The Lap-band is NOT about Restriction (by Dr. Simpson)

When talking about the band, some patients talk about restriction. Let's first be clear about one thing: the purpose of the band is not restriction; the purpose of the band is to lose weight by suppressing the appetite.

When band professionals talk about restriction we are talking about something totally different than "restricting what a person eats." In fact, many band surgeons avoid talking about restriction so as to not confuse patients. The band works by dimming the appetite, and this provides a conscious control and decision made by the patient, it does not work by "making" a person do something, or keep them from eating too much.

The Lap-band works by suppressing your appetite

As a result, you are less interested in food between meals, making it easier to resist temptation. The analogy is when you are near a vending machine when you are hungry-- what do you do? Probably find yourself with some junk food that is not a part of your plan. But, when you pass a vending machine when you are full, it may not even catch your eye. Having the appetite dimmed makes you less tempted by the many food choices modern living throws at you - -this is what the band does, by suppressing appetite you become less interested in food.

What you should not feel, with the band, is the sensation of being "stuffed."

When you eat Thanksgiving dinner, you can feel stuffed. Contrast that with the sensation two hours after you eat your big meal, at that point your appetite is suppressed. It is the subtle dimming of the appetite that the band should provide. Being stuffed after a large meal is a complicated sensation of the abdominal wall stretching and a lot of gas in the bowel, in addition to feeling a diminution of appetite. You will not, and should not, feel the abdominal wall stretch with the band. You should not feel the "near nausea" and you should not feel bloated.

Key point:

You should NEVER eat until you feel full. It is best to stop eating before you "feel full." If you do eat until you feel full you will most likely be overstuffed. This leads to the universal key to success -- patients who eat a small volume of food (which, if you measure, is consistent) will be successful with the band. If you want to succeed, you need to know how much you are eating, and then stop eating -- it is in your control, but the band will help you -- not by stopping you, but by allowing you to feel satisfied after the small volume.

Early on, most Lap-band patients do have a sense of "restriction"

...particularly after the first fill. When we place the band on a patient the stomach above the band typically will hold one to two ounces (by volume, not by weight). The stomach has a lot of muscle fibers, and the wall of the stomach is fairly thick. When food is consumed, it arrives in the pouch, and meets some resistance, first against the newly adjusted band, and then against the stomach which does not stretch easily. People love this feeling! It is a sense of control over food -- a leash. But it is not permanent. It makes it difficult to eat more, because the top part of the stomach and the band will resist it. If you over eat you will feel uncomfortable.

This is the honeymoon phase, you feel full with less, no appetite, and if you try to eat more it doesn't work. They eat a small amount of food, they feel satisfied, and they are losing weight.

For patients who rely on this sensation, they will find it will take ever increasing volumes of food to obtain this sensation. The initial response is to have their band adjusted so that they can "feel full again." Against a tighter band, the upper stomach stretches a bit (and if they eat fast it stretches more)and they again have the sensation of "feeling full." This becomes a cycle, a tighter band, the stomach stretches more-- and then instead of going back to its original size, the stomach stretches more and more to where it takes more to fill it.

The person who continues to eat until they have this sensation, will find that it takes more and more food to obtain this feeling. Two things happen -- first the stomach stretches to where it accommodates more food, and to stretch it means you have to eat more. The second is that to "feel full" it takes the brain time to register this sensation -- this is not the sensation registered by the hypothalamus, but registered in the conscious cortex. So your stomach can be full, but your brain won't register it for a while, and if you keep eating you can overeat. As a result, the pouch dilates. Similar to a balloon, when you first start to blow up the balloon it takes a bit of force. As you continue to fill the balloon, the wall of the balloon stretches (thins out), it is easier to blow it up -- the same is true with the upper pouch. Early on, before the pouch is stretched, it takes a little bit of food to cause it to stretch, but with chronic over-eating the pouch will accommodate more and more food. The stomach wall is thinner, it is easier to stretch, and to get that sensation it takes more food than at first. Often patients will complain that they "don't feel restriction," and wish to have the band made tighter.

There are two potential results to this: one is the patient will passively stretch the stomach and esophagus and not be eating a small amount of food. These patients simply do not lose the weight that the surgeon expects. The other is that the band will be forced down the stomach, the band will slip, which generally requires operative intervention to reposition it.

