UK Increases the Bandwidth

12 July 2009 (Last Updated July 12th, 2009 18:30)

During 2008, about 5,000 patients in the UK underwent gastric band surgery. Alex Hawkes talks to Dr David Ashton from Healthier Weight, a private medical firm that specialises in weight loss, to discuss the gastric bands increasing prominence in British society.

UK Increases the Bandwidth

The gastric band, an inflatable silicone device that is placed around the top portion of the stomach usually via laparoscopic surgery, was first invented by Swedish surgeons in the mid-1980s. In recent years it has become one of the UK's most common weight-loss operations.

Alex Hawkes: When did the procedure start becoming an integral part of business at Healthier Weight and how has it changed the way the firm is run?

Dr David Ashton: Between four and five years ago Healthier Weight witnessed a strong increase in demand for gastric band surgery. Since then there has been a gradual and steady growth of patients seeking the procedure.

We obviously had to recruit more members of staff to provide the necessary infrastructure for the long-term support of gastric band patients – as it has now become abundantly clear that to achieve better results with gastric bands, patients must attend regular follow-up appointments.

Healthier Weight runs an open-door policy at all four of our centres in the UK and provides a 24-hour phone service for gastric band patients wishing to seek advice or guidance.

"Once the patient has the gastric band inserted, they are a patient for life."

AH: You seem to be placing a strong emphasis on follow-up care, how fundamental is that in order to achieve the best results for a gastric band patient?

DA: It is absolutely fundamental. A patient can have a gastric band that has been perfectly inserted, but if the follow-up support is not there and the band is not correctly adjusted when it needs to be then the patient will not be successful.

At Healthier Weight, we have an intense follow-up period of three to six months with gastric band patients and from thereafter they are encouraged to visit a few times a year to see if everything is working fine. Once the patient has the gastric band inserted, they are a patient for life.

AH: What are some of the problems gastric band patients can run into?

DA: Typical stomach upsets can sometimes cause concern if they are not treated quickly. Gastric band patients are unable to vomit normally and they may contract a stomach virus and continue vomiting for a prolonged period of time – the band can slip and block the stomach. This rarely happens and, if for example, a patient was abroad when this happens, we would be able to offer simple advice to a doctor over the phone to stop the problem. If left untreated, however, it is possible the blood supply to the stomach could become compromised, causing a danger of the stomach rupturing.

The worst gastric problems I have witnessed are from people who have gone abroad to get quick-fix gastric band surgery on the cheap. Unfortunately, as interest in gastric bands has increased so have the number of centres offering the operation.

We operate a 'band rescue service' at the moment for follow-up care for patients who have had the operation abroad then run into trouble afterwards. We have had patients arrive with slipped bands from operations in Belgium, Latvia, Tunisia and many other locations from around the world, where the procedures have been done in a day and the patient has been offered no level of follow-up care.

Of course, when the general public reads about this sort of thing in the press it gives the impression that the gastric band is not a safe device. This is emphatically not true – gastric bands are an extraordinarily safe device in a good surgeon's hands and with expert follow-up.

AH: So do you feel the general public's perception of gastric band surgery is sometimes misled by the press?

"Gastric bands are an extraordinarily safe device in a good surgeon's hands and with expert follow-up."

DA: The media has given several impressions of gastric bands that are grotesquely wrong. Firstly they have tried to label the band a dangerous procedure. The first gastric band was inserted laparoscopically in 1993 and every study since then has indicated that it has a zero mortality rate. It is relatively speaking one of the safest procedures around.

Secondly, they have created a perception that having a gastric band fitted is an easy way to lose weight. We saw this recently when the UK television presenter Fern Britton was accused of 'cheating' her weight loss by having secret gastric band surgery.

Patients with gastric bands in fact have to work extremely hard to successfully lose weight – it is not a solution, it is a device to help a patient overcome a problem.

AH: I understand that roughly half of the gastric band operations that take place in the UK are provided by the National Health Service (NHS), with the other half being covered by the private healthcare sector. How does this influence your business?

DA: It is important to recognise that the most commonly performed procedure by the NHS for tackling weight-related problems is in fact a gastric bypass and not a gastric band. This is mainly because the follow-up work with a gastric bypass is minimal, while with gastric bands it can be considerable. The NHS currently does not have the right infrastructure in place to deal with large-scale follow-up work for gastric band patients.

Gastric bypasses, however, are a more dangerous operation and weight regain following the bypass is quite common. Often when the bypass does fail, they end up putting a gastric band on the patient at a later point.

We have, however, carried out gastric band work with various primary care trusts in the past and I suspect that in the future we will do more.

AH: Why do you believe it will be gastric band surgery and not gastric bypass surgery that will help counteract Britain's obesity problem?

DA: We are at a unique point in history where the obesity epidemic in the UK and the rest of Europe is such that surgeons are being called on to carry out a mass surgical intervention for what is effectively a public health problem. They cannot carry out such a large task with gastric bypasses but they can with gastric bands.

Let me give you an example of why. I have a colleague in the US who has fitted 2,600 gastric bands in his career, all which were outpatients who didn't even have to stay in the hospital overnight. Potentially, gastric bands could become just a daytime procedure, whereby patients arrive in the morning and are discharged in the evening.

AH: Surely if gastric bands are going to be implemented on such a scale it will become harder to identify which patients really need the procedure and which don't?

"Gastric bands could become just a daytime procedure, whereby patients arrive in the morning and are discharged in the evening."

DA: The guidelines from the National Institute of Health and Clinical Excellence recommend surgery for people with a Body Mass Index (BMI) of over 30 and have complications such as type two diabetes, high blood pressure, high cholesterol levels or breathing difficulties, or people with simply a BMI of over 45.

The problem with this is the NHS is using BMI as a surrogate marker for risk in an individual, which always leaves the danger of anomalies.

So for example, if there was an Asian gentleman [Asian and Afro-Caribbean are more susceptible to the risks surrounding obesity] who had type two diabetes, hypertension with central fat deposition, a long history of heart disease and a BMI of 44.9 then he would be denied surgery, which is absurd.

When we make a judgement whether a person is eligible for surgery, we take into account their height, weight, ethnic background, family history, fat distribution and a whole host of other variables.

AH: Finally, what difference can gastric bands make to the lives of patients?

DA: In 2008 we published a paper that compared the long-term mortality rates of gastric band patients with obese people who did not have the surgery. Out of the 1,791 gastric band patients, 60% were less likely to die prematurely compared to the other group.

Gastric bands deliver improvements to a whole range of risk factors such as type two diabetes, offer an improved quality of life and in the long term save lives.