Bariatric care: what to avoid

Bariatric surgery is one of the most effective ways to address obesity and related conditions. But not all bariatric surgeries are created equal—and different procedures can have drastically different outcomes.

Case in point: laparoscopic adjustable gastric banding (commonly called Lap-Band) used to be one of the most prevalent bariatric surgeries. In 2011, Lap-Band cases made up roughly 35% of all bariatric procedures. But as time has gone on, its popularity has plummeted. Today, Lap-Bands account for less than 1% of all bariatric procedures.

Why did it fall out of favor? The majority of surgeons have abandoned it due to long-term complications and poor outcomes (including lack of weight loss). The band removal rate has climbed by roughly 3% to 4% per year, and since 2012, more bands have been removed than placed.

Lap-Band procedures might not be as common as they once were, but 1% of procedures still adds up to thousands of bariatric patients—and that means real risk for them and the employers covering their care.

When an outdated procedure with a well-documented failure rate stays in a plan’s network, patients often need to go through (and pay for) two surgeries: the original procedure and the revision surgery that sometimes follows.

Put simply, it’s riskier and more expensive. So, why do these types of surgeries still happen at all? And what does it actually cost?

What is unvetted bariatric care?

Lap-Band surgeries are just one example of unvetted bariatric care. “Unvetted” doesn’t mean the surgery is illegal or performed by an unlicensed doctor.

Rather, it means that a provider hasn’t been independently checked against basic quality standards that monitor things like surgical volume, outcomes, and follow-up care. This check comes from accreditation through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), which verifies providers meet those standards.

In 2022, roughly 83% of all bariatric surgeries in the U.S. were performed at MBSAQIP-accredited centers. That figure might sound impressive, but it means that nearly one in five procedures happened at centers with no outside checks on quality.

Understanding the risks (and costs) of unvetted bariatric care

Unfortunately, falling short of those standards leads to some real, negative outcomes. Here’s how those commonly show up for patients and the employers footing the bill.

The clinical risk

Every surgery carries the risk of being unsuccessful. But Lap-Band procedures in particular have an alarming failure rate. In fact, research found that as many as half of patients have experienced some form of failure within five years.

Failure could mean the band gradually wears through the stomach wall and ends up inside the stomach itself (erosion), the stomach shifts out of place around the band (slippage), or the device simply fails to produce lasting weight loss.

That’s frustrating in and of itself—especially when patients hoped a surgery would meaningfully improve their life. But it also means the band needs to be removed with a second procedure known as a “revision procedure.” These fixes are surprisingly common, with one study finding that up to 60% of patients had their band removed within 10 years.

Unfortunately, revision procedures are often riskier than the original surgery, because operating on tissue that’s already been cut into once is technically complex. Outcomes vary, but across the board, revisions carry meaningfully higher complication rates than a first-time procedure.

Plus, patients need to deal with the physical and emotional toll of a second surgery, along with the disappointment of realizing that the procedure that was supposed to solve their problem only created a new one.

The financial cost

Bariatric surgery isn’t cheap to begin with. The exact price depends on the specific procedure, location, and hospital. But recent national estimates place costs between $15,000 and $38,000 before insurance.

When an initial procedure fails, patients need more than a follow-up appointment or quick fix. They need another major surgery with its own anesthesia, operating room time, and hospital stay.

Put another way, revisions require the same surgical resources as the original procedure. So, the plan needs to cover not one but two bariatric surgery bills—and that’s expensive.

Why does unvetted bariatric care still happen?

Unvetted procedures come with a lot of risks (and costs), yet they still happen for a couple of different reasons:

• Patient appeal: Lap-Band was originally marketed as reversible, less invasive, and more cost-effective than other options. Those selling points really matter to patients who are making a major healthcare decision. One study found self-funded patients kept choosing the Lap-Band at a much higher rate (42%) than patients overall (even as most of the field moved on), largely because it felt more affordable and less scary.
• Regulators issue warnings (but not withdrawals): Lap-Bands are risky, but the FDA has never issued a formal warning against the device itself—only against surgery centers that were running misleading advertisements about the procedure. And unfortunately, they aren’t the only example. When intragastric balloons (inflatable devices placed in the stomach to mimic the feeling of fullness) were linked to serious complications (including deaths), the FDA responded by updating product labeling—not pulling the devices from the market. Despite their dangers, providers can still legally offer them today.
• Plans authorize by category instead of procedure: Most self-insured plans cover “bariatric surgery” as a single benefit line, without distinguishing between accredited centers and unaccredited centers that offer procedures with documented safety problems.

These reasons add up and explain how a procedure that’s clearly outdated keeps showing up in benefits plans today.

What vetted bariatric care looks like (and how to find it)

Vetted care starts with accreditation. But that just confirms a provider meets minimum standards. It doesn’t go any further to ensure a certain procedure is the right clinical choice for a specific patient.

Centers of Excellence (COE) programs solve this by vetting providers on procedure-level outcomes, not just their accreditation status. This means employees are steered toward proven surgeries along with accredited facilities.

This type of procedure-level vetting is what actually prevents the dreaded two-surgery situation we covered earlier. But it’s not standard practice. Most networks vet at the provider level and don’t go all the way down to the procedure level. Carrum Health’s COE model is built around making this distinction, which helps keep high-failure procedures out of the picture entirely.

There’s a difference between covering bariatric care and covering it well. Carrum Health is here to make sure that employees get it right the first time by connecting them to vetted bariatric surgery providers.

Because employees shouldn’t have to pay for (or experience) a failed surgery, and employers shouldn’t have to pay for it twice.