Jean McMillan

Ok, PrettyThick! You make some good points! Unfortunately it's VERY SAD that we live in a "visual" society were some people will judge your intelligence based on size. I work in the corporate world and YES I got MORE contracts with a LOT more money after I'd got to a size 10 versus being a size 24, was it fair? NO, but it does happen, however --- I was not a size 24 that long, but I was a size 18 for A LONG TIME...and I never felt any type of discrimination due to size, because I was always GOOD at my job and I had very good skills. However, when I gained some weight back in 2012 and went back up to a size 18 ~gulp~ I honestly WAS NOT treated ANY different than when I was a size 10...but I will tell you this.. When I was a size 20 and newly divorced, about 15 years ago and single, I honestly GOT MANY dates, ....in fact I married my second husband when I was size 20...LOL... When I got my lap band and lost about 100 pounds, I went on Match.com and I will tell you, I had more dinner dates that I could handle I was a size 14 at this time...I honestly had to fight guys off when I went to the grocery store and out and about...it was overwhelming to get that type of attention both at work and home.... Honestly -- when I got my lowest weight size 8 -- my family would tell me how "old" I looked....my looks started to fade the skinnier I got with my lap band, I noticed I was not as "cute" in the face...lol the smaller I got...I was not a 25 year old in a size 8, I was a 40 something year old woman, at 5'7 inches tall and a size 8 was NOT PRETTY on ME.... I met my current husband when I was a size 8 and he later told me, I did not look that great at that size....and that he tried to fattened me up... So the moral of this post IS...there is a HUGE difference of being a size 12/14 and a size 24/26.... Men love curvy "Thick" women not necessarily FAT women.. . Naomi, look in the mirror! I suspect men are attracted not just to your thick, curvy body but to your beautiful face!

Yes, I am happier, but some of that happiness was hard-won. A lower weight and smaller body and clothing size have not cured all the tough stuff in my life. I've had to go through a lot of mental re-alignment and even more attitude adjustments. I've had to learn how to deal with the tough stuff without medicating myself with food. And so on and so forth. But on the whole, being smaller makes me feel emotionally bigger and stronger.

I think it's great that you and the hubster are doing a major food overhaul. That will be a great benefit to you and your family, but I have to ask... You're only 3 weeks post-op and allowed to eat anything you want? I'm not a medical professional and not employed by your bariatric surgeon, but at 3 weeks post-op, I wasn't allowed to eat brownies and graham crackers. I was allowed to eat liquid and pureed food. The reason for that is that the post-op period is all about healing and not so much about weight loss. In order to digest stuff like brownies and graham crackers, your stomach has to expand and contract to break the food down enough to pass into your intestines. That movement can disturb the position of your band against your stomach. In fact, one of the most common causes of band slips (which could require more surgery to fix) is failure to follow the post-op diet progression (Clear liquids, full liquids, purees, soft foods, solid foods). But...if your surgeon's post-op regime allows you to eat anything, so be it. And now I'll go on to answer your question about go-to sweets. The failure of sugar-free pudding cups to satisfy your sweet tooth doesn't surprise me. I felt the same was as new post-op, mostly because I was accustomed to eating 1/2 gallon of ice cream every night, plus Cookies and donuts and candy whenever I wanted. Most successful WLS patients find that they need to go through an uncomfortable period of weaning off sweets before they can give up that stuff forever. I'm not saying that you can never eat sweets again, but if sweets are your weakness, your ability to limit them may be totally absent, and if you want to lose weight and maintain that weight loss, sweets may be something you need to give up for the foreseeable future. The more you eat sweets, the more your body depends on and craves them. For a while I played with eating candy like sugar-free Reese's PB cups. I found that it was just as easy to eat a dozen of those as it was to eat a dozen of the regular stuff, so I ended up with a bad case of diarrhea from the sugar substitutes and (guess what?) stalled weight loss. Then I tried Atkins indulgence bars (or whatever they're called), especially one that tasted like a Mounds bar. I would tell myself I'd eat just half...ha! And then I'd have the diarrhea again and tell myself again that I'd never eat that stuff again. Finally I found some treats that worked. Now, you may be able to eat any amount of this stuff now, but may not be able to eat that much later on when you've had some fills, so I'm afraid you're going to have to exercise some self-restraint. Your band is not ever going to jump out of your throat and fling that naughty food aside. It's not going to ring alarms or flash red warning lights or scream, "Leepers! Cease and desist!" OK, finally I'll get to the sweet stuff. Thank you for bearing with me this far. When I'm in the mood for chocolate, I eat 1/2 of a chocolate Protein bar. Be sure to read the nutritional info on the package because a lot of Protein Bars are meant to appeal to body builders who want to gain weight. If there's more than 15 grams of carbs or sugars in a Protein Bar, I give it a pass. When I'm in the mood for ice cream, I peel a banana, put it in a zip-lock bag, and stick it in the freezer until it's very cold. It might look kind of brown after that, but once I stir a sprinkling of mini chocolate chips into it, it tastes like fabulous. You could even stir it into that blah sugar-free pudding, top it with sugar-free Cool Whip, and have yourself a choco-banana Sunday. Even better, combine 1 tablespoon of Peanut Butter with the banana, and you have a choco-monkey treat. If you're truly allowed to eat any food now, including solid foods like fruits and veggies, I can give you some more suggestions. Just let me know. Jean

