When gastric band surgery was approved by the U.S. Food and Drug Administration in 2001, it was considered a key weapon in the fight against obesity. However, the band's popularity has slipped in recent years, dropping from 55,300 in 2011 to 25,060 in 2013, according to the American Society for Metabolic and Bariatric Surgery.
A first of its kind longitudinal study on gastric band procedures has shed light on why fewer people are choosing this weight loss device.
Researchers looked at data from 25,042 Medicare patients who underwent gastric band surgery between 2006 to 2013 to see if they needed additional procedures in years following. The researchers from the University of Michigan found that 18.5 percent of these patients had to have additional procedures or "reoperations" to remove or replace the gastric band or to undergo another procedure like gastric bypass. On average these patients had 3.8 additional procedures after their initial surgery.
“Taken together, these findings indicate that the gastric band is associated with high reoperation rates and considerable costs to payers, which raises concerns about its safety, effectiveness, and value,” the authors wrote. “These findings suggest that payers should reconsider their coverage of the gastric band device.”
Dr. Andrew Ibrahim, the study's lead author, said, “The study underscores the importance of tracking our new procedures longitudinally. It’s amazing that it’s been 16 years and now we have our first longitudinal study."
The gastric band is designed to work by reducing the size of the opening of the stomach pouch to decrease feelings of hunger. The procedure is less invasive than a full gastric bypass, where the stomach is cut and reshaped. As a result, it does not require a lengthy hospital stay, according to the American Society for Metabolic and Bariatric Surgery.
However the ASMBS finds that it is less effective than other, more invasive gastric procedures, with a "greater percentage of patients failing to lose at least 50 percent of excess body weight compared to the other surgeries commonly performed." The organization points out that the band has the "highest rate of reoperation."
The costs for these additional procedures were substantial. Medicare paid a total of $470 million for gastric band-associated procedures during the study. Nearly $224 million of these funds were for reoperations.
The researchers found that the mean cost for an initial operation was $12,345. But the mean cost for additional procedures was $19,657.
By 2013 the proportion of money Medicare spent on re-operations far outstripped the money spent on the original operation. By 2013 77.3 percent of annual spending on gastric band devices was for re-operations. Ibrahim and the other authors said the study can help payers better understand the downsides of gastric band over other procedures.
“A device where half the money is being spent to revise or remove it should prompt us to question whether we should use it," Ibrahim told ABC News.
Dr. Alia Hassanali is a resident in the ABC News Medical Unit. She is completing her family medicine residency at Emory University in Atlanta, Georgia.