Permanent Long Term Weight Loss

[drgthemd 7]

Thank you for your response. In my experience over many years, I believe the band does cause restriction when it is appropriately adjusted and patients are eating solid foods. I'm aware that there's a difference of opinion and some people now state that everything that is chewed passes through the band quickly. I do not believe that is the case. Some foods pass through quicker than others, depending on the consistency, how well the food is chewed and how fast the patient is eating. One thing for sure, when a patient with a properly adjusted Lap-Band eats solid foods, it will definitely pass more slowly through the band than it would otherwise. I've counseled many patients over the years with success by telling them that by following the simple rules I outlined previously, combined with stopping any further food intake once they feel the fullness, they will avoid problems of dilating the upper gastric pouch and the lower esophagus and also avoid regurgitation. If a Lap-Band patient is eating too quickly, they will not recognize the point of fullness, and that is where they get into trouble with stretching out the upper gastric pouch above the band and the lower esophagus and also regurgitation of food problems. Let me know if that helps.

[CherieRyde 227]

You're right Kate, the issue is education, so patients know what they need to do to have success with the Lap-Band. The Lap-Band is not a magic pill. Cherie, I would suggest you get a second opinion from a physician specializing in allergies, not a nutritionist. It's unlikely that you would be allergic to all those types of foods. You may be intolerant to some foods, however, true allergies manifest themselves as skin rashes with itching or breathing problems.

You misunderstand. I DID see an allergist after having an anaphylactic reaction to some food that I ate about 6 weeks ago. The meeting with my dietitian is coming up in a couple of weeks. There's no way she could diagnose an allergy when she's not an allergist and hasn't seen me in two months. I'm not an idiot. I have started the elimination diet to see which foods I have a true allergy to and which foods I have an intolerance to. The intolerant reactions are bad enough that I'm removing those foods from my diet as well as the foods that I have a true allergy to.

I worked in Dentistry for 20 years, and I know the signs of a TRUE allergic reaction vs intolerance. it's drilled into our heads. Now, not being an allergist yourself, and NOT being my doctor, there's no way for you to know if I have a true allergy to the foods I listed off. I also didn't list off every single food that I reacted to, and I've not shared wich foods had what reaction. So, I find your comment to be intensely offensive.

[drgthemd 7]

I apologize, I had no intention to be offensive. I was merely attempting to pass along some helpful information. Please accept my apology for any offense. I wish you the best of luck in your efforts to identify food allergies and intolerances.

[B-52 7,113]

No Problems here...I feel my weight loss permanent as long as the band is permanent.

I live day to day and don't really think about it all that much...(except when I come here.)

I eat and drink things that dieters would never dream possible. That's because, whatever I do eat, it is not all that much within any 24hr period...just like my skinny friends do who did not have WLS...

And I do make the best food choices I can...I've become a heath nut, and a gym rat!

I feel normal weight is when one has a healthy body fat %...You can have a high BMI and still be healthy and fit, just like a football player or other athletes.

I have a very low body fat 5, but according to my BMI I still need to loose 20lbs. Yea, Right!

I feel my band is properly adjusted, and it is impossible for me to overeat. (I've tried) There is just so much then I MUST stop, or pay the consequences. Call it behavior modification, but it worked.

There are foods that will pass quicker, and that is the only way to "Cheat" the band. I could eat ice cream all day if I wanted to, but I don't want to.

There are also foods I, or my band I should say, will not tolerate. These include, but not limited to, red meat, rice, Pasta, and most things flour based like cakes.

I believe exercise is essential if you want to loose weight. You must burn off that fat we hunters and gatherers have been storing away for those days of famine.

[Andrew318 17]

I find your posts very suspicious. If you were a real MD, you wouldn't be giving out free advice on a message board for fear of being sued. Also why the secretive name and profile. Why are you hiding who you really are?

