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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.

Wow, so ok your refuse to not drink soda, not watch portions and not follow instructions and you think RNY will make is all magically better. I know many RNY patients who have stretched there pouches by drinking soda and eating to big portions. Sorry for being so blunt but I am not sure the band is the problem. Any WLS has risks and complications and rules to follow for success.

I had my first fill at the end of oct and had 3 ml's put in and I had some complications with the doc getting fluid to go from my port to my band. They thought I had received a bad band, but thankfully everything worked out just fine. I just went for my second fill and my port flipped. I'm do upset right now. The radiologist tried so hard to flip it with no sucess. Im seeing my surgeon on Monday. So my question is what happens now? I'm terrified to go back under general anesthesia. Has anyone had this experience? What happens????

I had a lap band that was removed after a lot of problems in 08/2010, and I am now looking to have the gastric sleeve. I am a self pay so money is a huge issue, and will help in part determine the choice of doctor that I use in Mexico. I had my lap band placed in Mexico and have been back there several times, so I am not afraid to have surgery there but I feel I need to make an informed choice. What I would like is for anyone that will to please tell me your doctors name, what the cost of your sleeve was, what kind of staples and or suturing were used during surgery, and what kind of leak tests were performed. The price is the second deciding factor with the suturing/staples and leak tests being first on my list of requirements. Thanks in advance for anyone that posts information, it is the people like you that pave the way for people like me, and without your valuable input we would be at a lose when we make our decisions. Also when I do go to Mexico for my sleeve I will be paying cash and as such will be there with very little extra money or access to extra money if needed. With that in mind what happens if I were to have complications from surgery, how does the cost of paying for that work? Here in US if you have complications that are an emergency they are fixed and the cost is billed to you later, but I don't have any ideal how that works in Mexico. I saw one site that gave the package price but then stated that it didn't cover any complications.

Yes what was your complications. Please share?

My surgery was Jan 3, it was very complicated i ended up having emergency open chest surgery before they could even do the sleeve. With gods grace I am still alive. Im 21 years old married and have step daughter. Even though i was almost gone and in icu i wouldn't change having the surgery for nothing. Im still in the hospital and hopefully i can get out tomorrow. If you have any questions fell free to ask me. God bless you all.

I used to cringe when I saw photos of Fat Jean, but now I want to hug that unhappy girl and tell her that life is good. When I look in the mirror now, I see a "normal" sized woman who strangers would never guess had once been morbidly obese. I think we all need to remember where we came from, and to forgive ourselves for our pre-op weight loss failures. But halfway through the first sentence of this article, I thought of an equally important aspect of Memorial Day that turned this article's theme upside down. The meaning of "lest we forget" is more complicated than you might think. It represents more than three sappy words and planting a flag and a geranium on your grandfather's grave. It expresses an important message for a bariatric patient like me and you. The phrase "lest we forget" forms the refrain of "Recessional," a poem by Rudyard Kipling (1865-1936). It warns about the perils of hubris and the inevitable decline of British imperial power. After World War l, "lest we forget" passed into common usage as a plea not to forget past sacrifices and was often used on war memorials and as an epitaph on tombstones. So it’s an appropriate title for a Memorial Day article. Hubris is the extreme haughtiness, pride and arrogance that makes us think we're as invincible and all-powerful as Great Britain thought it was back in the days when it was taking charge of big countries (India) and small (Singapore) all over the world. One of my jobs in life is to resist the urge to be conceited about my weight loss success and to remember that I’m not invincible. I don’t ever want to lose sight of the fat girl deep inside me who's just waiting to get out again. Losing 100 pounds is such an enormous accomplishment that at times it seems like the most magnificent and significant achievement of my entire life. I'm justifiably proud of that achievement, but having weight loss surgery is not a guarantee of continued weight loss and weight maintenance success. As a boss once told me on the occasion of my promotion to management, "Remember, you're only as good as your last act." In other words, my great performance won me a place on the stage, but I'm going to have to repeat that performance over and over again in order to stay on the stage. WLS is a wonderful tool that will improve my ability to manage my weight for another 30 or 40 years, but it doesn't make me bullet-proof. Weight loss is no longer the centerpiece of my life, and I think that's a healthy thing. Some days I even ask myself why I'm still writing about eating, obesity and weight management. Why can't I let go of it? What will happen to me if I run out of things to say about it? But while I'd like to know the future, or at least know it will be a happy one, a long, straight road with the same scenery for mile after mile sounds boring to me. I'll stay on this road, with its twists and turns and steep hills, and trust God to keep me from getting too far off course. Writing about obesity is one of the things that keeps me going in the right direction. When other bariatric patients ask me questions about how to live and succeed with the adjustable gastric band, it forces me to think, and being forced to think is much healthier, and more interesting, than switching on the cruise control for the rest of my life. Along the road to your weight goal, I hope that you, too, will be able to acquire new interests and activities that you can take with you into your new life as a "normal" weight person, but don't forget to look backward every now and then. Don't throw out all the fat photos and fat clothes. They're memorials to your past obesity.

