The Lap Band is NOT About Restriction

[DELETE THIS ACCOUNT! 12,703]

The Lap-band is NOT about Restriction (by Dr. Simpson)

When talking about the band, some patients talk about restriction. Let's first be clear about one thing: the purpose of the band is not restriction; the purpose of the band is to lose weight by suppressing the appetite.

When band professionals talk about restriction we are talking about something totally different than "restricting what a person eats." In fact, many band surgeons avoid talking about restriction so as to not confuse patients. The band works by dimming the appetite, and this provides a conscious control and decision made by the patient, it does not work by "making" a person do something, or keep them from eating too much.

The Lap-band works by suppressing your appetite

As a result, you are less interested in food between meals, making it easier to resist temptation. The analogy is when you are near a vending machine when you are hungry-- what do you do? Probably find yourself with some junk food that is not a part of your plan. But, when you pass a vending machine when you are full, it may not even catch your eye. Having the appetite dimmed makes you less tempted by the many food choices modern living throws at you - -this is what the band does, by suppressing appetite you become less interested in food.

What you should not feel, with the band, is the sensation of being "stuffed."

When you eat Thanksgiving dinner, you can feel stuffed. Contrast that with the sensation two hours after you eat your big meal, at that point your appetite is suppressed. It is the subtle dimming of the appetite that the band should provide. Being stuffed after a large meal is a complicated sensation of the abdominal wall stretching and a lot of gas in the bowel, in addition to feeling a diminution of appetite. You will not, and should not, feel the abdominal wall stretch with the band. You should not feel the "near nausea" and you should not feel bloated.

Key point:

You should NEVER eat until you feel full. It is best to stop eating before you "feel full." If you do eat until you feel full you will most likely be overstuffed. This leads to the universal key to success -- patients who eat a small volume of food (which, if you measure, is consistent) will be successful with the band. If you want to succeed, you need to know how much you are eating, and then stop eating -- it is in your control, but the band will help you -- not by stopping you, but by allowing you to feel satisfied after the small volume.

Early on, most Lap-band patients do have a sense of "restriction"

...particularly after the first fill. When we place the band on a patient the stomach above the band typically will hold one to two ounces (by volume, not by weight). The stomach has a lot of muscle fibers, and the wall of the stomach is fairly thick. When food is consumed, it arrives in the pouch, and meets some resistance, first against the newly adjusted band, and then against the stomach which does not stretch easily. People love this feeling! It is a sense of control over food -- a leash. But it is not permanent. It makes it difficult to eat more, because the top part of the stomach and the band will resist it. If you over eat you will feel uncomfortable.

This is the honeymoon phase, you feel full with less, no appetite, and if you try to eat more it doesn't work. They eat a small amount of food, they feel satisfied, and they are losing weight.

For patients who rely on this sensation, they will find it will take ever increasing volumes of food to obtain this sensation. The initial response is to have their band adjusted so that they can "feel full again." Against a tighter band, the upper stomach stretches a bit (and if they eat fast it stretches more)and they again have the sensation of "feeling full." This becomes a cycle, a tighter band, the stomach stretches more-- and then instead of going back to its original size, the stomach stretches more and more to where it takes more to fill it.

The person who continues to eat until they have this sensation, will find that it takes more and more food to obtain this feeling. Two things happen -- first the stomach stretches to where it accommodates more food, and to stretch it means you have to eat more. The second is that to "feel full" it takes the brain time to register this sensation -- this is not the sensation registered by the hypothalamus, but registered in the conscious cortex. So your stomach can be full, but your brain won't register it for a while, and if you keep eating you can overeat. As a result, the pouch dilates. Similar to a balloon, when you first start to blow up the balloon it takes a bit of force. As you continue to fill the balloon, the wall of the balloon stretches (thins out), it is easier to blow it up -- the same is true with the upper pouch. Early on, before the pouch is stretched, it takes a little bit of food to cause it to stretch, but with chronic over-eating the pouch will accommodate more and more food. The stomach wall is thinner, it is easier to stretch, and to get that sensation it takes more food than at first. Often patients will complain that they "don't feel restriction," and wish to have the band made tighter.

There are two potential results to this: one is the patient will passively stretch the stomach and esophagus and not be eating a small amount of food. These patients simply do not lose the weight that the surgeon expects. The other is that the band will be forced down the stomach, the band will slip, which generally requires operative intervention to reposition it.

