Lap Bands R Us

The Diabetic Quick Fix

Here it is. The lap band. The billboards advertising them, the TV ads, they never actually show you one. Cute little suckers, aren't they? You just pinch them around the stomach, fill them full of water to restrict the space you can dump food into, and you're good to go.

I'm a nurse practitioner. I have patients with them. Yup, they work. At least, for awhile. Diabetes improves. But in my experience, diet, nutrition, and lifestyle are unchanged. Same with other types of obesity/bariatric surgeries. I have patients who had gastric bypass 10 or more years ago, a more drastic approach to weight loss. Guess what. They are obese -- again. They are chronically ill. Some of them have even had a second procedure, to no avail.Without personal change, will improvements gained through surgery be sustainable? I have my doubts.

Typical of Western medical approaches, we do not address the underlying issues. Maybe we're sick because:

1- Our food supply is polluted and nutrient deficient
2- Our eating knowledge base -- how to cook, what and how much to eat -- is full of holes or empty
3- Our culture values quantity over quality -- in food, in housing, in income, in material goods -- which in turn leaves us fat, stressed, chronically time-crunched, in debt, and unhappy

As everything and everyone around us grows larger, as we feel less and less control over our lives and health, passive solutions like a lap band offer the ultimate cure. Good grief.

We're facing an election. Health care reform is on the top of the agenda. So a study like this that promises relief for millions of people, can provide a peek into what needs to be reformed. While this was an Australian study, American doctors and health care institutions (who stand to make a shitload of money off surgical solutions) are lining up to extol the virtues of this possible 'cure'.

If lap bands can be a solution to diabetes, then let's take a closer look at the study, OK? On the face of it, people who had surgery did much better than everyone else. Here's the glitch: the study compared a lap bad to 'usual care'. For you non-medical people, 'usual care' is the fucked up management you get in the current health care system. What you get when you go to the doctor and s/he tells you, "sorry, you have diabetes". Right this minute, in clinics and doctor's offices across America, "Usual Care" is handing you a pamphlet on diabetes (usually written by a drug company), a glucose meter for 'free' (provided by the folks who want your money for supplies), writing you one or more prescriptions, signing you up for an hour with a diabetic educator (maybe), and wishing you luck. In other words, 'Usual Care" is crappy care, plain and simple.

In the world of the lap band-aid, no one pays to teach people who have diabetes or who are at-risk, how to eat. No one shows you how to shop for and cook healthy food. No one works with individuals and families long-term to help them sustain changes or develop healthier eating habits. Obesity is a family problem, not just an individual one. It's also a food-chain problem, where we subsidize high-fructose corn syrup and processed foods at the expense of fruits, vegetables, and healthy grains. The recently passed farm bill did almost nothing to encourage the growth of locally grown, affordable organic vegetables or healthier school lunches. We're going to grow the same junk and rave about how lucky we are to have cheap food.

The cost of a lap band is at least $15,000; other obesity surgeries cost even more. Sometimes health insurance covers it. Sometimes not. When is the last time an individual or insurer invested this kind of money in a 2 yr program to reduce obesity, diabetes and heart disease? Short answer: never.

In the NBC video the lead researcher states that an adult cannot lose over 20 pounds and keep it off. Unless of course, a surgeon puts in a lap band (wanna bet he's a surgeon?). Bullshit. Granted, it is much, much harder for morbidly obese adults to lose weight and keep it off. But the study participants were overweight, not morbidly obese. We, as a country, have made no effort from a public health perspective, to look at the system that creates and nourishes obesity (no pun intended). That system includes schools, family farms, industrial agribusiness, processed food purveyors, the goddamned Food Pyramid ...I could go on, but you get the idea. This is a cultural, societal problem and while lap bands may be a stop-gap, and necessary for some, we're in a world of hurt if we don't invest in systemic solutions. At the least, we need to help families learn how to feed their kids to fend off the obesity epidemic. How 'bout that?

As for classifying a lap band as 'first line treatment for diabetes', God help us.