13 Things To Know About Living With the Lap-Band

[George Fielding MD 23]

I'm a Lap-Band WLS post-op. Sounds a bit like AA. Obesity is a disease, and fighting it is a life-long fight, that will never go away for me. Not only do I have a Lap-Band, but I’ve done more Lap-Band WLS procedures than anyone in the world. I started doing them in Brisbane, Australia in 1996, and still do them, every week, at NYU Langone Medical Center in New York, where I’ve worked the last 10 years. I perform all of the other bariatric operations and a lot of revision surgery, but I still love doing the Lap-Band, because it’s safe, and it works.

I weigh less now than I did in high school with the help of the Lap-Band.

I’ve had my own Lap-Band for 16 years. I’ve lost 120 lbs and kept it off. I was on 12 medications for obesity-related diseases and am now on three-one BP med, aspirin, and a Statin, which is sensible for anyone my age, 59. I weigh less than I did when I was 16 and playing high school rugby.

So, what have I learned from all this? Here are a few insights and tips that I’ve accrued over the years.

13 Things To Know About Living With the Lap-Band

1. Lap-Band and Other WLS Procedures. The Lap-Band can work as well as any bariatric operation, if it’s done right, and managed properly. It is by no means a lesser operation. It does, however, need you and your surgeon to work, and keep working.

2. Follow-up With Your Surgeon. It’s a two-way street. You have had your Lap-Band placed, which is usually a gentle, safe surgery that takes about 30 minutes, as a same day procedure. After surgery, you have to come regularly to have it adjusted, and your surgeon has to listen to you. I encourage my patients to come in for an appointment once a month for about 18 months, and in that time, they will normally get seven to eight adjustments. After that, it’s usually four times a year for a couple of years, then annually, or whenever the patient needs an adjustment. We have an open door policy for adjustments. Your doctor has to listen to you.

3. Lap-Band and Hunger. The aim of the adjustment is to control hunger. If you tell me you’re more hungry, if you’re eating after dinner at night while you watch TV, if you wake up starving in the morning, then your Lap-Band is loose. You don’t need to see a dietician, you don’t need to go to the gym, and you don’t need to change your diet. You need your band tightened a little.

4. What the Lap-Band Does. Having a Lap-Band is not about restricting yourself or not eating. It’s about eating a lot less, feeling satisfied, and not being hungry after you eat. The aim of a Lap-Band adjustment is to reduce hunger, to reduce the urge to eat, and secondarily, to allow you to get full and satisfied quicker. When your Band is doing this, it’s quite tight.

5. First Law of the Lap-Band. Which brings us to the first law of living with a Lap-Band. Like Newton’s first law, it’s absolute, and it’s true...you can’t live with a tight, well-adjusted band as if you don’t have one. It will beat you every time. Every. Single. Time.

6. How to Eat With a Lap-Band. With a Lap-Band, you have to eat slower than you ever thought. It takes about 20 seconds for the esophagus to push a piece of food into the stomach. You have to eat at that rate, or food will get stuck, it will hurt, and you will have an uncontrollable reflex to vomit, to get that stuck piece of food out. I am lucky enough to be married to a great woman, Chris Ren, the Chief of Bariatric Surgery at NYU Langone Medical Center. She’s a size 6 on a bad day. She doesn't eat much. Lucky her. With my Lap-Band, I eat about the same, or a little less than Chris. If I eat quicker than her, food gets stuck. For certain. Every time. So, mostly I don’t. If I’m excited, say watching the Giants beat the Cowboys, and I forget and gulp a couple of bites of my dinner, she rolls her eyes at me. I shrug, say It’s Eli, baby, and go to the bathroom. It’s how it is, and how it always will be.

7. Eat Slower. I just don’t understand the whole I can’t eat this or that, especially about vegetables and salad. It is always, always, about eating slowly. If you work out the slow eating thing, and you keep your band adjusted, you will not regain weight.

8. Be in the Moment When Eating. The next law of living with the Lap-Band is to be in the moment. If you’re in a nice restaurant with friends, or on a date, have a cocktail and relax. Order food you know you can eat easily - Oysters, Soup, risotto, steak or tuna tartare, flaky fish, salmon, veal, stews. Order Sashimi, not rolls. Try tomatoes, lentils, beets or arugula. Have thin Pasta, not rigatoni or lasagna. Have the pasta a little overcooked, not al dente. Get an 8 oz filet rare, and eat half of it. Don’t eat the bread!! Push food around the plate. Focus on eating slowly. Stop when you’ve had enough. Don’t mind leaving food on the plate (or take the rest home for another meal). Tell your dinner companions, if they ask, that you’re watching what you’re eating. Don’t rush. Have a glass of wine. It will relax you, and your esophagus. Have two if everyone else is. Above all else, enjoy yourself. Make it not about the food, but the experience.

9. The Lap-Band is About Moderation. Don’t obsess about what you choose to eat. Everything in moderation, like our grandmas told us. Skinny girls eat what they want. They just don’t eat a lot of it. I eat less than my wife, but I eat what I feel like eating. Have a scoop of ice cream every now and then. Have a slice of pizza. When did a slice ever hurt anyone? It's when you eat a pint of ice cream or a whole pizza pie that it’s a problem. Let the Lap-Band help you. All it asks of you is that you eat slowly. If it’s adjusted correctly, you’ll only want a slice, not a pie.