For those patients who are rigorous about the volume of food they eat, and do not let the stomach to tell them when to stop eating - they do very well. This is one of the keys of successful patients, only eat a certain portion of food - period. If the band is properly adjusted, the appetite will be dimmed for several hours. Once your brain realizes that a small amount of food keeps you satisfied, then your eyes will adjust to the amount you eat.

Some describe a "soft stop." Where before a sense of fullness occurs, there is a signal from your body -- this can be a runny nose, a sigh, or a subtle ache in the left shoulder. Patients who find this "soft stop," do very well with the band.

The other advantage of eating small portions is it becomes a lifestyle change

--you will have the ability to gauge the amount of food you can comfortably eat, knowing it will keep you satisfied for several hours.

You can always -- always, always, always, -- eat more food, because, contrary to what we believed for a long time-- food passes by the band within a minute and then into your stomach. But the key to successful patients is not how much they can eat, but how little they can eat to suppress hunger.

The band goes around your stomach, not around your brain, or your lips

This simple concept, of eating a specific volume of food -- eating it slowly, and then walking away, is the key to successful eating habits of patients. This means that the band works with effort from you -- not by it doing everything for you. You have to make the decision to eat a small volume of food, and let the band work with you.

The sensation that we would want the band to produce is the "soft stop." The soft stop is when you eat a small portion of food and walk away. Sometimes this is difficult, like most things, practice makes perfect. To set yourself up for success -- we recommend you use smaller plates, along with smaller utensils. If you go out to eat, ask for the to-go bag immediately, and remove the excess food from your plate. You can physically always eat more food, but the advantage about practicing small portions and walking away, is ultimately your eyes will get use to what the stomach is telling it, and it will be much easier to eat smaller portions as time goes on.

It isn't uncommon for patients to want an adjustment because they say they can eat more

The first question we ask is, "Why are you eating more?" The typical answer is, "Because I can." The typical response, "Just because you can does not mean you should." Since the band's job is not to restrict the amount of food you eat, do not leave that to chance -- that is your job. Part of personal accountability is to account for, to measure, to know how much you are eating at a time. The band is empowering; if you eat an appropriate amount and make appropriate food choices, you will be satisfied for several hours. This results in either weight loss, or weight maintenance (if you are at your goal). The purpose of the band is to assist you to lose weight -- and this occurs only with active participation by you: you chose what to eat, you choose how much to eat, and you practice walking away after eating that amount. The band is a tool to allow you to eat less and have your appetite dimmed resulting in weight loss, or maintenance. It is a tool to help you adopt a healthy lifestyle -- you still have the choices to make, but the band allows you to be satisfied with those choices.

"If I could eat less and walk away, what would I need this band for?" -- a common question we are asked. Without the band, if you eat a small amount of food and walk away your appetite would rise within a couple of hours -- you would find yourself hungry and wanting more food, possibly leading to unwanted snacking. You would also find, if you willed yourself to withstand the hunger, that your weight loss gradually decreases. The band fools your brain into thinking you ate more.

Think of it another way -- the hypothalamus does not have eyes -- it doesn't know how much you ate, it doesn't know if there is a lot of food around and you are not eating it, or if there is a band on your

original article by Dr. Simpson: http://drsimpson.net...estriction.html

[Bandista 7,466]

Missy, thanks so much for putting this up. I keep retreading and hope to memorize this prior to surgery. (LOL.) Very important points -- helpful to me as I attempt to get my head screwed on straight prior to surgery.

[GoingforGoal 1,734]

Mis,

Although I understand what you are sharing (and have shared many times). There is nothing wrong about talking about band restriction and differentiate this between restricting food intake. When we are getting fills, we are indeed adding restriction on the stoma which narrows the passage between the esophagus and lower stomach opening. And it can restrict what one eats because as we all know, some foods can be tougher to pass than others. Therefore it is restricting what you eat (at times). Dr. Simpson is not the only opinion to consider. And vocabulary is about semantics. When you use the word restriction in the context it is intended for, there is no reason to dispute it. When I speak of band restriction, I typically detail what I am referring to and it has nothing to do with the food, merely the band/stoma.

I understand you have adopted different vocabulary, but please allow others to label things the way that makes sense to them as well.