Do you know when to stop eating? To learn the when, you must pay attention to your “stop eating” signals. How do you know when to stop eating? Do you eat until you're full? No, you don't. You should never again try to eat until you feel full, not just because that’s how you became obese enough to qualify for bariatric surgery but because if you’re like me, your stomach (or soul) is an endless void that no amount of food will ever fill. You’re going to have to figure out a new stopping point. As mentioned in Satiated vs Stuffed, satiety is not quite the same as being full. Full means your upper stomach has reached its maximum capacity: that you have overeaten again – an old habit that made you obese enough to qualify for weight loss surgery. Satiety happens on your way to being full. With a properly adjusted band, you will be comfortable if you stop eating when you're satiated, but you’ll experience discomfort if you eat until you're full. This third article in the Satiety 101 series discusses the signals your body gives to tell you you’re satiated, but that’s only half the battle. The other half involves heeding instead of ignoring those signals. That subject could fill a book (which that I might write some day). Today we’ll focus on recognizing your own unique Stop Eating Signals. Because of its anatomical position (near your diaphragm, and pressing on the vagus nerve at the top of your stomach), the band’s presence (but not your band itself – which we must remember is an inert piece of plastic without any magic at all inside) can give you quick feedback about your eating behavior. The feedback is written in a language issued and understood by your brain, with assistance from your endocrine and digestive systems. Even if you were lousy in your high school French class, you will have to learn how to get directions in that language, so you won’t end up on Weight Gain Road instead op Weight Loss Avenue. Those directions come in the form of what I call Soft Stop and Hard Stop signals. To understand those directions, you’ll need to slow down and pay attention while you eat. It takes 15 to 20 minutes for satiety signals to reach your brain and to be broadcast to the rest of you. If you usually eat with a crowd (family, friends, coworkers), you might need to try eating by yourself for a few meals so you won't be distracted. Stop signals can be subtle and they can come from unexpected parts of your body. It's better to heed a gentle reminder than wait for a hammer to hit you on the head. SOFT STOPS are your early warning system, gentle reminders from your body that it's time to stop eating. Because they don't hurt much, they're easy to ignore. They include: · Mild queasiness (an icky, but not about-to-vomit, feeling) · Fullness or pressure in the back of the throat · Pressure in the chest or just below the breastbone · Throat clearing · Some difficulty swallowing · Burping (or the urge to burp) · Taking a deep breath · Mild coughing · A sigh · Hiccups · Watering eyes · Runny nose · Left shoulder pain · A sneeze · More saliva in the mouth than usual · A sudden distaste for the food you were enjoying a moment before As soon as you notice one of these signs, stop eating! I don't care if your stubborn mind is insisting that it's okay to continue (because it thinks you have room for just one more bite, or the food tastes good, or you haven't cleaned your plate, or you deserve the food, or whatever's going on in there). If you go on eating past this point, you won't be changing your eating behavior and you're likely to get into trouble…that is, a hard stop. HARD STOPS are the equivalent of running into a brick wall. They can happen without any apparent warning, but usually you have sped heedlessly past a soft stop before you hit the wall. Hard stops are the painful and sometimes embarrassing reminders that you have eaten too much, too fast, in bites that were too big, without chewing enough. They include: · Chest pain and/or painful pressure or tightness in the chest · Feeling like you have a rock in the back of your throat · A burning sensation in the throat · A “stuck” feeling, as if the food you’ve eaten has nowhere to go · Productive burps (PB's) – regurgitation of food, kind of like the way a baby erps up milk · Sliming (excess saliva and mucus that's so profuse, you have to spit it out) When you experience a hard stop, STOP EATING! It's not at all a good idea to keep eating after you experience a hard stop, even if the discomfort goes away and your plate of food still looks appealing. You may feel fine and may in fact be able to eat some more, but you should not eat more. The hard stop has irritated your upper gastrointestinal system. Continuing to eat will just perpetuate the problem, getting you into a never-ending cycle of eat-hard stop-pain-eat-hard stop-pain. Cycles like that tend to turn into complications like band slips and esophageal and stomach dilation. That’s the reason for my next piece of advice: follow a liquid diet for 24 hours after a hard stop episode, then transition carefully back to pureed then soft then solid food. If you’re like me, you did not have WLS in order to live on liquids for the rest of your life. That’s yet another reason to learn how to prevent hard stops in the first place, so that you can eat and enjoy real food at every meal. Now here’s one last chunk of information before the bell rings and today’s class ends. You may not experience any or all of these stop signals any or all of the time. At breakfast you might get one signal and at lunch, an entirely different one. At dinner, you may notice no stop signal at all. As time goes on and you lose weight and the amount of saline in your band changes, your stop signals may change as well. All that can be frustrating, but it will force you to go on eating slowly and carefully for the rest of your life, and that’s actually a good practice for anyone, banded or not. That plate of food before you is a blessing that some people in this world can only dream of. Those small portions may look puny to you, but would be a feast to someone else. So treat your food, and your body, with the care they deserve. Learning to recognize satiety over and over again is an ongoing process because our bodies are not statues made of marble. We are all marvelous, unique, and complex creatures who change by the minute, every day of our lives. Click here to read about how those changes can affect soft and hard stop signals. http://www.bariatricpal.com/page/articles.html/_/support/post-op-support/restriction-riddles-r93 This is the third and final article in the Satiety 101 series of articles.

yes jeannie.......nothing like HOMEWORK Well, don't try telling me the dog ate it.

CG, There you go, over-thinking again. Yet another reason we're soul sisters! But I think you're just on the verge of knowing that the infamous Green Zone is, after all, a RANGE and not a single point, and you've been roaming that range for a while now ("Home, home on the range, where the deer and the antelope play, where never is heard a discouraging word, and the skies are not cloudy all day"). Your next assignment: giving yourself credit for recognizing that. Jean

Excellent insight and advice!

