By: Patrick Totty
An ad in the November 15, 2009, edition of Parade magazine may be the opening salvo in a campaign to push adjustable gastric bands as a weight loss aid to help overweight type 2s dramatically improve their symptoms or even go into remission.
The ad for the LAP-BAND AP® System from Allergan, Inc., shows a pretty, overweight, young woman saying, “If I lost the weight, maybe I could improve, or even resolve, my type 2 diabetes.” The ad text then discusses the product, which is a device that’s placed around the upper part of the stomach and slowly inflated to create a sense of fullness that comes on faster and lasts longer than without the band.
By eating less, a patient fitted with the band can lose a large amount of weight without needing to resort to diets or sheer willpower. The benefit for type 2s is that dramatic weight loss often causes diabetic symptoms to lessen or even disappear
The band, which can be placed in an outpatient procedure, has an advantage over gastric bypass surgery in that it doesn’t involve cutting and stapling. This means that the band can be removed relatively easily or adjusted post-procedure without intrusive surgery.
The ad is careful to note that even though the pretty young woman is contemplating how the band might help her type 2 diabetes, doctors cannot currently recommend the band solely as a diabetes-specific treatment. Instead, the ad’s fine print states, “The LAP-BAND System is indicated for use in weight reduction for severely obese patients with a Body Mass Index (BMI) of at least 40 or a BMI of at least 35 with one or more severe comorbid conditions, or those who are 100 pounds or more over their estimated ideal weight.” The “comorbid conditions” cited can include diabetes, which is the “in” that the doctor of an overweight type 2 patient could use to recommend the band.
There are other fine-print warnings that take some of the glow off the procedure. Though it is done on an outpatient basis, insertion of the band is still considered major surgery, with the risks that surgery entails. Weight loss from the band is more gradual than with gastric bypass surgery, and patients fitted with it must still follow certain dietary requirements. Pregnant women or women trying to become pregnant are advised not to consider the procedure, and well as people who use aspirin or other anti-inflammatory oral drugs.
Parade Magazine, a Sunday newspaper supplement with a nationwide circulation of 33 million, attracts a varied viewership with its combination of celebrity gossip and interviews, recipes, health and lifestyle articles, cartoons, and inspirational stories. That in turn draws such mainstream advertisers as General Motors, Honda, Hewlett-Packard, Dell Computers, Campbell’s Soup, and Merck & Co., Inc., makers of the type 2 drug Januvia.
Consequently, inserting an ad that links the band insertion procedure with treatment for type 2 diabetes is a big step toward getting three distinct constituencies to begin thinking of gastric bands as a viable therapy: doctors, type 2s, and insurance companies.
A clamor-or at least an advocacy-for such a treatment could also create pressure to “move the goalposts” and amend the required BMI figures downward to accommodate type 2s who are overweight, but not severely so. The current requirement for very high BMI’s insures that remissions in patients with diabetes who undergo the procedure are happy incidentals, not the goal.
Previous discussions of gastric bypass surgery and gastric banding have noted that the remission rates among type 2s who’ve undergone the procedures have been dramatic-up to 92 percent in some studies. But even though the procedures amount to a proven means of dealing with type 2, there is still a lot of ground to cover before doctors or insurance companies will recommend and support them routinely.
For one thing, nobody knows what adverse long-term effects might arise in the wake of the procedures. Also, nobody is quite clear on why banding the upper part of the digestive tract can have such a dramatic effect on diabetes. How are the two related? It’s much like how people learned to use willow bark to treat fever and inflammation long before they knew that the bark contained salicylic acid-aspirin. Knowing that something works often comes well before knowing how and why it works.