[drgthemd 7]

B-52 I concur 100% with your post and I applaud your success. You're absolutely correct that the best indicator of a weight is not BMI. We have been doing hydrostatic body fat testing for many years and that indeed is the best indicator for a healthy weight. The Lap-Band certainly does stop you from overeating if the simple rules are followed and I couldn't agree more that the exercise component for success with the Lap-Band is absolutely critical. You sound like you would be a great coach for others struggling with their weight after the Lap-Band procedure.

Lose2be I am a licensed, practicing physician in Southern California with well over a decade in bariatrics. I do have a desire to help people with their weight loss post WLS and have done so for years with many patients. Our patients encouraged me to post some useful information, which has helped them, on Bariatricpal so that other post WLS patients who are struggling with their weight might also achieve long term success. Yes, the advice I'm giving is based on my experience and have no motive other than to impart some of the useful information I have learned from treating our patients over the years.

[KateP 359]

Thank you for your response. In my experience over many years, I believe the band does cause restriction when it is appropriately adjusted and patients are eating solid foods. I'm aware that there's a difference of opinion and some people now state that everything that is chewed passes through the band quickly. I do not believe that is the case. Some foods pass through quicker than others, depending on the consistency, how well the food is chewed and how fast the patient is eating. One thing for sure, when a patient with a properly adjusted Lap-Band eats solid foods, it will definitely pass more slowly through the band than it would otherwise. I've counseled many patients over the years with success by telling them that by following the simple rules I outlined previously, combined with stopping any further food intake once they feel the fullness, they will avoid problems of dilating the upper gastric pouch and the lower esophagus and also avoid regurgitation. If a Lap-Band patient is eating too quickly, they will not recognize the point of fullness, and that is where they get into trouble with stretching out the upper gastric pouch above the band and the lower esophagus and also regurgitation of food problems. Let me know if that helps.

This reply surprises me. I am told by my current baritaric team and the team who monitored me before I moved house, that research, much of it carried out at Monash University had clarified this beyond doubt. Food does not and most not remain above the band. It passes through in under a minute.

The consultant who did my operation (not sure you have that title in the U.S. but that is the most senior surgeon in the speciality) tells me that it is now accepted fact. He told me that this was first described to him at an international medical conference in the U.S. (I forget where and exactly when but it must have been prior to 2010)

Clearly from what you say, not all US surgeons teach this to their patients but I know a great many do.

[CherieRyde 227]

I wanted to sit on this for a little while before commenting again. I wanted to read what everyone had to say before I opened my mouth again.

@@drgthemd, where did you go to medical school? Where did you do your surgical rotations? When did you get your own lap-band?

That last one is critical because unless you HAVE one, have watched a barium swallow, or have otherwise witnessed how fast the food goes through the band, you have no real idea of how fast the food passes through the band. All you have is speculation. To say "One thing for sure, when a patient with a properly adjusted Lap-Band eats solid foods, it will definitely pass more slowly through the band than it would otherwise." without truly knowing is irresponsible. Yes, different foods behave differently when being swallowed. HOWEVER, an improperly adjusted lapband has the potential to cause a stuck episode.

All of us who have experienced a stuck episode form our own stupidity know how horrible that is. I had the experience of having slightly too much saline in my band, and that caused numerous stuck episodes while eating solids, but I had no issues with pureed or soft foods. You see ... being a doctor, or claiming to be one .. I'm not sure which you are yet, is NOTHING compared to being the patient. All of your experience and education tells you one thing, but from what I'm seeing, it doesn't jive with what we are living. Or. Maybe the food in Cali is different than the food we have in the Midwest.

