Delajuana

What is the green zone, and how do we get there from here?


GET INTO THE GREEN ZONE
Bandsters tend to obsess about finding their sweet spot** or perfect restriction, and in the process torturing themselves with the idea that weight loss won’t start until they reach that magic place. That’s kind of like trying to balance yourself on the pointy peak of a pyramid, where you’re all too likely to fall off and crash into the ground. Focusing on finding that one special spot (instead of appreciating what our bands are doing for us right now) is short-changing yourself. It’s kind of like sex: if you don’t pay close enough attention to how you feel now, you’re not going to appreciate the many small, pretty-good moments that lead up to and follow the one great moment. To my mind, it’s more helpful to use the term Green Zone.
Allergan, the manufacturer of the Lap-Band®, developed the Green Zone chart as a simple, visual way to explain the band’s performance without using the terms sweet spot or restriction. I agree with that approach. In my personal experience, it’s far better to think of restriction as a range of experience rather than a single point on a line. I’d really like to drop the term restriction altogether because it’s an outdated term from the olden days when adjustable gastric band was labeled a “restrictive” device that automatically limits how much the patient can eat. I prefer the term “optimization” - a band system functioning at its best. That system consists of the band and the patient who is taking responsibility for good food choices (both for satiety and for health) and Portion Control, plus fighting the good fight against emotional and addictive eating.
But having said all that, I’m going to go on using the term restriction because it’s more easily recognized by bandsters than the term optimization. Just keep in mind that when I mention restriction, I'm referring only to the signals the band system uses to communicate its status and/or need for adjustment. Let’s take a look at some of those indicators. They are signposts that can be hard to read until you’ve learned your band’s and your body’s idiosyncrasies.
** To read more about the sweet spot, click here:
http://www.lapbandtalk.com/page/index.html/_/support/post-op-support/the-elusive-sweet-spot-r59
YELLOW ZONE - hungry; eating big meals; looking for food Ü add fluid
This is territory that new bandsters often find themselves in – also known as “bandster hell.” We don’t have enough Fluid in our bands yet, and at this point, the patient has to work harder at weight loss. The yellow zone is very frustrating, but it doesn’t mean that your band is broken. It just means that your band system needs some tweaking.
GREEN ZONE - early & prolonged satiety; satisfactory weight loss or maintenance J no fluid adjustment needed
The Green Zone is the bandster’s Promised Land, where the patient and his/her band work in tandem to achieve weight loss or weight maintenance. It isn’t a worry-free or work-free zone – like many other good things, it needs attention, consistency, and plenty of work – but it’s a wonderful place to live.
RED ZONE - difficulty swallowing; reflux-heartburn; night cough; regurgitation; poor eating behavior Ü remove fluid.
You may find yourself in the red zone when your band is too tight. That can happen even when you haven’t recently had a fill, and for a variety of reasons, many of them benign if frustrating.
BE YOUR OWN TRAVEL GUIDE
I can’t over-emphasize how important it is for you, the patient, to participate in reaching the Green Zone and staying there. Being your own travel guide during your WLS journey is well worth the effort, because if all goes well, you’re going to be traveling with your band for the rest of your life. You need to be able to recognize your restriction signals and make good decisions for your weight, nutrition, and general health***.
I told you that the Green Zone is a wonderful place to live, but no one can guarantee that your residence there is or will be permanent. Even when you believe you have the “right” amount of fluid in your band, you can find yourself in the Yellow Zone again for several reasons:
1. You’ve lost enough weight for the visceral (internal) fat clinging to your stomach to shrink, so the band puts less pressure on the stomach and feels too loose.
2. You’ve been making poor food choices – that is, eating foods that are too soft to give you early and prolonged satiety. This can be sign of what I call Soft Calorie Syndrome. To read more about it, click here: http://www.lapbandtalk.com/page/index.html/_/support/post-op-support/tighter-isnt-always-better-r118)
Or perhaps you’ve been eating foods that by their very nature are not conducive to weight loss, (like fast food), or you’ve been overeating or snacking because of neglected emotional issues (often called self-medication).
Likewise, you can find yourself in the Red Zone even when you’ve been doing every little thing “right.” Your band can start feeling too tight when seasonal allergies are flooding your upper GI tract with excess mucus, illness has been making you cough or vomit a lot, you’ve been dealing with a lot of stress, you started taking a new medication, you haven’t been drinking enough Clear Liquids, and so on. Whatever the reason, the best course of action is to remove some or all of the fluid to allow inflammation of the esophagus and stomach to calm down, then gradually start adding fluid again until the patient moves back into the Green Zone.
Does all this sound like an awful lot of work? It is hard work. Bariatric surgery of any description is meant to make weight easier, but no WLS procedure makes it automatic. For me, there’s nothing quite as satisfying as achieving a goal I worked hard for. And once I have the prize in my grubby little hands, I’m going to hold onto it for dear life, because my life and my health are both very dear to me.
***Note: Jessie Ahroni’s book, Laparascopic Adjustable Banding, includes an excellent guide to determining if you and your band are properly adjusted, with questions to help you understand that adding or removing fluid is not the only way to adjust the band system: you may also need eating, behavior, activity, attitude adjustments.