I have been considering GBP for a LONG time. However, my insurance doesn't cover it so I have to be a self pay patient and it is $23,000. Needless to say I have been putting it off for financial reasons. Anyway, lately I have been doubting my decision to have GBP and have started considering the Lap-Band. I have a friend who had it done and has had very little success and I am afraid I won't suceed either. With GBP you have no choice but to succeed. I have researched GBP for a long time but not so much the Lap band. I have a lot of questions...... How much does it cost for self pay? How quickly do you lose weight? How soon after you get it on can you get it filled and how often? What are the complications?

Sunshine, I had a brain fart, I'm only on Mushies for another 3 weeks, which will be a total of 5 weeks on mushies. I have no idea why my Doctor wants me on mushies for 5 weeks, but he has been spot on thus far. I had very little pain after surgery, and no complications of kind, so If the doc says five weeks of mushies, then five weeks of mushies it is. I will say at this point I feel as though I could eat regular food, and the rebellious part of me that usually wins the war really wants some reg food, but I am going to be good. I have not had regular food since starting the pre op liquid diet on the 23rd of February, so going another few weeks will suck, but I'll make it through.

I preferred not to alter my intestines if I didn't have to, because THAT is what leads to 99% of RNY complications.

If you are self pat, you really should have some kind of contract that spells out the costs and obligations on both sides - the insurance companies do that in their network contracts and it is reasonable to do so as a self pay patient. We self paid for my wife's DS and that was under an all inclusive contract that the surgeon had worked out with the hospital - all hospital and surgical fees including anesthesia and incidentals (no lingering bills for $10 Q-Tips, etc. and it seems that everyone down to, seemingly, the floor sweepers are independent contractors wanting to send you a separate bill.) Our contract also included a cost cap in the event of complications, covering additional surgeries and hospital days, if needed. As a self pay, you have the choice of dealing with any surgeon and hospital in the world; the surgeons are often more sensitive to this than hospital administrators, though I would expect in a city like Huntsville they would be more sensitive to competition than an a rural county with only one hospital. Talk to your surgeon about this. They are often on staff at multiple hospitals, and some hospitals are more accommodating than others. Good luck, and hope all works out...

It depends on your insurance, but it's going to be a qualified maybe. Depending on type of procedure though the post-op complications are pretty rare (I think <1%) and probably not going to be a major concern. That said to alleviate the risk there are a couple things you can do. * Verify if your insurance will cover you. * Purchase a supplemental Medical Tourism Insurance Policy. * Stay in Mexico for a week so that if you do develop an issue you can be treated by the doctor who performed the surgery.

I have an intense fear of complications from having this surgery. At times I feel certain that its what I want to do, but then I will read a surgery gone wrong story and think that will be me. Here lately I have been keeping myself up at night wondering if I am making the right decision, worrying about all the things that could go wrong. Is it really a gamble? Forgive me, I'm just petrified and almost have myself talked into trying another diet for the 100th time and not having the surgery. What did you do to calm your nerves? How did you get over the anxiety of possibly having a complication or even death?

I am motivated by the way I feel everyday now, especially after a good work out. It still amazes me how crappy I used to feel and never realized I could get my health back. Never feeling like that again motivates me. I am motivated by my husband. We share laundry responsibilities and he tells me that it is so weird and quite funny to fold my jeans. He says they are so tiny! I went from a size 26 to a size 14/16. I am looking forward to smaller sizes in the future because I love his reaction. I am motivated by my Father N Law who tells me how pretty I look. He swears I lose more weight every time I see him. Not really the case as I see him about every two days now. I am mostly motivated by my children and grandchildren. I know that every lifestyle change I made, I have done it to remain here for them much longer than my Mom did. She passed away at 66 from complications of type 2 diabetes and sleep apnea. These were results of letting her Rheumatoid Arthritis get the best of her. When she gave up, the pounds came on fast. She developed type 2 diabetes, lost her toe, then a toe on her other foot, then her foot and then a leg. this disease really takes a toll on folks that cannot get around as easy. She saw no path to better health and paid the ultimate price. I am completely motivated by what happened to her and how it makes me feel as her daughter. She should still be here today. I never want my children to feel the way that I do! That is my motivation!

