Great Expectations

Recently an acquaintance told me about seeing an obese man on TV who claimed that bariatric surgery hadn’t worked for him. “How can it NOT work?!” Patsy exclaimed.

There’s no simple answer to that question. In the past I’ve written about why weight loss surgery fails (read the article here: http://www.lapbandtalk.com/page/index.html/_/support/why-does-weight-loss-surgery-fail-r88).

Today I’d like to revisit the topic and focus on how our expectations affect the perception of as well as the ultimate success or failure of WLS.

BARIATRIC MYTHOLOGY

Some powerful myths influence our beliefs about and expectations of WLS. An especially insidious one that affects both bariatric patients and the general public is that WLS is essentially magic, requiring little or no effort on the patient’s part to achieve the desired weight loss. Hence the infamous and heinous phrase: “Weight loss surgery is taking the easy way out.”

This magic myth has a corollary one that purports that the weight lost as a result of bariatric surgery is weight lost forever, again without any effort on the part of the patient. Sorry, but that’s not true either.

While the whole point of bariatric surgery is to make weight loss easier, it does not eliminate the need for hard work by the patient. No bariatric surgery can cure obesity, which is a chronic, recurring disease. That doesn’t mean that succeeding with WLS means you’re sentenced to a lifetime of hard labor, dragging heavy chains and digging ditches, but it does mean that in the long term a successful patient is one who takes responsibility for his or her eating behavior, weight management, and general health.

Reading the paragraph above may serve to shatter some illusions that you held dear, but when would you rather face the truth: early in your journey, or later? Although I was once a bandster like you, I lost my beloved band and recently converted to vertical sleeve gastrectomy. I have to tell you that despite all my advance research and preparation, the reality of living with a sleeved stomach is giving me a bad case of buyer’s remorse, but there’s no going back now. Seventy-five percent of my stomach is gone forever, but living with what’s left and finding a way to eat and to manage my weight now is an ongoing challenge. And I’ve heard countless stories from all kinds of bariatric patients about the challenges they face after surgery. Anyone who promises you a completely sunny picture of the future is either mistaken or trying to avoid bursting your bubble.

BAND MYTHS

There are a number of myths related to the adjustable gastric band. One of them is that slower weight loss with the band will prevent sagging or excess skin, and that just ain’t so. A more dangerous myth, peculiar to bandsters, is that fills cause weight loss and unfills cause weight gain. While fluid adjustments are an important part of how the AGB works,the fluid is NOT what causes weight loss. In fact, there is absolutely nothing in any part of the band system (the band, the tubing, and the port) that causes weight loss. The band does not directly affect the way nutrients from food are ingested or metabolized. It releases no weight loss instructions into the patient’s bloodstream, nervous system, or endocrine system. It doesn’t directly affect the patient’s eating behavior or exercise habits. It doesn’t compel the patient to make good food choices, limit portion sizes, eat slowly, or resist the urge to graze or binge because of boredom, stress, cravings, etc.

Weight loss results from eating fewer calories than you burn, and the band helps with that by reducing your appetite and causing early and prolonged satiety. Those features are related to the pressure of the band against the stomach and the consumption of solid food whose mechanical digestion triggers the vagus nerves in the upper stomach to send satiety signals to the brain. If the patient ignores those signals, the calories taken in may exceed the calories burned, slowing or preventing weight loss. And since weight is affected by many other factors entirely unrelated to the band (like medications, hormone imbalance, etc. etc.), all we can do is to concentrate on the ones that are within our control and understand that it’s a fallacy to attribute weight loss to the band or to fills.

One harmful consequence of the fills=weight loss myth is that the patient seeks more and more fills in the quest for “perfect restriction” (also a myth) or the legendary (but also mythical) “sweet spot.” This patient tends to tolerate side effects and eating problems that can cause serious damage to them and their band because they’re so focused on finding that perfect but elusive fill level and believes (erroneously) that the more fluid in their band, the better. When you suggest to this person that they may actually need less, not more fluid in their band (so that they can eat healthy, solid food instead of not-so-healthy slider foods), they react with panic, so aren’t able to make a good decision and may not even be willing to tell their surgeon about the eating problems they experience.

Please don’t read this article thinking that my purpose is to discourage you. I’m the eternal optimist who believes in self-fulfilling prophecies. If you’re determined to lose weight and work hard at it, you can indeed use your band to reach your weight goal. The key phrase in that sentence is “work hard at”. There’s just no getting around that, so if your expectation is that you’ll lose weight effortlessly, you’re probably going to be disappointed in your band, yourself, or both. Your band can assist your weight loss efforts by providing early and prolonged satiety, but it’s not going to make good food choices, control portion sizes, make you exercise, be vigilant with aftercare, win you cash and prizes, or turn you into America’s next top model.

On the other hand, believing that you will succeed and working hard to learn and change what you need to in order to lose weight will greatly increase your chances of becoming a bariatric superstar. And when stardom comes from hard work, it is much, much sweeter and longer lasting than stardom that falls at random out of the sky!