If you’re once a fatty, are you always a fatty?


THINK THIN, BE THIN
I think I’m well qualified to speak on this subject, since once upon a time my schoolmates chanted, “Fatty, Fatty, two by four, can’t fit through the kitchen door!” when I walked into the gymnasium for a physical education class with a teacher who, after weighing and measuring each kid, announced to her captive audience that Jean was the shortest and heaviest girl in the class. After which I was the last kid (once again) to be chosen for a volleyball team.
I believe that in order to become a thin person, we must learn to think like one. It’s a tall order, I know. You might as well ask my dogs to learn to think like cats (I’m pretty sure my cats can think like dogs, but it doesn’t seem to work the other way around, to the everlasting detriment of the dogs).
At the same time, I believe that we must never forget our inner fat person. If we do forget, the fat folks may burst out of us and take over again. I know mine did last year, for six months and 30 pounds of regain. She was aided and abetted by the loss of my beloved Lap-Band®, but once she was out of her cage, she took charge so fast it made my dizzy blonde head spin. That’s not a pretty sight when that head is busy gobbling all the food in the western hemisphere and the body attached to it is rejoicing, “Starvation has ended at last! It’s party time!” (which is what my gastroenterologist said my metabolism was doing, although not in those exact words).
I lost the weight I had regained, plus another 10 pounds. I know (or I hope) I don’t look like a fatty any more, but a fatty still lurks inside me somewhere. My fat demon is hidden from view, but she’s still my demon. Exactly what every girl needs, along with a good bra and a good hairdresser. Seriously, though, my fat potential lives on, mainly because obesity is an incurable, chronic disease that no surgery today can cure. As long as my inner fatty threatens to take over, it’s hard for me to think and act like a thin person. But I refuse to give up the Quest for Thin Jean, and I strive every day to emulate her. I believe that practicing thin behavior will eventually teach me thin thinking, and I believe that practicing thin thinking will keep my body thin.
FAKE IT UNTIL YOU MAKE IT
We have now arrived at the bad-tasting course in this home-cooked meal of advice. In order to practice thin thinking, we need to do things that we’ve done over and over again in the past without long lasting results, like making good food choices, practicing Portion Control, and exercising. I know that this concept frustrates many of us and infuriates some of us. Some people scorn the practicing part of the WLS journey. They say, “It’s just another diet.” A friend of mine declared a week before her band surgery, “I refuse to diet.” Perhaps it’s a matter of semantics or personal preference, but I persist in believing in the importance of practice because thin thinking and thin acting don’t come naturally to me. I wasn’t born with piano-playing skills. I had to take lessons and practice every day just to be able to play “Chopsticks”. Even famous concert pianists must practice every day. The same is true of being thin.
This reminds me of the “fake it until you make it” slogan repeated in 12-step groups. The 12-step tradition recognizes that sobriety or abstinence doesn’t come naturally to people with addictive tendencies. It doesn’t expect its members to leap from the first to the 12th step in one week, one month, or even one year. All it asks is that we practice desirable behaviors every day, day after day, while the struggle to do that gradually lessens and we gain some control over the undesirable behaviors. Eventually we discover that we don’t have to “white knuckle” it anymore because the desirable behaviors have become habits.
Assuming that you had WLS because you don’t want to be a fatty any more, I’d like to suggest that you begin by not eating like a fatty any more. You don’t have to do it perfectly, because you’re just practicing, right? As far as I’m concerned, you can leave the perfection stuff to God. All you need to do is do your best, day by day, to work with your strengths and work around your weaknesses. Even if practice doesn’t always make perfect, it’s got to help you with the fake it part until you get to the make it part. Yes, it’s a lot of work, but you can do it!

Frustrated by a weight loss plateau? You need a combination of patience and a plan to push through it.


