Bibliophile

I'm not denying that favorable studies exist. I am stating that there are studies that don't paint quite as a rosy picture of gastic banding outcomes. In order to be informed consumers we need to know *all* the information that is out there (& especially if the researchers have a conflict of interest) so that we can make the best decisions. I certainly would want to know about the peer reviewed evidence, and the methodology/quality of that evidence, if I were attempting to decide between the band and the sleeve.

If you will go back and carefully re-read, you will see that I posted about peer-reviewed studies. I only added personal thoughts or circumstances as a "friendly" addition.

I'm obviously not very good at explaining myself or at "thinking out loud" which indicates I should probably stop posting on this forum.

As I said in my first post, I am still on the fence about the lap band. I've looked at lots of studies and some of the current data is indicating that it is not as quite as complication free nor as successful long term, as it is being purported to be.

I am looking at peer reviewed studies published in major research journals. I posted some abstracts earlier in this thread. Unfortunately, the long term data on lapband is not as promising as once thought. We may have to agree to disagree here but I stand by my statement that anyone can lose 1-2 pounds per week with the right combination of diet and exercise. That's a basic truth. However, there are physical and mental factors which in reality influence individual ability to *follow* a prescribed diet, cope with severe caloric restriction and/or exercise. For example, I overeat and under-exercise. I am not someone who could realistically follow a 1200 calorie diet for the long term without a serious intervention. I chose lapband as an intervention and am not yet sure if it was the right or best choice. My concern is that we have a demographic (and I include myself in this ) that historically doesn't do well with a program of diet and exercise yet we're insisting that for lapband to be successful, they have to follow a program of diet and exercise. This is precisely why I think we need to evaluate various types of weight loss surgery independently of whether we think someone followed the proper "program" or not.

I agree with what you're saying but we're talking about the focus on diet *with* weight loss surgery and the idea of how important diet is to WLS "success." Other than making changes to adapt to the band, I am not sure it's appropriate to evaluate the success or failure of gastric banding with that confounder. Almost anyone who expends more calories than they're taking in will lose weight -- and they'll do that without going through a 12K+ risky procedure that's beginning to show an unexpectedly high complication rate 5-10 yrs out. Almost anyone can lose 1-3 pounds a week if they restrict their caloric intake and "follow" a diet. The issue is - if the band is a tool, how well does this tool really work and can that efficacy be evaluated independant of issues like individual willpower, etc.?

Just curious because I've often mused on this ------ shouldn't the effectiveness of a WLS be judged overall and independantly of individual "effort?" I've wondered about this because if a major criteria for success is to be able to follow a diet and exercise program, WLS would rarely be needed.

JustWes, I'm sorry to read about your situation. It sounds tramatic. Sadly I have spent the morning looking at the latest studies on long term complications and they are not good. The rate is much higher than I was initially told. I was just banded three months ago but had I known, I am not sure I would have so readily picked the band over other options. Do you have some kind of alternative plan in place?

In some ways, this is like asking people - "who belongs to the best church?" Unless you've directly experienced a negative outcome, you're inclined to shout-out the benefits. I have had the band a little over 3 months and I am still on the fence ---- however, I will say it has not worked the way I expected it to and I am now looking at a possible complication. The complication rates were downplayed (as they often are on this board) to me. The only true way to know is to look at the peer-reviewed, scientific studies (not the studies supported by those profiting by the band). Go to the PubMed site and search for terms like "gastric band" and "complications" "weight loss" "effective" etc.. Here are two I recently found: Surg Clin North Am. 2011 Dec;91(6):1249-64, ix. doi: 10.1016/j.suc.2011.08.008. Complications of adjustable gastric banding. Snow JM, Severson PA. Source: Minnesota Institute for Minimally Invasive Surgery, MIMIS Weight Loss Center, 320 East Main Street, Crosby, MN 56441, USA. Abstract: Adjustable gastric banding (AGB) has become increasingly used by bariatric surgeons and their patients as the surgical weight loss procedure of choice. The popularity of this procedure is in large part a result of the remarkable safety profile and low initial complication rate. Complications of AGB were initially believed to be minor and infrequent, but longer-term studies have increasingly described complications that lead to revisional surgery. In addition, a larger fraction of patients fail to lose weight than with other surgical weight loss procedures, frequently necessitating conversion to these other options. Obes Surg. 2010 Sep;20(9):1206-14. doi: 10.1007/s11695-010-0205-0. Graft survival and complications after laparoscopic gastric banding for morbid obesity--lessons learned from a 12-year experience. Naef M, Mouton WG, Naef U, Kummer O, Muggli B, Wagner HE. Source: Department of Surgery, Spital STS AG Thun, 3600, Thun, Switzerland. " ... In the present long-term high-participation follow-up study, LAGB is a safe and effective surgical treatment for morbid obesity. However, the high complication, re-operation, and long-term failure rates lead to the conclusion that LAGB should be performed in selected cases only, until reliable criteria for patients at low risk for long-term complications are developed."

Yes! This is exactly what I am talking about! As I said, perhaps it's the differing terminology used but I expected more help with portion control than I am currently getting. I expected to feel fuller with less food. Perhaps the nurse was talking about something different when she said restriction. I don't know.

Yes, overall it's how I believed the band worked as well. I've read all the stuff on restriction v not restricted, etc., different labels assigned to "green zone" "sweet spot" etc.. The differing labels and terminology add to the lack of clarification. Yet overall I assumed that except for the obvious slider foods, the band would help to keep you from overeating.

Yes, this is something I have to continually work on. I tend to mindlessly "stress eat". I just expected more help from the band than I'm getting.

I don't understand how anyone could assume I don't "want" it. I researched this for years, had no insurance, paid for everything out of my savings, waited months and months while jumping through all the hoops, went to the classes, did a grueling two-week liquids only diet and then had surgery. My discouragement and concern really has nothing to do with "want" but more feeling like things were not adequately explained to me. I also understand that the band is a tool but I don't think it's unreasonable to expect that tool to work. I realize that I am in what some refer to as "bandster hell" right now but to suddenly be told that I may never feel any restriction???

I've had three and no green zone yet. I was more than discouraged this week when my surgeon's nurse told me most people never feel restricted on the amount they eat. I am hoping she is soooooo wrong.

I just went for my third fill and had a talk with my surgeon's nurse. I told her I was discouraged but understood that it took a while for everyone to get to their "sweet spot" or perfect place. I explained to her that I was a bit concerned because while I felt I had to be careful and slow with what I ate (not to get stuck), I did not yet feel restriction. I still felt able to overeat big portions without feeling full. She replied, "Oh only a small number of banded people feel restricted about the amount they can eat. Those people are lucky and unfortunately you're not one of those. That's why I want you to be really careful about measuring your food." I was absolutely speechless and today I am in tears. Having my portions restricted was the ENTIRE REASON I had my surgery. Really, why else would anyone? If we only wanted to feel stuck once and a while, we could try to swallow quarters. It would be a lot cheaper! I feel duped and mislead. I did not spend my savings and have this surgery just to experience stuck and slime. Is what she told me true? Am I "one of those" so I am never going to feel fullness with just a few ounces of food?