Gastric banding and the obesity 'industry'

Further, there is no standardised screening tool for the surgery. I know of countless cases of people engaging in binge behaviour who are offered the opportunity of gastric banding, at huge cost to their health. In our culture of thinness-at-all-costs, it seems that health is a reasonable trade off for thinness. Complicating this further is the fact that the subtext of our culture is that thinness equals health.

The Australian Medical Association’s 2008 report, Bariatric Surgery: A Weighty Issue, warned against the potential and inherent risks associated with gastric banding.

The cost to health from gastric banding is huge. Studies suggest that patients require follow up procedures to correct secondary health issues such as hernias, gall stones, bleeding, blood clots, infections, gastritis, correcting loose skin etc. In every 1,500 cases there is one death (which can’t be corrected).

Common post-surgery complications include:

• frequent vomiting because the stomach is unable to hold so much food or because food is unable to pass out from the stomach;
• dumping syndrome which occurs when food enters the digestive tract too quickly, leading to adrenalin that results in nausea, palpitations, sweating and diarrhoea;
• nutritional deficiency due to malabsorption. This means that people need to follow a lifetime program of consuming nutritional supplements and vitamins;
• requirement for further surgery due to slippage, repositioning, adjustments and need for replacement of the band. In the aforementioned study, over one quarter of participants required revisional procedures that consisted of removal and replacement of the band or replacement of the access port; and
• permanent eating difficulties including: an inability to digest particular foods, requirement for extensive chewing, difficulty in drinking at meal time, difficulty in eating at certain times during the day, and food becoming lodged in the throat.

These associated health concerns are frightening given that gastric banding is framed as the “next step” when diet, exercise and medication have failed. Descriptions on web pages, brochures and even research reports invariably begin with scaremongering about the “obesity epidemic” followed by cartoon-style drawings of the seemingly simple procedure that will not only make the person thin, but will solve all their problems. Not surprisingly, the “success stories” on brochures and the media focus on the life that was “saved” through gastric banding.

The ability of 14-year-olds to make this decision

Given the associated complications, it is not just me who believes that it is unsafe to be proposing this intervention for teenagers. In November 2009, the Dieticians Association of Australia (DAA) released a “Position Paper on Bariatric Surgery in Children and Young People” which concluded that there is insufficient evidence of the surgery as a safe and long-term solution to weight loss in teenagers. Even Allergen normally requires patients to be over the age of 18 to undertake the surgery.

This begs the question: what teenager has the capacity to make a decision so significant, given the health risks and the lifetime maintenance of such a procedure? How can a teenager adhere to the strict requirements necessary to maintain the band? What happens when they experience other significant life changes, such as pregnancy?

We are talking about prescribing this intervention to people who are in high school and who are legally unable to drink alcohol or drive because their brain is insufficiently developed to manage these responsibilities.

Frequent vomiting, permanent eating difficulties and soiling pants may not be the alternative to “obesity”’ that teens really need.