Gastric banding is a surgical procedure that involves tying off a portion of the space between the oesophagus (food pipe) and the stomach for the purpose of minimising the space that food has to pass. By reducing the physical space for ingested food to pass, the patients either reduce the amount they eat or suffer the nauseating consequences. The food can build up leading to reflux and even physical vomiting. The key to thriving with a gastric band is to consume small amounts at slow rates, chewing it well is integral and because of the smaller space in the stomach, portions have to be significantly reduced. The result of all this is weight loss via a calorie deficit relative to requirements.
Gastric bands work for a large number of patients, but there is qualifying criteria that need to be passed in order to warrant the surgery. The criteria is based on 2 main factors, that the individual is a certain weight (based on Body Mass Index aka BMI) and that they can lose a certain amount of weight off their own volition prior to surgery in order to prove that they are serious about the weight loss.
NHS, NICE and Government make new recommendations
The NHS, National Institute for Health and Clinical Excellence (NICE) and our government have amended the qualifying criteria for gastric band fitment based on the direct correlation between obesity (BMI of more than 30) and type 2 diabetes. It is well accepted that obesity breeds diabetes, excessive weight reduces a person’s sensitivity to insulin, the primary hormone involved in controlling blood sugar levels. The new recommendation is that people with a BMI of 30 should be considered for a gastric band, a drop from the previous qualifying BMI of 35. This means that an estimated 800,000 people may now be eligible for the weight loss surgery. The theory is that diabetes is more expensive to treat/ control over a lifetime, than the one off cost of a gastric band is in the short term. With about 10% of the NHS budget spent on diabetes, these changes may reduce total expense, but whether or not the surgeons will be able to meet demand is yet to be seen.
Positive for those with diabetes
Diabetes UK, the UK’s main diabetes charity and information site are presently supporting a trial focussing on a very low calorie diet, and a long term weight management plan. The director of health intelligence and professional liaison Simon O’Neill explains:
"Bariatric surgery can lead to dramatic weight loss, which in turn may result in a reduction in people taking their type 2 diabetes medication and even in some people needing no medication at all. This does not mean, however, that type 2 diabetes has been cured. These people will still need to eat a healthy balanced diet and be physically active to manage their diabetes."
"If a very low-calorie diet can be used within routine GP care to bring about and maintain weight loss and type 2 diabetes remission, it could ultimately be of enormous benefit to millions of people living with the condition"
The ‘very low’ calorie diets are based on a daily intake of 800kcal, but it is important that this is performed under the guidance of a Registered Dietitian (the only nutrition expert qualified to advise on such areas) and is not routinely prescribed.
Science Daily, (2013). Rapid reversal of diabetes after gastric band surgery. Retrieved 11th July, 2014, from http://www.sciencedaily.com/releases/2013/10/131015094601.htm
The Guardian, (2014). NHS anti-obesity plans could lead to sharp rise in gastric band surgery. Retrieved 11th July, 2014, from http://www.theguardian.com/society/2014/jul/11/nhs-anti-obesity-gastric-bands-diabetes