Tighter Isn't Always Better
MORE, MORE, MORE
Americans love MORE: more of anything and everything. More food, more fun, and (for some of us) more fill in our bands. But striving for maximum fill in the effort to achieve maximum weight loss can be a terrible mistake.
Fat folks become obese enough to qualify for bariatric surgery because we’ve been eating more, more, more, so it’s not surprising that bandsters long for more, more, more fill. The tighter the band, the better, right?
Wrong. Here’s why: tighter doesn’t automatically yield more weight loss. It can cause eating problems, side effects and complications that none of us want. It can compromise our quality of life. It can make us miserable when all we hope for from bariatric surgery is a better life.
You’re not impressed by all that? You’re willing to risk everything in the pursuit of skinny? Then try this on for size. A tight band doesn’t guarantee weight loss. Just the opposite: it can stall your weight loss or even make you gain weight.
Do I have your full attention now? Good. Listen up and I’ll explain why tighter isn’t always better.
THE RESTRICTION FALLACY
Traditionally, the adjustable gastric band has been considered a “restrictive” weight loss surgery. Bandsters were taught to look for signs of restriction: the proofs that their bands were working. Instead of paying attention to her own eating behavior and lifestyle, the bandster waited impatiently for the flashing signs, ringing bells and slamming doors that would stop her from overeating. The idea was that the small upper stomach pouch would “restrict” food intake and result in weight loss. Sound familiar?
That was well-intentioned thinking, but it was wrong. In the past 5 or so years, band manufacturers and bariatric surgeons have come to believe that it’s a mistake to eat and eat until you set off your band’s emergency warning system, for the reasons mentioned above. Unfortunately, the re-education process is slow going, and in the meantime, the restriction fallacy lives on. Even now, approximately every third word out of a bandster’s mouth is “restriction”. It’s a catch-all term for the feelings that limit how much a bandster eats. Post-op band life tends to become a quest for enough fills to reach the Holy Land of Restriction. Next stop: Skinnyland.
Or not.
HAZARD AHEAD! THE DANGERS OF SOFT CALORIE SYNDROME
Soft Calorie Syndrome is one of the least publicized dangers of a band that’s too tight. Psychologists would call it a maladaptive behavior, that is: a nonproductive behavior that prevents you from adapting to situations, or changes in yourself or your environment, in a healthy way. It can begin as an attempt to deal with or avoid an unpleasant experience but it does not solve the original problem and eventually becomes dysfunctional. You can read more about maladaptive eating behaviors by clicking here: http://www.bariatricpal.com/page/articles.html/_/healthy-living/is-your-eating-maladaptive-r50
A bandster experiencing Soft Calorie Syndrome is responding to the unpleasant experience of eating with a band that’s too tight by eating the soft and liquid calories that slide most easily past their gatekeeper band. Instead of eating the healthy and solid foods (like dense animal protein, veggies, fruits) that provide the most satiety (both early and prolonged), that person favors easy-to-eat food that’s often junky and high in calories (for example: potato chips, ice cream, milkshakes). Even healthy foods( like yogurt, cottage cheese and, fat-free/sugar-free pudding) can fall into the soft calorie category, and they don’t provide any better satiety than the junky stuff. The net result is that you end up consuming more calories than you need because the soft stuff doesn’t provide enough early and prolonged satiety. And the result of that is a weight loss plateau, or even weight gain.
I discovered the perils of Soft Calorie Syndrome for myself when I traveled to New York City to attend a trade show when I was about 8 months post-op. I had gotten a fill the day before I left, and by the time I got to New York I had realized that my band was too tight for me to tolerate. I couldn’t eat any solid food, so I spent the next 3 days eating soft, high-calorie, low-satiety foods like creamy soups, milkshakes, and ice cream. I was just trying to survive long enough to go home and get an unfill. My maladaptive eating behavior achieved a temporary goal (comfortable survival) while sabotaging my long term goal of losing weight. In fact, I gained weight during that trip and ended up feeling disappointed in myself. I promised myself no more fills on Fridays and no more fills the day before a business trip. I called my surgeon’s every time I suspected my band was too tight and found that even tiny unfills could make all the difference in my quality of life as well as my weight loss.
