How does a gastric band work? Gastric banding is a type of weight loss (bariatric) surgery that involves placing a silicone band around the upper part of the stomach.2-4 It has been approved by the FDA in the US since 2001.5 The band has a balloon that is inflatable with saline solution, which can be injected via a port attached under the skin of the abdomen for adjustment after the surgery. The band creates a small stomach pouch above it, with the rest of the stomach below.2-4,6 diagram of an adjustable gastric band Weight loss surgery targets the gut, the stomach in particular. The smaller stomach pouch reduces the amount of food that can be held. The band produces fullness after eating a smaller amount of food and reduces feelings of hunger, and so lowers food intake, although the exact way in which it works is not clear.2-4 This form of bariatric procedure does not create any malabsorption - all food consumed is digested and absorbed normally.2-4 Other names for the procedure are Lap-Band (the name of the commercial device), laparoscopic adjustable gastric banding (LAGB), bariatric surgery, laparoscopic gastric banding and, simply, the band. How is gastric band surgery performed? A gastric band is fitted under general anesthesia, usually in an outpatients department as a day procedure - often going home on the same day.2,4 The procedure is minimally invasive, being performed laparoscopically using a camera through keyhole incisions - 1-5 small surgical cuts in the abdomen.2,4 Surgeons experienced in the procedure will take between 30 minutes and an hour to complete it.2,4 Because of the general anesthesia, patients should not eat on the day of the surgery (from midnight the night before). Most people undergoing it have a week off work and can begin normal activities within a day or two.2,4 For the first 2-3 weeks after the procedure, diet is restricted to liquids and liquidized foods, after which soft foods are introduced until diet is along a normal regime after around 6 weeks.2,4 Who is a suitable candidate for gastric banding? Eligibility for a gastric band placement is restricted to people who are severely obese, with a body-mass index (BMI) of 40 or over. [obese man] Only severely obese people are eligible for weight loss surgery - with a BMI of 40 or more. A smaller person may be eligible if there are other obesity-related problems such as diabetes, hypertension or sleep apnea.7,8 Other treatment options for obesity need to have been exhausted before surgery is considered - patients must first try lifestyle changes to diet and activity, and medications.7,8 Some research recommends bariatric surgery is done sooner rather than later in obese patients with type 2 diabetes - recommending the intervention in people with pre-diabetes or with a high diabetic risk.9 Some people cannot be considered for weight loss surgery - absolute contraindications include:8 Current drug or alcohol abuse Uncontrolled psychiatric illness Inability to understand the risks and benefits, outcomes, alternatives, and lifestyle changes demanded. Benefits of gastric banding A review of the research studies, for all the weight loss surgeries overall, found that the average result was excess body weight loss of 38.5 kilograms or 55.9%, along with complete resolution of diabetes among 78.1% of relevant patients.10 Having a gastric band comes with some risks, but there are advantages in addition to the weight loss:1-4,6,9,11,12 Results, in contrast to lifestyle and pharmaceutical alternatives, in substantial, long-term weight loss for obese individuals - nonsurgical treatments in the morbidly obese are rarely successful in the long term Helps people lose as much as 40-50% of their excess weight; although for its benefits, it does not help with weight loss by as much as other bariatric operations Can have a major effect in the prevention of type 2 diabetes - in one study, bariatric surgery, compared with usual care, reduced the risk of developing diabetes by 96% at 2 years, holding at 78% after 15 years (the study of over 2,000 obese people included a large proportion of patients undergoing other types of weight loss surgery) As with any major weight loss achieved by obese people, there are numerous health benefits, from making it easier to move around and do daily activities to helping against asthma, gastroesophageal reflux disease (GERD), high blood pressure, high cholesterol and obstructive sleep apnea Is reversible (the band can be removed) and adjustable (it can be tightened or loosened in response to problems eating, if not enough weight is being lost, or there is vomiting after eating) Involves no cutting of the stomach or rerouting of the intestines Needs only a short time in hospital, usually less than 24 hours, and often with same-day discharge Among the weight loss surgical options, is linked to the lowest number of complications after surgery and the lowest risk for vitamin or mineral deficiencies Compared with other bariatric operations, the postsurgical demands are lighter in terms of dietary recommendations, vitamin and mineral supplementation, and follow-up care Compared with open surgery (which is albeit rarely done now; just 3% of bariatric procedures), fewer complications such as wound infections and postoperative hernias Psychiatric symptoms can improve among severely obese adolescents following laparoscopic adjustable gastric banding Employers, who often pay for health insurance, benefit from greater worker productivity, and after the faster recovery allowed by laparoscopic surgery. On the next page we look at disadvantages and risks of gastric banding, and other types of weight loss surgery.

How does a gastric band work?

