I had heard--from patients--about patients being treated this way and was somewhat skeptical. Then I was treated this way, so I asked another surgeon. It seems that this concept was proposed at an ASBS conference, until the doctor proposing it was shouted down by his (banded) colleagues. I sent this message to the doctor who tried this with me. Please note that, at no time, did I accuse him of engaging any inappropriate behavior, INCLUDING this practice. He wrote back and was livid. Feel free to jump to your own conclusions:

The "Psychological Lap-Band Adjustment," a Patient's Perspective

There are those doctors within the community of surgeons specializing

in the adjustable gastric band, who are promoting the adoption of the

"Psychological Fill" or "Psychological Adjustment." Although their

motives are pure, they could not be more misguided. Inadvertently,

they are doing a disservice to their patients, to the manufacturer of

the band and to themselves.

The theory appears to include the following false assumptions:

1) there is not a physical cause component of obesity;

2) what patients most need is to retrain their brains to believe that

they are full when they are not;

3) obese people are below average in intelligence;

4) obese people respond positively to negative intimidation tactics;

5) the Lap-Band patient is unable to determine when restriction wanes;

6) obese people do not speak to each other or compare experiences with

each other;

7) it is ethical for surgeons to mislead or withhold information from

patients;

8) training as a surgeon prepares one to practice psychology; and,

9) surgeons are competent actors.

The technique being suggested includes the surgeon's telling the

patient that s/he is "the only patient" who is not cooperating, or "the

worst patient," or "the least compliant patient" encountered by the

surgeon. The surgeon then removes saline from the band, and

subsequently replaces essentially the same amount of saline, but

threateningly advises the patient that s/he will barely be able to

tolerate food. In some cases the surgeon insists on a follow-up

appointment to remove saline a month later, insisting that the fill is

so tight that the patient will have to return to have the band loosened

so that he or she does not cause damage to the esophagus.

There is a placebo precedent in medicine, but if it is appropriate at

all, it is appropriate in rare occasions. In the proposed situation,

however, the patient is required to be dim-witted enough to believe

that the surgeon would intentionally over-fill the band and announce

that s/he is overfilling it. The patient is supposed to be

psychologically needy enough to do anything to gain the surgeon's

approval. The patient is expected to believe what the surgeon says is

sufficient restriction rather than his/her her own sense of satiety,

when one of the prime benefits of the adjustable band is the

restoration of the sensation of satiety. The patient is expected to

refrain from communicating with other patients, 'lest numerous patients

discover that they all have been declared "the least compliant

patient." The patient is expected to present for the band adjustments

devoid of any training or experience in the field of psychology. The

patient is further expected to present for band adjustments devoid of

any training or experience in critiquing dramatic performances.

Some surgeons might easily be seduced into thinking that this kind of

false paternalism is helpful to patients. So many patients arrive in deep

states of need due to their histories or habits of not attending to

their own needs sufficiently. However, it is incumbent upon caregivers

to have EXCELLENT boundaries and the "Psychological Adjustment" is a

clear violation of said limits.

One of the biggest advantages of AGBs is the degree to which they

empower patients. Patients have control over the rate of weight loss.

The band supports change on every level and each patient changes at the

rate and in the order that best fits each one's individual needs. The

feedback loop is positive and the patient gains confidence, learning to

trust oneself over time. A lifetime of psychological undermining regarding

food and eating patterns can be healed, and more. By deceiving

patients, the "Psychological Adjustment" DIS-empowers patients, making

them dependent upon the surgeon's wisdom. The patient is left NOT

trusting him/herself and is, in fact, incented to NOT trust him/herself.

Faced with the"Psychological Adjustment," the more easily intimidated

patient merely drops out and BELIEVES that s/he has become a Lap-Band

failure, damaging both the patient and the manufacturer of the product.

The other patients--either alone or in discussion with each

other--conclude that the surgeon who practices the "Psychological

Adjustment" has limited understanding of--and even less respect

for--the obese patient. Inevitably, the surgeon will have damaged his

own reputation most of all.

Three damaged parties in a situation which should have included the

concept, "First, do no harm." A shame.

So, in case anyone received this kind of treatment, there is precedent. And feel free to complain.

Sue

It makes me so livid that doctors actually think they can treat patients like this! Ok, I'm fat, but I also happen to be pretty smart, and I've taken a few psychology classes myself. I cannot understand why doctors, not to mention the rest of the general public, make such ridiculous generalizations about overweight people.

I had no idea this was going on! This is an outrage. I can't believe that some doctors do this to their patients. What a cruel abuse of power. I hope you will send a copy of this to Inamed so they will be aware that some doctors are misusing their device.

bumping for review

Because it's again time...

I'd be ropable if I found out they'd done that to me.

yet I do believe (for me anyway) the psychological effect of having a band is at least as important as the physical effects.

this time I expect to be successful therefore I am. I always expected to fail before therefore I did.

MANY years ago, using placebos to treat patients was an acceptable practice. I can remember many MD orders that read, "Alternate Morphine Sulfate 4 mg IV with normal saline 4 mg IV every 4 hours." Since about 1990, that practice is now considered unethical and no longer practiced in the hospital setting. It's sad that some surgeons employ this technique and I'm glad you called the MD on the carpet for it, Sue.

I think if any doctor told me that I was their worst patient, or their least compliant patient, I'd probably walk out the door of the room, to the receptionists desks and request my medical records right there. Of course there ARE people out there, who are the least compliant, and the may need to be told that, but certainly not in the scolding unprofessional manor that I've heard it be said to patients. It's been a while since I read a post where someone's doctor told them they were doing horribly, but I believe it is still out there.

Placebo does have it's place, but certainly an adjustable medical implant isn't one of them.

Most people would not want to be treated like that - though there are always exceptions. I do believe there are people out there for whom, even though they have the band, this type of approach is the only thing that will get through to them. A surgeon is perhaps not the best practitioner of such a strongly behavioral intervention.

OH my goodness. I cannot believe that someone would act so callously. I know more about the lapband than many of my doctors (not my surgeon) and have explained it in its entirity to several other physicians.

I'm glad my doc shows me the syringe he uses and shows me how much he puts in. Wow, especially at $205 a pop!!

Kristin