As mentioned in Satiated vs Stuffed, satiety is not quite the same as being full. Full means your upper stomach has reached its maximum capacity: that you have overeaten again – an old habit that made you obese enough to qualify for weight loss surgery. Satiety happens on your way to being full. With a properly adjusted band, you will be comfortable if you stop eating when you're satiated, but you’ll experience discomfort if you eat until you're full. This third article in the Satiety 101 series discusses the signals your body gives to tell you you’re satiated, but that’s only half the battle. The other half involves heeding instead of ignoring those signals. That subject could fill a book (which that I might write some day). Today we’ll focus on recognizing your own unique Stop Eating Signals. Because of its anatomical position (near your diaphragm, and pressing on the vagus nerve at the top of your stomach), the band’s presence (but not your band itself – which we must remember is an inert piece of plastic without any magic at all inside) can give you quick feedback about your eating behavior. The feedback is written in a language issued and understood by your brain, with assistance from your endocrine and digestive systems. Even if you were lousy in your high school French class, you will have to learn how to get directions in that language, so you won’t end up on Weight Gain Road instead op Weight Loss Avenue. Those directions come in the form of what I call Soft Stop and Hard Stop signals. To understand those directions, you’ll need to slow down and pay attention while you eat. It takes 15 to 20 minutes for satiety signals to reach your brain and to be broadcast to the rest of you. If you usually eat with a crowd (family, friends, coworkers), you might need to try eating by yourself for a few meals so you won't be distracted. Stop signals can be subtle and they can come from unexpected parts of your body. It's better to heed a gentle reminder than wait for a hammer to hit you on the head. SOFT STOPS are your early warning system, gentle reminders from your body that it's time to stop eating. Because they don't hurt much, they're easy to ignore. They include: · Mild queasiness (an icky, but not about-to-vomit, feeling) · Fullness or pressure in the back of the throat · Pressure in the chest or just below the breastbone · Throat clearing · Some difficulty swallowing · Burping (or the urge to burp) · Taking a deep breath · Mild coughing · A sigh · Hiccups · Watering eyes · Runny nose · Left shoulder pain · A sneeze · More saliva in the mouth than usual · A sudden distaste for the food you were enjoying a moment before As soon as you notice one of these signs, stop eating! I don't care if your stubborn mind is insisting that it's okay to continue (because it thinks you have room for just one more bite, or the food tastes good, or you haven't cleaned your plate, or you deserve the food, or whatever's going on in there). If you go on eating past this point, you won't be changing your eating behavior and you're likely to get into trouble…that is, a hard stop. HARD STOPS are the equivalent of running into a brick wall. They can happen without any apparent warning, but usually you have sped heedlessly past a soft stop before you hit the wall. Hard stops are the painful and sometimes embarrassing reminders that you have eaten too much, too fast, in bites that were too big, without chewing enough. They include: · Chest pain and/or painful pressure or tightness in the chest · Feeling like you have a rock in the back of your throat · A burning sensation in the throat · A “stuck” feeling, as if the food you’ve eaten has nowhere to go · Productive burps (PB's) – regurgitation of food, kind of like the way a baby erps up milk · Sliming (excess saliva and mucus that's so profuse, you have to spit it out) When you experience a hard stop, STOP EATING! It's not at all a good idea to keep eating after you experience a hard stop, even if the discomfort goes away and your plate of food still looks appealing. You may feel fine and may in fact be able to eat some more, but you should not eat more. The hard stop has irritated your upper gastrointestinal system. Continuing to eat will just perpetuate the problem, getting you into a never-ending cycle of eat-hard stop-pain-eat-hard stop-pain. Cycles like that tend to turn into complications like band slips and esophageal and stomach dilation. That’s the reason for my next piece of advice: follow a liquid diet for 24 hours after a hard stop episode, then transition carefully back to pureed then soft then solid food. If you’re like me, you did not have WLS in order to live on liquids for the rest of your life. That’s yet another reason to learn how to prevent hard stops in the first place, so that you can eat and enjoy real food at every meal. Now here’s one last chunk of information before the bell rings and today’s class ends. You may not experience any or all of these stop signals any or all of the time. At breakfast you might get one signal and at lunch, an entirely different one. At dinner, you may notice no stop signal at all. As time goes on and you lose weight and the amount of saline in your band changes, your stop signals may change as well. All that can be frustrating, but it will force you to go on eating slowly and carefully for the rest of your life, and that’s actually a good practice for anyone, banded or not. That plate of food before you is a blessing that some people in this world can only dream of. Those small portions may look puny to you, but would be a feast to someone else. So treat your food, and your body, with the care they deserve. Learning to recognize satiety over and over again is an ongoing process because our bodies are not statues made of marble. We are all marvelous, unique, and complex creatures who change by the minute, every day of our lives. Click here to read about how those changes can affect soft and hard stop signals. http://www.bariatricpal.com/page/articles.html/_/support/post-op-support/restriction-riddles-r93 This is the third and final article in the Satiety 101 series of articles.

