• James C A Hopkins, Jane M Blazeby, Chris A Rogers, and Richard Welbourn.
• Department of Upper Gastrointestinal Surgery and Bariatric Surgery, Musgrove Park Hospital, Taunton TA1 5DA, UK.
• Br. Med. Bull. 2016 Jun 1; 118 (1): 64-72.

BackgroundObesity 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.Sources Of DataSummary data from Cochrane systematic reviews, randomized controlled trials (RCTs) and cohort studies.Areas Of AgreementCurrently, 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.Areas Of ControversyReliable Level 1 evidence of the relative effectiveness of the operations is lacking.Growing PointsAs 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.Areas Timely For Developing ResearchBetter 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.© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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