What is a Gastric Band?

Obesity is particularly prevalent in the UK, with the highest obesity rates in Europe having almost quadrupled in the last 25 years. Obesity is usually defined as having a body mass index (BMI) of 30 or above; a BMI between 25 and 30 is classified as overweight.

Body Mass Index (BMI) is calculated by dividing weight in kilograms by height in centimetres squared and multiplying by a conversion factor of 703, or you could use the NHS online BMI calculator, which is much easier.

The Health Survey for England 2019 estimates that 28.0% of adults in England are obese and a further 36.2% are overweight, but not obese. The survey found that men are more likely than women to be overweight or obese; 68.2% of men, 60.4% of women. People aged 45–74 are most likely to be overweight or obese.

Those living with obesity often develop other health conditions such as:

• Coronary heart disease.
• Stroke.
• High blood pressure.
• Diabetes.
• Cancer.
• Arthritis.
• Sleep disorders.
• Depression.

People who are overweight or obese can also experience stigma in every part of their life. However, as senior health officials such as the Royal College of Physicians campaign to have obesity recognised as a disease to encourage people to seek treatment, weight-loss surgery such as gastric band surgery may be an option to be considered for those struggling with being overweight or obese, as it can lead to significant weight loss.

What is a gastric band?

Gastric band surgery has a track record of over 25 years for helping people to lose excessive weight. A gastric band is a silicone ring that is placed around the stomach, creating a small pouch and reducing the amount of food that can be eaten at one time. The surgery is performed under general anaesthetic using keyhole surgery.

The surgery is used as a treatment for obesity and is considered to be less invasive than other weight-loss surgeries such as gastrectomy. A sleeve gastrectomy is where a large part of the stomach is removed so it is much smaller than it was before.

How does a gastric band work?

A gastric band works by reducing your hunger so that you don’t need to eat large portions to be satisfied. During surgery, a small, hollow silicone band is placed around the upper part of the stomach which can be tightened or loosened as required, to maximise weight loss. By restricting or limiting the amount of food that can enter the stomach it makes you feel full more quickly.

The gastric band is placed around the top of your stomach to create a small pouch. The larger part of the stomach below the band remains unused. The pouch can only hold a small amount of food before the feeling of fullness is triggered.

A gastric band therefore tricks the brain into believing that you have consumed enough food. It is a way of controlling portion size and achieving long-term weight loss results.

In the first year after a gastric band procedure, the average patient loses around 40% of their initial excess body weight. The following year weight loss will usually slow, but patients can still expect to lose another 10%–20% of their excess body weight. You can have the gastric band removed, but you will need to undergo another surgery. Some patients who have their band removed do put weight back on as the stomach returns to its normal size.

Who can have a gastric band?

Gastric band surgery is usually only advised when someone has repeatedly tried but failed to lose weight through making healthy lifestyle changes, such as healthy eating and increasing the amount of exercise undertaken. There are eligibility criteria for gastric band surgery, whether this takes place through the NHS or through a private clinic. The NHS eligibility criteria is detailed below.

In the private health sector, the criteria may vary slightly from clinic to clinic, but most reputable clinics will follow the NICE guidelines.

Their criteria are that the patient should:

• Be over 18 years of age.
• Have a BMI that is over 30.
• Not have any existing health conditions that could pose a risk during the surgery.
• Be committed to making permanent lifestyle changes following surgery.

A gastric band may be best suited to you if you want the safest weight-loss surgery with the lowest risk, lowest serious complications and a fast recovery. A gastric band is the least invasive gastric surgery and can offer a reversible change to your stomach size that can help you to modify your diet and lifestyle long term.

Who cannot have a gastric band?

Gastric band surgery is not suitable for everyone. Anyone under the age of 18 years and over the age of 70 years is not usually considered for this surgery.

Your general health will be checked to ensure that you are fit for surgery. This means checking your blood pressure and performing blood and urine tests as well as checking your medical history. Surgery puts significant strain on the body, as both the surgical intervention and the anaesthesia come with risks, and patients in poor general health increase those risks dramatically.

Certain long-term health problems may preclude you from surgery too, such as:

• Inflammatory bowel disease.
• Heart disease.
• Smoking – Patients must be able to quit smoking at least six weeks before the procedure.

It is standard for patients to have some sort of mental health screening before undergoing any form of weight-loss surgery to better understand their motivation, readiness, behavioural challenges and emotional factors that may impact their coping and adjustment through surgery.

Patients are asked how they have come to this decision and their rationale for having gastric band surgery. Given the seriousness of this choice, it is vital that patients are seeking surgery for the appropriate reasons and have realistic expectations about what can be achieved.

What are the health benefits of having a gastric band?

Gastric band surgery is the safest form of weight-loss surgery.

