To Band or Not to Band

The first weight-loss surgeries were tried in the late 1960’s. I took care of some of the people who’d had this type of surgery at the University of California, San Francisco Medical Center in 1974.


These surgeries, which were called “gastric bypass,” all involved tying off most of the stomach and hooking the remaining small section directly to the small intestine. The surgeries “worked”; the people who’d had them all lost weight. Unfortunately, most of them died. There were several killer complications that surgeons had not foreseen—digestive juices would leak into places they shouldn’t or blood chemistries would get way out of whack. Eventually, it was realized that weight loss wasn’t worth the risks.

But the surgical techniques have gotten better, and now “bariatric,” or weight loss, surgery is a reasonable option for many people. One new technique, “gastric banding” isn’t a major surgery at all. Rather, it’s a laparoscopic procedure (a minimally invasive procedure that uses tiny incisions to access the abdominal organs). In gastric banding, a silicone band is wrapped around the upper portion of the stomach and inflated with a sterile fluid that is injected into a port just beneath the skin. This process creates a small pouch at the top of the stomach, giving the person a feeling of fullness after very little food has been eaten. But the whole stomach is still there and it all stays connected to the intestines normally, so the risk of complications is much less.

A big advantage of banding over bypass surgery is that you can adjust or reverse banding just by injecting or withdrawing some of the fluid from the port. You can change the tightness of the band over time, and in fact, it usually takes a few doctor visits after the surgery to experiment and get the tightness just right.

Many people who have had gastric banding achieve reduced weight and insulin resistance and also improve their metabolic parameters. In many cases, insulin tolerance tests show no sign of diabetes. We can’t say that diabetes is “cured” in these cases, but doctors do say it goes “into remission.”

After banding, you can’t eat nearly as much at one time. Eating in general may become less enjoyable. Some people report, however, that if they really slow down and take lots of time to taste each bite, they can retain most of the pleasure of eating.

In addition to the effects on eating, some people experience nausea or constipation after gastric banding. Some develop gallstones or nutritional deficiencies. This can be prevented by taking bile salts and nutritional supplements, respectively.

Weight is sometimes regained over the course of two to ten years (but rarely all of it). Pouches stretch, or people learn how to eat more continuously. People who drink a lot of high-calorie fluids at a slow but steady clip can “outsmart” the gastric banding. When weight is regained, some of the insulin resistance may come back also.

You can read a list of possible side effects from gastric banding here and another one here.

Cost and Availability
Banding is a same-day procedure most places, meaning that a person goes home on the same day the banding is performed. If you have to pay for a weight-loss procedure yourself, the cost of bypass usually runs from $20,000 to $40,000, while banding runs from $14,000 to $18,000. You can pay approximately half that amount in Mexico, if you’re adventurous.

Many insurers will pay for banding because some studies show that people who have had bariatric surgery spend an average of 77% less for medicines for diabetes and hypertension and other studies show that they have 50% fewer hospitalizations than obese people.

You will probably not have to travel far to find a good bariatric surgery clinic or hospital. They’re springing up all over. If you do a Google search for “bariatric surgery” and then conduct a “search within results” for your home state or province, you will almost certainly find some links.

Jean, a reader of this blog, asked if banding is safe for people with Crohn disease. Sorry, Jean. Bariatric surgeons in Texas say it is not safe with any inflammatory bowel condition.

What do I think?
I’m a holistic guy. I’m not even big on drugs, so how can I recommend surgery for an environmental condition like Type 2 diabetes?

Well, I think it’s too bad that people have to mutilate their bodies to stay healthy. But the fact is that our food environment is so unhealthy that, for many of us, our Goddess-given stomachs may be too big. A banded stomach may be better for a significant number of people. It’s certainly better, in my opinion, than taking a dozen drugs for the blood glucose levels, cholesterol levels, blood pressure, depression, and pain that often go along with obesity and lead to diseases like diabetes and heart disease.