[DELETE THIS ACCOUNT! 12,703]

Mis,

Although I understand what you are sharing (and have shared many times). There is nothing wrong about talking about band restriction and differentiate this between restricting food intake. When we are getting fills, we are indeed adding restriction on the stoma which narrows the passage between the esophagus and lower stomach opening. And it can restrict what one eats because as we all know, some foods can be tougher to pass than others. Therefore it is restricting what you eat (at times). Dr. Simpson is not the only opinion to consider. And vocabulary is about semantics. When you use the word restriction in the context it is intended for, there is no reason to dispute it. When I speak of band restriction, I typically detail what I am referring to and it has nothing to do with the food, merely the band/stoma.

I understand you have adopted different vocabulary, but please allow others to label things the way that makes sense to them as well.

It has nothing to do with my vocabulary, it's everything to do with bariatric surgeons who now have a much better understanding of the band. I didn't write or edit this article. These aren't my words, they are the words of Dr. Simpson who is one of the leading experts in the field.

The problem (again, as Dr. Simpson states) is the fact most bariatric patients don't mean restriction in the way the surgeons do. The band's job isn't to be the food police or physically stop you from eating anything. Because people often misunderstand the meaning of restriction and think it will, they end up too tight and with slips as a result.

I'm sharing this article because I see a lot of people who are clueless around here lately and I'm hoping maybe this will help them so they don't become another failure statistic.

[olliensys 53]

So does this mean that if you are an emotional eater...the band is not for you? I think that the fact that many cant have bread is some type of restriction.

[DELETE THIS ACCOUNT! 12,703]

So does this mean that if you are an emotional eater...the band is not for you? I think that the fact that many cant have bread is some type of restriction.

It means your emotional eating is something to keep in mind and deal with. Support groups and counselors are a great resource. I too am an emotional eater (and a binge eater and a grazer) but I'm aware of it and spent over 2 years in counseling to deal with it. It doesn't mean the band isn't for you at all, it just means you'll have to take it into consideration.

The fact some can't have bread isn't restriction, it's simply a side effect of the band for some. I can eat bread but dry meat is a no-no for me. Restriction is the physical act of the band tightening around your stomach, not restricting what you can or can't eat.

[NaNa 878]

The Lap-band is NOT about Restriction (by Dr. Simpson)

When talking about the band, some patients talk about restriction. Let's first be clear about one thing: the purpose of the band is not restriction; the purpose of the band is to lose weight by suppressing the appetite.

When band professionals talk about restriction we are talking about something totally different than "restricting what a person eats." In fact, many band surgeons avoid talking about restriction so as to not confuse patients. The band works by dimming the appetite, and this provides a conscious control and decision made by the patient, it does not work by "making" a person do something, or keep them from eating too much.

The Lap-band works by suppressing your appetite

As a result, you are less interested in food between meals, making it easier to resist temptation. The analogy is when you are near a vending machine when you are hungry-- what do you do? Probably find yourself with some junk food that is not a part of your plan. But, when you pass a vending machine when you are full, it may not even catch your eye. Having the appetite dimmed makes you less tempted by the many food choices modern living throws at you - -this is what the band does, by suppressing appetite you become less interested in food.

What you should not feel, with the band, is the sensation of being "stuffed."

When you eat Thanksgiving dinner, you can feel stuffed. Contrast that with the sensation two hours after you eat your big meal, at that point your appetite is suppressed. It is the subtle dimming of the appetite that the band should provide. Being stuffed after a large meal is a complicated sensation of the abdominal wall stretching and a lot of gas in the bowel, in addition to feeling a diminution of appetite. You will not, and should not, feel the abdominal wall stretch with the band. You should not feel the "near nausea" and you should not feel bloated.

Key point:

You should NEVER eat until you feel full. It is best to stop eating before you "feel full." If you do eat until you feel full you will most likely be overstuffed. This leads to the universal key to success -- patients who eat a small volume of food (which, if you measure, is consistent) will be successful with the band. If you want to succeed, you need to know how much you are eating, and then stop eating -- it is in your control, but the band will help you -- not by stopping you, but by allowing you to feel satisfied after the small volume.

Early on, most Lap-band patients do have a sense of "restriction"

...particularly after the first fill. When we place the band on a patient the stomach above the band typically will hold one to two ounces (by volume, not by weight). The stomach has a lot of muscle fibers, and the wall of the stomach is fairly thick. When food is consumed, it arrives in the pouch, and meets some resistance, first against the newly adjusted band, and then against the stomach which does not stretch easily. People love this feeling! It is a sense of control over food -- a leash. But it is not permanent. It makes it difficult to eat more, because the top part of the stomach and the band will resist it. If you over eat you will feel uncomfortable.

