America's obesity ̒epidemic̕, coupled with increasing use of biomedical technologies in healthcare, has helped usher in new technoscientific methods to medically manage the bodies of overweight and obese individuals. Potential patients now have several surgical options to choose from in efforts to lose weight and (potentially) improve health outcomes, including gastric bypass, sleeve gastrectomy, and gastric banding; this research focuses on the gastric band, an implantable and adjustable silicone device designed to restrict the amount of food consumed. This study involves: in-depth interviews with predominantly female gastric banding patients, medical practitioners, bariatric surgeons, and representatives from the two U.S.-based biomedical firms that manufacture the gastric band; a multi-site ethnography examining the patient experience and the clinical encounter; and content analysis of scientific and non-scientific texts. Through this mixed methodological approach, this study charts the band's evolution and the complex forces guiding its design, development and adoption, and draws attention to the ways in which gendered assumptions enter into the pre- and post-surgical space with repercussions for patient care. Findings suggest that patients̕ decision-making process is shaped by - and shapes - multiple social, political, economic, and regulatory contexts. As a contested and unstable technology, the band's efficacy and ̒foreignness̕ is continually both challenged and reaffirmed by a diverse arena of social actors with a vested interest in the bariatric surgical space. These actors construct the band's role in the obesity epidemic in oppositional ways, affecting its use and perceived misuse: the depiction of the band as a safe, less invasive and - most significantly - removable technology helps drive its use, directing some patients away from other options - specifically, the anatomically changing gastric bypass procedure - portrayed as unnatural and extreme, though simultaneously more effective. While the band's reversibility represents freedom over technology and control over their bodies, it also reflects patients̕ struggle for both autonomy and desire for technological assistance in managing their weight. However, despite patients̕ attempt to assert themselves as active agents, the gastric band emerges as a disciplinary weight loss technology which serves to reinforce the perceived need for clinical intervention in the care and treatment of obesity. This study contributes to our understanding of the possibilities and limitations offered by biomedical technologies, and the ways in which humans resist, comply or are ambivalent toward their adoption and use.

Gastric banding as a weight loss surgery has increased in popularity in the United States since its approval by the Food and Drug Administration in 2001. Successful weight loss after weight loss surgery is most frequently defined as greater than 50 percent of excess weight loss (EWL). Systematic reviews show that the band is widely effective in achieving successful weight loss in most patients, however individual studies show more inconsistent outcomes. Although previous research supports gastric bypass surgery as having a positive effect on quality of life after gastric bypass, there is very little data to support this relationship in gastric banding patients. Weight loss outcomes after gastric banding surgery at Virginia Commonwealth Health System were less than 50 per cent EWL at one and two years. A retrospective, descriptive study sought to answer the following questions: 1) What is the relationship between physical activity, eating behaviors and hunger control on weight loss and quality of life after gastric banding surgery and 2) Does successful weight loss at one year predict successful weight loss at two years. The International Physical Activity Questionnaire Sort Form (IPAQ) was used to assess participation in physical activity. The Medical Outcomes Study Short Form (SF-36) was used to determine quality of life. Weight loss outcomes were 34.6 per cent at one year and 39.7 per cent at two years, which was less than the established success rate of greater than 50 per cent EWL, However, most patients lost some weight and demonstrated a significant improvement in most domains of health related quality of life. Participation in physical activity increased fro preoperatively to year one but decreased in year two. Although participation in physical activities overall decreased from year one to year two, there was a significant relationship between participation in greater than 150 minutes per week of moderate or vigorous physical activity and adequate weight loss (p =0.025) and participation in health enhancing physical activities and adequate weight loss (p < 0.05). There was no statistically significant relationship noted between any of these eating behaviors and the percentage of excess weight loss at one or two years. There was a significant relationship between degree of hunger reported by patients and successful weight loss at one year (p < 0.05). There is sufficient statistical evidence of a positive linear relationship between two- year weight loss and one- year weight loss (p < 0.05). That is, one-year weight loss is a significant predictor for two- year weight loss. Based on the results of this study, it is recommended that gastric banding patients participate in at least 150 minutes per week of moderate to vigorous physical activity. Additionally, clinicians should consider development of adjustment protocols that achieve early reduction of hunger in the banding patient.