In a city awash with splashy billboards featuring svelte models urging the obese to call 1-800-GET-THIN, it might seem that bariatric surgeon Ted Khalili couldn’t be more pleased.
The veteran Cedars-Sinai Medical Center doctor has performed more than 4,000 gastric procedures in the past decade, including hundreds using the hottest technique: the Lap-Band device that squeezes the opening to the stomach.
But he’s not pleased with the ads – and the recent news about his profession.
In the past several months, local coverage about four patient deaths after Lap-Band surgeries – and the characterization of some practices as gastric “surgery mills” – has put all bariatric surgeons on the defensive.
“The Lap-Band is the safest approved surgical procedure for weight loss, but traditional advertising doesn’t send the right message that this is a serious surgical procedure,” claims Khalili, whose Khalili Center for Bariatric Care practice is expanding next month to five surgical suites adjacent to his medical practice.
The deaths have reawakened long-standing concerns over the riskiness of the surgery. The 1-800 Beverly Hills service that referred the patients who died has been criticized about its marketing practices, and even Allergan Inc., the Irvine maker of the Lap-Band, has publicly expressed discomfort with some of the advertising. The service collects prospective patients’ names and refers them to surgeons.
“This is a surgical procedure that has lot of issues surrounding it,” said Betsy Merryman, who teaches health care public relations as a USC adjunct professor and has her own PR agency.
At the same time, there’s demand for the surgery. The Khalili Center and its competitors are benefiting from increasing concern about obesity, which puts sufferers at risk for life-threatening conditions such as diabetes and heart disease. About a quarter-million Americans likely had some kind of gastric surgery done last year.
Growing popularity
Khalili, 43, is considered a pioneer in minimally invasive bariatric surgery, performing the world’s first gastric bypass using a robotic arm in 2002. He spent the past decade building the weight-loss surgery program at Cedars-Sinai as its director, leaving in June with two colleagues to start the Khalili Center on a floor of a nearby Wilshire Boulevard medical office building.
The practice performs all types of bariatric surgery, which are still being conducted at Cedars-Sinai pending the opening of his outpatient surgical center.
One procedure is the gastric bypass, a longtime option for extremely overweight people, which involves surgically shrinking the stomach and rearranges the intestines to restrict the amount of food that can be eaten and how much can be absorbed. Though it has become more routine, the surgery still is complicated, requiring an overnight hospital stay and costing $20,000 to $30,000.
By contrast, gastric bands, introduced in the United States in 2001, are less involved. They are adjustable silicone rings surgically fitted around the upper stomach and filled with saline to restrict the amount of food a wearer can eat. Allergan’s Lap-Band is the market leader for the devices, which can be inserted at an outpatient surgical center for about $15,000. Insurance companies sometimes pay for gastric surgery if a patient meets the federal government’s definition for being “morbidly obesity.”
The simpler procedure has skyrocketed in popularity, with gastric banding accounting for an estimated 40 percent of the country’s 220,000 gastric surgeries in 2009, according to the American Society for Metabolic and Bariatric Surgery. At the Khalili Center, it accounts for roughly 50 percent to 60 percent of procedures.
However, the popularity has led to some poor outcomes. The husband of a Simi Valley woman filed suit this month against two doctors, a San Fernando Valley surgical center, 1-800-GET-THIN LLC and others when she died after a Lap-Band procedure in July. The lawsuit contends that the woman’s liver was lacerated several times during the insertion, which resulted in complications that lead to her death.
Relatives of three other Lap-Band recipients also have sued 1-800-GET-THIN and a Beverly Hills outpatient surgical center when their relatives died of complications after the procedure over the last year and a half.
Khalili and his two Cedars-Sinai colleagues do not have any public record of adverse actions by the California Medical Board. And they take pains to differentiate themselves and other established practices from what they call the minority of “surgical mills” that are giving bariatric surgery a bad name.
They also strongly dislike the in-your-face radio, Internet and billboard advertising done by 1-800-GET-THIN.
