Is the adjustable gastric band just an expensive diet?

[Jean McMillan 2,973]

Is it true that weight loss with the band is basically the same as weight loss with a diet? And if it is, why have surgery at all?

From time to time, a bandster will comment (sometimes in the context of a complaint, sometimes just in surprise or confusion) that weight loss with the band is basically the same as weight loss with a diet. They’re disappointed by this. They expected WLS to make weight loss easier than it is with dieting, and while that's true, it's only part of weight loss success. They may hold the mistaken belief that the band itself is what causes weight loss, but that’s not true either. The band is just a piece of plastic. Although it’s inside the patient’s body, it does not directly affect the way nutrients from food are ingested or metabolized. It releases no weight loss instructions into the patient’s bloodstream, nervous system, or endocrine system. It doesn’t directly affect the patient’s eating behavior or exercise habits. It doesn’t compel the patient to make good food choices, limit portion sizes, eat slowly, or resist the urge to graze or binge because of boredom, stress, cravings, etc.

After reading that long list of what the band doesn’t do, you may be thinking that it’s a mighty expensive and not very helpful weight loss tool. Why go through the risk, trouble and expense of WLS when you could achieve the same results with plain old dieting?

HALF EMPTY OR HALF FULL?

Here’s some news that may shock you: I lost 100% of my excess weight by dieting after my band surgery. My dietitian gave me a food plan to follow, and I followed it. It never occurred to me to do otherwise or to complain about that because my bariatric team had made it clear that I, not my band, was going to have to make some significant lifestyle changes in order to succeed. It wasn’t until after the excess weight was gone, after a big unfill to treat an irritated esophagus and stoma (after swallowing a large, corrosive antibiotic capsule), that I realized how much my band had been helping me by reducing my appetite and giving me early (if not always prolonged) satiety. I had been taking my band for granted – out of sight, out of mind.

I suppose it’s possible that I had been experiencing a placebo effect; that my band worked for me simply because I believed it would. If so, it was a remarkable and long-lived placebo effect. It wasn’t until my band was being refilled after a complete unfill (to treat a band slip) when I was 3 years post-op that I experienced a stunning, “Oh, so this is what it’s all about!” aha moment. My experience of restriction then was quite different than it had been the first time around, because I understood more about my band’s effects and how to optimize those effects, and because my body had changed so drastically since my surgery.

Whether your 8-ounce Water glass is half empty or half full, it still contains 4 ounces. Getting the most out of those 4 ounces is largely a matter of attitude adjustment. You can accept that you have 4 ounces, then make the best of it, or you can give up all together and spend your life in wistful regret. You can find another way to fill your WLS glass – complain to your surgeon, or the band manufacturer, revise to a different WLS procedure – or give up altogether and spend your life in angry regret.

Taking the “half full” viewpoint may be easier for me than for others because I’m an opportunist who actually enjoys making a silk purse out of a sow’s ear. Webster defines “opportunist” as one who uses the art, policy, or practice of taking advantage of opportunities or circumstances, often with little regard for principles or consequences. Since I do have immense regard for principles and consequences, perhaps I’m not a classic opportunist. But I see nothing wrong with taking advantage of opportunities and circumstances when my own careful plans aren’t working or have led me into unknown territory. Resourcefulness has been a handy life skill for me.

BUT I WANT IT TO BE RIGHT THE FIRST TIME

I do know what it’s like to be disappointed with a purchase, though, be it a band, a blouse, or a bicycle. I want the item I purchase to be suitable, if not perfect, for its intended use. During a shift at my retail “day job” the other day, I helped a customer whose garment size wasn’t in stock. She didn’t want to order that garment – she wanted it now, so much so that she considered buying the wrong size and having it altered to fit her. Before I could volunteer an opinion, this woman uttered the very words I was thinking: “I hate to pay good money for something new and have to alter it. I just want to buy it and wear it.”

If I were a better (or pushier) salesperson, she might have bought that garment, but I’m not and she didn’t. If your adjustable gastric band hasn’t (yet) lived up to your expectations, you do have my sympathy. It’s not easy – if even possible – to return a disappointing medical implant, and it’s maddening to have to “alter” it (by dieting, for example) to make it work for you.

I could tell you (unhelpfully) that your expectations were not realistic, but it’s also possible that your surgeon educated you well, you’re a “compliant” patient, and yet your band just isn’t up to snuff. According to Doctors Jerome Groopman and Pamela Hartzband, authors of Your Medical Mind, “Medicine is an uncertain science.” No one, not even your doctor, can say with certainty what impact a condition “will have on an individual’s life or how someone will experience the side effects from a particular treatment. Each of us is unique in the interplay of genetic makeup and environment. The path to maintaining or regaining health is not the same for everyone.”

Doctors Groopman and Hartzband go on to describe what they call the ‘focusing illusion’. “In trying to forecast the future, all of us tend to focus on a particular aspect of our lives that would be negatively affected by a proposed treatment. This then becomes the overriding element in decision making. The focusing illusion neglects our extraordinary capacity to adapt, to enjoy life with less than ‘perfect’ health. Imagining life with a colostomy, after a mastectomy, or following prostate surgery can all be skewed by the focusing illusion. We cannot see how the remaining parts of our lives expand to fill the gaps created by the illness and its treatment.”

Despite carefully-devised formulas and scoring systems (intended to direct resources and money to those most likely to survive) for calculating a patient’s chances of surviving a treatment or illness, doctors are lousy at predicting outcomes. A study in England found that one out of 20 ICU patients who doctors predicted would die actually lived, and most of those who survived had a good quality of life. I don’t think that’s a sign of medical incompetence. I think it’s a sign of the unquenchable human spirit and its enduring will to survive and even thrive against all odds.

One of my life goals is to survive and thrive, no matter what. That’s an ambition you can’t get from a medical device or bottle of medicine. It comes from within you, and if you think you don’t have it, or not enough of it, I suggest that you look again. You might be pleasantly surprised.