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In both the US & Australia, weight loss surgery has seen a dramatic rise in the past decade. It is being touted as 'the hottest thing' in weight loss and as a long-term weight loss solution, with minimal risk and side effects. For many this may be true but for many it is not as 'easy' as originally put forward by health care professionals. It is important to understand what the procedure is and the pros and cons before gastric banding is seen as an option:

What is the procedure?

In very simple terms, an adjustable band is wrapped around the upper part of the stomach to restrict food intake, causing feelings of fullness for longer. The band is adjusted through the injection of saline solution through an external port that is left just under the skin. The surgery is usually performed via laparoscopic incisions through the abdomen.

Pros
' Can significantly improve health in the morbidly obese
' Can reduce significant weight in a short period of time
' Can reduce lifestyle diseases (and risks of lifestyle diseases)
' Can improve mobility and activity levels to allow for more weight loss
' Can improve sleep
' Can improve pain
' Can improve psychological well being
' Can be performed on teenagers (13+)
' Reduced risk of surgical complications compared to other gastric surgery
' Can be adjusted (tightened or loosened) quickly and easily
' Can be removed
' Laparoscopic surgery means less tissue damage and shorter hospital stays

Cons

' Weight loss initially is fast and significant and then plateaus
' Weight loss results may not be as significant as advertised (some surgeons are saying up to 75% of excess weight. The FDA results are approximately 36%. Some Obesity Centers are saying that between a 20-30% loss is realistic and more typical)
' The band does not guarantee weight loss
' Diet and exercise is still need to achieve results
' Permanent lifestyle changes need to occur for effective, long-term results
' Food reduction is dramatic and some food groups may be difficult to digest e.g. proteins, complex carbohydrates, fibrous vegetables
' There are ways to sabotage weight loss results through eating soft, fatty and/or sugary foods
' A more liquid or soft food diet may be necessitated
' Vomiting, purging or feelings of illness after eating may be common
' Nutritional needs may be compromised due to band being too tight
' Expensive and most costs are not covered by most health insurers (Gastric banding is cheaper than gastric bypass surgery - $12000-$20000 versus $15000-$25000
' Extensive weight loss may lead to change in appearance ' some for the better and some for the worse (more wrinkles, sloppy/excess skin)
' Does not change psychological mechanisms for emotional eating
' Some people may never be able to get the band removed due to unresolved behavioral and psychological mechanisms e.g. lack of motivation, fear of attention, disliking exercise/activity, poor eating behaviors
' The Weight-control Information Network ' An information service of the National Institute of Diabetes and Digestive and Kidney Diseases reports the following outcomes:

o 1 year - Up to 50% excess body fat loss in the first year
o 3-5 years ' some patients may regain some weight
o 10 years - as few as 20% of patients have kept the weight off (due to a lack of behavioral and psychological changes)

' Post surgical complications and inability to get standard diagnostic imaging

o Some people may be too large for the diagnostic scanning and imaging equipment e.g. CT scans and MRIs. One study found 27% of morbidly obese clients were unsuitable.:
o Other more evasive, less accurate means of investigation need to occur e.g. more surgery
o Proper diagnoses may be compromised as a result of less accurate diagnostic tools
o More surgery and/or longer hospital stays may be required
o Complications - infection, tubing between the band and access port breaking, repairs, food can block the narrow passage into the stomach, vomiting, very rarely death

Like any surgery, gastric banding does come with risks. Like any effective, long-term weight loss method, gastric banding is not a quick fix solution that never needs to be worked on again.

The regulations for having surgery are, 'severely obese adults who had tried, but failed, to lose weight by other means'. Most of the time when obese people say they 'have tried everything', what they mean is that they have tried 'every diet' and it hasn't worked. The majority of people who are overweight or obese use food like a drug. Just like a drug addict has a drug of choice ' heroin, crack, marijuana; overweight or obese people have their drug of choice ' food (too much, sugary, fatty, high calorie, low nutritional value)! Just like drugs, food releases brain chemicals that alter feelings and mood and it masks or dampens thoughts and emotions. All that surgery does is reduce the amount of food that can be eaten, but it doesn't change the poor coping mechanisms for dampening or masking emotions or thoughts. Gastric surgery does not help someone identify why they emotionally overeat and then give them new strategies to better cope ' it's another band aide, another quick fix. Long-term, if new, healthy mechanisms are not developed to deal with emotions and thoughts, people will return to their faulty patterns. Therefore, what is missing from the obesity treatment plan pre- and post-surgery is a program based significantly on the psychological and emotional mechanisms resulting in obesity. The surgeons, organizations, societies and clinics that deal with obesity and gastric surgery all state that surgery is not a cure-all, it requires a lifetime commitment to lifestyle changes ' nutritionally, physically, emotionally, and psychologically.