Gastric banding is a type of weight loss (bariatric) surgery that involves placing a silicone band around the upper part of the stomach.^2-4 It has been approved by the FDA in the US since 2001.⁵
The band has a balloon that is inflatable with saline solution, which can be injected via a port attached under the skin of the abdomen for adjustment after the surgery. The band creates a small stomach pouch above it, with the rest of the stomach below.^2-4,6

Weight loss surgery targets the gut, the stomach in particular.

The smaller stomach pouch reduces the amount of food that can be held. The band produces fullness after eating a smaller amount of food and reduces feelings of hunger, and so lowers food intake, although the exact way in which it works is not clear.^2-4
This form of bariatric procedure does not create any malabsorption - all food consumed is digested and absorbed normally.^2-4
Other names for the procedure are Lap-Band (the name of the commercial device), laparoscopic adjustable gastric banding (LAGB), bariatric surgery, laparoscopic gastric banding and, simply, the band.

How is gastric band surgery performed?

A gastric band is fitted under general anesthesia, usually in an outpatients department as a day procedure - often going home on the same day.^2,4
The procedure is minimally invasive, being performed laparoscopically using a camera through keyhole incisions - 1-5 small surgical cuts in the abdomen.^2,4
Surgeons experienced in the procedure will take between 30 minutes and an hour to complete it.^2,4
Because of the general anesthesia, patients should not eat on the day of the surgery (from midnight the night before). Most people undergoing it have a week off work and can begin normal activities within a day or two.^2,4
For the first 2-3 weeks after the procedure, diet is restricted to liquids and liquidized foods, after which soft foods are introduced until diet is along a normal regime after around 6 weeks.^2,4

Who is a suitable candidate for gastric banding?

Eligibility for a gastric band placement is restricted to people who are severely obese, with a body-mass index (BMI) of 40 or over.

Only severely obese people are eligible for weight loss surgery - with a BMI of 40 or more.

A smaller person may be eligible if there are other obesity-related problems such as diabetes, hypertension or sleep apnea.^7,8
Other treatment options for obesity need to have been exhausted before surgery is considered - patients must first try lifestyle changes to diet and activity, and medications.^7,8
Some research recommends bariatric surgery is done sooner rather than later in obese patients with type 2 diabetes - recommending the intervention in people with pre-diabetes or with a high diabetic risk.⁹
Some people cannot be considered for weight loss surgery - absolute contraindications include:⁸

• Current drug or alcohol abuse
• Uncontrolled psychiatric illness
• Inability to understand the risks and benefits, outcomes, alternatives, and lifestyle changes demanded.

Benefits of gastric banding

A review of the research studies, for all the weight loss surgeries overall, found that the average result was excess body weight loss of 38.5 kilograms or 55.9%, along with complete resolution of diabetes among 78.1% of relevant patients.¹⁰
Having a gastric band comes with some risks, but there are advantages in addition to the weight loss:^{1-4,6,9,11,12}

• Results, in contrast to lifestyle and pharmaceutical alternatives, in substantial, long-term weight loss for obese individuals - nonsurgical treatments in the morbidly obese are rarely successful in the long term
• Helps people lose as much as 40-50% of their excess weight; although for its benefits, it does not help with weight loss by as much as other bariatric operations
• Can have a major effect in the prevention of type 2 diabetes - in one study, bariatric surgery, compared with usual care, reduced the risk of developing diabetes by 96% at 2 years, holding at 78% after 15 years (the study of over 2,000 obese people included a large proportion of patients undergoing other types of weight loss surgery)
• As with any major weight loss achieved by obese people, there are numerous health benefits, from making it easier to move around and do daily activities to helping against asthma, gastroesophageal reflux disease (GERD), high blood pressure, high cholesterol and obstructive sleep apnea
• Is reversible (the band can be removed) and adjustable (it can be tightened or loosened in response to problems eating, if not enough weight is being lost, or there is vomiting after eating)
• Involves no cutting of the stomach or rerouting of the intestines
• Needs only a short time in hospital, usually less than 24 hours, and often with same-day discharge
• Among the weight loss surgical options, is linked to the lowest number of complications after surgery and the lowest risk for vitamin or mineral deficiencies
• Compared with other bariatric operations, the postsurgical demands are lighter in terms of dietary recommendations, vitamin and mineral supplementation, and follow-up care
• Compared with open surgery (which is albeit rarely done now; just 3% of bariatric procedures), fewer complications such as wound infections and postoperative hernias
• Psychiatric symptoms can improve among severely obese adolescents following laparoscopic adjustable gastric banding
• Employers, who often pay for health insurance, benefit from greater worker productivity, and after the faster recovery allowed by laparoscopic surgery.

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On the next page we look at disadvantages and risks of gastric banding, and other types of weight loss surgery.