It happens to everyone sooner or later. Your bandwagon stalls. You’ve been going great guns, fired up with enthusiasm, working that tool, doing all the right things, and losing weight. Then one day the weight loss stops. One day, two days, twenty days go by…you’re still stuck, and you’re wondering what happened. And because you’ve spent so many years failing at dieting, and being told that obesity is always the fault of the patient, you start to wonder what you are doing wrong. You even think, “Is my band broken?”
Chances are, you’re not doing anything wrong, and neither is your band. What’s happening is that your body is adjusting itself to the many changes that have happened during your weight loss.
The human body doesn’t know what you’re going to do next, be it climb a mountain or relax on the couch, so it has to continually adjust and readjust your metabolism to make the best use of the calories you take in. It looks at the history of what you’ve been eating and how much you’ve been burning off through physical activity and comes up with a forecast of what you’ll need to stay alive for the next week or so.
THIS MONTH’S WEIGHT LOSS FORECAST IS…
At work I’ve had to prepare sales forecasts for various jobs through the years. How many widgets will we sell in the month of April? How many defective widgets will be returned by unhappy customers who want a refund? Will all this income and outgo generate enough cash (in our case, energy) to cover the payroll and the equipment maintenance and the CEO’s country club membership? I once had a boss who joked that we might as well toss a deck of cards down a flight of stairs to come up with a prediction of which new product (represented, say, by the joker card) was going to be the best-seller. That suggestion didn’t go over big with the finance guys. Like us, they were trying to follow the rules, keep everything identified, counted and categorized. And like the bean-counters, we count our calories, carbs, fats, Proteins, liquids, solids, income, outgo, with faith that this accounting system will help us win the weight game.
Meanwhile, our bodies have a different agenda: survival. When we decrease our food intake and increase our physical activity, the body watches to see what will happen next. As our purposeful “starvation” continues, the body struggles to accommodate the changes we’re making. It makes some withdrawals of funds from our fat cells and fiddles with our metabolism to prevent an energy (calorie) shortage. Gradually it becomes acclimated to the new routine so that it’s making the best possible use of the few calories we’re consuming. It’s keeping us alive, but it’s also putting the brakes on weight loss. Eventually we find ourselves stalled on what seems like an endless weight loss plateau. And unless we change our routine and keep our bodies working hard to burn up the excess fat, we’re going to grow to hate the scenery on that plateau.
AND ON THE FLIP SIDE
I’ve suffered through countless weight loss plateaus but by varying my exercise, my total caloric intake, my liquid intake, my sleep, and so on, did manage to finally arrive at my goal weight. For the past few years, I’ve felt mighty smug that I finally got promoted to the Senior VP of Weight Management here at Chez Jean. Maintaining my goal weight +/- 5 pounds seemed effortless. But it didn’t last.
Turns out it was time for me to learn another lesson about my body’s fuel economy. When I had all the fill removed from my band to deal with some bad reflux, my eating didn’t go berserk. I didn’t pig out at Burger King, didn’t drown my sorrows in a nightly gallon of ice cream. I was definitely eating more because I was so much hungrier than before – perhaps 500 extra calories a day, which would amount to a weight gain of one pound a week. Imagine my dismay when I gained seven pounds in 2 weeks – the equivalent of an extra 1750 calories a day! There was a time when I could have overeaten that much without any effort at all, but as a WLS post-op, I’d have to work hard at eating that much extra food. I was flabbergasted. And frightened. Obesity was a mountain on my horizon again – far in the distance across my weight maintenance plateau - when I thought I’d left it far behind.
So at the end of a visit with my gastro-enterologist during that scary time, I asked him if my sudden and substantial weight gain was the equivalent of my body shouting, “Yahoo! We’re not starving anymore! Let’s get ready for the next starvation period by hanging on to every single calorie she takes in! Let’s store those calories in those fat cells that have been hanging around here with nothing to do! C’mon, troops, get to work!”
I’m pretty sure that’s not the way Dr. Nuako would have explained it, but he smiled, nodded, and said, “Oh, yes.”
I felt like I was facing the flip side of a weight loss plateau: I might be in a weight gain plateau. All I could do is keep on keeping on with exercise and healthy eating, enjoying some of the foods, like raw fruits and veggies, that had been harder for me to eat with a well-adjusted band.
PUZZLING OUT THE WEIGHT LOSS PLATEAU
So the good news was that my wonky metabolism following that complete unfill wasn’t my fault, but the bad news was that my metabolism wasn’t in a cooperative mood. I was going to have to start playing much closer attention to the details of weight loss and maintenance again. What a pain!
But hey! I’d already had a lot of practice at that. I had the tools – a little rusty maybe, but still in usable condition. I ended up regaining 30 pounds between that unfill and my revision to VSG, but I have a suspicion that without those weight tools, it could have been 60 pounds. And that’s one of the reasons that even today, bandless for 14 months now, I don’t regret my band surgery. The band helped me lose 90 pounds and learn a host of useful (if uncomfortable) things about myself, my behavior, my body, my lifestyle.
What about you? How can you get your weight loss going again and avoid regain? So many factors can affect your weight that sorting out the reason(s) for your weight loss plateau can make you dizzy even if you’re not a natural blonde like me. To help you assess what’s going on and what might need to be changed, I created a Weight Loss Plateau Checklist. To access the checklist in Google Docs, click here: https://docs.google....emtSYjJLRnVGTFE
The checklist includes a long list of questions about you and your behavior, with answers and suggestions for each question. I can’t claim that it will give you the key to escaping that plateau, but it should give you some food for thought and perhaps some ideas to try. Use that to come up with a plan to deal with the plateau, and work that plan for at least a month to give your body a chance to get with the new program.