It has a major, often dramatic, impact on a wide variety of obesity associated health conditions such as:

• Type 2 diabetes.
• Coronary heart disease.
• Some types of cancer, such as breast cancer and bowel cancer.
• Stroke.

As a guide, patients can expect to lose 50%–60% of their excess weight over the first 2 years following gastric band surgery, although many patients will do much better than this and weight loss is known to improve:

• Infertility and polycystic ovary syndrome (PCOS) – Patients can experience correction of underlying hormonal problems and restored fertility.
• Asthma – Patients with asthma can see marked improvement in symptoms and a reduction in medication.
• Liver disease – Many patients see improvements and some may have complete resolution of liver disease.
• Back pain and arthritis – Patients experience marked reduction in joint and back pain and increased mobility.
• Psychological wellbeing – Many patients report reduced depressive and anxiety symptoms, improved social interaction and improved overall quality of life.

How much does a gastric band cost in the UK?

If you are considering using a private clinic for gastric band surgery, prices do vary. However, in the UK you should expect to be quoted a price that ranges from approximately £5,000 up to £9,000. Most clinics will give a quote of gastric band prices on an individual basis following a consultation, so the price that you are quoted may be higher than the clinic’s advertised price list.

Many clinics offer finance options to help pay for the surgery over a period of time, and the length of finance solutions can vary between clinics.

Price should not be the deciding criteria when choosing a gastric band surgeon and clinic. For peace of mind it is best to investigate and check that your proposed surgeon is fully trained and qualified in gastric surgery; they should be GMC registered and on the GMC “specialist register” for general surgery.

They should hold an FRCS; Fellowship of the Royal College of Surgeons (FRCS) is a professional qualification to practise as a surgeon in the United Kingdom or Ireland. Your surgeon will have needed to obtain the FRCS (General Surgery).

There are a number of professional organisations which your surgeon can belong to, such as the:

• Association of Upper Gastrointestinal Surgeons (AUGIS).
• British Obesity & Metabolic Surgery Society (BOMSS).
• International Federation for the Surgery of Obesity and metabolic disorders (IFSO).

Can you get a gastric band on the NHS?

Weight-loss surgery, including gastric band surgery, is available on the NHS if:

• You have a body mass index (BMI) of 40 or more,

Or

• A BMI between 35 and 40 and an obesity-related condition that might improve if you lost weight (such as type 2 diabetes or high blood pressure),

And

• You have tried all other weight-loss methods, such as dieting and exercise, but have struggled to lose weight or keep it off.
• You agree to long-term follow-up after surgery, such as making healthy lifestyle changes and attending regular check-ups.
• You are fit and healthy enough to have surgery under general anaesthetic.
• You have been receiving or will receive treatment from a specialist obesity team.

Surgery is also recommended for people with a BMI over 50; they are eligible for surgery even if they haven’t tried to lose weight. Also, people with a South-Asian ethnic background with recent onset diabetes who have a BMI under 30, which is a lower BMI than stated above. People with recent-onset type 2 diabetes and a BMI over 30 are eligible for weight-loss surgery. Type 2 diabetes diagnosed in the last ten years counts as “recent onset”.

However, according to the University of Warwick, the latest figures show that, of around 3.6m people in England who are eligible for weight-loss surgery, just 6,627 people had this surgery in 2017–18. Considering how many people are obese in England, it appears that only about 0.2% of eligible people are getting surgery.

They highlight that this is far lower than in other countries where similar methods of estimation suggest that 1.2% of eligible people in the US receive surgery and 0.5% in Canada. Surprisingly, low demand from patients is one of the main reasons for the low number of operations performed in England.

The Warwick study also found that while women are more likely than men to be eligible for surgery, 58% vs 42%, the proportion of women receiving surgery is significantly higher, 76% vs 24%. They conclude that this might be because men are probably less likely to go to the doctor with a health problem, so less likely to ask for help with their weight.

Although there are conflicting health priorities for limited NHS resources, the National Institute for Health and Care Excellence (NICE) has stated that, “The initial (NHS) cost of weight-loss surgery is around £6,000 in the short term, but preventing the long-term complications of diabetes is great for the individual and will save the NHS money. The health benefits of weight-loss surgery are so great that it should be considered as part of the treatment for obese diabetics.

The earlier you have the surgery in your diabetes course, then the more likely you are to have remission or a really good improvement.” Every week, the NHS carries out 100 amputations caused by type 2 diabetes and every year, 24,000 people die prematurely because of the condition.

Preparing for gastric band surgery

Gastric band surgery forms part of a long-term obesity plan so you will need to have started a healthy lifestyle plan. This will include stopping smoking, starting on a healthy eating plan and exercising to ensure that you are in the best possible shape before surgery.

