Published on December 07, 2010

Early Intervention for Obesity with Weight Loss Surgery

MEMPHIS, Tenn. - Obesity is occurring in epidemic proportions. Memphis is a melting pot for the four most overweight states in the country; Mississippi, Alabama, Arkansas and Tennessee. Not only is our adult population at risk but the pediatric obesity rate is growing rapidly. It would be easy to say 'it's their problem; just tell them to stop eating.' However, it is more of a societal issue and we can't ignore its reality.

Surgery is an option only for those who have tried other methods and have not been successful at losing weight and keeping it off. Simply losing a few pounds is meaningless, and surgery is never a first option.

The majority of weight loss surgery performed in the United States consists of three procedures; the Lap Band, gastric sleeve and the gastric bypass. The most common procedure performed in America is the Lap Band. The Lap Band is preferred due because it provides excellent weight loss and has fewer major complications compared to the other procedures. It is the only reversible procedure available in the United States. All bariatric surgeries have major risks. Surgery only works when it is coupled with a person willing to change their lifestyle.

Our healthcare system is overburdened by the obesity epidemic and by complications that obesity causes. Health care providers who deal with obesity on a regular basis believe that early intervention with surgery can help patients lead healthier lives and relieve a major burden on our healthcare system.

The Lap Band has proven to be remarkably safe and effective. It helps patients lose weight and become healthier individuals as they make lifestyle changes that include smaller portions, a reasonable low-fat diet and regular exercise. It helps patients achieve their goals by giving feedback when they have had 'enough' or an appropriate portion - often their most difficult realization.

Many patients seek help only after developing severe comorbid conditions such as advanced diabetes, high blood pressure with secondary heart complications, joint deterioration requiring major orthopedic surgery, hypertension, sleep apnea and so on. We know that both our patients and our healthcare delivery system would benefit if we could help patients lose weight at an earlier stage and potentially avoid those severe complications.

We already know that 97% of individuals, once they become at least 75 pounds overweight or have a BMI >35, will not be able to lose any significant weight and keep it off long term without the help of surgery. The Lap Band has proven to be a safe and effective product in hundreds of peer reviewed publications in treating this population. The success of surgery is not debatable. The simple fact is that close to 100% of severely obese people will develop complications without significant weight loss. Even if surgery does not lead to significant weight loss in every patient, it is a remarkable treatment option that has no peer.

By approaching obesity at an earlier stage, we will be able to treat patients before they develop many of their problems and before many of their existing problems result in major complications requiring surgery such as coronary artery bypass and joint replacement, or result in major lifestyle handicaps such as immobility, non-productivity and ultimately disability.

To qualify for weight loss surgery presently, patients are to weigh at least 100 pounds above their ideal body weight (BMI > 40) or weigh at least 75 pounds above their ideal body weight with an associated comorbid condition.

The early intervention trial targeted less obese patients with BMIs between 30 and 40, or being 50 to 100 pounds above their ideal body weight, and has clearly shown that the Lap Band is an effective and safe procedure to help these less severely obese patients reliably lose weight.

The FDA trial, which has been discussed nationally, was primarily performed at Baptist Memorial Hospital-Memphis. The early results were presented to the FDA and were felt to be worthy of extending criteria for weight loss surgery. We have now completed three years of this study and the results have only become more powerful and impressive.

The early intervention trial specifically addressed the Lap Band and the FDA ruling recommended lowering criteria for the Lap Band, not other bariatric surgical procedures.

Without real action to address our national and local obesity epidemic, our healthcare communities will be further overburdened. Life-threatening obesity complications will further siphon our insurance delivery systems resources, and the taxpayers will ultimately be burdened with a growing community that will need more complex and more costly treatment.


Terms used include: morbid obesity = 100 pounds over ideal body weight or BMI >40, severe obesity = 75 pounds over ideal body weight or BMI >35, obesity = 50 pounds over ideal body weight or BMI >50.

Dr. George Woodman is a general and bariatric surgeon who has performed more that 3500 minimally invasive bariatric surgeries in the Mid South. He is director of the bariatric surgery Center of Excellence at Baptist Memphis.

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