Gastric bands aren’t just for cosmetic purposes – they can help to prevent health problems too.
Gastric bands are inflatable circular balloons that are placed around the top of the stomach. They reduce the total capacity of the sack-like organ, so when the patient eats, their stomach wall stretches sooner and tells their brain that they are full, but with a smaller volume of food. This leads to a lower daily calorific intake and, as part of a controlled diet and exercise regime, results in weight loss.
The band is typically placed with keyhole (or laparoscopic) surgery, leading to smaller scars, less pain and a shorter hospital stay. However, patients first need a vigorous workout. They must try and lose weight through conventional methods and medications, which may take up to six months. All patients undergoing weight-loss surgery must see a health psychologist too. The patients should be mentally prepared and positive that a gastric band will help them slim down as part of a holistic approach – for example, it won’t work if they continue to eat pizza and chips at every meal!
The band is placed in position in its deflated state. Through a port placed just under the skin, its size can be adjusted incrementally, leading to a controlled rate of weight loss; uncontrolled, over-quick weight loss can be very dangerous.
As with any medical procedure, there are potential risks and complications. The band can slip or become too tight around the stomach, leading to pain and visits to the emergency department. In these circumstances, deflating the band through the port beneath the skin solves most problems in the short term.
How healthy are you?
The body mass index (BMI) is commonly used to estimate a person’s body fat. It is utilised around the globe, including by the World Health Organisation. It estimates a person’s body size by dividing their weight by their height squared (ie BMI = weight in kilograms/ height in metres squared). The advantages are that it is easy to use, is the same for males and females and, in adults, is age independent. In children, it is used slightly differently and correct values vary according to age.
The BMI reading corresponds to categories of underweight, normal, overweight and obese.
The disadvantage of the BMI system is that it doesn’t take into account people’s differing body proportions or muscle bulk. Athletes with lots of muscle, for example, would be classified as being overweight and thus unhealthy, although they’re probably very fit. Some children who grow at different rates may be classed as outside normal ranges too, whereas they are in fact just in a growth spurt. That’s why BMI must be used in conjunction with the person’s overall fitness and appearance, and should be measured at several points over time to detect trends.
What’s the alternative?
All patients should start with a regime of healthy eating and exercise before considering surgery. Medications should be tried next and, combined with the right lifestyle, most people will lose weight and regain their health. However, some people don’t manage to lose weight, despite trying hard, so surgery is the only option left.
An alternative to the gastric band is the sleeve gastrectomy. During this procedure, most of the stomach is removed, leaving a sleeve-shaped tube. In a similar way to gastric bands, the patient feels full sooner, reducing the calorific intake. Gastric bands are not permanent and can be removed, but they can also slip out of place. Sleeve gastrectomies are permanent and won’t dislodge, but the procedure is more invasive and there are other potential complications that will need to be discussed thoroughly with the surgeon.
During a gastric bypass, on the other hand, a small pouch of the stomach is created which is connected to the small intestine lower down. This has a malabsorption effect, which ultimately means that fewer calories from what is ingested are taken into the body.
There are other forms of intervention, such as intragastric balloons, but not enough evidence exists to assess them properly. Finally, abdominoplasty (a ‘tummy tuck’) is a quick way to get rid of some excess abdominal fat without changing anything inside; this is purely cosmetic surgery though and has no internal health benefits.
How does obesity affect you inside?
Gastric bands don’t just make people look better. There are serious consequences of obesity on the internal organs, which have health implications that are very expensive to treat. Thus gastric bands can improve health and be cost-effective in the long term.
The heart – Obesity reflects underlying high-circulating triglycerides and poor health. This ‘circulating fat’ can block the coronary arteries, leading to angina or heart attacks (myocardial infarctions).
The lungs – When obese people have a layer of fat sitting on their chestwall, combined with fat from the abdomen preventing complete expansion of the lungs, it can lead to breathing problems. This is worse at night when lying flat and can cause sleepapnoea, where all breathing stops.
The abdominal wall – Everyone has a fatty layer on their abdominal wall. In obesity, this is often larger and it reflects what’s going on inside too.
The muscles – Everyone has rectus abdominis (six-pack) muscles, even if they’re buried between layers of fatty adipose tissue.
The liver – Obesity can lead to fatty liver disease (FLD), which in turn can progress to serious scarring of the organ (known as cirrhosis).
The pancreas – Obese people are at a higher risk of developing diabetes, which is related to changes within the pancreas.
The kidneys – High levels of circulating fats can block the arteries feeding the kidneys, causing hypertension. There are other effects on the kidneys too, although these are not fully understood as yet.