Who is Considered Suitable For the LAP-BAND?

     We take four factors into account when determining whether this might be an appropriate procedure for you. These are the current level of your weight, the problems that this state of obesity generates, the confirmation that you have made significant effort at weight loss by other means and the confidence we have that you understand what you are getting yourself into and have the commitment to fulfill your part of the partnership.
We discuss these factors in more detail below.

• There Is Obesity
Obesity is a disease that exists in our community when the body mass index (BMI) is greater than 30. A BMI greater than 35 is described as severe obesity. Until recently, we would not wish to proceed with this procedure if the BMI were less than 35. At a BMI of 35 or greater there is a clear risk to a long healthy life, there are generally significant problems associated with obesity and there is known to be a poor outcome from any alternative therapy.

Recently, we have completed a major study of people with a BMI of between 30 and 35 and have found that those who had the LAP-BAND?had much better weight loss, improvement in health and improvement in quality of life than a matched group who had the best program of non-surgical treatment that we could offer. We are, therefore, now prepared to accept people in the program with mild-to-moderate obesity, particularly if there are medical problems associated with the obesity or if it is clear that serious and multiple attempts to lose weight have been made by non-surgical means before seeking LAP-BAND?

• The Obesity is Associated With Problems
If there is not a problem then we don't need to look for a solution. Even if you are truly morbidly obese by our definitions, we would not wish to proceed with any treatment unless you perceived a significant problem with your obesity. It may be a fear of the effects of your obesity in your future health life expectancy. It must be the solution that you are seeking in answer to your problems. It is not something for us to encourage just because we perceive that you have a problem.

• There have been serious efforts trying to loose weight
It is important that you have made significant effort to reduce your weight over a prolonged period of time. The effort is likely to include supervised diets and exercise programs and we find that almost all of our patients have spent considerable time and money with the commercial weight-loss groups in an attempt to loose weight. Most have tried some or all of the weight loss pills that are available and many have been to some of the various health professionals who offer "solutions" to obesity. This includes dietitians naturopaths, hypnotherapists, acupuncturists and psychologists.

We do not make this stipulation because we believe that these alternative lines of therapy are effective in the long term. We make the requirement because it is an expression of your commitment to loose weight and without that commitment we cannot be confident that you will follow your part of the partnership.

• You understand the risks and responsibilities
Your weight status, the problems associated with your weight and your efforts to reduce your weight in the past are the main measures that we make. However, in addition, we will only proceed if we believe that you understand how your obesity is a problem for you, what the procedure consists of and what are the realistic expectations of what it can do and what are the risks, and that we feel you are able to fulfill your part of the partnership.
The whole process of the placement of LAP-BAND and follow-up process of the placement of the LAP-BAND and follow up process after the procedure is a partnership between yourself and us. We are committed to do all that is necessary to get the best possible result for you and you must be committed and able ti fulfill your part of the partnership. For this we need to be sure that you have a realistic understanding of the potential benefits and risks, and your responsibilities with regard to eating pattern and exercise.

FULFILLING THE PARTNERSHIP
SURGEON'S THREE COMMITMENTS

1. To place the band correctly and safely.
2. To ensure the patient is able to access good follow-up.
3. To teach the patient the rules to follow their role.
PATIENT'S THREE COMMITMENTS
1. To follow the rules regarding eating and drinking, as discussed in Chapter 6.
2. To follow the rules regarding exercise and activity, as discussed in Chapter 7.
3. To come back for follow-up permanently with visits at least once every 6 months.

Decision-Making Time
Here, we have given you a wealth of information. We have explained how obesity is a common problem that causes many other problems to your health, quality of life and survival. Most of this information is derived from published studies of our own patients.

We have explained different options available to treat the problem of obesity, their strengths and their weaknesses. In particular, we have given you much information on the LAP-BAND.

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