Chris Christie's weight-loss procedure doesn't always work
All eyes will be on New Jersey Gov. Chris Christie since he revealed that he's had gastric-band weight-loss surgery. Just how many pounds he might lose remains to be seen.
The Lap-Band, or gastric band, that Christie has placed around his stomach 10 weeks ago poses the least amount of short-term risk compared to other weight loss procedures like gastric bypass and sleeve gastrectomy, and patients have a quick recovery, experts say. But the bands, declining in popularity among U.S. patients, also yield the least amount of weight loss, experts say.
“I would say of the operations we offer, Lap Band has the lowest average weight loss and the highest amount of people who are dissatisfied with their weight loss,” said Dr. Mitchell Roslin, chief of bariatric and metabolic surgery at Lenox Hill Hospital in New York.
On the plus side, said Roslin, who was not involved in Christie’s care: “It has the lowest early complication rate” and has patients “going back to work immediately.”
Still, once patients reach a certain weight, surgery is the best answer, experts say.
“I think anybody who makes a decision to have weight loss surgery, at his weight, is making the right decision because they’re going to live longer,” Dr. Janey Pratt, director of the Massachusetts General Hospital Weight Center, said, referring to Christie.
“When people get to the size of people like Gov. Christie, it’s absolutely impossible for them to maintain weight loss that’s significant without surgery,” Roslin said.
Christie had the procedure on Feb. 16, and has not disclosed any information about his weight before or after the procedure. The silicone band goes around the upper part of the stomach and is tightened to force patients to eat slower and feel fuller faster. But it doesn’t create changes like the other surgeries do to control hunger, both doctors said.
“You’re less likely to lose as much weight with a band as with bypass or have resolution of medical problems with a band, but the 30-day complication rate for a lap band is one-half the 30-day complication rate for a sleeve or bypass,” Pratt said.
“I may not have chosen a band for him because he’s significantly overweight,” she said of Christie. “I might have chosen a bypass or a sleeve gastrectomy. The patient has to want it. It’s a personal decision.”
Roslin said gastric band procedures have dropped about 30 percent in the last few years in favor of the sleeve procedure. “I’ll take out way more bands than I’ll put in,” he said.
The average one-year weight loss from a lap band is 7 body mass index points, whereas a gastric bypass cuts an average of 15 BMI points in a year, Pratt said. That translates to about 50 pounds for a band and 100 pounds for gastric bypass.
While some lap band patients continue losing weight in the second year after surgery, this type of weight loss surgery has the widest range of results, Pratt said. Some patients, she said, may lose 100 pounds in the first year, while others may not lose anything.
“In some patients, it doesn’t work at all,” Pratt said. “Some patients lose no weight and some lose all of their excess weight. There’s been no way to figure out who is going to lose that weight and who is not.”
Roslin offered a similar assessment, saying the jury is still out on the effectiveness of gastric bands. “There are some people who do phenomenally well with bands and some people who don’t,” he said.
The procedure takes less than an hour and is usually done on an outpatient basis, Roslin said, adding that patients can resume their normal routines when they feel up to it. Bypass and sleeve patients usually spend a night or two in the hospital, he said.
“The beauty of the band is the rapid recovery,” he said, calling it “absolutely fine” that Christie was back to work in a few days.
“The issue is living with it and the high amount of patients that require recurrent operations,” he said, for reasons like the band feeling so tight they can’t eat or too loose that they gain weight.
Christie is "the perfect candidate for the procedure," TODAY's Dr. Nancy Synderman said Tuesday. Unlike gastric bypass with [side effects such as] digestive problems and how people tolerate food, the biggest problem with gastric band surgery is "sometimes people don't lose weight."
But with a recovery plan including psychologists, nurses and dieticians, Snyderman predicts that "he will do extraordinarily well."
As the fat melts away from very overweight patients, sagging skin can be a problem. Patients who lose 100 pounds or more might require plastic surgery because the skin doesn’t bounce back to its original state after massive weight loss, Pratt said.
“The skin is like an envelope,” she said. “When you empty the envelope, it’s still hanging there.”
Sagging belly skin can hang down on the upper legs and cause rashes that are hard to control as well as painful open sores, she said.
About 10 percent to 15 percent of surgical weight loss patients undergo plastic surgery to remove the sagging skin, Roslin said. The surgery is often not covered by insurance, and Pratt said a full body lift could cost about $30,000.
“If they’re not covered by insurance and the patients are on Medicare or Medicaid, it doesn’t really work,” Pratt said.
Most patients deal with the excess skin by wearing shapewear garments, using powder to prevent chafeing or just ignoring it.
“It depends on their body image, their psyche,” Pratt said. “Many patients who have weight loss surgery just wear Spanx and don’t worry about it. It depends on them. In the grand scheme, it’s a minor issue.”