Stomach Restricting Surgery Poised to Expand

Posted By elissa on Dec 10, 2010 | 5 comments

… thanks to an FDA advisory committee which voted in favor of changing the guidelines for using Allergan’s Lap-Band device. The New York Times has the story:

A federal advisory panel Friday endorsed an expansion of the use of Allergan’s Lap-Band stomach-restricting device to patients who are less than severely obese.

The vote could pave the way to double the number of Americans who qualify for weight-loss surgery. And it could eventually lead to making other types of weight-loss surgery available to those who are not quite as heavy.

…The advisory committee to the Food and Drug Administration voted 8 to 2 that the benefits of Lap-Band surgery exceeded the risks for patients in the lower range of obesity. It voted 8 to 2 that the device was safe, and 8 to 1, with one abstention, that the device was effective.

…A person who is 5 feet, 5 inches with hypertension must weigh at least 210 pounds to qualify for surgery now. Under the proposal endorsed by the committee, that person would have to weigh only 180 pounds.

…Allergan, which is known mostly for Botox, hopes that expanding use of the Lap-Band to less obese adults — and also eventually to teenagers — will spur sales. Sales of its obesity products, mostly Lap-Band, fell 4 percent to $182.4 million in the first nine months of this year, a decline the company attributed to the weak economy. But obesity products make up only 5 percent of Allergan’s overall product sales.

Shares of Allergan rose 52 cents, to $68.80 in regular trading Friday. The shares rose 3 percent, to $70.89 in after-hours trading, following the panel’s vote.

Lately, I’ve been of two minds regarding weight loss surgery. On the one hand, it’s certainly not a cure-all (ask Carnie Wilson about that). In addition, it’s expensive, invasive, and has the potential for complications/side effects (including chronic malnutrition). On the flip side, procedures have improved and, in truth, surgery has the best (or at least the best-documented) record of success of all weight/fat loss approaches. There are plenty of people with stories like Tammy Miller’s – so it’s tough to condemn it from a practical perspective (however much I’d like to…).

Still, I find the Times story a tad creepy. While people should be free to make their own medical decisions, it’s not hard to forsee a future where surgical weight loss is hyped just like fat loss supps are. The financial incentives are too compelling, as this 2009 article makes clear:

Venture capital firms are increasingly backing bariatric ASCs, and the two makers of surgical devices for gastric banding procedures are engaged in “fierce competition,” a formula that’s turning a “once-controversial weight-loss procedure into the next big thing in elective surgery,” according to a recent Wall Street Journal report.

“We are just at the beginning of major marketing campaigns for laparoscopic banding by two very large medical device companies, and I think it’s going to have very potent affects on healthcare and ASCs and on how we treat obesity surgery,” says Dr. Sasse. “In a few years’ time, the idea that 100 million Americans qualify for outpatient laparoscopic band weight-loss procedures that are safe, private, non-invasive, effective, easy and relatively affordable will be much more accepted.”

…Dr. Sasse follows up by noting that primary care physicians need to be brought into the care loop, because that’s where the “marketing” of a weight-loss surgery program begins.

“Bariatric surgeons have to teach primary care physicians about what they offer and about the vocabulary for talking to their patients about this issue without sounding judgmental,” he says. “Some patients might be angry and defensive, but others will be very, very receptive.

Patients need to come before profits… but this certainly isn’t always the case, and I’m afraid that changing the criteria could muddy the waters even more.