It took me more like 3 weeks to get halfway normal. Your body is healing from major surgery. It takes time.

I truly appreciate the great responses and the eight rule video provided by 2muchFun. I am taking it slow and refocus on me now. Unfortunately I have no children so the lonelines and guilt for being alive weighs heavily on me.
A personal thank you to Marci for the wonderful advise, I hope I can be happy again.

I'm over three years banded and haven't had any "band" issues. I did have a installation issue that was corrected. KNOCK ON WOOD! It works for me when I work with it.

like the others, so very sorry for your loss..
the only thing i am going to offer as a (do) is to believe in yourself
the only don't i am going to offer is dont make excuses...either do it or dont.

I truly appreciate the great responses and the eight rule video provided by 2muchFun. I am taking it slow and refocus on me now. Unfortunately I have no children so the lonelines and guilt for being alive weighs heavily on me.
A personal thank you to Marci for the wonderful advise, I hope I can be happy again.

1st of all, I'm so sorry for the loss of your husband and dad. 5 yrs ago, I also lost my husband at age 46 (I was 40), so I know the depression and weight gain that it causes. Please try to find a support group for widows - it helped me tremendously.
Ok, you want the top ten things? Here you go:
1. Don't drink while you're eating or for 30-45 minutes afterwards. They say it's because you wash down whats in your tummy before the fullness feeling. I can't drink while eating because it caused me to vomit.
2. Make sure you only eat the amount directed by your dr. Some say 1 cup, some 3/4 of a cup. Follow your drs advisments. snack only if directed by your dr
3. AVOID VOMITING AT ALL COSTS! For 2 yrs, I ate way too fast and caused myself to vomit (not really pb'ing, as it's much more violent but only food comes up) about 4-6x a week. My band finally had it last year and slipped. I'm still paying for that decision.
4. Exercise. Looks like you're already doing that tho!
5. Don't drink your calories. Like grape juice has like 100 calories a cup, Water has 0.
6. Get your Protein in. If you have a choice between Protein and carbs, choose the protein first
7. Make sure you get fills when necessary. The band doesn't work if you're not adjusted properly
8.Watch your calories. With only eating 1 cup per meal, the calories should be fine and you probably won't need to count them, but I do in my head anyway.
9. I don't do this but keep a journal of everything you eat. Studies say that people who write down everything they eat, lose more weight.
10. Don't drink soda! Whether it's diet or not. The carbonation wreaks havoc with your band.
Hope that helps a little. I'm sure there's more "rules" but I'm not one for many rules and break them all the time! You shouldn't need to "diet" while the band is actually working, but until you get proper restriction, you may need to.
Good luck to you! And you will be happy again someday. I promise. I thought I'd never be happy again after losing my husband. 5 yrs later, I'm remarried and loving my new life. I still thik about Kevin with fond memories, but I'm so happy now I could burst!
Marci

