Permanent Long Term Weight Loss

[drgthemd 7]

I am a physician. I'm interested in communicating with Lap-Band patients who are having problems with achieving and maintaining a normal weight with the Lap-Band.

Dr. G.

[CherieRyde 227]

Doesn't "normal weight" vary person to person? Your idea of normal might not be my body's normal. Thanks though.

[KateP 359]

As the OP says - define " normal". Also, in your title, define "permanent" as that word seems to be an odd adjective to link to long term! Surely it eirher is or isn't permanent? Hopefully at nine years post-op, my loss will prove to be permanent but I would never be foolish enough to so call it as I presumably won't know until on my death bed.

For a physician, you seem to be taking a rather non-scientific approach.

[rose2014 81]

" Normal " hmmm I must agree with KateP & cherieryde. Normal for them and their height,body makeup etc and mine may all differ. I need a doctor to help me figure out how to keep the weight coming off like in the beginning fix my head hunger issues etc. Then when I reach my by goal I need a good reasonably priced surgeon for a body contour

Do you have any suggestions to my questions?

[drgthemd 7]

Thank you for your responses. You're absolutely correct. Normal is not an absolute number. It is a range dependent upon your height and weight. As you probably know, height and weight can be used to calculate your BMI (Body Mass Index). Normal BMI is approximately 18-25. As far as my reference to permanent weight loss, the goal with the Lap-Band should be to lose enough excess weight to arrive at a normal BMI range and maintain that range. If the Lap-Band has been properly placed and adjusted, (btw adjustments are VERY important to Lap-Band success and in my experience more of an art than science to arrive at the proper adjustment point and that endpoint varies from patient to patient) patients should need only 3-4 adjustments to the band until they reach the ideal point of losing 8-10 pounds a month, consistently. That kind of weight loss, in my experience, assumes a properly adjusted band and patient compliance with three simple rules:

1 - Take small bites of solid, healthy foods (fruits and vegetables and healthy processed foods), chew it well and go slow when eating

2 - Avoid fluids with calories the majority of the time

3 - Consistent, effective exercise at least 3 hours per week, ideally the exercise should be aggressive enough so that you are exercising in your target heart rate zone

For head hunger, in my experience the most effective way to deal with the issue is to be regularly involved in an active post-op support group. We have done that for years and has been very effective

[KateP 359]

May I ask why you are posting? Ibinitslkybassmed you were fount done dirt if research. Now I think you are looking if business?

[KateP 359]

Sorry. My iPad garbled that.

I initially supposed you were doing research. Are you in fact looking for business?

[drgthemd 7]

No, I'm not looking for business at all. I'm trying to help people with their Lap-Bands. My patients suggested I come on here and read/view/post and I believe I can offer assistance to others who may be struggling/have issues with the Lap-Band.

[KateP 359]

My apologies! Not clear from your posts! I shouldn't be cynical!

Your help may be very useful for some as education is often the key factor which is lacking when people, with no physical complications, fail to lose weight. There is often too high an expectation and, worryingly, some people still appear to believe that the band should physically prevent them over-eating and talk of " filling the pouch". Whether they are basing this on anecdote or (and I hope this is not the case) being poorly informed by medical staff is not clear.

[drgthemd 7]

Regarding body contouring, I would recommend not doing anything until you reach a normal BMI range. At that point, I suggest contacting a plastic surgeon for a consult. There are many excellent plastic surgeons that deal specifically with body contouring after weight loss and many of them offer free consultations. I suggest contacting several to make a good decision.

[KateP 359]

Actually, to add: I just read your longest post more carefully. I was interested to see you disagree with my own doctor. You say

"Take small bites of solid, healthy foods (fruits and vegetables and healthy processed foods)".

My own plan required dense Protein first and the avoidance of processed foods which are often high in salts and sugars. And, of course, many wls people limit fruits which are often high in sugars.

[drgthemd 7]

In my experience, if a Lap-Band is properly adjusted, patients will not be able to consume excess amounts of any healthy solid food. They will reach the endpoint of fulness after consuming much smaller amounts. People can cheat and get around that by eating unhealthy foods and also by consuming fluids with calories. Most fruits and vegetables when eaten in smaller quantities are excellent because they tend to have a lot of bulk which will fill you up and do not have a lot of calories. There are some exceptions to this, avocados for example have a lot of calories and a lot of saturated fat, but the majority of fruit and vegetables are great. Processed foods are ok as long as you buy healthy processed foods. Read the label on the product and buy processed foods which contain minimal amounts of sodium, sugar, cholesterol, trans fat and saturated fats. I guarantee you can find healthy processed foods which contain minimal amounts of the above that also taste good.

[CherieRyde 227]

I agree with @KateP.

Additionally, some of us have food allergies that prevent us from using the things you just mentioned. I, for example, have an appointment to speak with my Dietitian about the massive food allergy list that I just got. In checking the labels of processed foods, ALL of them either have something that I'm allergic to in them (eg: tomatoes, bell peppers, onions), or are processed in factories using things I'm allergic too (eg: tree nuts, peanuts, legumes). So, while what you are saying sounds *great*, and it's what I want to do so very much, it's not possible for me and some others to do.

Also .. salads ... I miss them. Oh my do I miss them. Sure, I can have cabbage, spinach, and kale ... but they aren't the same as a nice romaine lettuce. Considering that I'm allergic t most other things that go IN a salad (cucumbers, carrots, tomatoes (again), and bell peppers (again), it's not as satisfying.

So, without going into the entire list of things I'm allergic to, what do you do with patients like me who can only safely consume meats, *some* fish, and poultry? I used to be a vegetarian. Now .. with these new allergies, I'm forced to be a carnivore ... and I'm GAINING again. Not to mention the pain in my joints and feet that I didn't have when I was on a vegetable based diet.

[drgthemd 7]

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.

[KateP 359]

You are a doctor, I am not. I am, however, an extremely successful Lapband patient with a tendency to research things throughly and seek explanations from my medical team .

It is my understanding that a correctly adjusted lapband will not and should not prevent over-eating. If it is tight enough prevent more food passing, the food is building up above the band which risks damage to the oesophagus. I follow the medical advice I have been given which is that well-chewed food passes through a well-adjusted band in under a minute. It is therefore physically possible to eat more. That we can resist doing this (because the increased number of movements of the oesophageal walls signals satiety) is thanks to the band. But it is our choice not enforced by a restrictive band,

As I rarely feel physical hunger, I, like many banded people, do not require bulky vegetables to fill me. Isn't it rather contradictory to say banded people cannot over-eat but need bulky vegetables to fill them? I am aware that many processed foods are healthy but I do not personally need them.