LapBand What?: Explaining Weight Loss Surgery

I am simply blow away that so many people, most of whom I do not know — are reading my post that I made in a moment of total honesty.  I hope that for anyone who read that post, they will find out either more about what it is like to be a former fat kid — or even find support in the posting.

When I reviewed the posting, and did a bit of research.  I determined that there was not a lot of information about Gastric Banding out there.  There are TONS of books on amazon.com about Gastric Bypass and even the Gastric Sleeve.  Yet there is not a lot of personal information from Gastric Banding patients about their experiences    I have had many people, some who were thin and curious — others who were overweight/obese and looking for answers, to ask me about my band.  So I thought this would be the most appropriate follow up blog to the last one.

COPYRWRITE: Pink Explosions Blog

Copyright: Pink Explosions Blog

Alright — there I am again.  Law school again.  So how did I move from that girl up there to this one down here?  

Copyright: Pink Explosions Blog.

Copyright: Pink Explosions Blog.  Photography by: Liz Mitchell

Lap-banding.  Well and a lot of that sweat that you see in the other photo.

So how does a tiny (expensive) little piece of medical grade plastic help overweight/obese people to loose weight?

The inflatable band is placed around the upper part of the stomach to create a smaller stomach pouch. This slows and limits the amount of food that can be consumed at one time giving the opportunity for the sense of satiety to be met with the release of PYY. It does not decrease gastric emptying time. The individual achieves sustained weight loss by chosing healthy food options, limiting food intake and volume, reducing appetite, and progress of food from the top portion of the stomach to the lower portion digestion.[3]

According to the American Society for Metabolic Bariatric Surgery, bariatric surgery is not an easy option for obesity sufferers. It is a drastic step, and carries the usual pain and risks of any major gastrointestinal surgical operation.

However, gastric banding is the least invasive surgery of its kind and is totally reversible, with another key hole operation. Gastric banding is performed using laparoscopic surgeryand usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. Because no part of the stomach is stapled or removed, and the patient’s intestines are not re-routed, he or she can continue to absorb nutrients from food normally. Gastric bands are made entirely of biocompatible materials, so they are able to stay in the patient’s body without causing harm. (Source: Wikipedia)

Alrighty then, so now that the “science” is covered — how does this surgery really work for those who have undergone the procedure.

First things first, the procedure.  It is not easy to be medically qualified to have the lap band surgery.  This is not for someone who just wants to loose twenty or thirty pounds.  This is major surgery, with major consequences — that in my opinion should be a last resort of weight loss.  There are requirements to get a lap-band that I have listed below:

LAP-BAND® may be right for you if:

  • Your Body Mass Index (BMI) is at least 40, or
    • you are at least 30 pounds overweight with a BMI of at least 30 kg/m2 with one or more obesity related comorbid conditions. Check your BMI.
  • You are at least 18 years old.
  • You have been overweight for more than 5 years.
  • Your serious weight loss attempts have had only short-term success.
  • You are not currently suffering from any other disease that may have caused your excess weight.
  • You are prepared to make major changes in your eating habits and lifestyle.
  • You do not drink alcohol in excess.
  • You are not currently pregnant. (Note: If you become pregnant after having this procedure, the band can be adjusted for the duration of your pregnancy.) (Source: Lap-Band Website)

In addition to the medical requirements, each individual insurance company and policy has their own requirements for those seeking bariatric surgery.  My surgery was covered while I was under COBRA from the law firm I had briefly worked at.  I had to go through six months of monitored weight loss by a physician, a psychological evaluation, and then try and make it on a surgeons schedule (difficult — trust me).  I ended up beginning the process to get a band in January 2008, and was not banded until January 2009.  This is not a quick fix.  This is not an easy process.  This is not “cheating.”  In addition  there are out of pocket costs even if your insurance will cover a portion of your surgery.  I am still paying for my surgery.  I had to pay for the monitored weight loss physicians appointments, my psych eval appointment, my gym membership during that time and beyond, and the co-pay for every doctors visit I’ve ever had and will have.  On various websites people estimate they have spent $14,000.00 or more on their surgery (I’ve seen $30,000 as the highest amount).  There also are people who have to go out of state, or even out of the country for these procedures since they are either not available in their area — not covered by their insurance, or any other issue they may see.  Also, something I never thought of until I started researching again for this blog post — holy crap my lap band may have to be replaced.  It. May. Not. Last.  Oh goodness, oh finances!  This is not a quick fix.  This is not an easy process.  This is not “cheating” and it is not cheap.  