My doctor has set me up with a nutritionist and I'm on a very strict diet. I'm not saying you should follow it exactly if you don't feel like it's right for you but take into consideration maybe? My diet is very similar to Atkins which I had done in the past.
I do not eat any:
bread
Pasta
rice
potatoes
fruit
sugar
artificial sweetener
or any drinks other than coffee, tea, fat free milk and Water.
When I drink coffee I get something flavored and use fat free or low fat half and half or Creamer and whichever is lower in calories. When i drink tea I get the unsweetened.
Now I do my best to follow this diet but it is very strict and pretty damned hard to follow so for instance the creamer in my coffee although better for me than something that's flavored and amazing, it still has a little sugar in it.
for Breakfast most days I have a morning star vegetable patty. That brand has many to choose from like garden vegetable (so good and loaded with things like olives, bell peppers, Water chestnuts and carrot), chicken patties (vegetarian), and even sausage patties. all of them are full of Protein and taste great, seriously =)
for lunch I have something like chicken salad that I make with canned chicken (also full of protein) fat free italian dressing, a teensy bit of olive oil mayo, small chunks of swiss cheese and quartered cherry or grape tomatoes.
I need a fill so lately I've been having a snack between lunch and dinner although I probably shouldn't =( but I bring a string cheese and one bread and butter pickle spear. it's roughly 100 calories for that.
for dinner I try to stick with just meat and vegetables. Grilled chicken and carrots or broccoli or brussel sprouts. I stay away from ground beef since I looked at the package and saw that 4 oz is like 340 calories all by itself and I'm only supposed to have 300 calories a meal and 100 calories toward a drink (milk) or my snack. So 900 to 1000 calories a day.
I don't know if any of that will help you at all but it has helped me. I have had a plateau of about 4 months when I could not afford a fill, but I didn't gain and I'm back on track and losing slowly with the insanity work outs and eating better than I did.

I am struggling myself in finding a exercise routine and meal planning to follow. I do have Pyrex 1 cup bowls that I picked up from Target. It helps with Portion Control. I want to be one of those people that gets up at 5 am just to exercise and daily on top of it. I use Sparkpeople (its free) to track food and exercise. I plan for 60 grams of Protein a day. I was banded May 2011. I find when I fill my 1 cup bowls for the week on Sunday it helps. I started measuring my Snacks in snack size Ziplock baggies as soon as I buy bigger bags of rice cakes and stuff. I have Laughing Cow cheese wedges for a snack which are only 35 cal. pretzels sticks or apples and Peanut Butter. Hope this helps
Crystal

Do you ever look at your plate of tiny bandster food portions and think, "That's not enough to keep a bird alive"?
That thought, or one like it, crossed my mind every time I sat down to eat in my early days as a bandster. Although I was eating tiny portions, losing weight, and feeling stronger and more energetic as each day passed, my brain kept whispering, "Something's wrong with this picture." Eventually I grew accustomed to those small portions, and now I rarely think about it unless someone else makes a comment about it - like my coworker who looks at my doll-sized lunch and exclaims, "I don't know why you even bother eating!"
ONE MEAL AT A TIME
Getting used to bandster food portions took me 6 or more months. At first I would look at my small plate with tiny portions of food on it and instantly feel deprived and sorry for myself. Never mind that the small portions were plenty of food for my banded stomach...they just weren't enough for my brain to accept. By paying very close attention to how I felt as I ate, I realized that small portions were indeed enough to quell my physical hunger and that I wasn't going to drop dead from malnutrition. Of course, the small meals didn't keep the hunger at bay for very long until I'd gotten enough fill in my band for a small portion of food to send long-lasting satiety messages to my brain. Since I was terrified that eating too much at one meal would hurt my band somehow, I stuck it out. My nutritionist's eating plan included 3 small meals and 3 planned, healthy Snacks each day. I have to admit, I looked forward to each and every one of those meals or snacks.
It wasn't until after I'd reached my goal weight that I began to forget to eat and stopped looking forward to each upcoming meal as if it were a happily-anticipated Thanksgiving dinner. Yes, it would have been nicer and easier if the long-lasting satiety had kicked in earlier on my WLS journey, but really can’t complain because later is better than never at all. Maintaining my weight loss means eating like a bandster for the rest of my life. So I had to work my way through one challenging year in order to enjoy 35 or more years as a healthy, normal-weight person with a small appetite. Seems like a pretty good deal to me. But then you know me, Little Miss Sunshine!
