Why the Lap-Band is not perfect

how much weight can you lose with the band?Do not shoot the messenger! In this piece I will give you my professional opinion based on Band patients I have taken care of. I have shared with you that the Lap-Band Surgery is an OK obesity operation.  There are better bariatric procedures. I have patients (a few) that have been wildly successful. Another few have success, then it comes to a stop. Others, lose 10, 15, 20 pounds and then nothing.  In a different blog I will write about the highly emotional discussion going on about the current status of the Band.

The Band does not take away hunger

The Band is placed around a normal stomach. In the early stages of the operation, a person will have a lack of appetite. This is due to the stress of surgery. Once this passes, the stomach goes back to working like a normal stomach. Its job is to make you “feel” hunger, so you will eat.  There is absolutely nothing about the Band that changes this. The science to this is a lot. The concept that tightening the band, will take away hunger happens for very few patients. What takes away hunger is eating very small meals very frequently.

Eating until uncomfortable

I hear this from just about every obesity surgery patient, but a lot from the Band patients.  Eating to discomfort will defeat the operation. I do not believe in pouch stretching. What I have seen happen is that the esophagus (food pipe) above the small stomach pouch, starts to stretch to give more room, more capacity to accept more food. This produces a vicious cycle.  The esophagus stretches, patient does not get full quickly, patient demands the Band gets tightened, patient starts throwing up because the Band is too tight.  My Band patients who are most successful, eat a small measured portion of food, they learn
what portion size they can eat without becoming uncomfortable, then they are done until their next meal.
Not eating small meals / high protein / low carb The only thing the Band will do is to make you full quickly when you eat a small meal. This needs for a Band patient to do 2 things every time they put food in their mouth. 1-eat a small measured portion of food (1/4 cup, 1/3 cup, ½ cup, 1 cup). 2- stop eating when the portion is finished. Eating a high protein meal needs more time to be digested, keeping you not hungry
longer.

Not eating frequently / often – 5-6 times a day

In my practice this is standard counseling. Patients who come from other programs tell me they are told to eat 3 meals a day, not to snack and only to come back to the office for a fill. This will not work, because it will return patients back to where they were before the operation. The solution is to eat small measured portions. This will not only prevent hunger, it will increase your metabolism by forcing your body to burn energy.

Not exercising

This is a tough concept because in America, physical education was removed from public schools for a period of time. There is a population of Americans who do not understand what exercise is. Going to work, getting up and doing housework, walking from your car in to the office, walking during work is not exercise. There are activites of daily living that we must all do, unless of course you won the 50 trillion dollar lottery and can hire people to do everything for you!

Cardiologits have recently started putting cardio monitors on their patients when they go to work, to show them that their heart rate is no where close to exercise. Aerobic exercise is where you get your heart rate over 100 beats per minute AND it stay there for an extended period to time. My recommendation to patients is that the slowly but surely work up to 1 hour a day. Reseach shows that to lose weight it is necessary to aerobically exercise 1 continuos uninterrulted hour a day.  Read my previous blogs on exercise and some more to come.

Not getting the Band tightened

Are you surprised by this. Me too! But indeed I have had patients come to my office, having had a Band placed 1-2-3-4-5 years ago and not getting 1 fill. They are surpirseded they have not lost weight. Of course they are doing all the other stuff that does not work.  Eating salads, fruits and vegetables.
Many band patients are surprised that they are not losing weight. “Dallas Weight Loss Surgeon Dr. Dirk. I eat salads, fruits and vegetables every day. I drink orange juice, grape fruit, cranberry juice and apple juice every day! Why am I not losing weight?” I hear this from patients contemplating obesity surgery as well as from Band patients.

Commercial fruit juices have high amounts of concentrated sugar calories as well as have added high fructose corn syrup to improve flavor. They are  loaded in drinkable calories. It is thought that fructose may trigger brain chemical to make the body think it is still hungry. Eating a large salad or lots of fruits also has a lot of calories in sugar carbohydrates.

Don’t forget the salad dressing and croutons to go along with everything else. Again, the solution is to eat a very small portion. And when it comes to fruits, salads and vegetable, only do this once a day.

Eating junk

Yup, you read it right. Many Band patients come to me, honestly telling me or my staff that they make 1-2-3 daily trips to the vending machine, soda machine or to a fast food restaurant.  No matter what the fast food restaurants post, there is nothing healthy about eating in one of those places.

As for vending machines – have you ever seen a sign from the AMA or American Heart Association endorsing the stuff inside it? ‘Nuff said. Maybe just consider starting the change by making lighter versions of your favorite dishes.

I am not against the Band.  The Lap Band Surgical Procedure works for a small specific group of patients. I have had it work for specific patients. Younger, less than 30 years old, with less weight to lose, less than 100 pounds, who are able and willing to exercise aerobically every day for 1 continuous hour, and do not have diabetes or high blood pressure.