The Internet is a-buzz today with news that New Jersey Governor Chris Christie underwent secret (how juicy!) weight-loss surgery back in February, at the urging of his wife and kids. And so he did: On February 16th, Christie underwent a lap-band procedure, the New York Post reports, which “included placing a silicone tube around the top of his stomach, where it restricts the amount of food he can eat at one time and makes him feel fuller, faster.” Yum.
As pudding proof, the governor told the Post that he recently went to a steakhouse and ordered a steak, but only ate a third of it and felt full—so I suppose the surgery is working. He hasn’t confirmed how many pounds he’s actually lost in the past three months, but unnamed sources peg it at around 40 pounds.
I talked to Einstein’s director of bariatrics, Ramsey Dallal, to find out how the lap band works and what the gov can expect from here on out.
How often do you perform lap-band surgeries? What kinds of patients are right for this particular procedure?
The lap band was FDA-approved in 2001. The advantages are that it’s reversible; it has one of the lowest complication rates; it’s less invasive, because it’s usually an outpatient procedure; and it’s effective, compared to diet and exercise alone. However the results are variable, so it’s hard to predict which patients will do well with a lap band and which won’t do so well. The results are also a bit delayed, so you don’t see the dramatic drop in weight right after surgery. Because of these factors and the fact that there are other weight-loss methods that interest surgeons and patients today, lap bands went from 23 percent of all weight-loss procedures in 2008 to about 4 percent today. The ideal lap band patient is one who says, “I know how to diet and exercise, I’ve done it before, but I don’t want to cut my stomach and reroute my intestines.” These patients wouldn’t consider the other operations.
How does it work?
The band is a plastic ring the goes around the top part of the stomach with a balloon in it. You inflate the balloon incrementally with saline over the course of several months. Inflating it is a quick two-minute thing once the ring is in there. The ring restricts the amount of food a patient can eat and makes him feel fuller more quickly. The process of getting the balloon inflated to the appropriate tightness takes some time, so the weight loss isn’t the most rapid right after surgery. It takes a couple months before the band is appropriately adjusted, and even after that the patient might come back every so often for an adjustment. Every patient has a different schedule.
Does the lap band stay in indefinitely?
Typically if you take the band out, patients almost always regain all their weight pretty quickly. So most patients leave it in.
How much does the procedure cost?
The lap band has been widely covered by insurance for about seven years now. Medicare covers the procedure, as well. So most patients only ever pay their copay, and that’s it. The procedure itself could run between $12,000 to more than $20,000, but again the majority of patients don’t pay that number.
Now that Governor Christie is three months post-op, is he out of the woods as far as complications go?
The complication rate is very low once the band is inserted. Complications this far out would include the band flipping out of position, which happens in 2 to 5 percent of patients in 10 years. Or it can cause dilation of the upper stomach and esophagus. So there are complications that can occur in the long term, but they generally are never life-threatening. They can be managed through the adjustment process, or by replacing or removing the band.
Are there restrictions on what lap-band patients can eat? Was Chris Christie’s steakhouse dinner a good or bad choice?
The best foods for the band are ones that make you feel full and keep you full for awhile. So bad foods would be milkshakes and ice cream that slide down the band and are high in calories. Mashed potatoes will go down the band and won’t make you feel full, either. Most people say breads and beef are difficult to eat after a band—they get stuck and won’t go down. Many physicians will tell patients to avoid or limit those foods.
What are the upcoming milestones he can expect?
Depending on his adjustment schedule, what you’re looking for is a weight loss of one to two pounds week. If you’re not hitting that mark, you need a change in your diet or an increase in the band through the adjustment.