It's been a year since Deborah Shields, 56, of Parkersburg, had her LAP-BAND surgery performed by Dr. Adam Kaplan, general and bariatric surgeon with Camden-Clark Memorial Hospital.
"I had tried every diet there was, even tried hypnotism," Shields said. "And this had been a lifetime condition for me. But you feel so much better when the weight comes off."
Gastric banding is becoming the most common form of bariatric surgery and has been approved by the U.S. Food and Drug Administration, said Dr. Isidro Amigo, bariatric surgeon with Mid-Ohio Valley Lap Band Center at St. Joseph's Hospital in Parkersburg
"It's the best alternative for treating the morbidly obese," he said.
A person more than 100 pounds over his or her ideal weight, or with a body mass index (BMI) of 40, is considered morbidly obese. BMI is calculated by dividing weight (in pounds) by height (in inches).
"LAP-BAND works by making you less hungry because you feel satisfied after eating a small amount of food," Amigo said.
This is accomplished through a minimally invasive procedure in which a small band is wrapped around the upper part of the stomach, forming a small pouch with an opening in the bottom about the size of a dime. The band can be filled with saline solution to adjust its tightness.
The process, available in the U.S. since 2001, basically divides the stomach in two, with the smaller pouch located above the gastric band.
As the patient eats, he or she feels full faster because the stomach area above the gastric band fills with food, then slowly funnels it down past the band and into the lower portion of the stomach.
Unlike gastric bypass surgery, gastric banding does not change the gastrointestinal tract and does not interfere with nutrient absorption.
"A meal of about a cup of food or less will distend the small pouch above the band and make you feel full," said Kaplan. "Because the passageway (to the rest of the stomach) becomes relatively narrow, it takes two to three hours for food to empty out of the pouch, and the feeling of fullness is sustained.
"It works wonderfully with solid foods, but it does not work with fluids at all - so if you eat soup it will go right through you," Kaplan added. "If you drink supplements, they will go right through. If you eat solid foods, then drink water, it will empty the solid food out of the pouch like flushing a toilet."
He said his patients are taught not to drink fluids with their meals and to wait half an hour after each meal before taking a drink.
Gastric bypass patients reach their weight-loss goals twice as fast as banding patients - in about 12 months - but bypass patients also tend to fall back into their old habits and can regain all the weight they lost or more, Kaplan explained.
Banding patients, on the other hand, lose weight more slowly, typically reaching their plateau in about two years, but they're much more likely keep the weight off indefinitely, he said.
"The reason they keep the weight off is, number one, the band is always there and they can always get it tightened if need be, and number two, these people continually do follow-up, which is not required of gastric bypass patients," Kaplan said. "LAP-BAND is follow-up intensive. You have to see the doctor on a regular basis; you have to see the nutritionist on a regular basis; you have to see the nurse practitioner on a regular basis, and patients have to come to support groups every month. It's critical - and if you don't do the follow-up you will not lose weight."
Amigo agreed.
"The surgery only takes about an hour, but follow-up is extremely important with LAP-BAND," he said. "And the people who lose weight and keep it off are the ones who follow through with the program. When we initially talk with patients, they must be willing to commit to a long-term follow-up program or the operation isn't going to work."
"It's not something that magically makes you lose weight... you have to take time and eat right and you have to exercise and it works," said Amy Boyles, 33, a Williamstown resident who underwent the LAP-BAND procedure in 2008 as Amigo's patient.
Amigo said LAP-BAND patients can start eating regular foods four weeks after the surgery.
"Beginning at five weeks after the operation, I start seeing the patient on a regular basis to see how they're doing and to determine if the band needs to be tightened or loosened," he said.
The band can be made tighter if a patient is eating too much or loosened if the patient is uncomfortable or not getting enough nourishment.
"I always notice when I'm starting to eat bigger portions, and I realize I need to get (a saline fill of the band) done... if my portion size gets bigger, I need to get (a fill) done," Boyles said.
Kaplan explained that gastric bands are tightened by adding saline fluid through a nipple-shaped plastic port, placed just beneath the skin, into a catheter that is attached to the band. The band can also be loosened by removing some of the saline.
"For example if a patient gets pregnant I can remove the fluid to let her eat during pregnancy, then fill the band up again after she delivers," Kaplan said.
Amigo also noted that a banding patient with a case of the flu may need to have the band loosened until the illness is passed.
Kaplan said gastric bypass can be done with minimally invasive surgery, but statistics still indicate a mortality rate of about 0.5 percent within the first 60 days after the operation.
"But the mortality rate for (gastric banding) is 1 in 13,000 - about the same as for gall bladder surgery," he said.
Costs for LAP-BAND surgery range from $15,000 to $20,000. While many insurance companies cover the operation, there are strict guidelines that must be followed.
Kaplan said insurance companies require a six- to 13-month wait prior to undergoing gastric banding operations. During that time, all patients must make a genuine effort to lose weight through diet and exercise.
"We really emphasize this. It's cheap, it's safe, it's proven, and it is the way to lose weight," he said. "Unfortunately it only works for about 5 percent of the population, so 95 percent of us will fail to lose a significant amount of weight with a diet and exercise program."
Patients must also qualify for the surgery based on several factors that may include age, body mass, being 100 pounds or more overweight for more than five years and inability to lose weight through diet and exercise.
The surgery is generally performed on patients between the ages of 18 and 60. But anyone considering the process should first consult with their primary care doctor.
Shields did nine months of research on gastric banding before she decided to have the surgery done.
Her procedure took less than two hours, and the next week she was back at work and teaching Zumba lessons.
"Now it's been a year, and I'm only 9 pounds from reaching my weight loss goal," she said. "I would tell anyone considering LAP-BAND that as long as your mind is firmly set to make this work - go for it."
