Backstage Pass, Part 2...

                                                                                                     Photo by M Clock

   Banding is a kind of enigma.

   There are Bariatric Surgery practices that are almost exclusively Banding practices, offering few, if any other options.  There are leaders in the field of weight loss surgery that are staunchly opposed to Gastric Banding as an acceptable procedure.  Emotions flow on both sides.

  Practically speaking, it works, but as in most medical interventions that require a behavioral input from the patient, the results can be variable.

   So, for Diabetes,  the major drawback is that without any transection of the stomach, or intestinal malabsorption, there is no immediate metabolic benefit to placing the band, as does occur perioperatively with a Sleeve or Bypass.  The upside is potentially less complications, no staple lines, outpatient-type of  length of stay, and likely less micronutritional deficiencies as the procedure is only restrictive, and not malabsorptive.  Further, the downside of that is a slower (1-2 # / week) weight loss, vs. more drastic weight changes early on with the other procedures.

   Even so, weight loss is weight loss, and with the 10% weight loss requirement we have before surgery, and the attendant weight loss after surgery, especially if coupled with appropriate changes in dietary content (more protein, less CHO) and volume / portion size, easier regulation of blood sugars  will usually be seen early in the post operative period, just not in the immediate postoperative time frame.  Medicines for Diabetes are often steadily reduced in the preoperative weight loss phase, and monitored to be reduced in subsequent post surgery visits as we adjust the band for optimal restriction.

   Studies have been done on looking to find the optimal patient for a Band, and there really is no consensus that can be drawn from them.  They have looked at BMI, socioeconomic status, dietary practices, and psychological profiles. Some suggest this may be the best approach for a surgical treatment of adolescents, avoiding more 'irreversible' surgical methods, while potentially reinforcing proper dietary habits.  This is experimental at this time and not FDA - approved.

  The other way to look at the lack of a clear cut patient profile that is likely to succeed is that anyone is as likely as another to succeed that applies themselves and follows the rules of proper diet and followup with adjustments as needed.  It is easier to 'beat the Band' than the other procedures if the patient does not comply with regular follow up and adjustments, but most that do adhere to the rules usually do well.

   The FDA did approve last year an indication for Gastric Banding starting in the 30-35 BMI range for a patient with Diabetes, although insurance companies have been reluctant to approve this, and it usually requires a case review, but may be approved on an individual basis. Traditional NIH criteria, as you are likely aware,  starts at 35-40 BMI with comorbidities to qualify for surgery.

    This may be a nice niche for the Band in Diabetes - catch it early, reduce a mild amount of weight, and maintain that balance of weight and insulin sensitivity for a prolonged amount of time.  Success!

   In the third and final part of this Band discussion, I will focus on the practical standpoint of side effects and complications from Gastric Banding.