Why so few NHS bands?

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We look into the success and failures of the gastric band and tackle the big question that gets asked regularly in the UK.

Why does the NHS do so few band procedures?   Since 1992, when the first gastric band was implanted, hundreds of thousands have been implanted around the world, including here in the UK. As so many have been done we have a huge amount of published data to show the results that can be expected. Here at Healthier Weight we publish our data. Our results compare with the best centres in the world.Our latest study shows that patients achieved excess weight loss of over half of their excess weight (57%) over 5 years, with the vast majority achieved in year one (42%). Our complication and band removal rates are also at the low end of the range we see from the World’s Centres of Excellence.

A previous study into gastric banding was titled, The Gastric Band: First Choice Procedure for Obesity Surgery. This was published in 2009 and nothing has changed since then. We know that gastric banding is the least invasive and safest weight loss surgery procedure, so why are so few being done in the NHS? We see fewer than 1000 bands being done in the NHS every year now and its hard to understand given the results that can be achieved.Well, there seem to be three main reasons:

  1. Gastric band results are only as good as the aftercare that patients receive. Good aftercare requires the right ‘coaching’ for the patient about what to eat and what not to eat, responsible adjustment of the band and the early diagnosis of problems. When these things are done, complication rates over a 5 year period can be kept well below 10%. When the aftercare is poor however, band removal rates were shown to be as high as 40% in one large study recently. So, bands are great but you need the right aftercare.
  2. The aftercare programmes required to support band patients are expensive and complicated to manage. You need regular clinics with specially trained nurses and other clinicians. The same requirements do not exist for the other procedures. In summary, it is more hassle and more expensive to manage gastric band patients. The gastric sleeve andgastric bypass need less maintenance after surgery.
  3. The NHS has to direct it’s resources to those patients who are most in need. This means surgery is rationed to those patients who are at the greatest risk to their health as a result of their weight. Very often these are patients with Type 2 diabetes or other conditions that would be remedied by weight loss. Sleep apnoea and hypertension are two other examples. For patients with these health problems, the gastric bypass or the gastric sleeve can be a better option than the band as they deliver health improvements more quickly. For patients with higher BMIs, for example in the super obese category (BMI over 50), they are more powerful and will deliver more weight loss quickly.

So, for this combination of reasons the NHS is doing fewer bands. However, if you have a body mass index below 50 and you are not already managing health problems related to your weight, the gastric band is a great option. Just be sure you have it with a specialist gastric band centre that can provide the dedicated aftercare required for good long term results. In the best centres therefore, the gastric band really should still be the ‘first-choice’ for obesity surgery.

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Rishi Singhal

Rishi Singhal

Rishi is an expert bariatric surgeon based in the West Midlands and also Medical Director at Healthier Weight

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