A MATTER OF PERSPECTIVE
One day when I was about 9 months post-op, I found myself in a restaurant looking at the food on someone else's plate and thinking, "Oh my God, look at genormous plate of food!" That genormous plate of food contained the same huge serving sizes I ate as a pre-op, but because of the mental adjustment I'd made, it no longer triggered the "Oh, goodie!" button in my brain. In part, it's a matter of perspective. Perspective refers to the appearance of objects (or subjects) in relationship to each other. When my personal perspective was to view a Thanksgiving dinner plate as my "normal" food portion, the genormous plate of food looked right to me. After 300 or so bandster meals and snacks, my perspective had changed so that a tiny portion was my "normal", and the genormous plate of food looked ridiculous, even overwhelming.
MASTERING THE FEAR OF FOOD DEPRIVATION
The issue of food deprivation is a topic that deserves more attention. If we don't learn how to deal with it in a healthy way, achieving weight loss and a healthy lifestyle is going to be a lot harder.
Fearing food deprivation is a basic instinct that drives every living organism. Every creature - human, animal, insect, you name it - survives by seeking food and shelter. So when I tell you that you need to master your fear of deprivation, I'm not telling you to deny this basic instinct by not eating when you're hungry. In fact, I'm telling you to respect it, that in fact you should eat when you're physically hungry. If trying to ignore physical hunger has been your strategy during years of dieting, it's time to try another strategy. You will never learn to recognize early satiety, or to experience and honor prolonged satiety, if you ignore your hunger. There's nothing intrinsically wrong with hunger. It's simply your body's request for more fuel. Food is fuel that you need, fuel that you deserve, fuel that you must have to stay alive and be healthy.
While you're re-training your conscious mind to respond appropriately to physical hunger cues, you may go on experiencing uncomfortable emotions about eating less. There's no shame in that. Talk about it with your support group, friends, and/or counselor, or write about it in your journal. Generally speaking, keeping your emotions bottled up gives them more power to hurt or control you. On the other hand, talking about them to the exclusion of everything else isn't helpful either and borders on the obsessive. When I need to talk or journal about something upsetting or painful, I give myself a time limit. The time might be a 50-minute counseling session, or 10 minutes of journaling. When the time's up, I go on to something else.
THE HALF-PORTION APPROACH
I talk a lot about this approach because it's a good way to prevent overeating, and I’ll repeat it now because the half-portion approach is also what made it possible for me to survive my fear of deprivation while my mind and body adjusted to eating small food portions.
Here's how it works.
1. Do not put serving dishes on the dining table.
2. In the kitchen (or wherever), measure out your planned bandster portion. Put half of it on a small plate (like a salad plate or the saucer for a tea cup), take it to the dining table, sit down, and slowly eat it, paying as much attention as possible to how you feel as you eat. (If you're eating in a restaurant, ask the server to bring a to-go box with your meal, put most of the food in the box, close it, and start eating what's left on your dinner plate.)
3. If your body gives you any "soft stop" signals, stop eating. You can throw the uneaten food on your plate away, or if that makes you anxious, put it and the other half of your portion (the one you left in the kitchen) in a storage container in the refrigerator, knowing that you can eat it later if and when you get physically hungry again.
4. If you finish the half-portion without getting any soft stop signals, go back into the kitchen, put the rest of your portion on your plate, take back to the dining table, and eat it, following the same instructions as in #3 (above).
5. If you get physically hungry again before your next planned meal or snack, go ahead and eat the reserved food portion. Eating it is not cheating, because you had planned to eat it, you measured it, and it's yours if you want it.
This approach helped me get used to eating small portions while staying alert to satiety signals without the overhanging fear and anxiety of food deprivation. Give it a try, and let me know how it works for you!

