More Revision Surgery After Lap Band or Gastric Bypass

Bariatric surgery, even in the best of hands, is not a panacea, and while most patients report a favorable outcome following the surgical procedure, a significant subset of patients may experience complications or not fail to achieve their ideal body weight as expected.

In these circumstances, a follow-up surgical procedure, known as a bariatric surgery revision, may be necessary to either achieve the ideal body weight, help resolve co morbidities, or manage the complications of the first surgery.

A comparison of the between the Roux-en-Y gastric bypass and lap band surgery becomes exceedingly relevant when considering a bariatric surgery. Whether there are more revision surgeries required after lap band or gastric bypass is therefore an important consideration.

Both of these surgeries are radically different in terms of their mechanism of action. Gastric bypass has a dual mechanism of action, being restrictive as well as a malabsorptive procedure, while the lap band surgery is only restrictive. The former, therefore, has been found to be more effective over time. The weight loss however is slower, and steadier with lap band surgery. The final weight loss is achieved by the end of three to four years after lap band surgery, and by the end of eighteen to twenty four months following the gastric bypass procedure.

Approximately 5 to 10% of patients who have had a gastric bypass reportedly require a revision surgery over 5 years. The reasons for the same vary from complications, unsatisfactory weight loss, or weight regain.

The revision rate following lap-band surgery is reported to be approximately 10% during the first two years. The reasons for the same include device-related problems, slippage or unsatisfactory weight loss.

Collated data from multicentric trials indicates that the excess body weight loss following gastric bypass surgery ranges from 69 to 84% at one year, while the same following a lap band procedure is 45 to 55%. Given that a weight loss less than 50% of the excess body weight constitutes surgical failure, it is evident that the rates of revision surgery following lap band surgery are higher than that following a gastric bypass.

Even though the incidence of early complications following gastric bypass has been reported to be higher than those following lap band surgery(4.2% and 1.7% respectively at the end of first week) the complication rates of the two procedures become comparative by the end of one and a half years (8 and 9.1% respectively).

Experts believe that long-term failure and complications after this time are rare with gastric bypass, while a significant number of lap band patients experience problems which may require a re-exploration or conversion to a different surgical procedure.

However, given that the safety profile of the lap band surgery is significantly better than that of the gastric bypass, and the former is a reversible technique, several patients as well as bariatric surgeons are opting for it. However, when making a choice, the decision must be made keeping in mind the relative rates of revision surgery following each of the surgical procedures.

Obesity Reality: Discrimination Starts With Jobs

Do you realize that if you are heavier than average you may encounter discriminatory attitudes and may be denied equal opportunity even in the work place? You may have taken the barbed, and often not veiled, references to your size in your stride, but do you realize that you may have been allocated a job beneath your ability, and run the risk of being denied promotion and increments, as well as being demoted or fired because of weight prejudice?

Another dimension of the bitter obesity reality: discrimination starts with jobs!!!

A recent study from Yale University brings to light certain disturbing facts in this regard: weight discrimination is rampant in daily interpersonal relationships as well as in the work place. It is almost as common as racial discrimination and, in certain circumstances more frequent than age and gender discrimination. Statistics from the Equal Employment Opportunity Commission (EEOC) also second this finding. Discrimination on the basis of body size is just about as frequent as racial discrimination.

The Yale study also emphasizes that overweight women are twice as likely to be victims of discrimination in comparison to overweight men.  Also, women are discriminated against at lower ends of the weight gain spectrum.  In fact, men run a serious risk of being discriminated against when their BMI reaches 35; for women this becomes real at a BMI of 27.

Given that as many as 34% of adults in the U.S.A are clinically obese, that is, having a body mass index (BMI) of 30 or higher the repercussions of this prejudice are phenomenal. The economic and social ramifications of the same are also not trivial, even if we were to disregard the enormous psychological ramifications of the same.

Various authors and social scientists have brought forth startling figures in this regard. Overweight workers draw a salary which is $1.25 less an hour, in comparison to their slimmer counterparts. That effectively translates into a salary up to $100,000 less, before taxes, over a 40 year career span. Women who are slightly overweight make about 6% less in wages, while very heavy women make as much as 24% less than standard weight women.  Men, however, experience significant wage losses only when grossly overweight.

Heavier workers do not get pay hikes similar to their thinner co-workers, with wage growth rates being almost 6% lower over three years.  Obese young women (speciallt between the ages of 18 and 25) are especially at risk of prejudice, earning 12% less than their thinner counterparts. In fact in several agencies like airlines, the weight cut offs for men correspond to large body frames for men; women are limited to maximum weights corresponding to medium body frames. 

In another population based survey, 26% of subjects who were more than 50% overweight reported they were denied benefits such as health insurance because of their weight. Another 17% claimed that has faced social discrimination in the workplace and had been pressured into resigning, or had been fired.

Managers have been guilty of hiring prejudice when it comes to obese subjects. Equal qualifications, equal references, and similar personalities do not translate into equal job opportunities at the work place, with most choosing the thinner applicants. Very often the hiring staff has been found to make baseless assumptions about overweight applicants, often labeling them as aggressive, lacking in self discipline, or less productive.

Several employers and insurance agencies also view obesity as a liability. This is totally uncalled for as an objective, medically supportable evaluation is imperative before a worker is condemned. Corporate decision makers and personnel managers must be trained to overcome prejudices and reject false stereotypes in order to match the best person to the job at hand, based on qualifications and performance, and not body size.

The flip side of this scenario is that there are legitimate concerns about the rising costs associated with obesity in the workplace for the employers because of the morbidities associated with a higher BMI. As per the Conference Board, obese employees have cost U.S. employers as much as $45 million per annum in medical expenses and lost productivity alone. 

The employers are thus advised to implement a weight reduction wellness program instead of discriminatory tactics. Maintaining a healthier workplace culture for employees with healthier options in terms of products on vending machines, health club memberships, and outdoor activities can cut costs and help foster a team spirit with greater productivity in the long run.

Until such time that adequate legislation is put into place and practice, and corporate consciousness regarding the issue becomes a reality, those overweight will continue to bear the brunt of prejudices in the working environment. In the current context, the grim obesity reality that we have to contend with is that discrimination starts with jobs and spills over to almost each area of social interaction.