The NHS local stop smoking services are free, friendly and can massively boost your chances of quitting smoking for good.

Before your surgery, start off by doing some gentle walking and gradually increase this, then you will see and feel the benefits. Once you have recovered from your surgery you can look to increase this or take up new exercise activities.

It is vital to get into good eating habits as soon as possible prior to the surgery, as having the gastric band fitted means that you will not only be eating smaller portions of food but will have to eat healthy food as well.

What happens during gastric band surgery?

Gastric band surgery itself usually takes around an hour, it is performed under a general anaesthetic, which means that you are asleep during surgery, and is performed using laparoscopic (keyhole) surgery.

The surgeon will make several small cuts in your stomach and insert a long, thin telescope with a light and camera lens at one end, called a laparoscope, so that they can see inside.

The surgeon will place the gastric band around the top part of your stomach to create a small upper pouch. The band is kept in place by folding some of your lower stomach over the band and stitching it to your upper stomach pouch. Your gastric band is connected to an injection port just under your skin via a thin piece of tubing.

Your surgeon will inflate the band with sterile fluid after your operation. The injection port allows your surgeon to inflate or deflate your band and adjust the size of the opening from your upper to your lower pouch and this will control how quickly your pouch empties. Your surgeon will then close the cuts, usually with disposable stitches under your skin.

How long does it take to recover after gastric band surgery?

After gastric band surgery you will normally stay overnight in hospital; some people may have a slightly longer stay but usually it is no longer than 3 days. When you wake up after the operation you are likely to feel a little discomfort.

This arises from the small incisions through which the instruments were passed into your abdomen, especially the one where the band access port has been placed, which is the larger.

Some people experience pain in the left shoulder after the procedure. This pain is usually mild and is coming from the diaphragm. As you recover from gastric band surgery you may need to take pain relief; you can take over the counter painkillers such as paracetamol or ibuprofen.

During the first 24 hours you should only have water. You must drink slowly but regularly in small sips and not drink more than 100mls at a time. For the first few days following gastric band surgery, you will be restricted to a liquid diet such as thin soup, and for the first few weeks you will only be able to have foods such as yoghurt or puréed food.

After that you will progress to soft foods and then gradually return to a healthy, balanced diet. The weight-loss charity WLS provides useful post-surgery dietary information. Most people are able to start to return to their normal activities 4 to 6 weeks after gastric band surgery.

Regular follow-up appointments at the hospital or clinic are needed to adjust the tightness of the collar of the gastric band by injecting a saline solution into it through the port.

What are the complications of gastric band surgery?

You may experience some side effects such as bruising, pain and swelling around your wounds and vomiting or feeling sick after eating, especially if you try to eat too much, although many people find their enjoyment of food is curtailed. Productive burping is an effect suffered by those with very tight restriction. It is unpleasant and can cause damage to the gastric band. It can result from eating too quickly or too much, practices that overwhelm the capacity of the pouch.

Possible complications of any operation may include bleeding or a blood clot, pain and wound infection, but other complications particularly associated with gastric band surgery include:

• Infection of your gastric band. Signs of a wound infection can include pain in or around the wound, red, hot and swollen skin, and pus coming from the wound.
• Your gastric band may slip out of place, leak, erode or slowly work its way through your stomach wall. Up to 1 in 5 people may need a further operation following gastric band surgery to put it back in place or to remove it.
• Gastro-oesophageal reflux.
• Constipation or diarrhoea.
• Injury of an organ such as stomach, oesophagus or spleen.
• Gallstones – These are small, hard stones in the gallbladder that can form if you lose weight too quickly – This is regardless of the gastric weight-loss surgery. The main symptom of gallstones is episodes of severe tummy pain that come on suddenly and can last a few minutes to a few hours.
• Food intolerance resulting in symptoms such as nausea, vomiting and gastro-oesophageal reflux (GER).
• Erosion – This happens very slowly, and particularly if the balloon is tightly inflated, the band can work its way into or through the wall of the stomach and cease to be effective.
• Malnutrition – Weight-loss surgery can make it harder for your gut to absorb vitamins and minerals from food, so there is a risk you could become malnourished.
• Excess skin – As you lose weight after gastric band surgery, you may be left with excess folds and rolls of skin, particularly around your breasts, tummy, hips and limbs. Cosmetic surgery such as a “tummy tuck” can resolve this, but it is not usually available on the NHS.

As with all surgical procedures there is a very slight risk of dying during surgery. The surgeon should discuss all these risks and complications in detail with you before you decide to have gastric band surgery.

Final thoughts

Gastric band surgery has been proved to be a safe and effective way to achieve dramatic weight loss, but it is not a cure for obesity on its own. Anyone considering or undergoing gastric band surgery will need to be committed to making major lifestyle changes to make sure that they do not put the weight back on.