Expert: John Pilcher, MD - 7/10/2007

Question
I am 19 years old and have been overweight my whole life. I am currently 237 and 5'2. I have been considering the lap band procedure because i heard that it is less painful and you don't end up with a lot of scars or sagging skin since the weightloss isn't as rapid as it would be with gastric bypass surgery. first of all is what i said true about lap band and do you think i would be a good candidate for this particular surgery. I went through all the steps on lapband.com  and they said i qualify but I'm not sure and my pediatrician will not recommend me because she is against surgical procedures for weightloss unless you have medical problems and i don't have any.

Answer
Brittany,
At the height and weight you described, it usually is medically sensible to proceed with surgical treatment for obesity as long as a couple of conditions are met first:
1)  You ought to have really tried non-surgical weight loss first.  Some few people can achieve sustained significant weight loss by diet and exercise - if you can do it that way it is a better option than surgery.
2)  You need to be well educated about the surgery, and prepared to undertake the lifetime habit changes needed to work with the surgery.  The information and preparation ought to come from the surgical program.
3)  Your surgeon needs to be sure there are no medical/physical problems that would interfere with surgery.  Fortunately, such problems are fairly uncommon in a 19 year old.

For your pediatrician, I propose two questions:
1)  Does she feel that your excess weight is an important medical problem?  (it has been clearly statistically proven that a BMI > 30 leads to a higher rate of severe medical problems, with a shorter life and more disease during that life - the fact that you don't have problems at this moment is a little beside the point because your body is suffering damage from the weight every day)
2)  If she accepts that the weight is a serious problem, how else would she propose to treat your weight?

Regarding your statements about Lap-Band:  it is true that Band surgery is the least painful bariatric surgical procedure.  However, I disagree with the idea that slower weight loss (Band) leads to less loose skin - I think the amount of loose/sagging skin depends on the total amount of weight you lose.  The factor in your favor for skin sagging is your young age - younger people usually have better elastic rebound of their skin tissues.

Best of luck!
Dr JP