As a new bandster, it took me a long while to even begin to pay attention to my eating, never mind figure out when to stop eating. And no wonder. For over 50 years, I had eaten mindlessly, greedily, endlessly. Every single day, every meal, every moment, I ate and ate to reach what I call Thanksgiving Dinner Full. I loved to cook (and still do). I loved to eat (and still do). My business travels took me all over the world, so that in each country I was able to enjoy a huge variety of different and delicious food. Occasionally the food was very strange – I can’t recommend eating the lightly grilled, still wriggling sea slug I sampled in Taiwan – but I was always game for a culinary adventure. It’s very ironic that during those overseas travels, I witnessed true hunger, deprivation, and near-starvation firsthand. What I ate in one day then could probably feed a whole family for a week. In Southeast Asia I once met a new business associate for the first time. We talked business for a while. Then he said something startling, seemingly out of the blue: “Your family must be very wealthy.” I said, “Uh, not especially.” He smiled at my modesty, gestured at my size 24 body and said, “But it is true, because I can see that you eat very well.” That encounter was mortifying on several levels, as I’m sure you can imagine. When I left that business career and coincidentally began dealing with my weight and eating issues, I also began to feel shame for my eating behavior, for the waste of all the food I’d gobbled up in my perpetual quest for TDF (Thanksgiving Dinner Full). But how on earth could I end that quest? How could I ever learn to stop eating before I reached the TDF level? I was extremely fortunate to start my weight loss surgery journey a short while later, and even more fortunate that my Lap-Band® eventually became such an effective tool in helping me eat less and lose weight. Although I felt I’d done a lot of research as a pre-op, I have to smile every time I think of a bandster friend who told me, “I had no idea how much work this was going to be.” I had no idea either. Every bite of food, every sensation in my body before, during, and after I ate, became a big project. If you’re a new post-op, or even a further-out post-op, are you too discovering how much work is involved in living with and succeeding with your band? Perhaps wondering, “What have I gotten myself into?” If so, that’s OK. Remember that you’re not alone, and that you can succeed even if feels like getting there is taking forever and a day. So, c’mon, Jean. Get to the point. Tell us: how do you know when to stop eating? Do you eat until you're full? What is “full” supposed to feel like now? My answer to the first question is no. As a WLS patient, you don't eat until you’re full. You should never again eat that way, not just because that’s how you became obese enough to qualify for bariatric surgery but because eating that way will hinder your weight loss and can cause some nasty side effects and complications. So you’re going to have to figure out a new stopping point. And that stopping point is the satiety point. Satiety is not quite the same as being full. For a bandster, full means that you have overeaten again and will soon be so uncomfortable you’ll have to take a few breaths before you go on to clean that plate like a good kid. (Which, by the way, is another practice you’ll have to give up sooner or later). Full means your upper stomach has reached its maximum capacity and that at any moment, that food is going to back up into your throat and make an ungraceful exit all over you, the table, and your dining companions. Full means that you sped right past your satiety point. Full means that it’s time to start paying much closer attention to how you feel as you eat. Satiety happens on your way to being full. With a properly adjusted band, you will be comfortable if you stop eating when you're satiated, but will experience discomfort if you eat until you're full. If you eat to the TDF point, you won’t have that old faithful full-belly sensation that made you loosen your belt while waiting for Mom to bring you a big piece of pumpkin pie. Instead, you’ll probably feel pressure, even pain, in your upper abdomen and chest. You’ll produce enough excess saliva to make you drool. You’ll think you’re about to power barf. You’ll be very sorry you overate. You’ll promise God and your bariatric surgeon (who are not actually the same person, by the way) that if you can feel relief right now, you’ll never overeat again. You’ll need to learn some strategies to prevent another episode of overeating. In article #3 of the Satiety 101 series, “Recognizing Satiety,” we’ll take a look at some common signals our bodies give us when we’re closing in on the satiety point.

MORE, MORE, MORE Americans love MORE: more of anything and everything. More food, more fun, and (for some of us) more fill in our bands. But striving for maximum fill in the effort to achieve maximum weight loss can be a terrible mistake. Fat folks become obese enough to qualify for bariatric surgery because we’ve been eating more, more, more, so it’s not surprising that bandsters long for more, more, more fill. The tighter the band, the better, right? Wrong. Here’s why: tighter doesn’t automatically yield more weight loss. It can cause eating problems, side effects and complications that none of us want. It can compromise our quality of life. It can make us miserable when all we hope for from bariatric surgery is a better life. You’re not impressed by all that? You’re willing to risk everything in the pursuit of skinny? Then try this on for size. A tight band doesn’t guarantee weight loss. Just the opposite: it can stall your weight loss or even make you gain weight. Do I have your full attention now? Good. Listen up and I’ll explain why tighter isn’t always better. THE RESTRICTION FALLACY Traditionally, the adjustable gastric band has been considered a “restrictive” weight loss surgery. Bandsters were taught to look for signs of restriction: the proofs that their bands were working. Instead of paying attention to her own eating behavior and lifestyle, the bandster waited impatiently for the flashing signs, ringing bells and slamming doors that would stop her from overeating. The idea was that the small upper stomach pouch would “restrict” food intake and result in weight loss. Sound familiar? That was well-intentioned thinking, but it was wrong. In the past 5 or so years, band manufacturers and bariatric surgeons have come to believe that it’s a mistake to eat and eat until you set off your band’s emergency warning system, for the reasons mentioned above. Unfortunately, the re-education process is slow going, and in the meantime, the restriction fallacy lives on. Even now, approximately every third word out of a bandster’s mouth is “restriction”. It’s a catch-all term for the feelings that limit how much a bandster eats. Post-op band life tends to become a quest for enough fills to reach the Holy Land of Restriction. Next stop: Skinnyland. Or not. HAZARD AHEAD! THE DANGERS OF SOFT CALORIE SYNDROME Soft Calorie Syndrome is one of the least publicized dangers of a band that’s too tight. Psychologists would call it a maladaptive behavior, that is: a nonproductive behavior that prevents you from adapting to situations, or changes in yourself or your environment, in a healthy way. It can begin as an attempt to deal with or avoid an unpleasant experience but it does not solve the original problem and eventually becomes dysfunctional. You can read more about maladaptive eating behaviors by clicking here: http://www.bariatricpal.com/page/articles.html/_/healthy-living/is-your-eating-maladaptive-r50 A bandster experiencing Soft Calorie Syndrome is responding to the unpleasant experience of eating with a band that’s too tight by eating the soft and liquid calories that slide most easily past their gatekeeper band. Instead of eating the healthy and solid foods (like dense animal protein, veggies, fruits) that provide the most satiety (both early and prolonged), that person favors easy-to-eat food that’s often junky and high in calories (for example: potato chips, ice cream, milkshakes). Even healthy foods( like yogurt, cottage cheese and, fat-free/sugar-free pudding) can fall into the soft calorie category, and they don’t provide any better satiety than the junky stuff. The net result is that you end up consuming more calories than you need because the soft stuff doesn’t provide enough early and prolonged satiety. And the result of that is a weight loss plateau, or even weight gain. I discovered the perils of Soft Calorie Syndrome for myself when I traveled to New York City to attend a trade show when I was about 8 months post-op. I had gotten a fill the day before I left, and by the time I got to New York I had realized that my band was too tight for me to tolerate. I couldn’t eat any solid food, so I spent the next 3 days eating soft, high-calorie, low-satiety foods like creamy soups, milkshakes, and ice cream. I was just trying to survive long enough to go home and get an unfill. My maladaptive eating behavior achieved a temporary goal (comfortable survival) while sabotaging my long term goal of losing weight. In fact, I gained weight during that trip and ended up feeling disappointed in myself. I promised myself no more fills on Fridays and no more fills the day before a business trip. I called my surgeon’s every time I suspected my band was too tight and found that even tiny unfills could make all the difference in my quality of life as well as my weight loss. I know I’m not the only person who’s discovered the perils of Soft Calorie Syndrome. I also know that you’re not alone in believing that more fill is better and that unfills will slow or stall your weight loss. A few months ago I talked about this with a smart and successful bandster named Denise. When her surgeon reacted to her too-tight band by suggesting an unfill of .5 cc, her dazed and frightened face made him reassure her that she could start being re-filled in a month. The month ahead scared her, but she agreed to the unfill, and discovered that rather than returning her to Bandster Hell, it had restored sanity to her eating life. She said, “I was able to eat again. Solids went down easily. Bread was on my menu. Meals lasted me several hours. I didn’t snack because I was able to eat enough to keep me satisfied.” When Denise went back to her surgeon a month later, he was delighted her hear her say that she didn’t even need a re-fill. She told him, “I can eat anything, but I’m not eating everything.” And that, my friends, is what healthy eating is all about.