This is the honeymoon phase, you feel full with less, no appetite, and if you try to eat more it doesn't work. They eat a small amount of food, they feel satisfied, and they are losing weight.

For patients who rely on this sensation, they will find it will take ever increasing volumes of food to obtain this sensation. The initial response is to have their band adjusted so that they can "feel full again." Against a tighter band, the upper stomach stretches a bit (and if they eat fast it stretches more)and they again have the sensation of "feeling full." This becomes a cycle, a tighter band, the stomach stretches more-- and then instead of going back to its original size, the stomach stretches more and more to where it takes more to fill it.

The person who continues to eat until they have this sensation, will find that it takes more and more food to obtain this feeling. Two things happen -- first the stomach stretches to where it accommodates more food, and to stretch it means you have to eat more. The second is that to "feel full" it takes the brain time to register this sensation -- this is not the sensation registered by the hypothalamus, but registered in the conscious cortex. So your stomach can be full, but your brain won't register it for a while, and if you keep eating you can overeat. As a result, the pouch dilates. Similar to a balloon, when you first start to blow up the balloon it takes a bit of force. As you continue to fill the balloon, the wall of the balloon stretches (thins out), it is easier to blow it up -- the same is true with the upper pouch. Early on, before the pouch is stretched, it takes a little bit of food to cause it to stretch, but with chronic over-eating the pouch will accommodate more and more food. The stomach wall is thinner, it is easier to stretch, and to get that sensation it takes more food than at first. Often patients will complain that they "don't feel restriction," and wish to have the band made tighter.

There are two potential results to this: one is the patient will passively stretch the stomach and esophagus and not be eating a small amount of food. These patients simply do not lose the weight that the surgeon expects. The other is that the band will be forced down the stomach, the band will slip, which generally requires operative intervention to reposition it.

For those patients who are rigorous about the volume of food they eat, and do not let the stomach to tell them when to stop eating - they do very well. This is one of the keys of successful patients, only eat a certain portion of food - period. If the band is properly adjusted, the appetite will be dimmed for several hours. Once your brain realizes that a small amount of food keeps you satisfied, then your eyes will adjust to the amount you eat.

Some describe a "soft stop." Where before a sense of fullness occurs, there is a signal from your body -- this can be a runny nose, a sigh, or a subtle ache in the left shoulder. Patients who find this "soft stop," do very well with the band.

The other advantage of eating small portions is it becomes a lifestyle change

--you will have the ability to gauge the amount of food you can comfortably eat, knowing it will keep you satisfied for several hours.

You can always -- always, always, always, -- eat more food, because, contrary to what we believed for a long time-- food passes by the band within a minute and then into your stomach. But the key to successful patients is not how much they can eat, but how little they can eat to suppress hunger.

The band goes around your stomach, not around your brain, or your lips

This simple concept, of eating a specific volume of food -- eating it slowly, and then walking away, is the key to successful eating habits of patients. This means that the band works with effort from you -- not by it doing everything for you. You have to make the decision to eat a small volume of food, and let the band work with you.

The sensation that we would want the band to produce is the "soft stop." The soft stop is when you eat a small portion of food and walk away. Sometimes this is difficult, like most things, practice makes perfect. To set yourself up for success -- we recommend you use smaller plates, along with smaller utensils. If you go out to eat, ask for the to-go bag immediately, and remove the excess food from your plate. You can physically always eat more food, but the advantage about practicing small portions and walking away, is ultimately your eyes will get use to what the stomach is telling it, and it will be much easier to eat smaller portions as time goes on.

It isn't uncommon for patients to want an adjustment because they say they can eat more

The first question we ask is, "Why are you eating more?" The typical answer is, "Because I can." The typical response, "Just because you can does not mean you should." Since the band's job is not to restrict the amount of food you eat, do not leave that to chance -- that is your job. Part of personal accountability is to account for, to measure, to know how much you are eating at a time. The band is empowering; if you eat an appropriate amount and make appropriate food choices, you will be satisfied for several hours. This results in either weight loss, or weight maintenance (if you are at your goal). The purpose of the band is to assist you to lose weight -- and this occurs only with active participation by you: you chose what to eat, you choose how much to eat, and you practice walking away after eating that amount. The band is a tool to allow you to eat less and have your appetite dimmed resulting in weight loss, or maintenance. It is a tool to help you adopt a healthy lifestyle -- you still have the choices to make, but the band allows you to be satisfied with those choices.