Hello everyone! I am 34 years old and have had my band since August, 2007. I've had a few complications throughout my banding. I was having a lot of pain at first, I wasn't eating because everything made me throw up. I won't get into all the details but after switching doctors, they found that my port was infected internally. So, after surgery to remove the port and replace it, I started with some weight loss. Shortly after I became pregnant with my now 3yr old daughter. Not only have I put on weight, I've put on more weight that I ever thought humanly possibly. I used to tell my friends, if I ever get that big, shoot me. Well, I am that big now. I've been back to my surgeon for a fill. He won't fill me. He says I need to do a food log for a while and then we will reconsider. Everyday I have good intentions. I am over 400lbs and I fell like if I don't do something, I'm going to die. My Mom said it best, I was waiting for divine intervention and it never happened. She is a gastric bypass patient. I need some support. Of course I can talk to my family but I get easily irritated when they say you need to do this or you need to do that. I know what I need to do, doing it is the hard part. Please tell me I'm not the only one who feels this way!

I can't imagine what you're going through with your toe. I am a pedicure kinda girl and I get one regardless of whether I need it or not. I have always been lucky but my friend's daughter also had to have her big toe nail removed because of infection from a pedi. It is a rough recovery and she didn't even have the complications you did. Listen to everything your doctor says because this is really serious. Good luck!

Why won't your insurance cover it? Did you explain to them that they are going to have to pay out way more if you have medical complications resulting from your weight than they would ever have to fork out if you just had the surgery? I know you are disappointed, but have you appealed it with your insurance company? I would get your PCP to make a case with you. Since I have been on these boards I see that this is a common problem. I am thinking there must be some kind of funding...I am so going to call Oprah! Fund raiser? bank robber? sugar daddy? Let me think on this for a bit. I am a social worker...we are all about the cause... Take care, Chris

Yes, I think I paid the hospital about $84.00. Their bill was $43,000 but allowed amount was about $7600. It was the copays of all the different billers that added up to the total. I never met my catastrophic cap so it wasn't that that limited the amount I owed. That's why its difficult to find a dr. that takes Tricare. But they are out there. The allowed amount is low, but the cost to the insured...you can't beat it!! I had private secondary ins at the time, more trouble than it was worth, it paid zero. Now I have a cheap supplemental plan that will pay the difference if I need to have any thing going forward, or complications. You might want to check on one before seeking the surgery if you aren't too far into it yet or maybe for afterward in case of complications. Don't think that's likely, but I'm one of those people that likes to be prepared for anything! LOL!! Good luck to you!!

I am single and live alone. I had my surgery at 1:00pm on a Wednesday and was released at about 4:30 later that afternoon. I had a friend pick me up at the clinic, and stay overnight. She left my house at 7:00 am the next morning to go to work. An hour later I walked the dog. I did not have any complications other than a hiatal hernia that the doc found and repaired. I felt like crap for the first 48 hours or so, but honestly I have felt worse with the flu. By friday I was at the spa getting a mani and pedi As you say, everyone is different.........based on my experience you will be just fine without someone hanging around and annoying you

If there are no complications your 9 year olds should be able to help you with what you need. My 12 year old son has been able to do a ton for me. :seeya:

Brian & Savery... While I respect your doc's honesty and ability to be bloody blunt you have to understand that he has to tell you folks the worst possible scenarios. Hypertension is a problem if it is not under control at the time of surgery. Is Savery on high blood pressure meds? If so, may I ask which drug(s)? If it is well controlled that part shouldn't be an issue. Sleep Apnea, the key here is to make sure that you bring your C-Pap to the hospital with you. There will likely be extra orders written for the PACU nurse regarding breathing issues. As long as they know what to look or it shouldn't be much of an issue. If they did not know about sleep apnea that could be a little un-nerving but since they know, the necessary precautions should be taken. Hiatal hernia or a wide hiatus... not a biggie. It does not affect surgery unless it is so huge that they have to do that repair first and the banding another time. However, if your doc knows about the hernia he already knows how large or small it is. He already knows if he can fix it at the time of banding or not. I've only heard of one case where it was a consideration to fix the hernia and do banding at a later time and they ended up doing both at once. Obesity is a big cause of hiatal hernias thus, many of us had them. Most docs will fix it while they are doing the banding. It usually requires 1-2 sutures, it's not a big deal in the least. Most people don't even know they have a hiatal hernia or a wide hiatus until they are told after banding that it was fixed. Diabetes... that is certainly something that is a consideration before surgery. Again, if the docs know about it up front they take the required precautions. There is currently a great deal of hoop-la regarding WLS and diabetes. I would encourage you to read the following study. This is not the full study, I have read the full study and this is just the beginning of the study. It applies to banding as well as bypass but with banding, diabetes improves with weight loss so results end up being the same: Welsh Medics To Examine How Surgery Can Cure Diabetes Stopping weight loss... many people have a slight unfill if they have reached their goal and they wish to maintain vs. losing. It's just a matter of increasing caloric intake a bit. Longest anyone has had their band, I honestly don't know. I don't recall when the first adjustable band came out. There was/is a non adjustable band that has been around longer and it had horrible results, but remember, it was a completely different band and non adjustable. Complications from the band can be immediate or years down the road. No way to tell. However, they are not common. Slips are 3+% and erosion is 1.3% per Inamed. Coffee... most can, a handful cannot. Coffee can be an irritant to the stoma and some people swell after drinking it and others end up with reflux but for the vast majority of people they are fine with coffee. Soda... that one is up to your doc. Docs differ on that one. I can't/don't drink it because it ends up being very painful but docs have differing opinions on this one.