Khalili likes to note that his center doesn’t just do surgery but also requires patients to go through extensive pre- and postsurgery behavioral and dietary counseling, weekly support groups and monthly group walks, among other activities.
“The surgery is almost a secondary thing,” Khalili said. “To make the operation successful, you have to have a lot of education and support before and after so patients continue making the right decisions to improve their health.”
However, the growing practice can’t do without some marketing of its own. Next month, when the five surgical suites open, the 3,000-square-foot center will more than triple its size to about 10,000 square feet.
Much of the marketing is done through the practice’s website, which emphasizes its counseling services; medical research the doctors have co-authored; and media clips featuring Khalili and his partners, Dr. Gregg Kai Nishi and Dr. Eraj Basseri, as expert sources on obesity, diabetes and related issues.
However, the practice is not shy about using the website for glowing video testimonials from patients or making those videos available on YouTube. Last year, the practice hired Santa Monica public relations firm Arlene Howard Public Relations to promote it.
Last month, the firm assisted the center in issuing a press release in response to the new of deaths at the other surgical centers. The PR Newswire release offered “5 Tips for Avoiding Unsafe ‘Surgery Mills’ When Considering Lap-Bands.”
Merryman, the USC adjunct professor, said the Khalili Center is smart to emphasize expertise in its marketing and avoid billboard-type advertising.
“An obese patient who’s to the point of considering surgery likely has been contemplating it for years. So what they’re looking for now is a surgeon they feel comfortable with and trust,” said Merryman, who does not have a professional relationship with the Khalili Center.
Few options available
Attorney Robert Silverman, who represents one of the surgical centers in the wrongful death lawsuits and 1-800-GET-THIN, said Khalili’s press release is false.
He also said that his surgery center client contends that care the patients received from others after the initial procedure was responsible for their deaths.
“Morbidly obese individuals have very few options … and the Lap-Band is a very safe and effective option for the morbidly obese,” Silverman said. 1-800-GET-THIN “lets them know they are there to help. You never know when a person is ready to make that call – that is why the advertising is pervasive.”
If anything, the advertising is likely to get even more visible, even though Allergan’s chief executive told the Los Angeles Times this month that the company was planning on issuing guidelines requiring surgeons to include risk statements in their advertising.
Allergan was successful last week in winning approval from the U.S. Food and Drug Administration to market the product to less obese patients.
Under the old federal guidelines, Lap-Band use was largely limited to patients with a body mass index of at least 40, which is equivalent to a 5-foot-4-inch-tall woman weighing about 235 pounds. She would only have to weigh about 175 pounds and have other serious health problems to be eligible under the new guidelines, which are a benchmark for insurance companies.
That worries Dr. Diana Zuckerman, president of the Washington, D.C., advocacy group National Research Center for Women & Families, who in December testified before an FDA panel against expanded use of gastric bands without longer-term studies tracking patients who received the bands years ago.
“If I were a patient who was obese and considering a gastric band, I’d want to know if several years after the surgery, it’s still more effective than going to Jenny Craig,” Zuckerman said.
Still, many specialists contend the Lap-Band and other bariatric procedures have their place in assisting obese patients who can’t lose weight through exercise and portion control alone.
“We all can’t have (celebrity trainer) Jillian Michaels riding us,” said Dr. John Morton, a Stanford University Medical Center surgeon who is California chapter president for the American Society for Metabolic and Bariatric Surgery. “Once you reach a certain weight, your body changes in key ways that makes it very difficult to take off the weight the hard way.”
As the debate lingers, the Khalili Center continues putting the finishing touches on its surgical center and works to prepare for its latest marketing event: the L.A. Marathon.
About 500 patients and family members, all sporting Khalili Center T-shirts, are signed up to participate as a group in the 5K portion of the L.A. event.
“With all the other advertising out there … we just have to keep remembering that a successful patient is our best billboard,” said Basseri, who at 34 is the youngest member of the practice.