I really never thought I would say something like this, but I think gastric banding is right for a lot of people. Bypass surgery, not so much—too invasive, too expensive. I’d like to know what you think about it. Please comment here or write to me at

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  • CalgaryDiabetic

    Is it insanity to have a non necessary operation? Or if there is no longer anything that works to loose weight it should be considered ? I found that since I have been on insulin I am gaining 10 lb per year and nothing I can do to avoid this. I tried to add Metformin but it made me so sleepy. Cutting the calories to 2200 per day worked for 60 days but then the body went ape. Increasing exercise frequency to every day makes me feel like been broken on the rack. Help I am at wits end, BMI is at 30.

  • David Spero RN

    Dear Calgary,
    It’s not insane. But it might not be right for you—you sound like a borderline case. A BMI of 30 is not that high.

    The American Society of Bariatric Surgery gives these criteria for surgery:
    1. BMI (Body Mass Index) above 40 or between 30 and 40 in the presence of other associated diseases that may improve with weight loss (high blood pressure, diabetes, sleep apnea, and painful joint condition arthritis proven by X-ray)
    2. Age between 18 and 55 years
    3. Failure of dietary or weight-loss drug therapy for more than one year
    [some omitted]
    4. Acceptable operative risk

    One question—you say everyday exercise makes you feel terrible. Might there be other forms of exercise you could do? Formal exercise is not always necessary if you are active in your life—stairs instead of elevators, walking whenever possible, that sort of thing. Physical activity is diabetes medicine #1.

  • LAW

    A BMI of 30 is Obese and, by definition, is “high”. Obesity (30+ BMI) increases risk for heart disease, type 2 diabetes, cancer, hypertension, stroke, asthma, sleep apnea, depression, chronic pain, infertility, high blood cholesterol, premature death.

    Yes, diet and exercise are ideal, but, according to National Institutes of Health (NIH), 90 percent of the people who participate in diets and weight-reduction programs do not experience significant and sustained weight loss.

    Also, see recently published research in JAMA and The New England Journal of Medicine regarding benefits of weight loss surgery.

    Another good resource in Plano, TX is iVital, combines lapband with personalized weight loss programs. Both the NY Times and Wall Street Journal have written at length about the benefits of gastric banding.


  • Janice

    I had lap band a year ago. I lost 45 pounds, then stayed the same for six months. We tightened the band,learned very quickly the adjustment was past my ideal spot,deflated the band, I lost another 9 pounds through the whole process, and I have learned it isn’t worth it to try to eat things that aren’t low carb for good success.I feel better,it was the best decision I have ever made. I have decreased my insulin and metformin levels,my goal is to be off all medications by the end of this year. I now know and understand where my boundaries are, and that I need to stay within those for successful weight loss. The band can only do so much for you, but it is a terrific tool to let you know when to stop eating or pay the price.I have been diabetic for 30 years. When put on insulin I was gaining 10-15 lbs a year and couldn’t lose it and kept gaining. Since the band, blood sugars are in great control,losing weight is easier,and exercise is an important part of success.

  • CalgaryDiabetic

    Since 55 years is a cut of for banding something else is needed. Well only another month or two of winter left. Maybe uping the exercise and cutting down on insulin should be tried. It is warm enough to go bicycling most days. Has anyone tried to replace insulin therapy with Byetta? Will this help one loose weight? Does anyone know if Symlin is available in Canada?

  • David Spero RN

    Increasing exercise is a good idea. But 55 might not be too old for lap banding. That’s just the recommendation of the Society of Bariatric Surgeons. You might want to check with local doctors.

  • mwarner711

    I’ve had type 2 for about 5 years – that along with the usual other accompanying demons of high cholesterol, high blood pressure, fatty liver. A friend had lap band surgery and is so happy that she did. My Doc thinks that I am a good candidate for the other… more permanent bariatric. I am 58 – 3 years over what I see here is the outside boundary. I am about 100 pounds overweight – but otherwise in good health for the short term. just wondering if any of you might throw some light on the subject for me. Mark