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Determining When to Adjust Your REALIZE® or LAP-BAND®

By Dr. Ajay Goyal | April 16, 2013

For patients who have just had Gastric Band surgery (LAP-BAND® or REALIZE® band), one of the first questions they want to know is how will they know when they need to adjust their Gastric Band. But before you’ll know when it’s time to adjust your gastric band, you need to understand how gastric band surgery helps you lose weight.

Gastric band surgery works by restricting you from eating large portions of food at one time. When the band is filled, the opening between the small stomach pouch at the top of the stomach and the lower portion is made smaller. This restricts the amount of food you can eat at one time.

The LAP-BAND® does not prevent you from eating high calorie or unhealthy foods, such as ice cream or fast foods. It also does not prevent you from ingesting liquid calories − like soda, juices, vitamin water − which slip through the band’s restriction around the top of the stomach with ease. Eating more than 3 meals per day, or grazing, will hamper weight loss as the total calorie count per day will go up. It’s critical for LAP-BAND® and REALIZE® band patients to aim for three meals per day with 30 minutes spent on each meal.

Patients typically lose one to two pounds per week with LAP-BAND® or REALIZE® Band. So if you are no longer able to achieve a 1- to 2-pound per week weight loss while eating healthy foods, you may want to talk to your doctor about adjusting your band. Or if you feel hungry between meals to the point that it is distracting you from normal daily activities, you may need a Band adjustment.

During the first year after surgery, you will likely require approximately three to five adjustments to your LAP-BAND® to achieve your goal weight − although some patients require more, some less. The band adjustments are done either in your surgeon’s office or under fluoroscopy (x-ray) at a hospital or surgery center. At the New Jersey Bariatric Center®, the great majority − 99% − of LAP-BAND® or REALIZE® Band adjustments are done in the office. There is no need for local anesthesia with adjustments. They usually take five to 10 minutes and are less painful than getting blood drawn.

The key is finding the level of restriction that decreases your food intake without making you uncomfortable or hungry all the time. It’s important to be patient with yourself in the beginning; you will be getting accustomed to a new way of eating and may face the inability to tolerate certain hard foods that you used to eat prior to surgery.

LAP-BAND® Myths and misconceptions

I hear different gastric band myths from patients all the time. Here are some of the most common misconceptions about LAP-BAND® and REALIZE® Band.

  1. The tighter the band, the faster the weight loss. When the band is too tight it often leads to cheating. When it’s so tight that you’re at the point where you can’t tolerate solid foods, you will often compensate by eating high-calorie liquids like soda or soft foods like ice cream. So you’re band may be tighter band, but you can actually gain weight from consuming too many calories. Another way to cheat is to graze, eating smaller meals all day long. This can backfire too by increasing your calorie intake. And finally, patients whose bands are too tight often will “lubricate” it with sauces and creams to get the food through the opening, once again increasing the calorie intake and gaining weight, instead of losing it.
  2. The more adjustments, the faster the weight loss. Making too frequent adjustments will only lead to a very tight band, leaving you unsatisfied, which often leads to cheating.
  3. You can lose the same amount of weight per week as with Gastric Bypass surgery or Gastric Sleeve. Gastric bypass surgery restricts your food intake like gastric band surgery, however it also involves malabsorption of food, which increases weight loss. Therefore, you will not lose weight at the same rate as a gastric bypass patient, which is about 3-5 pounds per week. While the Sleeve does not have a malabsorptive component, the procedure decreases hunger hormones, making patients feel less hungry in addition to restricting the amount of food that can be eaten at one time. Weight loss with the sleeve is about 2-4 pounds per week.

If you feel off track and aren’t happy with your weight loss, try a calorie-counting experiment for a week or two to determine why you’re not losing the weight. The assignment starts by recording everything you eat daily to calculate the total calories taken in each day. Two sites I recommend to help with the calculations are or I find that patients who aren’t happy with their weight loss tend to take in more calories per day than they realize. Remember, to lose weight with the band, you need to take in no more than 1,200 calories per day and perform 30 minutes of cardio exercise three times per week to be successful. Some additional tips to maximizing weight loss include weighing yourself on a weekly basis, regular monthly appointments with your bariatric surgeon to evaluate progress and regular calorie counting to keep you on track.

Ajay Goyal, MD, FACS, is founder and director of the New Jersey Bariatric Center, a medical & surgical weight loss center with offices in Springfield, Somerville, Hoboken, East Brunswick, Sparta, and Totowa New Jersey. New Jersey Bariatric Center helps patients achieve long-term weight loss success through the most advanced bariatric surgery procedures, including gastric sleeve and gastric bypass procedures. New Jersey Bariatric Center’s approach to patient care has resulted in zero mortalities and a complication rate that is lower than the national average.
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