Our previous experience with vertical (nonbanded) gastroplasty proved disappointing because of unsatisfactory maintenance of weight loss. Vertical banded gastroplasty seemed to be an attractive alternative operation because it provided an externally reinforced (banded) stoma that would not enlarge over time. In this study, our aim was to determine prospectively the results of vertical banded gastroplasty used as a primary, weight-reducing procedure in patients with morbid obesity. Seventy consecutive patients with morbid obesity (mean weight, 139 kg), all of whom had obesity-related complications, underwent vertical banded gastroplasty and prospective follow-up. The hospital mortality was nil, and substantial morbidity occurred in 3% (two patients). Long-term achievement and maintenance of satisfactory weight loss, however, were variable. The median weight loss at 1 year after operation was 36.7 kg or 48% of excess body weight. At 3 years postoperatively, however, weight loss was only 32.4 kg or 40% of excess body weight, and only 38% of patients had achieved and maintained a weight loss of 50% or more of their preoperative excess body weight. Vertical banded gastroplasty caused major changes in eating habits, and many patients were unable to eat red meat or untoasted bread; moreover, approximately 30 to 50% of patients continued to vomit once or more per week. Despite theoretically attractive advantages as a weight-reduction operation, vertical banded gastroplasty does not seem to be the optimal procedure for most patients with morbid obesity.