I know I’m not the only person who’s discovered the perils of Soft Calorie Syndrome. I also know that you’re not alone in believing that more fill is better and that unfills will slow or stall your weight loss. A few months ago I talked about this with a smart and successful bandster named Denise. When her surgeon reacted to her too-tight band by suggesting an unfill of .5 cc, her dazed and frightened face made him reassure her that she could start being re-filled in a month. The month ahead scared her, but she agreed to the unfill, and discovered that rather than returning her to Bandster Hell, it had restored sanity to her eating life. She said, “I was able to eat again. Solids went down easily. Bread was on my menu. Meals lasted me several hours. I didn’t snack because I was able to eat enough to keep me satisfied.”
When Denise went back to her surgeon a month later, he was delighted her hear her say that she didn’t even need a re-fill. She told him, “I can eat anything, but I’m not eating everything.”
And that, my friends, is what healthy eating is all about.
I do that often times as well but then I worry about whether or not I am getting a good amount of calories in to keep weight loss going. At some point if you don't eat and start skipping meals it can also put you in a stall and eventually you start to lose muscle instead of fat..at least that's how I understand it.
Saw my Nut this week and she told me to only count my calories if I feel I need to. She told me I am getting in my own head too much with the numbers. She said as long as I am working out and I am losing weight then do not focus on the calories and just ensure I am eating good foods and getting in the proper Protein.
Saw my Nut this week and she told me to only count my calories if I feel I need to. She told me I am getting in my own head too much with the numbers. She said as long as I am working out and I am losing weight then do not focus on the calories and just ensure I am eating good foods and getting in the proper Protein.
Hmm. Sounds familiar. I got a similar talking-to from my surgeon last fall! It's hard for me to recognize when I'm obsessing and over-thinking things, and I tend to anticipate disaster if I can't control every little detail or calorie.
Since we know our bodies better than some doctor's, WE are the only ones that can judge what we need and how we eat. Opinions and lot's of free advice always is around us to try and use, but WE will make the decision and choices that WE feel are the correct ones. Most of us already know that Protein first, then the rest. WE just have to retrain our brains and DO IT!
PS. Jim1967 you're doing GREAT!
Best wishes
BEST article EVER! This was me for quite a few months! Now that I've had 2 slight unfills I'm happy to say the insanity has stopped! Any new binders on this pay close attention to this! Tighter us not better! I'm 2 years post op and have kept 110 lbs off. Now that I'm eating better (well, can finally eat normal) I have more energy and I'm back working out and trying to get another 40 lbs off this year! The band has been a good tool but weight loss surgery is not magic! Like the article said...the control needs to mainly come from your head. Good luck to everyone! Stay strong, positive, focused, healthy and always believe in yourself!!
Thank you so much for referring me to this site, after reading this article it makes so much sense, because that's exactly what I was doing the"soft diet" thing no more, thank you,
Thank you so much for this article. It explains so much. I had my surgery 5/28/13 with a 1.5c fill. The first month I was able to work my way up to "real food, " exercised a couple times a week, and lost 16 lbs. Then I plateaued. At my next appointment the surgeon gave me a small fill (2cc). I felt like I could "eat a steak," and didn't lose a thing. I went back and against his better judgment, I insisted on another fill. Since then (last Thursday) all I can get down are shakes and Soups. And, I'm not losing weight. My surgeon is now out of town. Should I contact his on-call partner and get an un-fill? I feel like if I don't I will be eating soft foods until my next appointment mid August and won't be losing weight. And I miss all my summer fruits and veggies!! I feel like a failure...
Thank you so much for this article. It explains so much. I had my surgery 5/28/13 with a 1.5c fill. The first month I was able to work my way up to "real food," exercised a couple times a week, and lost 16 lbs. Then I plateaued. At my next appointment the surgeon gave me a small fill (2cc). I felt like I could "eat a steak," and didn't lose a thing. I went back and against his better judgment, I insisted on another fill. Since then (last Thursday) all I can get down are shakes and Soups. And, I'm not losing weight. My surgeon is now out of town. Should I contact his on-call partner and get an un-fill? I feel like if I don't I will be eating soft foods until my next appointment mid August and won't be losing weight. And I miss all my summer fruits and veggies!! I feel like a failure...