Kellee Waters ' The Fat Whisperer
BSc ' App Psych, PGradDip ' Psych, PGradCert ' Hyp, Cert IV - PT
http://www.mindandbodypower.com
kellee@mindandbodypower.com

Below are several case studies of clients who have had gastric banding with different experiences and outcomes:

1) Jenny ' 39 year old female ' obese since early teens. Had a medical history of a degenerative digestive system disease. Underwent gastric banding and was told that even with her medical condition, this was the safest possible option with very little risk. She underwent the surgery. Was discharged from hospital 3 days later still in pain and vomiting. Readmitted through emergency 2 days later and investigation found that she had some internal bleeding from the surgery. She was told that she would need surgery to stop the bleeding and was told that there was very little risk involved. She woke up 10 days later in the ICU (Intensive Care Unit) ward of the hospital! Complications had occurred and she had died on the operating table. She was then told that the doctors had to perform an emergency gastric bypass. Her stay in the ICU was for another 10 days and she was finally discharged 3 weeks later. She was still in a lot of pain, vomiting and could not hold down food and very little fluid. She remained very ill for the next 6 weeks where she was continually readmitted into hospital until further diagnostic imaging found that surgical instruments had been left inside of her. She had to undergo more surgery. After seeking further medical treatment after the surgery, she was also told that the original surgeon had left her with very little stomach (he removed 2/3 of her stomach) and had left blind endings (basically he had not plumbed her digestive and organ system back correctly). 3 years on and she was malnourished, vomited even if she consumed more than 150ml of liquid at a time and was know verging on anorexia. She was constantly in pain as the malnourishment and lack of correct digestive and organ connection had caused other medical conditions. She was now dying and no medical professional could help her!

2) Amanda ' 28 year old female ' obese since childhood. Healthy despite being morbidly obese. Had tried dieting (and every diet on the market) since she was 14. She was a good candidate for surgery. Her surgery was successful. She lost 1/3 of her excess body weight in 1 year but then plateaued for 2 years (she was still obese). She hated having the band in and wishes she had never done it and was too petrified to have it removed. She could hardly eat ' meat, fibrous vegetables, complex carbohydrates were all off the menu. She could only eat ' cup of food in any one sitting and then still she felt sick or would vomit it all back up. She kept getting the band adjusted to try and stop the vomiting but no matter how much it was loosened, she still felt sick or vomited every time she ate. She knew that she had not changed her behavioral or psychological mechanisms and believed that if she had the band removed, she would quickly eat her way back to being morbidly obese. She realized that the gastric band had helped her lose weight but it had not changed the way she thought about food and activity. She realized that if she was to lose more weight, with or without the band, she would have to deal with her psychological issues around food and change her lifestyle behaviors. She started doing this and felt more confident, self-efficacious over food, she began exercising and losing weight. Amanda came to the realization that the band was a helping hand in weight loss but it was not a life changing experience. Only she could change her life.

3) Jessica ' 25 year old female ' mother of 2 ' morbidly obese since mid teens. She had an underactive thyroid, diabetes type II and her blood pressure was increasing. She had trouble keeping up with her young children and was so sick of being ridiculed for her weight and size, especially by the men in her life. She looked into gastric banding and decided that it would help her. She had the surgery and it was successful. She was so happy with the results ' very little recovery time, little illness post surgery and 1 year on, just over a 1/4 of her excess body weight was lost. She was feeling confident and everything was going well until she hit a plateau 2 years later. She started emotional eating again, she lost confidence, felt self-conscious and was starting to retreat to all of her old, negative thoughts and behaviors. 4 years on and she is still struggling with her emotions, food, activity, motivation and self-esteem. She continually yo-yo diets ' losing weight and putting it back on. She is still obese and still struggling. She has started on the road to changing her old emotional, psychological and behavioral patterns and has a long road ahead.

4) Rachel ' 32 year old female ' morbidly obese since early teens and obese since childhood. In good health and underwent gastric banding. She got an infection and was admitted to ICU within 5 days of the original surgery. She was given some very intensive drug treatment to try and control the infection however, this failed and she had to undergo surgery. She was admitted to ICU immediately after the second surgery and while there underwent more drug therapy and one more operation. 21 weeks after the initial gastric band surgery she was able to leave the hospital. As a result of her ordeal she was left with an incisional abdominal hernia (approximately 20cm in diameter) and renal failure. She requires an operation to repair the hernia and a kidney transplant but need to reduce her weight by 66 pounds to be eligible and safe for surgery. She visits the hospital 4 times a week for dialysis. She has type II diabetes and an underactive thyroid. She has posttraumatic stress disorder relating to operations due to her first experience. She has significant grief and loss for a normal life as she is sick much of the time, making it difficult to work, she would like a relationship with someone special but does not want to burden them with her illness and potential death (if she does not get a transplant), her life expectancy has been significantly reduced and her medical expenses far outweigh her income, making it very difficult to seek appropriate medical treatments.