Adjustable gastric bands are growing in popularity as a treatment for morbid obesity -- defined as a body mass index (BMI) of 40 or higher. Such obesity increased by a whopping 225 per cent between 1990 and 2003, according to researchers at Queen's University in Kingston, Ont. Obesity is a risk factor for heart disease, diabetes, hypertension and some cancers.

What you need to know about gastric banding
1. The stomach is reduced to about the size of a golf ball
The band is an inflatable silicone ring about five centimetres in circumference that divides the stomach into a small upper pouch and a much-larger lower portion. The upper pouch expands when you eat solid food, causing you to feel full quickly. The band controls food emptying into the lower stomach, fooling your brain into thinking you are full. A doctor can make the opening bigger or smaller (depending on whether you want to speed up or slow down the food emptying process and therefore the rate of weight loss) by injecting or removing liquid (usually a salt solution) through a reservoir placed deep under the skin of the abdominal wall. Patients can lose up to 60 per cent of their excess weight, says Dr. Nicolas Christou, the director of the bariatric surgery program at McGill University Health Centre in Montreal.

2. You have to be very obese
You typically need to have a BMI of 40 or more or a BMI of 35 with obesity-related medical complications such as high blood pressure, sleep apnea or diabetes. This rule applies to other weight-loss surgeries as well. Some provincial health-care plans pay for such surgery, but waiting lists are uniformly long, according to Christou.

3. Surgery at private clinics is relatively expensive
In Canada, the adjustable gastric banding procedure costs between $15,000 and $17,500, depending on who performs it and where. For more information on private clinics that may offer gastric band surgery, go to the Find Private Clinics web site.

Other weight-loss surgeries that may also be effective
Gastric bypass -- Surgeons create the same small pouch at the top of the stomach but by using surgical staples. This pouch is connected to the middle part of the main intestine, bypassing the upper part (or duodenum). A smaller amount of the intestine is exposed to food, so less food is absorbed. Patients can lose 65 to 75 per cent of their excess weight.

Duodenal switch-- A significant portion of the stomach is removed. The “switch” bypasses a large portion of the intestine, thereby limiting the amount of food absorbed from the intestine. Patients lose approximately 75 to 80 per cent of their excess weight.

While patients are more likely to keep weight off following these procedures than with gastric banding, they're also more likely to develop anemia and vitamin deficiencies because these procedures interfere with nutrient absorption. Duodenal switch can cause bloating and diarrhea.

The gastric band occasionally slips and may obstruct the stomach -- requiring corrective surgery. Postoperative complication rates for gastric band surgery are low compared with gastric bypass and the duodenal switch; however, all surgeries have the same long-term complication rates.

Not just for cosmetics
Obesity is not always just a cosmetic issue; it can be a matter of life and death. Dr. Nicolas Christou, the director of the bariatric surgery program at McGill University Health Centre in Montreal, followed 1,035 patients who had undergone weight-loss surgery between 1986 and 2002. During that time, these patients lost 67 per cent of their excess weight. Mortality rates among these patients were compared with those of 5,746 other obese subjects who did not undergo wight-loss surgery. Researchers found that the relative risk of death was 89 per cent lower among the surgery group compared with the non-surgery group, They concluded that weight-loss surgery prevents medical conditions associated with morbid obesity and reduces risk of death.


Page 2 of 2 – Discover three important facts about gastric banding on page 1.