Please do not leave this page until complete. This can take a few moments.
A preliminary recommendation by the Food and Drug Administration to loosen eligibility requirements for lap-band weight loss surgery could lead to a wave of new patients for Connecticut hospitals, which have invested hundreds of thousands of dollars in recent years to boost that line of business.
But before the surgery technique becomes more mainstream major impediments stand in the way, including insurance companies’ willingness to pay for the procedure which can cost up to $15,000 or more.
The FDA’s decision comes at a time when the number of obese Americans is climbing and the cost of caring for them is reaching into the billions of dollars. About 35 percent of U.S. adults are considered obese, including 21 percent of Connecticut’s population.
The growth of lap-band surgeries as a major service line for hospitals may ultimately come down to a cost-benefit analysis made by insurers or the willingness of employers to pay the premium to include lap-band surgery as part of their health benefits package.
“Demand will definitely be there, but it’s going to be a struggle to have third-party payers cover it,” said Carlos Barba, the director of the bariatric surgery program at The Hospital of Central Connecticut.
A lap-band surgery involves a saline-filled silicone band that is wrapped around the upper part of the stomach to create a small pouch and restrict stomach capacity. Patients eat less because they feel full more quickly. The technique has been around for less than 10 years, and most Connecticut hospitals have only been offering it for the past five years.
But the procedure is quickly becoming one of the most popular forms of weight loss surgery, forcing Connecticut hospitals to add and expand their bariatric departments to grab a piece of the market.
That effort includes attempts to woo top surgeons away from the competition. Barba, for example, helped start the bariatric program at St. Francis Hospital years ago before moving to The Hospital of Central Connecticut.
Under today’s guidelines, the lap band is implanted in patients with a body mass index (BMI) of 40 or above, or in patients with a BMI as low as 35 if they have an obesity-related health problem like diabetes, heart disease, sleep apnea, hypertension and high cholesterol. That qualifies about 15 million Americans who are about 100 pounds or more overweight.
But a panel of FDA researchers recently recommended, in an 8-2 vote, lowering the requirement to a BMI of 35 or higher, or as low as 30 if the patient has one of the related problems. That opens up the market to another 27 million Americans.
Barba said there is no question that decision will lead to more demand for the lap-band surgery, especially as the public becomes more informed about it and sees its potential good.
He said THCC’s Center for Bariatric Surgery has seen a steady uptick in patients and now performs about 150 surgeries annually. He expects that number to grow 10 to 20 percent in the coming years. The demand has forced the hospital to add a second surgeon.
Griffin Hospital in Derby started a bariatric program just this year, investing hundreds of thousands of dollars in new technology, staff and support services to get in on the market.
Timothy Ehrlich, the program’s medical director, said the FDA’s recent decision is important because it builds awareness for the procedure, but also because it lets doctors hone in on a population — which is typically 40 to 80 pounds overweight — that hasn’t had treatment options before.
The goal is to use the lap-band as a form of preventative medicine to keep this group of overweight patients from getting even heavier, and subsequently making them more susceptible to chronic diseases.
“The key is to help patients before they need the knee replacement or treatment for diabetes,” said Erlich, who previously established the bariatric surgery program at St. Vincent’s Medical Center in Bridgeport. “That presents huge cost savings.”
But Ioannis Raftopoulos, the medical director of bariatric surgery at St. Francis Hospital, which does about 50 to 75 lap-band procedures a year, said cost remains a major barrier in allowing more patients access to the procedure, especially as insurers remain skittish about picking up the tab.
“The fact that FDA made this decision doesn’t mean insurance companies will jump in and cover it,” Raftopoulos said. “So whether it will have a significant impact or not is hard to tell.”
At the THCC, for example, a lap-band surgery costs about $14,500, but nearly 50 percent of its patients with insurance can’t get the procedure covered.
As a result, Barba said, several of his patients have gone outside the U.S. to get the surgery done at a much lower price, sometimes as cheap as $8,000.
Bruce Wolfe, president of the American Society for Metabolic & Bariatric Surgery, said the problem is that insurers don’t anticipate keeping the average customer on their rolls for more than two years, but it takes up to four years to recover the costs from a bariatric surgery.
“An insurance company doesn’t want to spend upfront money and then have some other insurance company reap the benefit,” Wolfe said. “I don’t expect that to change overnight.”
But if enough insurers provide adequate coverage, the juggling of membership among the companies would not matter as much, Wolfe added.
Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry trade group, said most insurers do have some type of plan that provides coverage for bariatric surgery, but it varies widely across the industry.
There are some insurers that don’t cover it at all. But she also noted that a lot of the decisions are driven by the types of plans employers want to purchase and offer their workers.
And the recession has caused many employers to cut back on benefit packages.
Ehrlich, of Griffin Hospital, said large, self-insured employers may be the ultimate drivers of providing coverage for bariatric procedures, since those companies are bent on reducing the health care cost curve.
Many corporations are already implementing weight loss and other wellness programs to encourage their workers to be healthier. Providing morbidly obese employees the chance to lose significant amounts of weight through a lap-band surgery would be a logical extension of that effort, Ehrlich said.
The Hartford Business Journal 2025 Charity Event Guide is the annual resource publication highlighting the top charity events in 2025.
Learn moreHartford Business Journal provides the top coverage of news, trends, data, politics and personalities of the area’s business community. Get the news and information you need from the award-winning writers at HBJ. Don’t miss out - subscribe today.
SubscribeDelivering vital marketplace content and context to senior decision-makers throughout Connecticut ...
All Year Long!
The Hartford Business Journal 2025 Charity Event Guide is the annual resource publication highlighting the top charity events in 2025.
Hartford Business Journal provides the top coverage of news, trends, data, politics and personalities of the area’s business community. Get the news and information you need from the award-winning writers at HBJ. Don’t miss out - subscribe today.
Delivering vital marketplace content and context to senior decision-makers throughout Connecticut ...
All Year Long!
In order to use this feature, we need some information from you. You can also login or register for a free account.
By clicking submit you are agreeing to our cookie usage and Privacy Policy
Already have an account? Login
Already have an account? Login
Want to create an account? Register
In order to use this feature, we need some information from you. You can also login or register for a free account.
By clicking submit you are agreeing to our cookie usage and Privacy Policy
Already have an account? Login
Already have an account? Login
Want to create an account? Register
This website uses cookies to ensure you get the best experience on our website. Our privacy policy
To ensure the best experience on our website, articles cannot be read without allowing cookies. Please allow cookies to continue reading. Our privacy policy
0 Comments