Dr. David Provost performs weight loss surgery, including Lap-Band surgery, in Denton, TX. He has taught weight loss surgery procedures to hundreds of doctors from around the country. He also specializes in revision surgery for patients who have experienced challenges following a previous weight loss surgery procedure. In this article, Dr. Provost offers his advice and guidance to help patients who undergo Lap-Band surgery achieve long-term success awith proper follow-up care.

Frequently Asked Questions about LAP-BAND® Adjustments
By Dr. David Provost

Q: Why are adjustments important?

A: Ongoing adjustments, either adding or removing saline from your LAP-BAND System, are necessary for continued success with your LAP-BAND System.  This unique feature provides the right level of restriction for your individual needs.

Q: When do I need an adjustment?

A: It is important to remember that everyone requires a different amount of restriction and a different adjustment schedule. But, several indicators may alert you to schedule an appointment to have a LAP-BAND adjustment. Some of these include:

• No weight loss for more than four weeks
• Increased appetite
• Feeling hungry less than four hours after eating a meal
• Ability to eat more food during a meal than usual
• Increased snacking
• Ability to eat foods that you were unable to eat before (i.e. white breads, fibrous vegetables)

Q: How do I know that I have been properly adjusted?

A: You should feel an early and prolonged satiety, or fullness.  Small meals should satisfy you while maintaining a target weight loss of 1-2 pounds per week.  The LAP-BAND makes you eat less and feel full in two ways -– first, by reducing the capacity of your stomach, and second, by increasing the time it takes food to get through the digestive system.  If you follow the nutrition guidelines provided by your surgeon, when you choose your food and then chew it well, you should not feel hungry or deprived.

Q: Can I be over-adjusted?  If so, how will I know if I am?

A: Yes, there is such a thing as too much saline in your band.  Tighter is not always better!  Indicators that you may be over-adjusted include:

• Difficulty swallowing
• Unable to swallow saliva
• Foaming at the mouth
• Regurgitation
• Waking up at night coughing or vomiting
• Frequent reflux/heartburn

If you experience any of these symptoms, you should contact your surgeon’s office immediately.

Q: Why do I feel more restricted in the morning than I do at night?

A: Your esophagus muscle, like any other muscle, tightens when not being used overnight.  Your esophagus must work to push food down through the band and needs some “stretching/warming up” in the morning. Often, this results from eating a larger meal in the evening without sufficient time to empty your pouch prior to lying down for sleep.  Try making your evening meal smaller and not eating for 3-4 hours prior to bedtime.

Weight loss surgery is proven to aleviate or resolve many associated medical problems, including high blood pressure, acid reflux, diabetes, sleep apnea, asthma, and joint pain. However, to have long-term success and maintain a healthy weight, you need to be prepared to make several permanent lifestyle changes. 

The biggest change will be in your portion size. If you’ve been to a restaurant recently, you know that what is considered a normal serving size in the U.S. is often enough food for three people. If you’re used to sitting down to a heaping dish of pasta or a large steak and stuffed bake potato, you may be surprised at just how little food you add to your plate following weight loss surgery.

After either gastric bypass or gastric banding (Lap-Band) surgery, you will only be able to eat a few bites at each meal. You must take small bites, chew your food well, and eat slowly, taking two to three minutes between each bite. By slowing down, you will be more aware of what you are eating, and are more likely to feel satisfied sooner. Most importantly, you should stop eating when you become comfortably full or are no longer physically hungry. Overeating or eating too quickly will result in discomfort or vomiting. Similarly, you will no longer be able to gulp large volumes of liquid when thirsty, and you will have to learn to drink water continually throughout the day to prevent dehydration.

FOOD CHOICES
After a gastric bypass, the types of food you eat will also change. You may have difficulty eating tough meats, particularly beef, following surgery. And, you should avoid greasy or fried foods, because your body cannot process them the way it is used to and they can make you feel ill. You generally won’t have a problem with most vegetables, although you may want to avoid raw vegetables, such as broccoli, celery or carrots. Carbonated beverages, even diet sodas, are a big no-no. They can stretch your pouch, limiting weight loss, and defeating the purpose of the surgery. And, if you know anything about the gastric bypass procedure, you know that foods high in sugar cause the dumping syndrome, which causes light-headedness, sweats, a jittery feeling, nausea, and vomiting. Cake, candy, ice cream, pies, cookies, and other sweets and desserts all can cause dumping and are off limits. (Artificial sweeteners, however, are permitted.)

With the Lap-Band procedure, adherence to the prescribed eating habits is equally important, and follow-up visits with your surgeon for adjustments are essential to long-term success. If you do not go back for routine fills to maintain the appropriate amount of restriction for the Lap-Band, you can easily regain the weight that you lost after your initial procedure. When the Lap-Band is adjusted correctly, you should feel full or satisfied fairly quickly. If small meals no longer satisfy you, if you still have weight to lose but have plateaued, or if you find yourself snacking more often and eating foods you previously couldn’t eat, like white breads and fibrous vegetables, then you are probably overdue for an adjustment. Overall, if you follow the nutrition guidelines provided by your surgeon, when you choose your food and then chew it well, you should not feel hungry or deprived.

PROPER EXERCISE
Exercise is an essential component of any weight loss program, and both the gastric bypass and Lap-Band procedures are no exception. You will be expected to begin a daily walking program upon discharge from the hospital. Patients who are unable to walk due to joint or back problems are encouraged to participate in alternative methods of exercise including water aerobics and stationary biking.

Like your new eating habits, maintaining an exercise regimen will be a long-term commitment. You don’t have to become a fitness junkie, but you do need to work regular exercise into your daily routine. Even walking on a treadmill for 30 minutes a day will help you shed pounds fast, and keep them off for good. Plus, you will lower your risk of heart disease by improving your cardiovascular fitness. 

If you are considering weight loss surgery, you need to have a complete understanding and acceptance of the changes you will face. This is not the easy way out. Achieving weight loss goals requires dedication, and if you do not believe you can comply with your surgeon’s instructions, then weight-loss surgery may not be your best option.

After weight loss surgery, the first and most dramatic change you will make is how you eat. Whether you have had a Lap-Band® or gastric bypass procedure, the rules are essentially the same. Your stomach has been altered so that anything you eat goes into a small pouch the size of a golf ball. That means after just a few bites, you feel full—something that might come as a shock if you’re used to devouring huge portions at the dinner table.

Bariatric surgery will alter your eating habits dramatically, particularly in the first few months after surgery. To gain the greatest benefits of the surgery, Dr. David Provost recommends patients follow a simple formula:

3 x 3 + 30

What this means is that you should only eat three bites of food at each meal, and separate each bite by three minutes. In addition, you should not drink anything—including water—for at least 30 minutes before you eat and 30 minutes after you eat.

That may sound like a ridiculously small amount of food, but the truth is, after weight loss surgery, you won’t want to eat any more. Both the Lap-Band and the gastric bypass restrict the amount of food that you can fit in your stomach. If you try to eat more than your stomach can hold, you will feel extremely uncomfortable and you may even vomit. In addition, waiting at least 30 minutes after drinking liquids before a meal and also waiting 30 minutes to have a beverage after you eat will help ensure that you get enough nutrients and keep you from cheating your surgery by washing down your food through your pouch.

Finally, slowing down your eating will also let you experience your meals in a whole new way. When you wait three minutes between bites, you have the chance to savor your food, and also appreciate the people who may be sharing the meal with you. So, remember 3 x 3 + 30 at each meal will promote rapid weight loss and help you achieve your goal weight faster than you ever thought possible!