BACKGROUND: Often, in severe obesity, diet and physical activity are not enough to achieve a healthy BMI. Bariatric surgical approach, in particular laparoscopic adjustable gastric banding (LAGB), has encouraging results in terms of weight loss and resolution of obesity-related comorbidities. However, several months after LAGB, some patients are enable to lose weight anymore and don’t tolerate a further calibration because of its collateral effects (excessive sense of fullness, heartburn, regurgitation and vomiting). AIM: The aim of this study is to identify the potential role of high protein-low carbohydrate ketogenic diet (KD) in managing weight loss in patients who underwent gastric banding and didn’t lose weight anymore. METHODS: 50 patients underwent LAGB between January 2010 and December 2013. In twenty patients (GROUP A) we observed a stop in weight loss so we divided this patients into two groups. One group (group A1: 10 patients) continued to follow a LCD low calorie diet and underwent a further calibration; the other group (group A2: 10 patients) started to follow a KD for the next 8 weeks. RESULTS: Both group resumed a significant weight loss, however group A1 patients reported collateral effects due to calibration and a higher Impact of Weight on Quality of Life – Lite (IWQOL-Lite) that correlates with a lower quality of life than patients following KD. CONCLUSIONS: KD can improve the weight loss and quality of life in patients who underwent LAGB and failed at losing more weight allowing a weight loss comparable to that obtained with a further calibration and it is useful to avoid drastic calibrations and their collateral effects.