Now, the FDA has made a change that will open up the operation to people with a lot less weight to lose.
Bud Jones restaurant is a South San Antonio favorite, serving up homestyle dishes like omelets and chicken fried steak and cream gravy.
Owner Kathy Bettencourt is around food all the time. Over the years, her appetite caught up with her, putting more than 200 pounds on her 5'3" frame.
"I think I just got to the point where I had exhausted everything else I had tried. I had done Weight Watchers, the Atkins diet, you name it I have spent the money on it. I have tried" said Kathy.
Kathy wanted weight loss surgery, but she wasn't overweight enough to qualify for her insurance to pay for it. She shelled out $12,000 of her own money for what she calls a "life-changing" procedure.
"My biggest regret is not doing it sooner" said Kathy.
Now, the FDA has lowered the weight standards for surgery, making the lap band procedure more accessible to people like Kathy and thousands like her.
"Currently, the guidelines are to be roughly a hundred pounds overweight. Now you're talking about people that are maybe only fifty pounds overweight who would qualify for surgery" said Dr. Terive Duperier, a Beriatric Surgeon.
Morbidly obese patients with a body mass index of at least 40 qualify, or 35 if there's another health indication like diabetes or high blood pressure.
The new guidelines lowered the threshold to a BMI of 30 when there are other health problems. But the requirement is still 40 for otherwise healthy people.
Lap band is considered the least invasive form of weight loss surgery. The operation itself takes 30 minutes to an hour, but the effect can be life-changing.
Advocates say the lap band helps not only with obesity, it also reduces the risk of joint problems, hypertension, even cancer. Still, bariatric surgeons say it should be the option of last resort.
"There's a lot of people that could use this surgery" said Dr. Duperier.
Those opposed to the idea said it would make weight loss surgery too accessible, and discourage patients from trying less expensive options like diet and exercise first, Kathy disagrees. She sees it as a way for thousands of people to avoid expensive health complications.
"It's hard to understand that they would not just have a one time charge instead of years of maintenance on someone that has diabetes or high blood pressure" said Kathy.
An estimated 26 million patients who previously did not qualify for surgery may now choose lap band as a tool for major weight loss.