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Who should get gastric banding?

3 June 08 09:29 GMT
By Martin Hutchinson

Television presenter Fern Britton has caused controversy after it was revealed that her recent weight loss followed a "gastric band" operation, and was not simply down to dieting and exercise.

But how does a gastric band work, who should receive them, and is there still a stigma attached?

For some obese people, attempts at conventional dieting and exercise will fail, and their weight means a far higher risk of health problems later in life.

It is at this point that their doctor may suggest gastric banding.

The principle is a simple one. Most people eat when they feel hungry, and when their stomachs are full, they stop.

The operation leaves a silicone loop tightened about three-quarters of the way up the stomach, creating a much smaller space at the top, with a tiny gap leading to the rest of the stomach.

Much less food is needed to fill up this little "pouch" at the top, at which point the person feels full.

The "pouch" then slowly empties through the gap into the rest of the stomach, and appetite returns.

Dr Ian Campbell, Medical Director of the charity Weight Concern, said: "If you reduce the volume of food you can comfortably put in your stomach, you'll eat less."

The NHS does offer gastric banding, but many people choose to have the operation privately, at a cost of around £7,000.

On average, people will lose up to 50% of their excess weight in the two years after they have one, almost immediately cutting the risk of diabetes, heart disease or high blood pressure.

But it is not recommended to all obese people - guidelines from the National Institute of Clinical Excellence say that it should be considered only after other, non-surgical solutions, have been fully exhausted, and patients need to be free of psychological problems, and receive the correct advice and counselling.

New lifestyle

The reason it is not recommended to all overweight people are the small, but significant risks of having a band, which are normally balanced against the health risks of obesity.

Although the band is normally placed using "keyhole" surgery, having a general anaesthetic still carries a risk, especially to an obese patient. There is also the chance of infection, or a problem with the band, such as leakage, which will require a second operation to correct.

Dr Campbell insists it is no easy option. Patients will need to change what they eat - the new stomach shape may not cope well with food which comes in large chunks, causing vomiting, and lavish dinner parties may be a thing of the past.

"You need to break off your love affair with food. You simply can't sit down to a three course meal with your friends any more."

Despite that, the stigma remains, despite the fact that thousands of gastric banding operations are carried out each year in the UK.

Fern Britton chose to keep her operation private, and was criticised for doing so by newspaper columnist Carole Malone.

"She is a public persona, but she is making money out of her weight. She also has made a career out of being a trustworthy person - a person that people look up to.

"She shares lots of parts of her life with the viewing public, and she gets paid an awful lot of money for that. She has made a little bit of a career out of dieting."

Psychological need

Some psychologists are also not convinced that the rising numbers of operations is a good thing.

Dr Funke Baffour, who specialises in the psychology of weight management, suggested that would-be patients should first be dealing with the underlying emotional issues which helped cause the weight gain.

"People aren't using their willpower, they're looking for a quick fix, but this will not resolve the psychological problems they may have.

"I'm of the opinion that no-one should need that drastic an intervention.

"I have had patients who are thinking about it, tell me they have done everything they can to lose weight, but, after discussing it, they haven't."

Dr Campbell, however, is adamant that the public perception of weight loss surgery is a false one. He said: "It's seen as a cop-out, a cowardly way of dealing with it.

"But what we have here is a perfect example, someone who is an intelligent, very able person, who has tried everything, over many years, without success.

"The forces that make her overweight cannot be overcome just by willpower."

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