Eligibility for Gastric Banding

Your eligibility for gastric banding depends on a careful balance of risks. The medical and lifestyle risks of being morbidly obese must be balanced against the short and long term risks of gastric banding surgery. The psychological and social impediments of obesity must also be taken into account.

Various guidelines on patient selection have been published over the years and opinions have changed over time and will vary between different surgeons.

In 1991 the National Institutes of Health (NIH) published the first set of guidelines to help surgeons determine who will benefit from obesity surgery (Ref: Gastrointestinal Surgery for Severe Obesity. NIH Consensus Statement 1991 Mar 25-27;9(1):1-20.). At the time this was based on the Lap Band system of gastric banding.

These guidelines are summarised as follows:

BMI should be over 40 kg/m²

OR

BMI should be over 35 kg/m², and the patient should be suffering from an obesity-related medical condition (e.g. type II diabetes or obstructive sleep apnoea)

In addition to this are the following points:

• There should have been repeated and prolonged attempts at diet and exercise programmes for weight loss
• Patients should be motivated and well informed
• There should not be untreated endocrine disorder*
• There should not be unstable psychological disorder**
• The patient should be capable of and commit to an ongoing course of post-operative attendance and management***
• The patient should not have uncontrolled drug or alcohol dependency
• The patient should not have severely impaired intellectual capacity
• The patient should not have active malignancy (cancer)

*Endocrine disorders are disturbances in body hormones. For example, low thyroid levels (hypothyroidism) will predispose to weight gain and should be identified and treated prior to considering surgery. Uncommonly, an excess of cortisol can produce Cushing’s Syndrome which leads to weight gain. This should be identified and treated on its own merits

**Severe depression or psychosis will make it very difficult to succeed with the gastric band due to the significant lifestyle changes that are required. Other issues such as binge-eating disorder or obsessive-compulsive disorder must be carefully managed when considering surgery

***If you spend a lot of time away from specialist medical care, such as on an oil rig for example, you will be unable to access urgent medical assistance if you have a blockage or acute slippage of the gastric band.


The BMI criteria are to exclude patients whose medical risk from obesity is too minor to justify the risks involved in surgery. Note that these guidelines were originally penned in an era where the majority of surgery was done “open” rather than “keyhole” and gastric bypass and other more complex operations were the mainstay of obesity treatment worldwide.

With the passage of time, surgeons’ ability to perform weight loss surgery in a safe manner, usually with keyhole surgery, has improved, as has the technology of the surgical instruments we use. We know a lot more about obesity surgery and post-operative management than we did twenty years ago.

In the light of these facts, and the increasing focus on good diabetes management, the guidelines have been relaxed by many surgeons to include the following...

Poorly controlled diabetics with BMI 30 – 35 kg/m² may also be considered candidates (Ref: Ann Surg, Vol 251, No. 3, Mar 2010)

The Food and Drug Administration of America has also recently approved the gastric band for use in BMIs between 30 and 35 kg/m ². This approval has been granted for the Lap Band brand at this stage.

So rather than adopting the original guidelines rigidly, surgeons will sometimes take on patients who may be slightly outside the original guidelines in carefully selected cases. What is not well addressed by the original guidelines is the impact on quality of life, self esteem, relationships, job prospects and other more personal aspect of morbid obesity that are not necessarily considered to be “medical problems”.

Call (03) 9895 7215 for more information on weight loss surgery.