The world of bariatric surgery is full of myths. Every time myths are repeated, they gain strength and credibility (deserved or not), so it’s important to look at them closely before accepting them as true.


TIME TO THROW OUT SOME OLD MYTHS
It’s time to throw out some old myths about the adjustable gastric band, but before we start flinging those myths around, let’s all agree on what a myth is.
The traditional definition is that a myth is an ancient story of unverifiable, supposedly historical events. A myth expresses the world view of a people or explains a practice, belief, or natural phenomenon. For example, the Greek god Zeus had powers over lightning and storms, and could make a storm to show his anger.
If you think myths are dry stuff found only in schoolbooks, think again. They surround just about every aspect of our lives, and travel much faster now, in the age of technology, than they did in the dusty old days of ancient Greece and Rome. They’re a way for us to make sense of a chaotic world, both past, present and future. They affect thoughts, beliefs, emotions and assumptions in our everyday lives, coming alive in our minds as we, and the people around us, seem to act them out.
Some myths are helpful because they give us a shared sense of security and express our fundamental values and beliefs, but some myths are just plain wrong and can be harmful to us and to others. A good example is the myth that having weight loss surgery is taking the easy way out. Every time I hear that one repeated, I want to laugh and scream at the same time. If you’re a post-op, you know why. Weight loss is hard no matter how you do it (surgery, diet pills, prayer, magic cleanses, and so on). On the other hand, WLS is supposed to be easy, compared to the dozens or hundreds of weight loss attempts in our past. Why on earth would I put myself through a major surgery if it wasn’t going to help me lose weight and keep it off?
Now that we’ve shared a little laugh (or scream) over a WLS myth we can all agree upon, let’s test out some band myths whose validity may not be as clear. This kind of examination can be uncomfortable, but believing in a falsehood is almost guaranteed to make your WLS journey bumpier than it needs to be.
Let’s start with the myths that are easiest to digest and end with the ones that can be tougher for a bandster to swallow.
#1 – THE BAND IS THE LEAST INVASIVE WLS PROCEDURE
I believed this one at first, mainly because I knew little about the other WLS procedures back in 2007. It’s still a widely-circulated myth, one that even my surgeon’s well-intentioned dietitian endorses. So, what’s the truth according to Jean? Face it: any surgery done on an anesthetized patient, during which a surgeon cuts into the belly in several places, does some dissection (more cutting) and suturing (stitching) of the internal anatomy, and implants a medical device (the dreaded “foreign object”), is invasive. It is true that band placement generally involves less internal dissection and suturing than other weight loss surgeries, but neither is it on the same level medically as having your teeth cleaned. So while the invasiveness of a surgery is worth considering, you do yourself a disservice if you let that override other considerations. A bariatric surgery might last 45-60 minutes, with recovery lasting a week or so, but its effect on your health and lifestyle last a lifetime. Or I sure hope it does.
Some people associate invasiveness with irreversibility. Although the band is meant to stay put once clamped to your stomach, it can indeed be removed if medically necessary. Gastric bypass (RNY) surgery can also be reversed, while the sleeve (VSG) cannot and only the “switch” (malabsorptive feature) of the duodenal switch (DS) can be reversed. Removal or reversal is not as easy as operating on a “virgin belly” (as my surgeon so colorfully puts it), so it’s important to weigh the benefits against the risks of reversal or revision surgery.
#2 – BAND WEIGHT LOSS TAKES TOO MUCH WORK
Aside from the desire for instant and effortless weight loss (which is a fairy tale if I ever heard one) that so many obese people share (me among them), this is a myth that often turns people away from the band and towards other WLS procedures. While this myth may be true in the first 12-18 months after surgery, eventually everyone ends up in the same boat, rowing hard against the powerful tide of obesity.
Weight loss and weight maintenance is hard no matter how you achieve it. A dietitian who spoke at a band support group meeting I attended a few years ago said that while band patients must change their lifestyle immediately in order to succeed, every WLS patient must do that sooner or later. It’s a pay-me-now or pay-me-later deal. You can slice it, dice it, sauté it and serve it on your grandmother’s best china. However you serve it, weight loss and maintenance is a lifetime project because obesity is a chronic disease with no cure. No matter how successful we are as new post-ops, all of us must face the possibility of regain. That’s why I cringe when someone proudly crows, “XXX pounds gone forever!”
#3 – THE BAND’S SLOWER WEIGHT LOSS PREVENTS SAGGING SKIN
This is a fairy tale. According to several plastic surgeons I’ve heard speak on the subject. The effect of weight loss on skin depends mostly on your genetics and your age (because skin loses elasticity as we age). Other factors can be how obese you were, how long you were obese, how you carried your weight, and how much (and how) you exercise as you lose weight.
I’ve heard women say that they’d rather be obese than have sagging or excess skin. To my mind, that’s a sad statement, because I’d rather have sagging or excess skin (as long as it didn’t interfere with my ambulation or activities) than excess weight. Don’t get me wrong: I loathe the excess flab on my midsection (whose nickname is “The Danish Pastry”) and I’m not thrilled about my batwings, throat wattles, or anything else that’s happened to my skin in the past few years (during which I’ve undergone the double-whammy of weight loss and the fast approach of my 60’s). On the other hand, I think I look pretty good for a woman my age, especially when I conceal my figure flaws in flattering clothing which, I might add, no longer needs to be purchased at Lane Giant.
#4 – TO LOSE WEIGHT, YOU HAVE TO FIND YOUR SWEET SPOT
I used to wonder how the Sweet Spot Myth could survive in the face of so much clinical evidence against it, but last year I heard the “you gotta find your sweet spot” claim uttered by a bariatric dietitian, so apparently this is a myth being validated by medical professionals who ought to know better.
Instead of the sweet spot, Allergan (the first to introduce the band in the USA) uses a zone chart to illustrate band restriction, with not enough restriction in the yellow zone, good restriction in the green zone, and too much restriction in the red zone. In other words, restriction happens in a range of experience, not at a single static point. That experience changes over time as we lose weight, deal with ordinary processes such as hormonal fluctuations, hydration changes, stress, medications, time of day, and so on. It’s also affected by our food choices (solid vs soft/liquid food).
In my banded days, I traveled through and around a sweet spot many times. It might last for 30 minutes, 3 days, 3 weeks, but it never stayed exactly the same, and yet I still lost weight! I don’t actually want to stay exactly the same for the rest of my life (throat wattles notwithstanding). As any Parkinson’s disease patient will tell you (if they’re able to speak), a body that gets stuck in time is a very big problem (and with my luck, I’d get stuck in the worst sinus infection or case of the flu of my life). Some people who are very sensitive to their band and its fills find sudden or unexpected changes in restriction to be very, very frustrating, and I wouldn’t wish that on anyone, either.
To read more about the sweet spot, click here to go to an article, The Elusive Sweet Spot.
http://www.lapbandtalk.com/page/index.html/_/support/post-op-support/the-elusive-sweet-spot-r59
#5 – NO SIDE EFFECTS MEAN MY BAND ISN’T WORKING
Equating side effects with a properly working band is very common, and potentially very harmful. The two most significant signs of the band’s proper functioning are (1) early satiety and (2) prolonged satiety. Those signs are rarely expressed in large, bold, uppercase letters, such as