Are you still searching for the feeling we call “full”? Not once in my life before my band surgery did I ever feel I had eaten enough food. Day after day, meal after meal, I searched for the feeling of “full”. I had no idea what it felt like, for many reasons. Some were emotional, some spiritual, some physical. Researchers now theorize that the internal message system in obese people doesn’t function properly, so that we don’t receive or comprehend “full” messages. Whatever the reason(s), I ate as if I was shoveling food into a bottomless pit that no amount of food could ever fill. As a new bandster, it took me a long while to even begin to pay attention to my eating, never mind figure out when to stop eating. And no wonder. For over 50 years, I had eaten mindlessly, greedily, endlessly. Every single day, every meal, every moment, I ate and ate to reach what I call Thanksgiving Dinner Full. I loved to cook (and still do). I loved to eat (and still do). My business travels took me all over the world, so that in each country I was able to enjoy a huge variety of different and delicious food. Occasionally the food was very strange – I can’t recommend eating the lightly grilled, still wriggling sea slug I sampled in Taiwan – but I was always game for a culinary adventure. It’s very ironic that during those overseas travels, I witnessed true hunger, deprivation, and near-starvation firsthand. What I ate in one day then could probably feed a whole family for a week. In Southeast Asia I once met a new business associate for the first time. We talked business for a while. Then he said something startling, seemingly out of the blue: “Your family must be very wealthy.” I said, “Uh, not especially.” He smiled at my modesty, gestured at my size 24 body and said, “But it is true, because I can see that you eat very well.” That encounter was mortifying on several levels, as I’m sure you can imagine. When I left that business career and coincidentally began dealing with my weight and eating issues, I also began to feel shame for my eating behavior, for the waste of all the food I’d gobbled up in my perpetual quest for TDF (Thanksgiving Dinner Full). But how on earth could I end that quest? How could I ever learn to stop eating before I reached the TDF level? I was extremely fortunate to start my weight loss surgery journey a short while later, and even more fortunate that my Lap-Band® eventually became such an effective tool in helping me eat less and lose weight. Although I felt I’d done a lot of research as a pre-op, I have to smile every time I think of a bandster friend who told me, “I had no idea how much work this was going to be.” I had no idea either. Every bite of food, every sensation in my body before, during, and after I ate, became a big project. If you’re a new post-op, or even a further-out post-op, are you too discovering how much work is involved in living with and succeeding with your band? Perhaps wondering, “What have I gotten myself into?” If so, that’s OK. Remember that you’re not alone, and that you can succeed even if feels like getting there is taking forever and a day. So, c’mon, Jean. Get to the point. Tell us: how do you know when to stop eating? Do you eat until you're full? What is “full” supposed to feel like now? My answer to the first question is no. As a WLS patient, you don't eat until you’re full. You should never again eat that way, not just because that’s how you became obese enough to qualify for bariatric surgery but because eating that way will hinder your weight loss and can cause some nasty side effects and complications. So you’re going to have to figure out a new stopping point. And that stopping point is the satiety point. Satiety is not quite the same as being full. For a bandster, full means that you have overeaten again and will soon be so uncomfortable you’ll have to take a few breaths before you go on to clean that plate like a good kid. (Which, by the way, is another practice you’ll have to give up sooner or later). Full means your upper stomach has reached its maximum capacity and that at any moment, that food is going to back up into your throat and make an ungraceful exit all over you, the table, and your dining companions. Full means that you sped right past your satiety point. Full means that it’s time to start paying much closer attention to how you feel as you eat. Satiety happens on your way to being full. With a properly adjusted band, you will be comfortable if you stop eating when you're satiated, but will experience discomfort if you eat until you're full. If you eat to the TDF point, you won’t have that old faithful full-belly sensation that made you loosen your belt while waiting for Mom to bring you a big piece of pumpkin pie. Instead, you’ll probably feel pressure, even pain, in your upper abdomen and chest. You’ll produce enough excess saliva to make you drool. You’ll think you’re about to power barf. You’ll be very sorry you overate. You’ll promise God and your bariatric surgeon (who are not actually the same person, by the way) that if you can feel relief right now, you’ll never overeat again. You’ll need to learn some strategies to prevent another episode of overeating. In article #3 of the Satiety 101 series, “Recognizing Satiety,” we’ll take a look at some common signals our bodies give us when we’re closing in on the satiety point.

