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When is Lap-Band Medically Necessary?

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For some patients, losing a lot of weight would be a tremendous boost to their health, and, for those people, lap-band surgery may be an ideal solution. Lap-band surgery, or laparoscopic adjustable gastric banding surgery, is a procedure that creates a smaller stomach pouch with an implanted, adjustable band around the stomach. This reduced stomach size can result in earlier feelings of fullness, which can decrease caloric intake and lead to weight loss. While diet and exercise are the mainstays of weight loss treatments, there are several criteria that are used to determine if lap-band surgery is medically necessary.

BMI Requirements

Body mass index, or BMI, can influence if lap-band surgery is medically necessary. According to the National Institute of Health, an adult patient with a BMI of 40 or greater is considered severely, or morbidly, obese and is usually a candidate for bariatric surgery. Someone with a BMI greater than 30 can also be a potential lap-band patient if he or she also has a serious medical condition. In addition to BMI requirements, insurance may cover the cost of the procedure if the patient has attempted several months of a physician-monitored diet and exercise program without success.

Serious Medical Conditions

Coupled with BMI criteria, there are several serious medical conditions that may make lap-band surgery medically necessary, and they include cardiovascular risk factors, diabetes, and sleep apnea. Cardiovascular risk factors are medical conditions like high cholesterol, high blood pressure, and elevated insulin levels, and they can increase the risk of heart attack, stroke, and sudden death. In a ten year study, these factors were found to be significantly decreased after bariatric surgery.

Type 2 diabetes is an acquired illness that occurs when the body has difficulty processing sugar. After lap-band surgery, patients tend to have improved fasting blood sugar levels.

Sleep apnea is a medical condition that happens when a patient stops breathing for short periods of time while sleeping. This condition can appear when someone has an increased neck size, and the weight loss that occurs with lap-band surgery can produce a marked improvement in sleep apnea.

Lap-band surgery can make a dramatic, positive difference in someone’s ability to lose weight. Weight loss may be considered medically necessary when a person has an elevated BMI and potentially life-threatening medical conditions.