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Selection Criteria

On the basis of the data reported above, and recognizing the contraindications described, we use the following 4 basic criteria for patient selection in Lapband® placement:

  1. BMI >35 or BMI > 30 with significant comorbidity .
    In the past, when performing RYGBP, we used BMI >40 as a cutoff due to the greater risk of the bypass. The safety of Lapband® surgery has been very high and therefore, over the past 10 years, we have used a lower weight cut-off value of BMI > 35.

    We have recently completed a randomized, controlled trial comparing medical therapy with Lap Band placement in people with BMI between 30 and 35. This trial has shown a major benefit in weight loss, improved health and improved quality of life for those having the Lap Band procedure and we are currently re-evaluating where the cut off should be. Certainly, for those with significant obesity-related diseases, such as Type 2 Diabetes, we are happy to use a cutoff of BMI >30. In the United States, BMI limits are still linked to the 1991 National Institutes of Health Consensus Report [14], which required a BMI >40, or a BMI >35 with 2 or more serious comorbidities.

  2. The presence of problems associated with the obesity.
    These may be medical, physical, psychosocial, or future health and life expectancy problems.

  3. A history of prolonged attempts at weight reduction by multiple means.
    In general, there should be evidence of involvement in multiple significant programs for weight loss.

  4. An understanding by patients of their role in ensuring a successful outcome, and the presence of realistic expectations of the possible outcomes, both good and bad.
    A successful outcome after Lapband® surgery requires a partnership in which both the surgeon and the patient have clear responsibilities. Both need to understand those responsibilities and have a commitment to do their best to fulfill them. The assessment of patients’ understanding of their responsibilities can come only after all the information has been provided and full discussion has occurred.
  
Patient Selection