My band was removed because of esophageal damage from several decades of "silent" reflux whose symptoms I managed to ignore because I was never aware of any acid. My symptom was a persistent cough, and I didn't believe the ENT doc I saw for the cough when he suggested my problem was reflux. My band probably aggravated the problem. And to illustrate what a contrary person I am, I later revised to the sleeve despite knowing that reflux is extremely common in sleeve patients. So it looks like I'll be taking omeprazole for the rest of my life, and I hope that PPI (omeprazole is a proton pump inhibitor) use doesn't cause me the problems it causes other folks.

Restriction is a myth, and it’s time to stop believing in it. The adjustable gastric band isn’t all about restriction after all. It’s all about satiety. I tend to talk about satiety a lot. Why? Because recognizing satiety is absolutely crucial to our weight loss success and good health, no matter what bariatric surgery we have. Satiety is the sensation of having eaten enough food. Understanding satiety is so important to weight loss success that I’m dividing up what I have to say into three Satiety 101 articles. This is the first of the three. Let’s start by asking an important question: do you think that your properly-adjusted band will restrict how much you can eat, so you take in fewer calories and lose weight? I realize that someone – perhaps more than one person (perhaps even your very own bariatric surgeon) may have told you that the adjustable gastric band works by creating a small stomach pouch that restricts how much you can eat. But I’m here to tell you, it’s a lot more complicated than that, and to go on thinking of the band as a “restrictive” method does bariatric patients a disservice. The notion of restriction is a myth, a holdover from earlier times, before the band’s function and effects were fully understood. Now, after nearly 30 years of clinical use and studies, band manufacturers and bariatric surgeons are beginning to see that the old idea of the band’s “restrictive” mechanism is not only incorrect, but can cause a host of unpleasant and sometimes dangerous side effects and complications (such as band slips, esophageal dilation and achalasia, pouch dilation, and disappointing weight loss), and some of those complications can cause permanent damage. If you swallow a few bites of barium-coated food (doesn’t that sound yummy?), fluoroscopy will show that food passes through the upper stomach pouch, right past the band, and into the lower stomach pouch within in minutes of each swallow you take, so that you can go on eating just like you did as a pre-op: fast and furious (when food doesn’t make that trip a quick one, it may mean that the band is too tight and needs fluid removed from it). That quick trip also means that you can eat far more food than you need, just like you did as a pre-op. Finally, the bariatric medical community is beginning to see that instead of being restrictive, the band works by reducing physical hunger (the need to eat) and appetite (the desire to eat), and by creating early and prolonged satiety, so that the patient, not the band, can reduce her/his food intake. Now, let me re-state that from the point of view of someone who lived with a Lap-Band® for five wonderful years. It’s up to you, not your band, to make the band work for you. Your band is an inert, expensive piece of plastic that doesn’t limit how much you eat. It doesn’t know your name or that you hate broccoli. It’s not going to leap out of your mouth and throw your forkful of food on the floor when it’s time for you to stop eating. It’s not going to sound an alarm or start flashing red lights. It’s not going to shout, “Jean McMillan! Stop eating right this minute!” (Yeesh! In that last scenario, the band sounded an awful lot like my mom!) Seriously, though. One of your jobs as a successful bandster is to learn when and how to stop eating, all by yourself. The “how” to stop is a big topic, not just for WLS patients but for every human trying to lose weight and avoid wasting precious resources like food, and far beyond the scope of this article. So for now, let’s concentrate on the “when” to stop eating part. We’ll do that in the second article in the Satiety 101 series: Satiated vs Stuffed, so stay tuned! This is the first in the Satiety 101 series of articles.

I'm so glad that this article spoke to you. And I completely, utterly, 1000% believe that tighter isn't always better. So much so that I wrote an article about it, which you can find here: http://www.bariatricpal.com/page/articles.html/_/support/post-op-support/tighter-isnt-always-better-r95

I had yet another thought earlier today. Port infections are often a sign of band erosion (that is, the band eats through the stomach wall, from the outside to the inside of the stomach) because infection at the erosion site travels along the tubing to the port. Band erosion isn't usually fatal, but it demands urgent treatment, at least with antibiotics. Please let us know how you're doing!

Once again, I must apologize for tardiness in posting about satiety signals. I'm usually a get-there-15-minutes-in-advance person, but nowadays, I move more slowly (I'm almost elderly) and life tends to intervene (I'm way too busy). Anyway...the whole topic of satiety signals kept me stewing for several hours this afternoon, and I finally decided to divvy up the topic into 3 articles. The first one is here: http://www.bariatricpal.com/topic/293230-satiety-101-satiety-the-restriction-myth/#entry3308624. I hope it helps to at least begin to clarify things. Stay tuned for #2 in the series, which I will post as soon as I've had some sleep. Jean