STOP EATING NOW!


Those signs won’t be accompanied by clanging bells or flashing lights, either. In fact, the less noise and distraction (such as “Why don’t I have stuck episodes?”), the more likely you are to be able to recognize early and prolonged satiety.
Before I tell you why the no side effects = broken band worry is a sign of mythical thinking, let’s make sure we agree on the definition of a side effect, and how that relates to complications. A side effect is an unintentional or unwanted effect of a medical treatment, and it’s usually exceeded (or at least balanced) by the benefits (the intentional, wanted effects) of that treatment. For example, antibiotics can cause diarrhea. That’s an unpleasant side effect, but an untreated infection can have far worse consequences for the patient. Side effects can often be managed by tweaking or changing the treatment, and they are rarely worse than the original condition.
A complication, on the other hand, is a more acute, serious consequence of a medical treatment, and usually needs a more aggressive approach, including surgery to fix the problem. Now let’s go back to the antibiotic example. An allergic, anaphylactic reaction to the antibiotic can be fatal without prompt medical treatment. That’s a complication, and it’s far worse than the original condition.
So in the context of all that, it seems strange to me when bandsters long for side effects like regurgitation (PB’s), stuck episodes, and sliming. Instead of looking for more subtle clues from their bodies (like early and prolonged satiety), they go looking for problems, and worse than that, they tend to “test” their band with foolish eating and/or overeating, hoping to provoke a side effect that will signal to them that they really do have a band in there. One of the many problems with that approach is that it can also provoke a complication. And that brings us to the final myth in today’s article:
#6 – THE MORE FILL, THE BETTER
I’ve heard bariatric surgeons comment that some band patients seem
to be addicted to fills. I can identify with that because I had a good relationship with my band surgeon who not only administered my fills but gave me a lot of encouragement as well as answers to my many questions. I left each fill appointment with a renewed sense of commitment and hope. How can you not get hooked on something good like that?
The problem with equating fills with weight loss success is that more fill is not always better. In fact, too much fill (which varies from one patient to the next, and also varies in a single patient as time goes on and the patient’s body keeps changing) can be downright dangerous. An overfilled band, and the side effects it causes (see #5 above), can lead to a complication like a band slip, esophageal dilation, or stomach dilation. While complications can come out of nowhere, most bariatric surgeons agree that too much saline in the band puts too much pressure on the stomach. Eventually something’s got to give. That’s often hastened by the patient’s efforts to eat around the problem, and it is absolutely not a guarantee of weight loss. I gained weight several times because of what’s called Soft Calorie Syndrome. My band was too tight and I was dealing with it by consuming mostly soft and liquid calories that offered little or no satiety.
The human body is an incredible organism, capable of amazing feats of growth and healing that we take mostly for granted, but it’s not endlessly forgiving. Too much fill in your band, too many eating problems, too much inflammation and irritation in the upper GI tract, can compromise your body’s ability to recover from a complication like a band slip. Sometimes a complication can be treated conservatively, with an unfill and rest period, but sometimes it requires a surgical fix, including removal of the band. And after all you’ve gone through to get that band wrapped around your stomach, shouldn’t you be doing your utmost to treat it (and your body) with respect?
Finally, the fill myth can cause us to overlook a very important guest at your WLS party….you. If you are going to succeed with your band, lose weight and keep it off and keep that band safe and sound inside you, sooner or later you will have to take personal responsibility for your success. Expecting your band alone to carry you to your goal weight is like expecting your car to safely deliver your child to school without anybody in the driver’s seat. And I sure hope that you are a very important person in your life!

How do you like your band? Tight? Tighter? Tightest?


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.