[drgthemd 7]

Kate & Cherie, thank you for your responses. I am fully aware of the debate going on regarding food passing through the Lap-Band. There is still much disagreement on this issue, despite the studies that have been done. In my experience over the last decade with many patients, I believe the Lap-Band is a restrictive device and it does slow the passage of solid food through the stomach and also causes an early feeling of fullness if adjusted properly. The factors involved in the rate of passage of chewed, solid food through the Lap-Band are many, but not limited to:

1 - Consistency of the food, i.e. doughy and fibrous foods would pass more slowly

2 - The size of each mouthful of food

3 - Amount of chewing

4 - How fast one is eating

5 - Tightness of the band

Nonetheless, in my opinion, the important simple things to remember to achieve success with the Lap-Band are as follows:

1 - Be sure the Lap-Band is in proper position

2 - Have the band adjusted correctly

3 - Eat healthy solid foods

4 - Avoid fluids with calories

5 - Exercise within your target heart rate zone a minimum of 3 hours per week

6 - Take small bites, chew well and eat slowly

7 - Stop when you feel the fullness

In my experience, the Lap-Band is a great tool to achieve and maintain a healthy weight if the above simple steps are followed. Expected weight loss should be about 2 pounds a week. I have followed this protocol diligently with many of our patients and have had great success. If there is noncompliance with the above steps, it is unlikely that success will be achieved.

[KateP 359]

Oh, I fully agree with your rules. I have followed them with complete success for nine years.

My issue lies with your suggestion that the band can make it impossible to over-eat. If this is the case, it can only happen if food is retained above the band. I have seen too many people suffer with oesophageal problems to be happy with the idea that the band should be tight enough to allow this to happen.

I am very sure food passes through my band quickly because, following that principle, I drink with meals, waiting the suggested one minute after a mouthful. I can drink freely and easily and if food had not passed through, it would cause a back-up.

I stop eating when I have eaten a sensible amount. I then walk away, if I chose, I could physically eat more. But I feel comfortably satiated. So I stop, and I do not feel hunger.

So my issue is entirely with the concept that the band stops the intake of food. If people rely on that, they are regularly putting pressure on the base of the oesophagus. I am sure many of your pAtients are very successful and, of course, people post more in forums such as this when they have problems. But at nine year out, I have seen so many people with problems serious enough to necessitate band removal. And many of these are down to oesophagus dilation or even dysmotilty,

[drgthemd 7]

Kate, in my experience, the patients who can overeat and consume larger quantities of food when they have a properly adjusted band are patients who have a dilated upper gastric and lower esophageal pouch which usually results when patients do not stop eating when they feel the fullness. Additionally, those patients usually have a history of multiple regurgitation episodes. I've found the key to avoiding this problem is to eat slow, take small bites and chew well. It's very easy to not be able to recognize the appropriate endpoint of fullness if one is eating rapidly. When eating rapidly, the food is almost always consumed with large bites and not chewed well. The diagnosis of a dilated upper gastric pouch and a dilated lower esophagus is easily made with an upper GI x-ray. If there is significant dilatation, it can easily be reversed by removing the Fluid in the band for a rest period of 4-6 weeks. The intestinal tract should return to normal in that time and then the patient can have fluid placed back into the band for a proper amount of restriction. In my experience, patients with a properly adjusted band and who do not have a dilated upper gastric pouch and lower esophagus should only be able to consume approximately 2 ounces of solid chewed food at a time. That amount will vary somewhat from patient to patient and can also vary based on a multitude of factors, including time of day, menstrual cycles, etc. Patients with a dilated gastric pouch and lower esophagus typically will be able to consume larger volumes of food and if they eat late at night they oftentimes have night night coughing which can potentially lead to pneumonia because of aspiration. I applaud you for your success with the Lap-Band by following the simple rules. I do not know if you may have dilation of the upper intestinal tract above the band, but as mentioned, it can be easily diagnosed with an x-ray. In summary, the real key point, in my experience, to staying out of trouble with dilatation issues and regurgitation of food is to eat slowly so you can recognize when approaching fullness.