I tend to talk about satiety a lot. Why? Because recognizing satiety is absolutely crucial to our weight loss success and good health, no matter what bariatric surgery we have. Satiety is the sensation of having eaten enough food. Understanding satiety is so important to weight loss success that I’m dividing up what I have to say into three Satiety 101 articles. This is the first of the three. Let’s start by asking an important question: do you think that your properly-adjusted band will restrict how much you can eat, so you take in fewer calories and lose weight? I realize that someone – perhaps more than one person (perhaps even your very own bariatric surgeon) may have told you that the adjustable gastric band works by creating a small stomach pouch that restricts how much you can eat. But I’m here to tell you, it’s a lot more complicated than that, and to go on thinking of the band as a “restrictive” method does bariatric patients a disservice. The notion of restriction is a myth, a holdover from earlier times, before the band’s function and effects were fully understood. Now, after nearly 30 years of clinical use and studies, band manufacturers and bariatric surgeons are beginning to see that the old idea of the band’s “restrictive” mechanism is not only incorrect, but can cause a host of unpleasant and sometimes dangerous side effects and complications (such as band slips, esophageal dilation and achalasia, pouch dilation, and disappointing weight loss), and some of those complications can cause permanent damage. If you swallow a few bites of barium-coated food (doesn’t that sound yummy?), fluoroscopy will show that food passes through the upper stomach pouch, right past the band, and into the lower stomach pouch within in minutes of each swallow you take, so that you can go on eating just like you did as a pre-op: fast and furious (when food doesn’t make that trip a quick one, it may mean that the band is too tight and needs fluid removed from it). That quick trip also means that you can eat far more food than you need, just like you did as a pre-op. Finally, the bariatric medical community is beginning to see that instead of being restrictive, the band works by reducing physical hunger (the need to eat) and appetite (the desire to eat), and by creating early and prolonged satiety, so that the patient, not the band, can reduce her/his food intake. Now, let me re-state that from the point of view of someone who lived with a Lap-Band® for five wonderful years. It’s up to you, not your band, to make the band work for you. Your band is an inert, expensive piece of plastic that doesn’t limit how much you eat. It doesn’t know your name or that you hate broccoli. It’s not going to leap out of your mouth and throw your forkful of food on the floor when it’s time for you to stop eating. It’s not going to sound an alarm or start flashing red lights. It’s not going to shout, “Jean McMillan! Stop eating right this minute!” (Yeesh! In that last scenario, the band sounded an awful lot like my mom!) Seriously, though. One of your jobs as a successful bandster is to learn when and how to stop eating, all by yourself. The “how” to stop is a big topic, not just for WLS patients but for every human trying to lose weight and avoid wasting precious resources like food, and far beyond the scope of this article. So for now, let’s concentrate on the “when” to stop eating part. We’ll do that in the second article in the Satiety 101 series: Satiated vs Stuffed, so stay tuned! This is the first in the Satiety 101 series of articles.

Hang in there! You're not crazy, and you just need to keep on keeping on. If you'd like to read more about the infamous Green Zone, click this link: http://www.bariatricpal.com/page/articles.html/_/support/post-op-support/get-into-the-green-zone-r97

Oh, I know so well the feeling that I must eat plenty now in anticipation of future famine. In one sense, it's ridiculous. I'm a middle-aged, middle-class, well-fed woman living in an over-fed nation. On the other hand, every living creature is hard-wired to fear famine. If we don't eat, eventually we die. It's a very tough nut to crack, but if we don't try, we die anyway, sooner or later.

Do you ever feel that you’ve eaten enough food? Do you even know how that feels? RETRAINING MY OVEREATER’S BRAIN Early and prolonged satiety (the sense of having eaten enough food for now) is the name of the band’s game, and restriction (the feelings that communicate satiety to a bandster) is a greatly misunderstood term. I talk a lot about what a bad idea it is to eat until your band’s alarms flash and bells clang, but let me step off my soapbox for a moment and tell you about my own satiety experiences. When I was obese, I could never eat enough food. Aside from my love of its smell and taste, of chewing and swallowing, I wanted a full belly. The problem with that was that there isn’t enough food in the entire universe to fill the hole in my belly, never mind the hole in my soul. As a pre-op, I had the vague idea that my band would help me eat less, but I had no recent experience of eating small amounts and no idea of how that would feel. I blindly committed to weighing and measuring small portions of food despite the sense of deprivation that aroused in my overeater’s heart. It wasn’t until perhaps six months post-op that I realized I wasn’t actually hungry after eating my measured meal. Often I wanted to eat more – because the food tasted so good, I’d looked forward to it so much, I deserved it even more, or because I was a good girl who always cleaned her plate. But none of that “head hunger” was related to an empty, hurting, grumbling tummy. That was a shocking discovery for someone who had eaten to the point of Thanksgiving Dinner Full every day, every meal, every snack, for over 20 years. I suppose that until I came to that realization, I had been doing as much (if not more) of my weight loss work as my band had been doing. It didn’t really matter, because by then, as I inched closer and closer to my goal weight, I was also realizing that my band and I would have to go on working together for the rest of my life. So whether lessons came to me early or late, they were all valuable. Looking back now, I think my band and my conscious commitment to my dietitian’s food plan were both helping me to retrain my brain. No matter what you’re trying to do – lose weight, run a marathon, raise a child – survival and success depends a great deal on practice. Like a concert pianist playing scales, you have to practice over and over and over again in order to keep your skills sharp. To feel that I had regained some control over my eating with the help of my band, to no longer feel enslaved to food, was worth all the risk and trouble of weight loss surgery. So imagine my delight as time went on and my brain-band partnership got even stronger and better. HOW TO RECOGNIZE SATIETY Eventually I progressed to my next band lesson: learning to recognize satiety and stop eating as soon as I felt it, even if that meant leaving food on my plate. It was easy enough to weigh and measure my food when I was at home, but I needed more portable skills to take with me to social events and on business trips. First, I’ll re-state a definition: when you’re satiated with food, you're no longer hungry and more food doesn't interest you. You’ve just had enough for now. Hard to imagine, isn’t it? Satiety is registered by both conscious and unconscious processes, and the two may not always be in synchronization, especially in an obese person who's been overeating consistently. It's entirely possible to be physically satisfied but mentally unsatisfied after a meal, for reasons that are unique to everybody and shared by some of us. Each brand and model of the adjustable gastric band is clearly defined in its specifications, executed in the manufacturing process, and policed by quality assurance technicians, but human beings are very unique, so we respond to the band in different ways. So, how do you know when to stop eating? Do you eat until you're full? No, you don't. You have to figure out a new stopping point. The overeater's definition of "full" is the normal eater's definition of "stuffed". Most of the time, the normal eater stops eating when they've had enough, not when they're full, but the control center in an overeater's brain doesn't get the "enough" message soon enough, or it exerts a powerful override, so the overeater keeps eating long after the normal person would have stopped. That person keeps on eating until all the food is gone, then goes looking for more. Also, overeaters often use food for emotional rather than physical nourishment. While there certainly is some psychic (non-physical) value in the experience of eating, food cannot fill you up emotionally. When you eat for reasons unrelated to physical nourishment, you will never experience “enough”. For a bandster, satiety is not quite the same as being full, nor should it be. Full means your upper stomach has reached its maximum capacity. Satiety happens on your way to being full. With a properly adjusted band, you will be comfortable if you stop eating when you're satiated, but you experience discomfort if you eat until you're full. The band gives almost instant feedback about your eating behavior. The feedback comes in the form of the Soft Stop and Hard Stop signals. In order to learn and recognize your own stop signals, you’ll need to slow down and pay very close attention to how your body feels when you eat. If you usually eat with a crowd (family, friends, coworkers), you might need to try eating by yourself so you won't be distracted. Stop signals can be subtle and they can come from unexpected parts of your body. It's better to heed a gentle reminder than wait for a hammer to hit you on the head. Soft stops are your early warning system, gentle reminders from your body that it's time to stop eating. Because they don't hurt much, they're easy to ignore. Your job is to recognize them (even though they may vary by the meal or the day) and heed them every time you recognize them. Hard stops are the equivalent of running into a brick wall. They can happen without any apparent warning, but usually you have sped heedlessly past a soft stop before you hit the wall. Hard stops are the painful and sometimes embarrassing reminders that you have eaten too much, too fast, in bites that were too big, without chewing enough. To see lists of common soft and hard stop signals, click here: http://jean-onthebandwagon.blogspot.com/2013/03/stop-eating-signals.html

