title: The use of adjustable gastric bands for management of severe and complex obesity.
abstract: Obesity levels in the UK have reached a sustained high and ∼4% of the population would be candidates for bariatric surgery based upon current UK NICE guidelines, which has important implications for Clinical Commissioning Groups.
  
  
  
  Summary data from Cochrane systematic reviews, randomized controlled trials (RCTs) and cohort studies.
  
  
  
  Currently, the only treatment that offers significant and durable weight loss for those with severe and complex obesity is surgery. Three operations account for 95% of all bariatric surgery in the UK, but the NHS offers surgery to only a small fraction of those who could benefit. Laparoscopic adjustable gastric banding (gastric banding) has potentially the lowest risk and up-front costs of the three procedures.
  
  
  
  Reliable Level 1 evidence of the relative effectiveness of the operations is lacking.
  
  
  
  As a point intervention, weight loss surgery together with the chronic disease management strategy for obesity can prevent significant future disease and mortality, and the NHS should embrace both.
  
  
  
  Better RCT evidence is needed including clinical effectiveness and economic analysis to answer the important question 'which is the best of the three operations most frequently performed?' This review considers the current evidence for gastric banding for the treatment of severe and complex obesity.
authors.affiliation: Department of Upper Gastrointestinal Surgery and Bariatric Surgery, Musgrove Park Hospital, Taunton TA1 5DA, UK.
authors.forename: James C A
authors.initials: JC
authors.lastname: Hopkins
authors.affiliation: Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
authors.affiliation: Department of Upper Gastrointestinal Surgery and Bariatric Surgery, Musgrove Park Hospital, Taunton TA1 5DA, UK Richard.welbourn@tst.nhs.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Welbourn
mesh_terms: D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D015391:Gastroplasty / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D015431:Weight Loss
keywords: bariatric surgery; diabetes treatment; gastric banding; metabolic surgery; obesity surgery