Background: A low quality of life has been regarded a cue to action. Some patients with unsuccessful weight loss after laparoscopic adjustable gastric banding (LAGB) undergo a conversion of gastric banding to gastric by-pass. This study examines whether patients who did or did not undergo conversion to gastric bypass differed in quality of life before and after gastric banding. Methods: Of 34 patients with unsuccessful weight loss after gastric banding (excess body mass index loss < 25%), 14 had a conversion to gastric bypass 2 years or more after gastric banding. All patients completed the RAND-36 quality of life questionnaire before gastric banding. After gastric banding, 24 patients (70.6%) filled out the RAND-36 at 6, 12, and 24 months. Results: Pre-banding and postbanding mental quality of life was lower in the conversion compared to the non-conversion group. Conclusion: Our results suggest that a relatively stable lower mental quality of life is a signal for further intervention. The bariatric team and patients should be aware that mental health may play a role in the decision for conversion to gastric bypass. The possible mechanisms underlying this finding, and limitations of the study are discussed.