I'm responding to this because I have the adjustable gastric band.

This article is a little screwed up:

"They attribute the dramatic increase to the introduction of a laparoscopic adjustable gastric banding surgical procedure following approval by the FDA in 2001. Although this surgery is more costly and time intensive, patient recovery times are shorter, and the surgery itself is less invasive," researcher Tonya M. Smoot, PhD, and colleagues wrote."

The Gastric Band procedure is much less expensive and the surgery is much shorter. There is followup that must be attended to but if the bypass is to be ultimately successful that requires long-term followup as well. The article doesn't mention that the mortality rate for the band is 1 in 2000 as opposed to 1 in 200 for the bypass.

"Weight loss surgery is increasingly being recognized as the most effective treatment for a host of obesity-related diseases, bariatric and general surgeon William Richards, MD, tells WebMD."

This is true for obese people more than 100 pounds overweight. At that weight, the chances that a person will successfully lose weight and keep it off for a couple of years are about 1% without surgery.

At my age and size, I discovered that no amount of low-carb, low calorie approach was going to work before I died of some nasty, obesity-related illness. At this point my metabolism is screwed.

"Bypass vs. Banding

Laparoscopic gastric bypass surgery is still the most commonly performed weight loss surgery in the U.S. But more and more patients are opting for gastric banding, which restricts the amount of food a person can eat by closing off a portion of the stomach."

It doesn't just leave less space in the stomach, it slows the passage of food through the system. That has the effect of keeping us feel full longer.

"Banding has the advantage of being less invasive than bypass surgery. It is also reversible with removal of the band system. A disadvantage is that banding requires frequent postsurgical medical visits for band adjustment.
Gastric bypass tends to be a better option for diabetes patients, Richards says, because the procedure not only restricts the amount of food the stomach can hold, but restricts calorie and nutrient absorption.

"Gastric bypass has been shown to have a profound effect on diabetes that is independent of weight loss," he says. "Patients also tend to lose more weight with this procedure. But if a patient is highly motivated and is willing to see their surgeon once a month for the first year after surgery and then four or five times the second year, laparoscopic adjustable gastric banding may be the best option."

This is where it really gets off track. After three years the average weight loss is the same between the two procedures and it is roughly just 50% of total weight that needs to be lost. The weight comes off faster with the bypass (at first) but the patient has to deal with more drastic side effects (dumping syndrome and malabsorption). I can only surmise that the inability to process sugar after the bypass (dumping) is the "effect on diabetes that is independent of weight loss" to which he refers. Either surgery requires motivation to make it work past the initial easy weight loss stage. I don't consider 4 or 5 trips a year to check in with the surgeon for an adjustment a big deal; nor does my surgeon.

Having the band has decreased the amount of food I can eat - and also limits or eliminates some types of food: breads, pasta & rice are most common. They tend to clump together and temporarily stop up the stoma. That creates a very uncomfortable situation when not even saliva can pass through. In an effort to loosen things up the body makes even more saliva. It can't go down so it has to come up. This event is called "sliming" for obvious reasons. I've only experienced it a handful of times since my surgery in early August. The most memorable time was Christmas morning - all morning. Merry Christmas!

Metabolically I still have the same problems - but without the overwhelming extra problem of excessive quantities of food. It doesn't take much to make me full now and I've learned to stop before it hurts. I'm still learning to put much less food on my plate. It looks more like a child's plate to me (but my perspective may be warped). Three ounces of a solid protein is about all I can eat at one time. I can usually add some veggies to that. That will keep me full for 4 - 5 hours. If I eat soft foods like cottage cheese, kefir - liquid protein, I won't stay full as long and I can down a lot more calories at one time.

This is where I will reveal the great pitfall of the band: it is still possible to eat lots of crap (crisp cookies, candy, ice cream, most cake). Lot's of junk food goes down just fine - better than meat, eggs or cheese. I have to stay in control of what I eat in order to lose. On the other hand, I can get off track for a few weeks and not really gain. In my pre-surgery days I could gain 20 to 30 pounds in a month if I was really wigged out and eating everything in sight. My body still doesn't handle carbohydrates well. Even if I can only eat 1/2 a banana instead of 3 or 4 whole ones, my blood sugar will go up and I won't lose weight.

I was about to go on, but I'll spare you any more details. I'm glad I had the surgery and that's allowed me to lose from 282 to 228 since last summer. It didn't "make" me lose. I had to low (<60g) carb most of the time to lose it. I've wandered from the path many times, once for a 3 month depression. Otherwise I would have lost much more quickly. I'm happier that it has come about slowly. I need time for my fat head to catch up with my body.