10. How to Take a Break. There’s no harm in having a break for a week or two. If you’re going on a trip to Paris, or Tuscany, and you’ve been waiting your whole life to try all the restaurants you’ve read about, and are nervous, loosen it before you go. Relax, enjoy the moment, then come back and get retightened. But make sure you get retightened, or you will regain weight.

11. Keep Your Adjustment. Everyone who empties their Lap-Band so they can eat “healthier” regains weight. A lot of weight. As sure as the sun rises in the morning. You can eat as healthy as you want if you eat slowly.

12. Eat According to Your Band and Time of Day. The power of the Lap-Band varies by time of day. It’s because the esophagus’s ability to push food is weaker in the morning. Have a cup of coffee, a little yogurt, a soft boiled egg, slowly. It’s looser at night because the esophagus is pumping strongly. Adjust your Lap-Band to deal with the evenings, so you're not hungry after dinner, then adapt to having less in the morning. Emotions affect your Band. It’s the stress hormones affecting your esophagus. If you’re overtired, angry, sad about something or just plain frazzled, stop for a bit before you eat. Sit down, calm down, then eat your meal slowly. Put your knife and fork down between bites. Put the sandwich down between bites. Go slow. Wait until you’ve calmed down.

13. Stay Connected to Your Surgeon. The final thing I’ve learned is to stay in touch with your doctor. If you start getting hungry again, get a fill. Don’t be embarrassed that you haven’t been for a year or two. If you’re getting hungry, if you’re gaining weight, go back.

The Lap-Band works. You can’t live with a Lap-Band WLS as if you don’t have it!

[gowalking 10,790]

Your Mrs. did my lapband surgery a little over three years ago and about six months ago, she had to move the port under the muscle as it stuck out like a golfball...which she said was because I had no fat anymore.

She's a great doctor and the office and those who work there have been great as well. I lost all my excess weight and got my life back thanks to your wife and the office that supports her.

Many thanks to both of you.

[Alex Brecher 10,484]

@Dr. Fielding,

Thanks for this informative article and for sharing your insights about the lap-band. You have so many great points here about the role of the lap-band, the role of the patient, and the role of the surgeon. I am very impressed that you encourage your patients to come back monthly for 18 months – that’s more than many surgeons ask for, and that may be why your patients are so successful.

I like the way you emphasize that the lap-band needs to be properly adjusted and placed for it to work, and the patient needs to follow the rules. I also love that you recognize real life: the patient can and should eat out and enjoy life and eating, and it’s possible to do that while sticking to the lap-band diet. Thanks also for the reminder that it’s okay to go back to the surgeon for an adjustment even if it’s been a little too long since the last one.

[jfc193 718]

Your information you have provided is almost the same as my surgeon provided my wife and I almost 9 years ago.

While I have had my ups and downs with the lap band mostly due to my own lack of follow-through.

I do consider the lap band as a true life saver.

[jnt1 37]

What the band doesnt offer that other WLS surgeries do offer is the effect on hunger hormones.

This is a big failing with the band as to feel hungry yet have the tiny stomach us like a horrible torture! !

I cant wait to have my gb revised to mini bypass next month.

Sent from my GT-I9505 using the BariatricPal App

[BayougirlMrsS 3,933]

Dr. Fielding... i couldn't agree more with your 13 points... they are spot on. Thanks for writing this.

Banded 11/09..... What is this hunger you speak of... i never feel hungry. I wake up, wait about 30 min and have a cup of coffee, then another when i get to work at 7am. I fix myself a 1/2 cup of plan yogurt with some granola in it and eat on that till about 9-10ish... depends on how busy i am it sits on my desk and i eat a bite.. work.. bite...work. lunch comes around and i normally eat tuna or chicken salad with half of avocado... that normally takes me till 1ish... again depends on work. I normally have a snack of nuts or cheese. I cook supper... last night was Crawfish stew, rice and potato salad... (its a Louisiana thing)... i had a glass of wine while i cooked... ate my cup of stew with out the rice and two tablespoons of potato salad... The end. I eat slowly.. very slowly and i find im never hungry....

I saw my dr. every month for the firs 1.5 years.... some were for adjustments some were for just advice. I have been able to maintain an 80-87lb weightloss and could not be happier with my band.... I pray every night that the band gods keep me in there good graces....

Thanks again.....

[meeshee 3]

Thank you so much Dr. Fielding,

I'm pre-op, hoping to get approved to have surgery next month, and you have answered many of my questions with just these 13 facts. It seems out here on the West Coast that the lap band is a bit poo poo'd by the bariatric community, that they are discouraging people from having it, but I think it seems like a really good solution for someone like me. I'm 45 years old, 5'4" 225 lbs, fighting going on insulin, and i think this is the best option - I'm so glad to hear from a patient AND Dr. that thinks it is worthwhile.

Thank you!