Restriction is a myth, and it’s time to stop believing in it. The adjustable gastric band isn’t all about restriction after all. It’s all about satiety.

I tend to talk about satiety a lot. Why? Because recognizing satiety is absolutely crucial to our weight loss success and good health, no matter what bariatric surgery we have. Satiety is the sensation of having eaten enough food. Understanding satiety is so important to weight loss success that I’m dividing up what I have to say into three Satiety 101 articles. This is the first of the three.

Let’s start by asking an important question: do you think that your properly-adjusted band will restrict how much you can eat, so you take in fewer calories and lose weight? I realize that someone – perhaps more than one person (perhaps even your very own bariatric surgeon) may have told you that the adjustable gastric band works by creating a small stomach pouch that restricts how much you can eat. But I’m here to tell you, it’s a lot more complicated than that, and to go on thinking of the band as a “restrictive” method does bariatric patients a disservice.

The notion of restriction is a myth, a holdover from earlier times, before the band’s function and effects were fully understood. Now, after nearly 30 years of clinical use and studies, band manufacturers and bariatric surgeons are beginning to see that the old idea of the band’s “restrictive” mechanism is not only incorrect, but can cause a host of unpleasant and sometimes dangerous side effects and complications (such as band slips, esophageal dilation and achalasia, pouch dilation, and disappointing weight loss), and some of those complications can cause permanent damage.

If you swallow a few bites of barium-coated food (doesn’t that sound yummy?), fluoroscopy will show that food passes through the upper stomach pouch, right past the band, and into the lower stomach pouch within in minutes of each swallow you take, so that you can go on eating just like you did as a pre-op: fast and furious (when food doesn’t make that trip a quick one, it may mean that the band is too tight and needs fluid removed from it). That quick trip also means that you can eat far more food than you need, just like you did as a pre-op. Finally, the bariatric medical community is beginning to see that instead of being restrictive, the band works by reducing physical hunger (the need to eat) and appetite (the desire to eat), and by creating early and prolonged satiety, so that the patient, not the band, can reduce her/his food intake.

Now, let me re-state that from the point of view of someone who lived with a Lap-Band® for five wonderful years. It’s up to you, not your band, to make the band work for you. Your band is an inert, expensive piece of plastic that doesn’t limit how much you eat. It doesn’t know your name or that you hate broccoli. It’s not going to leap out of your mouth and throw your forkful of food on the floor when it’s time for you to stop eating. It’s not going to sound an alarm or start flashing red lights. It’s not going to shout, “Jean McMillan! Stop eating right this minute!” (Yeesh! In that last scenario, the band sounded an awful lot like my mom!)

Seriously, though. One of your jobs as a successful bandster is to learn when and how to stop eating, all by yourself. The “how” to stop is a big topic, not just for WLS patients but for every human trying to lose weight and avoid wasting precious resources like food, and far beyond the scope of this article. So for now, let’s concentrate on the “when” to stop eating part. We’ll do that in the second article in the Satiety 101 series: Satiated vs Stuffed, so stay tuned!

This is the first in the Satiety 101 series of articles.

Jean, another great article. The above is true for any restrictive weight loss surgery. If you don't change your eating habits and physical activity, you may lose for awhile but not get great results. Weight loss surgery is not a magic pill or wand. It is a tool to assist and still takes work to be successful.

Jean, thanks so much for this. I have your words from the other day and another great piece you put up -- that satiety is the sensation of having had enough food, for now. I like the "for now" because for over-eaters there is something in the brain that makes us feel like we have to pack it on for later. All set for the famine, thank you very much! For now, though? Yes, I've had enough

Also I just have to say that my husband and I watched the Dr. Paul O'Brien youtubes and his thick Australian accent is such fun with the word, "satiety." Suh-tie-i- tee. We are having a lot of fun with that.

Best wishes and thanks so much for all your thoughtful input -- much appreciated!

Jean, thanks so much for this. I have your words from the other day and another great piece you put up -- that satiety is the sensation of having had enough food, for now. I like the "for now" because for over-eaters there is something in the brain that makes us feel like we have to pack it on for later. All set for the famine, thank you very much! For now, though? Yes, I've had enough

Also I just have to say that my husband and I watched the Dr. Paul O'Brien youtubes and his thick Australian accent is such fun with the word, "satiety." Suh-tie-i- tee. We are having a lot of fun with that.

Best wishes and thanks so much for all your thoughtful input -- much appreciated!

Oh, I know so well the feeling that I must eat plenty now in anticipation of future famine. In one sense, it's ridiculous. I'm a middle-aged, middle-class, well-fed woman living in an over-fed nation. On the other hand, every living creature is hard-wired to fear famine. If we don't eat, eventually we die. It's a very tough nut to crack, but if we don't try, we die anyway, sooner or later.

Wow! If some people would read this maybe they would stop sending the message to brand new bandsters that all they have to do is get their band really tight and sit back and get skinny. This is such a great article. I'm glad I'm not alone in believing that the band is a "tool".

Wow! If some people would read this maybe they would stop sending the message to brand new bandsters that all they have to do is get their band really tight and sit back and get skinny. This is such a great article. I'm glad I'm not alone in believing that the band is a "tool".

I'm so glad that this article spoke to you. And I completely, utterly, 1000% believe that tighter isn't always better. So much so that I wrote an article about it, which you can find here: http://www.bariatricpal.com/page/articles.html/_/support/post-op-support/tighter-isnt-always-better-r95

I agree tighter is not better. I believe my band being overfilled is a major reason it prolapsed. When I first had my surgery, my doctor did not do fills under fluoroscope. For me at least there was a fine line between the green zone or sweet spot and being too tight.

Please don't think you're doing yourself a favor and you'll lose more weight by having your band too tight. If it's too tight, you will more than likely wind up gaining weight. If it's too tight you can experience difficulty eating and keeping down food which could result in you eating slider foods because they stay down but are much higher in calories.