[drgthemd 7]

Kate, as I mentioned in the previous post, there are a number of factors involved in the rate of passage of food through the band. If a Lap-Band patient doesn't have a dilated upper gastric pouch and lower esophagus and they are still able to consume large quantities of food at one time, it could merely be because the band does not have a lot of Fluid in it, the type of food the patient is eating, size of the bites, amount of chewing and how fast they're eating. It sounds like you are eating slowly and are chewing your food well and taking small bites, so those factors would definitely increase the rate of passage. What type of band do you have and how many CC's of fluid do you have in it? When you eat, do you focus on healthy solid food? It sounds like you do.

[KateP 359]

I have a an old 4cc band, it is so long since I had a fill that I forget the saline content but think it is around 2cc. I do not have oesophageal dilation as I have an annual barium swallow. I know some dilations can be reversed by short term removal of saline, I also believe (anecdotally) that once a dilation has occurred, recurrence is more likely.

I may be explaining myself badly. If I ate fast and carelessly, food wouid not pass quickly. If I eat sensibly ( and I can eat all foods,certainly not just usliders - some require extra care), I will not have problems.

I find this interesting as, until this thread, I had assumed that all medical thinking about the band had moved on. When I was banded in 2006, we were taught that food shouod remain above the band for some time to stimulate the vagus nerve. So we were told to work out or oetsoball "soft stop" and eat until that point, not drinking for 30 minutes.

But, sometime around 2008/9, my baritaric team (and as I said, due to a house move, I had two of these) told me that research (meta-analyses as well as individual studies) had changed the understanding and that it was now accepted that the cause of satiety was the brain monitoring the number of movements of the oesophageal walls and that, obviously, the narrowing caused by the band necessitated a greater number of movements with anything other than liquid or very soft foods.

I am, as you probably realised, in the UK. But I know that many people in the U.S. are taught the same.

And this makes total sense of how my band works. As long as I wait for, say, a minute after swallowing, well-chewed dense food goes down. As I can then drink with ease, I know it has gone down. I can then continue eating. I feel comfortably well-fed after a small amount and stop. I no longer feel hungry. But if I choose to do so, I couid eat more.

[drgthemd 7]

Kate, thank you for your response. It does not surprise me that the food you eat passes quickly through your band because you have an older 4cc band with perhaps only 2cc's of Fluid in the band, plus you follow the simple rules of eating slow, taking small bites and chewing well and apparently eat healthy foods. You're to be applauded for that.

Regarding satiety, or fullness, in a Lap-Band patient, I honestly don't think anyone has the real answer. There is a lot of speculation and difference of opinion and that debate will probably continue on, but in my opinion, realistically it doesn't matter what the precise mechanism is, because we know that the Lap-Band does work if a patient complies with the simple guidelines for success. If they are not followed, patients will either have marginal or no success.

Over the years, we've had patients who've used the Lap-Band as a temporary tool to achieve a normal healthy weight and then they've requested to have the Fluid removed from the band. Most of those patients have maintained their weight because they changed their behavior by eating healthy, consistently exercising, avoiding fluids with calories and eating slowly. However, the majority of patients we've operated on over the years prefer to maintain some fluid in the band, which is fine. I think that's because they've been up and down so many times on a variety of diets and they have a fear they will not maintain necessary behaviors.

I wish you ongoing success with your Lap-Band and I would encourage you to continue your efforts at helping others who may be struggling with their weight loss.

[KateP 359]

Thanks. I think I agree to a large extent that the precise way it "works" is less important than following the basic rules. I only disagree if the banded person starts relying on discomfort or even pain to stop them eating. And I think you would probably agree on that!

My pet paranoia (can one have a pet paranoia?) is being too tight. I have seen very large numbers of people relying on the band too heavily and ending up with complications, right up to, for many of them, those necessitating removal. To that end, I am very vigilant. Twice I have had very mild night time reflux which showed no signs of going away; on both occasions, despite having no day time symptoms at all, I had a tiny amount of saline removed (0.1ml) and the problems went away.

There are no guarantees in all of this. But I do everything in my powers to keep my band, if it were removed or all saline taken out, I am fairly sure I would not be one of those who maintained my weight loss.