Q:  How much does Lap-Band surgery cost?  How much does it cost to remove a Lap-Band?

A:  It usually costs between $15,000-$30,000 to put in a Lap-Band.  If there are complications, removal will cost at least that much and possibly much more.  If you are considering a Lap-Band, find out if your health insurance will pay for the surgery and be sure to find out if it will pay to have the Lap-Band removed.  Many insurance companies will only pay for one Lap-Band surgery, so they will pay to put it in, but not to take it out.

Remember that Lap-Bands do not last forever, and we don’t know exactly how long they usually last. Some last just a year or two, and we estimate that most will not last more than 10 years even in the most ideal circumstances. (Source: National Research Center for Women and Families)

Then once you undergo the procedure you start to really feel the effects.  I was out of work for about two months — but that was due more to the nature of my job at the time (I was a Sales Lead for Bath and Body Works, and therefore had to lift lots of heavy things — I stayed out longer to not pop a stich or have my band slip/flip — still did though).  You are on a liquid diet before surgery and for a portion of time after.  And let me tell you how much that sucks.  You slowly are able to increase your food intake, and then the work begins.

Friends, let me tell you — it’s hard.  Once anyone undertakes a major lifestyle change in the area of eating — they soon realize how food centered our culture is.  It’s not just Thanksgiving Dinner, but even when you go out with your co-workers it is typically for food.  We go on dinner dates, have meals out, share meals in our homes, grab snacks from the break rooms of our offices, comfort ourselves with tasty treats.  I am typing this in the waiting room of my automobile service center, and there are even snacks for purchase while you wait (no no, I resisted — yes yes I grabbed a bottle of water).  So once you decide to take on Whole30, Jenny Craig, Weight Watchers, Nutrasystems, the Dukan Diet — well anything, you start to find out how hard it is to be social stick to your chosen path.  It’s no easier with a surgically implanted tool.

The lap-band is a tool that creates the sense of satisfaction after eating a small quantity of food.  Doctors  have found that the top of ones stomach is what lets many people know they are full.  Many of us cannot self regulate this sensation through portion control alone, we need that biological release to let our brains know that we really are full.  Ever wonder how that one person can take down a whole pizza alone?  They probably have to fill their stomachs full of food, until the top of their stomach is “activated” to let their brain know they are “satisfied” or full.  Its a great chance that that person isn’t just a glutton, but they really just have to have that last resort full sensor tapped into action.  Here is a bit more on the “mechanics” of the lapband from our good friends at Wikipedia:

The placement of the band creates a small pouch at the top of the stomach. This pouch holds approximately ½ cup of food, whereas the typical stomach holds about 6 cups of food. The pouch fills with food quickly, and the band slows the passage of food from the pouch to the lower part of the stomach.[6] As the upper part of the stomach registers as full, the message to the brain is that the entire stomach is full, and this sensation helps the person to be hungry less often, feel full more quickly and for a longer period of time, eat smaller portions, and lose weight over time.[3]

As patients lose weight, their bands will need adjustments, or “fills”, to ensure comfort and effectiveness. The gastric band is adjusted by introducing a saline solution into a small access port placed just under the skin. A specialized non-coring needle is used to avoid damage to the port membrane and prevent leakage.[7] There are many port designs (such as high profile and low profile), and they may be placed in varying positions based on the surgeon’s preference, but are always attached (through sutures, staples, or another method) to the muscle wall in and around the diaphragm. (Source: Wikipedia)

So imagine that you are out with your friends, and they order an array of tapas and small plates.  You as the lap band patient must carefully choose what will work for you and your surgical tool.  For example: I cannot eat and drink at the same time.  It does not seem like such a big deal, but as you go through this week (if you are not a bariatric surgery patient) notice how often you take a sip of this or a gulp of that while noshing on tasty things.   I miss being able to eat and drink simultaneously.  I have a problem with near constant dehydration since I cannot eat and drink together — I must choose nutrition or liquids — and then wait in between my choice before starting in on the other.

Another point: Many very basic foods do not like lap-bands.  Breads, meats, raw veggies, pasta — all on the list of possible things that may or may not work with each patient.   Currently my body is negotiating (as my fiance calls it) with a small portion of oatmeal that I tried to eat for breakfast.  What is negotiating?  That means I’m right on the edge of throwing up regurgitating what I have tried to eat.  If I “loose” then I’ll have an empty pouch and have to try again to find something to eat.  If I win then the food stayed put, and will continue to digestion.