For those patients who are rigorous about the volume of food they eat, and do not let the stomach to tell them when to stop eating - they do very well. This is one of the keys of successful patients, only eat a certain portion of food - period. If the band is properly adjusted, the appetite will be dimmed for several hours. Once your brain realizes that a small amount of food keeps you satisfied, then your eyes will adjust to the amount you eat.

Some describe a "soft stop." Where before a sense of fullness occurs, there is a signal from your body -- this can be a runny nose, a sigh, or a subtle ache in the left shoulder. Patients who find this "soft stop," do very well with the band.

The other advantage of eating small portions is it becomes a lifestyle change

--you will have the ability to gauge the amount of food you can comfortably eat, knowing it will keep you satisfied for several hours.

You can always -- always, always, always, -- eat more food, because, contrary to what we believed for a long time-- food passes by the band within a minute and then into your stomach. But the key to successful patients is not how much they can eat, but how little they can eat to suppress hunger.

The band goes around your stomach, not around your brain, or your lips

This simple concept, of eating a specific volume of food -- eating it slowly, and then walking away, is the key to successful eating habits of patients. This means that the band works with effort from you -- not by it doing everything for you. You have to make the decision to eat a small volume of food, and let the band work with you.

The sensation that we would want the band to produce is the "soft stop." The soft stop is when you eat a small portion of food and walk away. Sometimes this is difficult, like most things, practice makes perfect. To set yourself up for success -- we recommend you use smaller plates, along with smaller utensils. If you go out to eat, ask for the to-go bag immediately, and remove the excess food from your plate. You can physically always eat more food, but the advantage about practicing small portions and walking away, is ultimately your eyes will get use to what the stomach is telling it, and it will be much easier to eat smaller portions as time goes on.

It isn't uncommon for patients to want an adjustment because they say they can eat more

The first question we ask is, "Why are you eating more?" The typical answer is, "Because I can." The typical response, "Just because you can does not mean you should." Since the band's job is not to restrict the amount of food you eat, do not leave that to chance -- that is your job. Part of personal accountability is to account for, to measure, to know how much you are eating at a time. The band is empowering; if you eat an appropriate amount and make appropriate food choices, you will be satisfied for several hours. This results in either weight loss, or weight maintenance (if you are at your goal). The purpose of the band is to assist you to lose weight -- and this occurs only with active participation by you: you chose what to eat, you choose how much to eat, and you practice walking away after eating that amount. The band is a tool to allow you to eat less and have your appetite dimmed resulting in weight loss, or maintenance. It is a tool to help you adopt a healthy lifestyle -- you still have the choices to make, but the band allows you to be satisfied with those choices.

"If I could eat less and walk away, what would I need this band for?" -- a common question we are asked. Without the band, if you eat a small amount of food and walk away your appetite would rise within a couple of hours -- you would find yourself hungry and wanting more food, possibly leading to unwanted snacking. You would also find, if you willed yourself to withstand the hunger, that your weight loss gradually decreases. The band fools your brain into thinking you ate more.

Think of it another way -- the hypothalamus does not have eyes -- it doesn't know how much you ate, it doesn't know if there is a lot of food around and you are not eating it, or if there is a band on your

original article by Dr. Simpson: http://drsimpson.net...estriction.html

I think both are right angles are correct, it's just a matter of how you are defining the term. I just wanted to insert the thought becuase if someone refers to the bands restriction (opposed to food restriction) they are not incorrect. That's all

I use the word 'restriction' in the same way that hazel does. That someone doesn't understand what I mean when I'm using it in the correct context is, to me, more their failure to understand than my failure to be contextual. Though I do get where you're coming from, sometimes disputing the contextual use of the word 'restriction' causes more confusion than not, imo.

I absolutely agree with almost everything you've posted MIs but I also disagree that the band doesn't tell me when to stop eating. The signals are there, and VERY clear signals too. They can be ignored, sure, if you really are determined, but they're there. I certainly don't push past those signals - I know that stopping is a good idea, will avoid discomfort and in 10 mins I won't be hungry anymore. So I think it's important for anyone not yet banded to understand that, because sometimes I read these posts, and I walk away thinking, if I were new, that the band did nothing for me, so why bother getting one? It's not like that, it's a very very handy tool to assist you in managing your hunger, and it DOES tell you when to stop, often quite clearly too.

