Gastric banding: Pros and cons of Christie's surprising choice

New Jersey Governor Chris Christie's choice of gastric banding has prompted questions about why he opted for a weight-loss procedure less favored by bariatric surgeons and patients.

Lap-Band stirred excitement a decade ago when the anti-obesity device was introduced in the United States. The adjustable silicone cuff filled with saline is placed around the upper part of the stomach. That creates a small pouch less than 1 inch across that limits how much food one can consume at a sitting. The patient also feels full sooner, and can thereby shed weight.

In early 2011 the U.S. Food and Drug Administration extended the approved use of Lap-Band to include use by some people who are barely obese. At the time, manufacturer Allergan Inc, better known for its Botox wrinkle treatment, said the new criterion would make 26 million Americans eligible for the product.

The company's high hopes were quickly dashed, however, when sales plunged from almost $300 million in 2008 to $160 million in 2012 because of concerns about Lap-Band's effectiveness. Most studies find that although some gastric-band patients lose 100 pounds or even more, in general gastric bypass produces more, and more enduring, weight loss. Allergan is now trying to find a buyer for the product line and earlier this year said it considered Lap-Band a "discontinued operation.

Another important reason for Lap-Band's decline is growing evidence that a form of bypass surgery called Roux-en-Y may be more effective in treating type 2 diabetes, which typically develops in adulthood and is linked to obesity.

Christie has not explained why he chose banding instead of a bypass, but experts who were not involved in his case pointed out several possibilities, including that he may not have needed to treat diabetes. In the past, Christie has described himself as healthy despite his weight.

"If he didn't have any other medical problems, that could have come into the decision-making," said Dr Jaime Ponce, president of the American Society for Metabolic & Bariatric Surgery.

Lap-band surgery, also referred to as laproscopic adjustable gastric banding, is one of the most common surgical weight loss procedures. In fact, it is only second in line as the most commonly performed weight loss surgery, following gastric bypass surgery. For this type of surgery, a doctor puts a silicone band around the upper portion of the patient's stomach. With the lap-band in place, the stomach's capacity is reduced to about 1 oz. of food. A saline solution runs into the band, allowing it to be tightened or loosened, altering the stomach's capacity.

Potential

One of the major pros of lap-band surgery involves potential weight loss. According to the Consumer Guide to Bariatric Surgery, patients who undergo lap-band surgery lose an average of about 50 to 60 percent of excess weight. While this is a significant amount of weight, it's important to keep in mind that the results from this and other types of weight loss surgeries vary.