Special Cases

Gastric Banding in Over 60s

Many patients over 60 years of age seek have approached us seeking advice about weight loss surgery. This scenario is quite different to offering the gastric band or any type of weight loss surgery to a patient in their 20s or 30s. The challenges which more elderly patients are facing with obesity include difficulties in mobility, pain for arthritis in the hips, knees and back, personal hygiene issues and ultimately, independence.

Weight loss in the elderly may provide some metabolic benefits but for this population it is less about extending one’s lifespan than it is improving quality of life. Medical problems such as diabetes and hypertension are much harder to treat at this time of life and other illnesses independent of obesity, such as cancer, may impact adversely on health. It is also more difficult for those in their 60s or 70s to undertake an exercise programme to augment their weight loss compared to younger patients.

The risks of undergoing any kind of surgery are greater in the elderly than for younger patients, although gastric band placement still remains a relatively safe procedure compared to many other operations which might be contemplated at this time of life (for example, total hip replacement).

Quality of life improvement for elderly patients after gastric banding can be substantial and satisfaction rates are high.

(Ref: Obesity Surgery (2011) 21(1):10-7, 2011 Jan)

• Improved energy levels
• Improved mobility
• Improved personal hygiene
• Better Self Esteem
• Improves urinary incontinence
• Reduces reflux
• Ultimately should enhance independence

Gastric Banding in Adolescents

The rate of obesity in high school children is currently around 10%. Children of this age are particularly vulnerable to the social effects of morbid obesity such as bullying, exclusion and difficulty relating to the opposite sex. The development of self esteem can be markedly impaired in a child suffering from obesity. At least 25% of obese adolescents will end up being obese adults. The metabolic insult of obesity will be life-long for these patients.

Bariatric surgery in adolescents must never be undertaken lightly.

The family must be closely involved in the decision making as should a paediatrician with a knowledge and understanding of weight loss surgery. It is generally accepted that completion of adult growth including bone maturity should be achieved before considering any form of weight loss surgery.

The effects of potential nutritional impairment on growing bones, body and neurological systems must be considered.

Despite all these considerations, gastric banding and other procedures have been performed in this age group with great success in highly selected and supported cases.

Gastric band with BMI under 35

The standard guidelines as laid out by the 1991 National Institutes of Health (NIH) consensus conference included only patients with BMI over 40 or BMI over 35 kg/m2 with an associated obesity-related medical disorder. The medical risk of obesity with BMI in the range of 30-35 kg/m2 is less than that of greater BMIs and consequently the benefits of weight loss are probably less.

Graphic: Relationship between Body Mass Index (BMI) and all cause mortality (Ref: Med Clin North Am. 1989;73(1):1–13.)


Nevertheless it is true that conditions such as type II diabetes increase dramatically in incidence with BMI even around the 30 mark. Individuals with BMI of 30 are 60-80 times more likely to develop Type II Diabetes than those in the healthy BMI range.

For diabetics who are poorly controlled with medication, a consensus conference was held in Rome in 2010. This included a multidisciplinary group of 50 voting delegates from around the world who published the following statement:

“A surgical approach may also be appropriate as a non-primary alternative to treat inadequately controlled type 2 diabetes mellitus in suitable surgical candidates with mild-to-moderate obesity (BMI 30–35 kg/m2).”

Read this Link: Article describing outcomes of diabetes consensus conference in Rome 2010. (Ref – Ann Surg Vol 251, No. 3, Mar 2010)


Given the inherent safety and reversibility of the gastric band, many surgeons of the opinion that BMI under 35 kg/m2 should be considered for surgery in select cases. The safety profile of weight loss surgery has improved since the 1991 guidelines publication and the vast majority is done with laparoscopic (keyhole) surgery these days.

In 2011 the Food and Drug Administration of America formally approved the potential use of the gastric band for use in patients with BMI 30-34.9 kg/m2 in the United States. This approval related to the LAP-BAND® brand of gastric band specifically.

As with any potential bariatric operation a decision is made on an individual basis after careful research by the patient and discussion with the bariatric team.

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