Here's my list for choosing VSG over RNY for my revision: I could have had RNY very easily, but I fought for VSG. 1) Malabsorption of fat/calories only last 18-24 months (after that the villi in the intestine regrow), but the malabsorption of nutrients/vitamins are for the rest of your life. Not a fair trade off if you ask me. 2) Blind stomach left behind that is difficult to scope, but can still get ulcers and cancer. 3) The whole pouch/stoma thing is not natural. I had a pouch/stoma thing with the band, and it sucked. I loved the fact that I would have a normal stomach with my pyloric valve intact. 4) Regain stats with RNY are downright scary 5) Long term complications related to pouch dilation, vitamin/nutrient deficiencies and the number of patients seeking RNY revision to either DS or ERNY were just too high for me 6) Dumping syndrome only happens to about 30% of RNY patients. For me, if I can't keep my hand out of the cookie jar without some form of sick self-punishment of puking, nausea, and fatigue then do I really need to have WLS? I knew I had to change my relationship with food regardless of which WLS I chose. 7) I like my NSAIDS. With RNY, they are a complete NO NO. Also, in the future, if I were to need to take steroids, I didn't want to worry about them eating my pouch. 8) I have a lot (like 10) friends in real life that all struggle tremendously with RNY especially those that are 5-8 years out. I have one that just had her 4th surgery related to her 7yr old RNY. My other dear friend is now on Iron infusions every 4 weeks because she can't eat iron rich foods, and iron pills irritate her pouch so badly. 7 out of 10 have regained at least 40 pounds, and only 4 of them experience dumping, but it's not as severe as it was for them when early out. 9) That no hunger thing is awesome with the sleeve. The fundus being cut away and removed from the body, removes the main source of Ghrelin production in our bodies. At 15 months out, I'm still never physically hungry. I love food, I eat, but I'm not hungry. I was always hungry with my band. I would eat, be satisfied with the small portion in my pouch. Then food would pass through, and I'd be starving again. It was a miserable cycle. The stats with VSG and RNY on weight loss are neck and neck. The studies out there for gastrectomies (partial or full removal of the stomach) for cancer and ulcer patients gave me peace of mind that for my long term health, VSG was the answer to my weight loss surgery needs. Best wishes on your research. I have tons of links and information in my blog on here if you'd like to read some of the stats. I'll add you to my contact list so you can access my blog if you'd like. Look for the blog post called "Just to bookmark this" it's lapband information, but at the bottom of that post, there are lots of links for VSG.

so many fears 1 I would not wake up from the surgery---- don’t know why to date I have had 11 surgeries (including the lapband) and have been anesthetized an additional 7 times for colonoscopies and have woken up from all of them with no complications 2. it would not work and it would be something else I could add to the failure pile----so far 18 ½ pounds since surgery on aug 22…slow but going in the right direction 3. I could only eat baby food and Protein drinks--- not true just finished ½ or so of a grilled cheese sandwich – I have a bad cold that makes everyone real hungry 4. everyone would know-----my family still does not know and will never know

My starting bmi was 53, I chose bypass. I'll say I've seen many with equivalent bmi's be successful with the sleeve. I wanted bypass cause I didn't like the idea of having 1/2 my stomach removed... Seemed like if there were a complication, at least having it there (albeit unused) may give more options. I see many saying rerouting intestines wasn't for them. I've known many who, without wls, needed bowel resection etc for a myriad of reasons. I figured why avoid something that I could get anyway for any number of reasons. But outside of cancer, you never hear about one's stomach being removed. Just the rationale I used in my head. I happy with my complication free (so far) bypass.

I was told in the kaiser seminar that if you have sleep Apnea and its not being treated that getting you off the breathing machine used during surgery can be complicated. The instructor said that your lungs are so tired they clamp town on the tube and wont release and you have to be in ICU until they can get it out. Additionally it is a condition that can be caused by obesity so its something up there with Blood Pressure, Diabetes etc that can be treated by losing weight.