Does a 30 BMI warrant Lapband surgery

You may have seen the recent announcement that the FDA approved lowering the BMI threshold to qualify for adjustable gastric banding, i.e. Lapband, surgery. Previously a person with one obesity-related medical condition such as diabetes needed to have a BMI of 35 or more. The new guidelines lower this to a BMI of 30 or more. For people with no obesity-related medical conditions, the threshold was lowered from 40 BMI to 35 BMI. As the result of this action, a larger number of the American population now qualify for Lapband surgery.

Let me put this into perspective. Today I am 5’7” 191 pounds with a BMI of 29.9. In 2008 at the time of my surgery, I was 256 pounds with a BMI of 40.1. The 35 BMI threshold was 224 pounds at that time. This illustrates an interesting fact. Even after losing 65 pounds after surgery (87 pounds since the start of the pre-op diet), I could still qualify for Lapband surgery on a fat day when I cross over to 192 pounds.

I find myself questioning this decision since I find myself in a completely different place 2 ½ years after surgery. I see myself as healthy. I exercise daily and eat a much better diet. I am not a skinny guy but also not a chubby guy. I guess I am a man with just a little more to love. I would in no way consider myself a candidate for weight loss surgery.

I have noticed that this FDA announcement has been a hot topic in the weight loss community. I see people with tweets about it. Obesity Help and other weight loss surgery forums are abuzz with differing opinions. Those who were on the edge of qualifying before are ecstatic on being suddenly within the safe boundaries of qualification. Others question the need for weight loss surgery at the new low end of the weight qualifications.

Let’s look at two of the most convincing opinions that say the new lower BMI requirements for Lapband are just a bad idea. The “easy way out” argument is in play here. It is a good argument that a proper diet and regular exercise would help people in this weight range lose that excess body weight. The other sound argument on this side is that any surgery has a risk. Is the benefit of losing 40% of excess body weight worth any of the risks of surgery?

On the positive side supporting the lower BMI, the fact that Lapband surgery is very safe and relatively unobtrusive demonstrates that the benefit could outweigh the risk. The ever increasing American waistline and increase of obesity related diseases such as diabetes and heart disease show the need to reduce the weight of obese and near obese people to improve their wellness outlook. Is this the magic bullet?

So what is the answer? I tie my answer back to my personal situation mentioned earlier in this post. As I hover at 30 BMI, I am a pretty healthy guy. My surgeon, primary care physician and cardiologist are all ecstatic about my health and new lease on life. I think this taints this discussion because how I feel and live today is due to my weight loss surgery and the changes I MADE afterwards.

If a person with my BMI is chronically ill with heart disease or diabetes, I believe they could benefit from Lapband surgery. As with any weight loss surgery, people need to be qualified for surgery to determine if they are a “fit” and would embrace a new lifestyle rather than not change their bad eating and fitness habits. This evaluation identifies the person who would benefit from surgery. All weight loss surgery patients need to demonstrate a history of failure with weight loss before taking this big step. Surgery is not the easy way out and even the most unassuming surgery can result in complications.

Weight loss surgery is surgery. It is used to treat a chronic disease. It is not about appearance alone. People fail to understand that insurance approval is based on improving an individual’s heath and reducing the risk of insuring the person. Insurance companies are looking to keep you healthy to reduce the expense of maintaining you as a customer. This will be the test of these new guidelines. Insurance companies may chose to not cover individuals who fit in this new range. They have no obligation. I think we will see resistance to pay for these surgeries unless a substantial case can be made for improvement in health. This will be an interesting subject to follow in the coming months and years.

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