And even if the food works — I can only have a little of it.  My fiance has a huge family, and we have to do multiple Thanksgiving Dinners and multiple Christmas meals.  Those are two of the hardest days of my life.  You don’t want to insult the cook, but I really can’t eat more than bites of things.  The family members who know are usually super good at watching the portion size that hits my  plate — but I have been known to (1) slide my plate to my fiance for him to nibble a bit more off the edges for me and (2) turn green and have to as graciously as I can run for a rest room.  One bite of food can send me running — and it’s annoying as well as embarrassing.

Can I just complain for one moment — darn I miss just being able to eat.  To just sit, eat, finish, and move on. To not have to try and choose what foods my band may like today (because one day it may like Food X, and the very next day it does NOT like Food X), to be able to guzzle down a bottle of water without issues, to be able to try new foods and not worry about turning green and having to excuse myself to go visit the porcelain throne.  I. Miss. Eating.   After nearly four years one would think I would be used to it — but I’m not.  

One last food point — I chose to be very open about having a lap band.  So most of my close friends and family know that I may turn green in the middle of a meal.  That I may have to run, not walk, to the restroom if something dosen’t work (we banders call it “getting stuck”).  That I am not being uppity if I don’t try your great-grandmothers Food X, and that I am refusing seconds because I just cant.  They know I cannot eat and drink at the same time, and they know that if I am noshing on Oreo cookies its because I am hungry and haven’t been able to keep anything down all day — not because I’m an inherently unhealthy person.  However, some people do not choose to be open (as is their right).  A benefit of the banding is that you loose weight slowly.  No Star Jones/Al Roker type overnight weight loss to explain away.  But you simply drop weight very slowly, calmly, and quietly.  So for those banders who choose to keep mum, it’s got to be even more of a struggle when you “get stuck” or have to refuse food.  When you have to explain why suddenly you cannot eat a full slice of pizza – let alone your usual three.  When you have to figure out how to make it through a business dinner, or how to refuse your favorite foods because you know they no longer “work.”  This is all part of a surgery that some people think is “cheating” and equals “easy” weight loss.  I hope this post can help inform them that there is NOTHING about weight loss surgery that is “easy” or “cheating.”

So here you are lap-band patient.  You can’t eat everything you want — but in many ways you can’t eat ANYTHING some days.  You are working out — and maybe you find that you aren’t loosing any weight or not at the rate that you prefer.  I *knock on wood* have not had that experience — but if you take a spin of any of the lap-band message boards/support groups, you will find folks who just have not lost any weight.  Even worse, you gain your weight back — maybe some (I’ve gained about 10 pounds back after my knees decided to give out on me, and I can no longer teach three+ dance-fitness classes a week.  It’s been hard seeing the weight creep back on, but I’d like to walk down the isle at my October 2013 wedding — thank you very much — and not walk down the isle using a walker, yes it was that bad) weight, or maybe all of it.

Q:  Whatever diet I use, I can’t keep my weight off.  Will a Lap-Band help me lose weight and keep it off?

A:  Most people with Lap-Bands lose weight during the first year.  Surprisingly few people continue to lose weight after that, despite the small amounts of food they can comfortably eat.  After a year, people who have Lap-Bands usually stabilize at their new weight, or start gaining weight again.  Some gain and lose weight just like they did when they were on different diets. Despite how difficult it is to eat solid food, many people don’t lose weight with a Lap-Band.  Approximately one-third of the people with Lap-Bands have them removed and not replaced within 1-5 years.

Q:  If a Lap-Band makes it impossible to eat a large amount of food, how is it possible that some people don’t lose weight with a Lap-Band?

A:  There are fattening foods that people can eat large quantities of even with a Lap-Band, such as ice cream and liquids.  If you enjoy ice cream, drink many high-calorie beverages, or eat small meals all day long, it is possible to not lose weight or not lose much weight.  In fact, a company that makes Lap-Bands, Allergan, found in their research that some patients actually gained weight! (Source: National Research Center for Women and Families).

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5 thoughts on “LapBand What?: Explaining Weight Loss Surgery

  1. Courtney says:

    Again. I think you are awesome. Thank you for sharing something so personal with the rest of the world. You will be blessed for your courage (more so than you already are) 🙂

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