what his idea of ’short term’ is. Is he talking the first year? The first 5 years? The article doesn’t say. But the people I know with bands have largely had to have their band replaced within the first 5 years (usually the first 3 years), have had to have their gall bladder out not long after the banding surgery, find eating in public traumatic due to ‘productive burps’ (ie vomiting after food has become ’stuck’) and have put on the weight they initially lost (and often more) by the 5 year mark. This is not to say that this happens to everyone, it doesn’t. But there are serious questions that need to be asked and the people who the band fails are often too ashamed to come forward and speak their piece. These people often feel they are the failures rather than the band and doctors and society have no qualms in allowing these people to believe it is all their own fault that they are still fat. Not to mention that banding is considered ’successful’ if the patient loses 10% of their initial body weight, regardless of side-effects and long term complications. So for a 130kg patient that means a loss of 13kg is considered successful. At 117kg that person is still classed as ‘obese’ and still a stigmatised member of society. All that seems important is that the fatty complied and at least tried to do something about their fat and to conform to the social ideal. No matter the cost.
A Swiss study published in the Obesity Surgery journal concluded that ‘gastric banding should be performed in “select cases only” until more data is available (bolding mine). I know for a fact that there are surgeons in my region, respected surgeons, who spend less than 10 minutes assessing prospective patients for banding and that if you are in the ‘overweight’ or ‘obese’ BMI designation, they will band you, no questions asked. They also claim that banding ‘cures’ diabetes and depression. Obviously the “select cases” refers to anyone who is ‘overweight’. An Australian study of 276 banding patients discovered that almost half of patients had their original band replaced within 9 years of their first banding procedure but once again the patient is blamed, they ate too much, they didn’t stick to the follow-up routine. All care and no responsibility on the part of banding proponents.
There needs to be recognition of the long term issues surrounding banding as well as regulation of surgeons who carry out banding surgery. Patients need to be comprehensively screened by a number of health professionals and extensively supported on a long term basis following their surgery. Surgeons and researchers need to come clean regarding their connections with Allergan and they, and society en masse, need to stop blaming patients for ‘failure’. Until this happens banding remains an unknown quantity.