"If I could eat less and walk away, what would I need this band for?" -- a common question we are asked. Without the band, if you eat a small amount of food and walk away your appetite would rise within a couple of hours -- you would find yourself hungry and wanting more food, possibly leading to unwanted snacking. You would also find, if you willed yourself to withstand the hunger, that your weight loss gradually decreases. The band fools your brain into thinking you ate more.

Think of it another way -- the hypothalamus does not have eyes -- it doesn't know how much you ate, it doesn't know if there is a lot of food around and you are not eating it, or if there is a band on your

original article by Dr. Simpson: http://drsimpson.net...estriction.html

Great post! But unfortunately some people will choose to use the band as they please. The "tighter the better" for some people.

Everyone that I know over 8 years ago that used the band based on restriction (and physically stopping them from eating most solid foods) and not satiety..well they no longer have a lap band, the too tight approach only last for about 3-5 years, (a few may get lucky, with a few total unfills/refills along the way) , but most aren't as lucky.

[olliensys 53]

Well i hope this works for me because i really need the type of restriction that forces me to stop eating. I start off great..but end badly.. Sometimes i dont even realize i am eating...its just something i do during commercials. There is only one therapist in my town and she is pretty busy because she also runs a wolf preserve. I guess i will have to figure something out...because i refuse to ho under the knife unless it is an emergency.

[DELETE THIS ACCOUNT! 12,703]

Well i hope this works for me because i really need the type of restriction that forces me to stop eating. I start off great..but end badly.. Sometimes i dont even realize i am eating...its just something i do during commercials. There is only one therapist in my town and she is pretty busy because she also runs a wolf preserve. I guess i will have to figure something out...because i refuse to ho under the knife unless it is an emergency.

But the band isn't meant to "force you to stop eating". So often people getting their bands tighter and tighter expecting it to physically stop them from eating. They then end up with bands too tight, slips, and other serious complications because of it.

Not to mention a lot of the foods people tend to overeat are sliders, anyway. chips, chocolate, ice cream, and many other foods liquefy the moment you eat them and because of it you can eat them like you didn't have a band at all.

Even with the band, we have to take responsibility for what and how much we eat. The band isn't magic, it's just a tool.

What Nana stated above is sadly true and wise words to take to heart.

[Bandista 7,466]

I think the point here is that there is a restriction which means a closing off, like restricting an opening -- or restriction in terms of disallowing something. I totally get it but can see that the terminology might be confusing. Welcome to the English language!

[☠carolinagirl☠ 18,721]

this is how my band works for me---(copied from missys post)

"patients who eat a small volume of food (which, if you measure, is consistent) will be successful with the band. If you want to succeed, you need to know how much you are eating, and then stop eating -- it is in your control, but the band will help you -- not by stopping you, but by allowing you to feel satisfied after the small volume"

this is how i am losing weight/inches (and by me adding exercise and eating good/healthy foods)

[♕ajtexas♕ 3,771]

Missy,

In my opinion you are right on, I agree 100%. I am a success (at least they tell me I am) by using this approach.

[Sharpie 3,306]

Missy thanks so much for posting the link.. I have a friend who called me tonight and I was trying to explain the band to him.. He saw me at a dinner the other night and was so surprised to see how much I had lost and how good I looked (his words not mine) anyway he has had weight issues for as long as I have known him and I have always been reluctant to discuss it with him but tonight he called me too ask about the surgery.. I just sent him the link to Dr. Simpson's article because to me it is very clear and self explanatory... Thanks Again

[GoingforGoal 1,734]

Mis I understand. Im not trying to be confrontational at all I'm just saying that using words like restriction etc is not always wrong. Some people may confuse the terms, but I am using it properly and want others to realize that people will use words like diet instead of lifestyle adn restriction instead of tightness (yellow, green, red etc). Just saying htere is wiggle room on how to describe the aspects of the band

[tipsyb 71]

This has really helped thank you. I've had a hard time the last three weeks I have lost fifty six pounds and have forty to go. I'm struggling with restriction emotional eating and 'fighting the band' . This has re focused me.