Women spend years trying to lose that excess weight through diet and exercise. And for many, it's to no avail. As a result, more and more people are opting for a more technical approach; lap band surgery, a laparoscopic, bariatric surgery for weight loss that places an adjustable gastric band around the upper part of the stomach, reducing the stomach pouch and restricting the amount of food that can be consumed.
Tracy Adams was one of those women.
"I dieted, I exercised, I went through different weight-loss programs -- nothing helped," Adams, of Mitchell, said.
After a visit with her family's physician, she found her health was at risk. She had high blood pressure and thyroid problems. Obesity and heart disease runs in her family -- her mom died at 62 from heart disease and her dad has had two heart attacks.
"I had two younger kids and I wasn't going to make that mistake and not do something about my weight," she said.
Adams started researching the Lap-Band system, and was pleased to discover that it was minimally invasive, meaning there are only several small incisions made through the abdomen during the procedure.
Dr. Michael Haley, a surgeon at Avera Queen of Peace Hospital in Mitchell, S.D., said bariatric procedures are increasing and the Lap-Band system has become a mainstay for weight loss. Avera Queen of Peace holds bariatric informational meetings throughout the year to inform people of the procedure, the cost and what to expect after the band is in place.
"In the past, people always talked about being overweight meant you failed to do what you were supposed to do -- mainly diet and exercise," Haley said. "It's not always that easy. We know it's a disease, not something we choose." Weight vs. Risks There are many risks to being overweight. As excessive weight is gained, there is a 40 percent greater risk of diabetes, Haley said. Also, there is an increased risk of hypertension, joint pain and sleep apnea, as well as an additional burden on finances. Haley said those who are overweight can spend an additional $700 in pharmacy costs. Over-the-counter medication costs, co-pays or outright payments for doctor visits and lab work all increase. Adams opted for the surgery and since her procedure three years ago, she has lost more than 75 pounds. It's been a total lifestyle change -- physically and mentally. "Mentally, your mind is trying to tell you something is changing," Adams said. "People look at you differently." Erick Hoffman of Sioux Falls, formerly of Ethan, S.D., agrees. Hoffman had the Lap-Band procedure in 2006. An athlete in high school, Hoffman routinely exercised but the weight just didn't come off. "I've been a pretty large kid all my life," he said. "My mom had (Lap-Band) surgery and it was a success."
Hoffman lost 90 pounds within his first year and has dropped approximately 100 pounds total. "It opened up a lot of doors for me, not carrying around 90 extra pounds," he said. Haley said those who opt for the procedure can expect to lose at least 100 pounds within the first year. On average, 49.6 percent of excess weight is lost in 48 weeks, and long-term, 55 percent of the body weight is lost, he said. Gastric Bypass Another popular bariatric procedure, mostly in years past, was gastric bypass. However, Nathan Hinker, a nurse practitioner at Avera Queen of Peace Hospital, said the Lap-Band procedure is less invasive and does not deprive the body of necessary nutrients. "They bypass approximately seven feet of the small bowel in gastric bypass," Hinker said. "And in those seven feet is where the vitamins and minerals are absorbed best." With the Lap-Band procedure, nothing is bypassed and patients still have all their intestines to absorb vitamins. Also, gastric bypass patients rapidly lose weight, dropping at least half of their total weight loss within six months of bypass procedure, Haley said. Such rapid loss can leave patients feeling weak and tired. The Lap-Band procedure provides less chance of complication during and after operation, as well as no stomach stapling or cutting during the procedure. The band around the stomach is adjustable and reversible. However, weight loss is at a slower rate and patients must have regular follow-ups with the doctor.
To qualify for the Lap-Band procedure, patients meet with their regular physicians, who determine if the patient is indeed overweight. Patients are considered overweight with a Body Mass Index of 35 or higher. The BMI is the ratio of height to weight. A BMI of 35 is considered severely obese. The total estimated cost for the procedure is $21,900 to $25,500. Patients must check with their individual insurance companies to determine how much of the surgery cost is covered. Haley said, however, that more insurance companies are including Lap-Band procedures in their coverage plans. If qualified for the procedure, patients will meet with a nutritionist and get accustomed to a healthier lifestyle before the band is placed around the stomach. Adams lost 20 pounds prior to the surgery, and already, she felt more energized. Does the procedure always work? No, says Kristi Riggs, who works at the Avera Queen of Peace Bariatric Center. Riggs said that although of all of the patients who undergo the Lap-Band procedure lose 50 percent of their excess weight in the first two years, the procedure is only a tool. The surgery even can have reverse effects -- weight gain -- if proper diet and exercise routines are not maintained. Also, the band can slip and allow for weight gain, but that happens in fewer than 2 percent of cases, Riggs said.
Food Restrictions The entire Lap-Band procedure takes about an hour. Recovery time after the procedure depends on each patient. Hinker said some go home the day of the surgery; others may leave the next day. Haley said it's important that patients do no heavy lifting after surgery, yet it's equally important for patients to begin walking immediately. After surgery, patients need to restrict their diets. For the first two weeks, doctors recommend a liquid diet -- clear broth, skim milk or fruit juice. Once solids can be consumed, they should be soft or pureed. Because the stomach is reduced, those that have the Lap-Band procedure only eat one cup of food per meal. The cup of food sits in the stomach and is a large enough portion to keep each patient feeling full and satisfied. "The food goes through the normal GI tract," Haley said. "The band just restricts the amount of food you eat." And many foods are off-limits. White bread, celery and steak are common foods that can get caught and plug the entrance into the stomach. Long-fibered beef can swell up once ingested and carbonated beverages should be avoided, too. Sodas can create gas bubbles within the Lap-Band port and cause bloating. For Adams, carbonated beverages were the hardest to eliminate.
"I had a Diet Pepsi fetish. I would drink six to eight cans a day and I quit cold turkey. I haven't had one since," she said. Adams said she just makes sure to eat slowly and chews each bit thoroughly, too, so she doesn't overeat and her port doesn't become plugged. Haley suggests pureeing meats and vegetables, allowing for easier digestion. "It's tough. I love steak. I was raised on a farm -- I'm a meat-and-potatoes girl. And I have to give that up," Adams said. Foods like fish and vegetables are easily digested with the Lap-Band system. And because less food is eaten, Haley said he requires patients to take a multi-vitamin to make up for loss nutrients. Although the Lap-Band aids in weight loss, it's still important to continue exercising after the surgery. "You don't lose weight immediately. It takes time. And even after you lose it you have to maintain it and not get back to the point of where you were," Adams said. Hoffman agreed: "If you work out, your results will double. I had some struggles with the weight loss when I stopped working out." Hoffman tries to do 30 minutes of cardio to keep his metabolism steady, as well as general weight lifting to firm up loose skin from weight loss. Patients can choose to have cosmetic surgery, but it's an expensive procedure, which Adams said, is often not covered by insurance companies.
"I do different weights and that's tightened up a lot of my extra skin, but I still have some, especially in my stomach area," she said. But no matter what, Hoffman and Adams said they recommend the procedure. "Your self confidence goes way up. You're not so scared to go out into public where there are a lot of people," Hoffman said. "It takes dedication. A lot of dedication," Adams said. But above all, Haley reinforces this to all considering the lap band procedure: "You need to be committed and know you want to do it."
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