I use the word 'restriction' in the same way that hazel does. That someone doesn't understand what I mean when I'm using it in the correct context is, to me, more their failure to understand than my failure to be contextual. Though I do get where you're coming from, sometimes disputing the contextual use of the word 'restriction' causes more confusion than not, imo.

I absolutely agree with almost everything you've posted MIs but I also disagree that the band doesn't tell me when to stop eating. The signals are there, and VERY clear signals too. They can be ignored, sure, if you really are determined, but they're there. I certainly don't push past those signals - I know that stopping is a good idea, will avoid discomfort and in 10 mins I won't be hungry anymore. So I think it's important for anyone not yet banded to understand that, because sometimes I read these posts, and I walk away thinking, if I were new, that the band did nothing for me, so why bother getting one? It's not like that, it's a very very handy tool to assist you in managing your hunger, and it DOES tell you when to stop, often quite clearly too.

Actually, no one is saying it won't give you a signal when to stop eating. It definitely does. That's why the article talks about "soft stops".

The problem I see is people expecting the band to physically stop them from eating so it's impossible to over eat. That isn't the band's job. It'll give you very clear signals that you've had enough but if someone wants to over eat the band won't stop them- especially considering the most overeaten foods are slider types to begin with.

^^ exactly, I agree. And I guess I wanted to point that out in particular because I see many MANY posts where an unbanded person sees 'it won't stop you eating' as translated to 'it won't help'. The band definitely helps. In fact without the band, I would not be at, or be maintaining, the weight I am now.

As a tool, it can be incredibly effective, if the band is filled and maintained in the green zone, the bandster is mindful of what they eat (there are plenty of posts about eating the 'bandster way' so I won't bother going into it) and do some exercise. It CAN be miraculous, it was for me. But understanding how it work is very important, so as to give the patient the best chance of success. And that's what I see as missing, the understanding. I don't think the language is the problem.

I've been banded for three months. I am still a little confused about some things. Well, a lot of things! My main confusion is around whether or not the band can assist you in stopping eating. I know that nothing will physically stop the fork going to my mouth. I control that. But a lot of people quote the line "I control the quality, the band controls the quantity" or something like that. Does the band control the quantity?? This article suggests that I need to control the quantity, but the band will dim my appetite.

Ok, the best way I can explain it is this, at the RIGHT fill level, the band works like this:

• You can still eat most foods, and should be eating solid food, mainly proteins, as these work best with the band.
  
• If you're eating solid food, and your band is at the right fill level, you will feel a 'soft stop' once you're had not a lot of food, and the soft stop can take the form of discomfort, or a runny nose, or hiccups, though there are others, you will start to recognise your own. You should stop eating at this point.
  
• This small amount of food should keep you from being hungry again for 3 - 4 hours. And by hunger I mean REAL hunger, not 'I feel like eating' hunger.
  

If you follow the rationale above, and eat solid, mainly protein, foods 3 meals a day, you will be eating about 1/2 to 1 cup of lean protein plus veg and maybe carbs (if you do that) and sustaining yourself ALL day pretty much. So you could be on 1.5 to 3 cups of food all day without feeling geniune hunger.

I've been banded for three months. I am still a little confused about some things. Well, a lot of things! My main confusion is around whether or not the band can assist you in stopping eating. I know that nothing will physically stop the fork going to my mouth. I control that. But a lot of people quote the line "I control the quality, the band controls the quantity" or something like that. Does the band control the quantity?? This article suggests that I need to control the quantity, but the band will dim my appetite.

Lellow worded it perfectly.

It controls the quantity by giving you signals "hey, it's time to stop eating". It's a learning experience but if you learn to listen to your band it becomes second nature. But, can you still eat if you want to eat beyond that "soft stop" signal? Yes, most of the time you can. Think of the band as tapping you on the shoulder saying "you're done" not plugging up the hole so you don't have a choice. You always still have a choice.

"I control the quality, the band controls the quantity"

this is on my signature...so i am guessing its referencing me

yes, i listen to the band for my (signals) and i pay attention

and yes i eat better foods aka quality

in short, it works for me.....

yes i could eat around the band and eat more than i need to

and eat junk food like like use to, but i choose not to..i merely help

the band...