July 10, 2012 -- For the Scafuri family, weight loss has been an experience in family "banding."
Dr. Frank Scafuri, a primary care physician in Staten Island, N.Y., has been obese since childhood. Two years ago, the 5-foot, 10-inch 39-year-old weighed 360 pounds. He also had high blood pressure and diabetes.
"I couldn't live like that anymore," he said. "My ankles were hurting, plus, how am I going to tell my patients to lose weight when I have a weight issue?"
But he's not the only one in the family who struggled with weight. His younger sister, Jennifer, said she was also an obese child.
"In the sixth grade, I weighed 180 pounds," said Jennifer, a nurse practitioner at NYU Langone Medical Center. Her weight peaked at around 300.
After years of yo-yo dieting, Frank finally got fed up with losing weight, only to gain it all back and then some. He decided to have gastric banding surgery.
He had the surgery in July 2010 and has already dropped 135 pounds. After seeing his success, Jennifer decided to have the same procedure -- followed by their younger brother and Frank's wife. Their mother will soon follow and have the surgery later this year.
Jennifer has lost 70 pounds so far, and said she hopes to lose another 30. Like her brother Frank, she did lose quite a bit of weight in the past -- 100 pounds in her early 20s -- but was unable to keep it off.
"I must have lost and gained about 10 people in my lifetime," she said.
The procedure helped the four family members lose quite a bit of weight, but Frank and Jennifer say the key to keeping it off and staying motivated is family support.
"We come from a big Italian family," Jennifer said. "My mother likes to feed us. We go to her house and there are maybe 10 of us, but she'll cook for 25.
"Now, there are four of us asking her to not make as much food, or to cook healthy foods."
Bariatric surgeons say gastric banding and other procedures are very effective for weight loss, and the family support can bolster efforts and keeping off the pounds.
"It's a terrific and healthy way to lose weight. The family unit is making dietary and behavior changes together," said Dr. Christine Ren-Fielding, the Scafuris' surgeon and founder of the NYU Langone Weight Management Program.
Not An Easy Fix
But they also warn that these procedures are not for everyone and should not be taken lightly. As with any surgery, there are risks involved.
"Having surgery is not easy at all. It takes a lot of courage to admit you have a lot of problems with your weight and to be put under general anesthesia, and it's a lot of sacrifice to lose weight and have an adequate lifestyle," said Ren-Fielding.
Dr. Carson Liu, a bariatric surgeon in Santa Monica, Calif. has performed many successful laparoscopic banding surgeries, but said that for the surgery truly to work, people need to be committed to major lifestyle changes.
"People really need to change their way of eating and the types of foods they're eating," he said. "They need to exercise every day to maintain their weight loss."
In his practice, he said about 10 percent of patients lose 20 or 30 pounds, but then lose their motivation to continue.
"They could have dieted that off," he said.
Patients should also do their research and discuss the options with their doctors. They should also be sure they seek out a reputable surgeon. In December, the Food and Drug Administration issued warning letters to eight providers and one marketing firm for not providing enough information to patients about the risks of gastric banding surgery.
Without insurance coverage, laparoscopic banding surgery costs around $15,000 to $25,000, said Dr. Mitchell Roslin, a surgeon at Lenox Hill Hospital in New York.
Insurance coverage varies from company to company, he said. Medicare, for example, covers the surgery if a person has a body mass index of 35 or higher -- indicating severe obesity -- along with a medical condition that's related to their obesity. Surgery may also be covered when a person's BMI is greater than 40, considered morbid obesity.
In many cases, a person must have tried unsuccessfully to lose weight through diet and exercise for a certain amount of time before being approved for surgery by an insurance company. Being approved, however, is never a guarantee.
Weight loss after gastric banding tends to be more gradual. Other procedures are more invasive and involve anatomical alterations of the stomach or small intestine.
"There is a more intensive reduction in the capacity to eat with other surgeries, so weight loss is faster, but in the end, they reach the same weight loss," said Ren-Fielding.
Roslin places less faith in bands than the other doctors, saying that bands frequently need to be readjusted after their insertion because they are too tight. If the band is too tight, it can cause problems swallowing, which can lead to changes in the size of the esophagus.
"They also leave a lot of scar tissue and it's hard to do other procedures if the band is not successful with weight loss," he said.
While they disagree on the benefits of gastric banding, Ren-Fielding, Roslin and Liu all say weight loss surgery, while not for everyone, can help in ways that go beyond shedding the pounds.
"Weight loss surgery is no joke, but once you start with diabetes and metabolic syndrome, then you have to weigh the odds of the unknown risk of the progression of other diseases," Roslin said.
For Frank Scafuri, his band-induced weight loss led to his hypertension and diabetes being resolved.
In addition to Ren-Fielding -- his surgeon -- he said he has his family to thank as well.
"We'll support each other, text each other, cook healthy for each other and keep each other motivated," he said. "We're still eating partners, but we eat a lot less now."