Allergan, the makers of the Lap-Band, has been in the news lately. They recommended to the FDA that the Lap-Band be approved for use in patients with a BMI as low as 30 kg/m². The FDA panel voted to recommend the Lap-Band for use in these patients. The vote was 8-2.

Currently, the Lap-Band is approved for use in patients with a BMI of 40 kg/m², or 35 kg/m² with co-morbidities. The new recommendations would allow use in patients with a BMI of 35 kg/m², without co-morbidities, or of 30 kg/m², with co-morbidities.

While expanding bariatric surgery to less-obese patients could be a positive change, the Lap-Band should not be the only surgery approved. The Lap-Band has the least promising statistics for excess weight loss, and there is no reason to suspect that it would be more effective in less-obese individuals.

A study evaluating the Lap-Band for patients with a BMI over 40 kg/m² found that “approximately 20% of patients were able to lose at least 50% of their excess weight by 3 years, and 10% lost 75% of their excess weight.” In other words, at three years post-op, 80% of Lap-Band patients had not lost even 50% of their excess weight. I’ll use myself as an example. My pre-op weight was 285, and my ideal weight is 160. So, before surgery, I had 125 pounds of excess weight. If I had chosen the Lap-Band, statistically I could expect to lose less than 62.5 pounds. I would still weigh at least 222.5. That would put my BMI at 30.6, which is still considered to be obese. In fact, I would still qualify for Lap-Band surgery under the new recommendations, as I’m sure we would have been able to find a co-morbidity.

Even the manufacturers admit the limitations of the Lap-Band:

The treatment of severe obesity with respect to long-term weight loss is less than that of other bariatric surgical procedures, but substantially better than traditional behavioral or medical therapy.

Apparently, we should be satisfied and settle for a solution that’s a little bit better. Sure, the Lap-Band won’t help you lose all your excess weight. Sure, it has a higher reoperation rate than other bariatric surgeries. But it’s better than diet and exercise!

That’s not good enough for me, and it shouldn’t be good enough for you, either. Why not offer better options to obese patients? Why not approve the vertical sleeve gastrectomy (VSG) for patients with a BMI under 35 kg/m²? Like the Lap-Band, the VSG is a restrictive-only procedure that does not involve malabsorption. However, the VSG appears to be safer and more successful than the Lap-Band. Unfortunately, no manufacturer stands to benefit from approving the VSG for use in the less-obese. At least, that’s my cynical take on the situation. (Another fun fact: The chair of the FDA panel reported that she owns stock in Allergan, the company that manufactures the Lap-Band…)

In my opinion, the bottom line is that it’s promising to see obesity treatment expanded beyond the morbidly obese, but it’s disheartening to see only the least promising option offered.

Read more on the subject at Medscape.