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Body-mass standard lower for Lap-Band surgery

More people will soon qualify for laparoscopic gastric banding (Lap-Band) surgery, due to the lowering of the body mass index (BMI) standard for the procedure, the U.S. Food and Drug Administration (FDA).

Dr. Srinivasa Gorjala, medical director of the Bariatric Center for Southern Regional Health System, said that, in December 2010, the majority of the FDA panel approved allowing obese people with lower BMI measurements to use Lap-Band treatment for weight loss. The BMI standard was reduced from a BMI of 35 and above, to a BMI of 30 and above, he said.

According to Gorjala, the BMI of a person is a general number determined his, or her height and weight. "Once the FDA approved it [lowering of BMI], [health] insurance companies start approving it," said Gorjala. "It takes about six months ... Insurance companies work at their own benefit, and take their time.

"So what has happened is, it's made [the] criteria much looser, and more people are applicable to have the Lap-Band surgery to lose weight," he explained.

Gorjala added that July, most health insurance companies should approve it, and doctors will start accepting patients with a BMI of 30 and above for the surgery. Currently, the surgery is only approved for patients with a BMI of 35 and above, he said.

"No [health] insurance has approved it, as of yet," cautioned Gorjala, who has worked at the Bariatric Center for two years. In addition, said Gorjala, another criteria to qualify for the surgery is that individuals must have a medical condition related to obesity, including high blood pressure or diabetes.

Gorjala said it is less likely that an individual with a BMI above 32 will lose weight and keep it off through other means. "They're going to require help to keep the weight off, and that's where the band comes in," he said.

Gorjala said that during Lap-Band surgery, the "band" is placed near the stomach and below the esophagus. The junction creates a small pouch of about 30 cubic centimeters. The pouch is connected to a port, through a small inner tube below it. The port is affixed to the abdominal muscle, he said.

Gorjala said the hour-long surgery is not extreme, and is an outpatient procedure. Patients are required to rest for a week after the surgery is complete. After a patient heals, he said, he or she comes to the Bariatric Center where the band is tightened. As a patient progresses with the band, it is increasingly tightened over a period of time.

The Lap-Band forces patients to eat in very small portions, and allows them to feel full quicker, he said. If a patient eats too much, they will throw up, he added.

"So what happens when they eat this small amount of food, [the] pouch dilates and they feel full, they stop eating," he explained.

The band also allows a patient to lose a percentage of excess weight, he added.

For example, said Gorjala, if a person is 100 pounds overweight, he or she could lose about 50, to 60 percent of excess weight, which is about 60 pounds.

"What is great is they get better, medically," he said.

Gorjala explained that a "normal" BMI is anything below 25, and a BMI from 25 to 28 is considered overweight. A BMI of 30 is considered early obesity, he said.

"The FDA backed the idea for this ... so, for us, that opens up a huge load of patients," he said. "We assume we have about 5 million more patients [in the nation] that are qualified for surgery."

Gorjala said that once FDA's new standard is approved health insurance companies, it is estimated that the Bariatric Center will experience a 20-percent increase in Lap-Band patients.

Laura Jones, of Jonesboro, is a patient of Gorjala's, and had the Lap-Band surgery, on March 18, 2010. Jones said her obesity caused her to have numerous health issues, including Type 2 diabetes and high blood pressure. "I use to be really athletic when I was younger," the 53-year-old said.

Jones said she decided to have Lap-Band surgery because her health conditions worsened. She said her feet would hurt and she experienced back and leg pain.

She added that she was unable to keep up with her grandchildren. "Even with my husband, I just wanted to sit around and not do anything," said Jones.

She said she weighed 286 pounds and had a BMI of 45, but now she is 199 pounds with a BMI of 31. She said she is proud of making her first goal of losing 87 pounds, and will keep the Lap-Band for a lifetime.

She said she is 5 feet, 7 inches tall, and her ultimate goal is to weigh 165 pounds.

For more information, contact the Bariatric Center of Southern Regional Health System, at (770) 897-7546.