You're not a failure. This whole thing is brand new to you, and you still have a lot to learn.
If I were you, I'd contact your surgeon's on-call partner and schedule a small unfill. liquid and soft calories just do not provide the early and prolonged satiety that you need, and keeping your band too tight can cause complications like band slips.
Also, try to be patient about the weight loss. I know that's hard, but losing 16 lbs the first month is very fast, and the plateau you've experienced then is quite likely due to your body's effort to readjust your metabolism. It may be thinking, "Oh, no! We're going to starve to death! Better slow this engine way down!" Because the body perceives calorie restriction as potential starvation, tt's possible to cause a plateau by eating too few calories. I've heard so many people say they started to lose again after they started adding more (healthy) foods to their daily intake.
I love my summer fruits and veggies too, and complex carbs like that can also help weight loss because the Fiber content helps keep you satisfied while its doing all kinds of good stuff for your health.
Hang in there!
Jean, thank you so much for your sage advice. I finally saw my surgeon's partner today and I was surprised when he told me to not get an unfill and stick to Clear Liquids another 48 hours and then smooth liquids a couple of days, and then finely ground foods - like my post-op diet. He said there's nothing wrong with giving my body time enough to get used to the fill (3cc) and that I needed to stop vomiting to heal. He also felt there was nothing wrong with liquids for another week provided I was getting my fluids, Protein, and Vitamins (which I am). He said if I'm not comfortable with real food by next week I could come back for the unfill but he would take a whole cc out. I am meeting with the dietician tomorrow. I have a lot to learn about eating/exercising with my band, and I will take a look at some of the links to your books and blog. Thanks!
Jean, I've been reading your fabulous articles for a few months now and just realized you are the author of the awesome cookbook I have next to my reading chair! Not sure why I haven't made the connection sooner, but thank you for the great articles AND the delicious recipes :-)
Saw my Nut this week and she told me to only count my calories if I feel I need to. She told me I am getting in my own head too much with the numbers. She said as long as I am working out and I am losing weight then do not focus on the calories and just ensure I am eating good foods and getting in the proper Protein.
Yeah, calorie counting can become a "can't see the forest for the trees" thing!
Jean, thank you so much for your sage advice. I finally saw my surgeon's partner today and I was surprised when he told me to not get an unfill and stick to clear liquids another 48 hours and then smooth liquids a couple of days, and then finely ground foods - like my post-op diet. He said there's nothing wrong with giving my body time enough to get used to the fill (3cc) and that I needed to stop vomiting to heal. He also felt there was nothing wrong with liquids for another week provided I was getting my fluids, Protein, and Vitamins (which I am). He said if I'm not comfortable with real food by next week I could come back for the unfill but he would take a whole cc out. I am meeting with the dietician tomorrow. I have a lot to learn about eating/exercising with my band, and I will take a look at some of the links to your books and blog. Thanks!
I'm sure your surgeon would be relieved to hear that I approve of his advice!
Following a liquid diet when you've been having eating problems and difficulty adjusting to a new fill is a good idea that I advocate often. It gives your upper GI tract a chance to calm down so that the next time you try solid food, you should be able to eat and enjoy it more easily. But I think we have to be cautious about that approach because it can delay facing up to the fact that we might need an unfill.
I think that having my band too tight is going to result in me having to have it removed. I am 6 years and have been on prescription heartburn medications for 3 years with no relief. Last year my esophagus was dialated and they removed some Fluid. It went back down. I go see a new doctor on 7/31 and I know he will do some diagnostic tests.
leannel90 206
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This made me feel so much better. I was at my doctor the other day and when I said the word restriction he told me not to use it. He gave me the same information as this article but I haven't heard this as much as I've seen the word restriction. I really enjoyed this article...thanks!
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