If and when you decide to get another fill, make it a small one. Nothing wrong with taking it slow and easy!

Well, I know I promised earlier to post a list of satiety signals this afternoon or evening, but I don't think I'll be able to do that along with everything else I've got going on today (it's amazing how losing weight can fill your days up with fun and interesting things that have nothing to do with food!). So I will do my best to get that list out tomorrow.

Yes. In a sense, it's all in your head. Or most of it. But a lot of it is autonomic (like breathing, heart beating, blood circulating, etc.) and not within your conscious control. The (extremely simplified) way the band works is to press against the walls of the stomach fundus (the curved upper part), thereby activating the vagus nerve that passes through that area. The vagus nerve carries satiety messages (as well as a lot of other messages) to the brain. Your physical hunger ceases and your brain broadcasts that it's time to stop eating, via various stop signals. Your conscious job is to pay attention, notice those signals, and stop eating when they happen. That can be tricky because some of those signals seem to have nothing to do with hunger or eating. My nose used to run when it was time for me to stop eating. Weird, huh? And yes, your sense of "restriction" can vary from one day to the next. Or when the weather changes. For example, I used to feel a lot tighter in the morning than in the evening. I have to run now but will post a separate thread about satiety signals later today. Jean Edited to Add: also, the band's proximity to the diaphragm can trigger satiety signals, like a hiccup.

I just had another thought, about something that might help you find your very own Green Zone. One of the biggest jobs for any WLS patient, no matter what surgical procedure they have, is learning how to recognize satiety. That's something I managed to completely ignore for 54 years before my band surgery, mainly because I was eating for a lot of reasons that had nothing to do with physical hunger, good nutrition, health, or any of that good stuff. Satiety is the feeling of having eaten enough food for now. For someone like me who had a gaping void inside that no amount of food could ever fill, learning to recognize satiety wasn't just hard - it was scary. Deprivation was one of my worst fears. I think that fear exists to some extent in every living creature. If we don't eat, we eventually die - every single one of us. A morbidly obese, middle-class, middle-aged woman with a job and a home and loving friends and family is not likely to starve to death, but that fear haunted me for a long time. Fortunately, I made lots of friends on online WLS sites like Bariatricpal who helped me by sharing their own satiety signals. The work of paying attention to and heeding those signals was all up to me. I got better at it as time went on. My conscious behavior and the effect of more saline in my band helped a great deal. Now that my beloved band is gone, that work is much harder, but like it or not, it's my job for life. Other members have shared some of their "stop eating" signals on this thread, but please don't kick yourself (or blame your band) if all those signals don't happen to you on the magical, mythical day that your band is filled to an optimal level. Even if and when that day arrives, those signals and that optimal fill level are probably going to change. One of the best - and hardest to handle - consequences of my WLS has been learning to pay attention to and take good care of my body. It's the only one I have, and I plan to make it last a long, long time. Jean P.S. - I wrote an article about recognizing satiety here: http://www.bariatricpal.com/page/articles.html/_/support/post-op-support/how-much-food-is-enough-r96

The "real" Green Zone signs vary from one person to the next, and vary in one person from one day to the next. Every creature on earth, even of the same species (such as human), is unique - in anatomy, genetic inheritance, environmental influences, you name it. We're all influenced by weather; hydration; illness; stress; time of day; time of month; medications; food choices; a host of internal, autonomic processes; and more. I wrote an article about the Green Zone here: http://www.bariatricpal.com/page/articles.html/_/support/post-op-support/get-into-the-green-zone-r97 Keep in mind that average weight loss with the band is 1-2 pounds a week. In 6 years, I haven't met a single WLS patient who lost a steady 1 or 2 or 1.5 or whatever pounds a week, for many of the reasons mentioned above. My own weight loss was very uneven - something like: - 1, -.5, + 1.5, -2, -.25, -1, + .5, and so on. As long as the overall trend is downward, that counts as success in my book (speaking of which, I highly recommend the bandster's Bible, Bandwagon). Many of us lose more quickly at the beginning of our WLS journey and more slowly as we approach our goal weight. Men tend to lose more quickly than women because they have greater muscle mass. Even when you get to your goal weight, you're not likely to see that exact same weight on the scale every day for the rest of your life.For example: a few days ago, I gained 2.5 lbs overnight. Why? Because I'd been eating high-sodium stuff for a few days. That's a red flag, not a cause for panic. After a few days of making better food choices, I know that 2.5 lbs will go away. Jean