Laparoscopic Associates of San Francisco

New FDA endorsement on lowering the BMI range for weight loss surgery

December 13th, 2010 Posted in Bariatric surgery, Lap-Band, LapBand, weight loss surgery

I came across this blog post last night. It’s the first thing I have read that hasn’t been supportive of the FDA’s decision on lowering the BMI range for weight loss surgery. I was surprised and wonder if this is a popular opinion.


Nicole Kimbrough


Here’s the post from

Last week, a U.S. Food and Drug Administration advisory panel endorsed the expanded use of Lap-Band weight-loss surgery in less-than-the-severely obese. If approved by the full F.D.A. — as these recommendations usually are — the number of potential patients eligible for the procedure could double.


Okay, where do I start?


Not surprisingly both Allergan, the company that makes the actual Lap-Band equipment, and representatives for bariatric surgeons, supported this move. Currently Medicare and most health insurance companies cover the surgery for those with a body mass index (BMI) of 40 or over. If a patient has at least one other disease such as diabetes the BMI threshold is typically lowered to 35. But the findings presented to the FDA advisory panel, based on a study of 149 people, showed benefits for those with a BMI of 35 and no other health problems, and 30 for those with a related disease.


That means, as the New York Times put it:

“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.”


Costs for the Lap-Band procedures vary between $10,000 and $20,000, never mind what happens to those who gain the weight back. That’s scary, especially as we get fatter. In 1995, almost half the U.S. population fell in the normal BMI range, while just over 15% were considered obese. By 2009, those in the normal range fell to about one-third of Americans, while obesity rates nearly doubled to 27%.


Those numbers should be enough to get anyone off their feed. But the reality is that obesity is a behavioral problem that manifests itself as a medical one. If an individual chooses to spend their own funds to achieve a BMI of 35 or more (I’m no supermodel by the way), they should similarly be willing to pay for the surgery and any of its long-term consequences. That should be sufficient to choke off the demand for the expanding range of medical weight-loss procedures. If, however, we find ourselves in the unfortunate case where “insurance” — that is, other peoples’ money — covers the cost, there’s no limit to the amount we could eventually be spending on Lap-Bands.


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