Thousands of women and men are undergoing weight loss surgery annually in the U.S., and throughout the world. You can’t help but notice the growing popularity of weight loss surgery. We see it everywhere. We’ve watched television and entertainment personalities from singer Carnie Wilson to recording star and American Idol judge Randy Jackson lose weight after gastric bypass surgery.

On the face of it, weight loss surgery, or WLS, sounds like a simple, quick fix for those with long term obesity. Of course, nothing is ever that easy. Weight loss surgery is definitely not for those who want a quick fix or who simply don’t want to diet. Patients who undergo WLS often must adhere to strict dietary guidelines following surgery or they will be sadly disappointed in their weight loss results.

Exercise is also a key component in weight loss for those who opt for weight loss surgery, as it is for everyone. Patients who exercise at least thirty minutes a day following weight loss surgery lose weight thirty percent faster, as well as gain the overall health benefits of regular exercise.

If you only have ten or twenty pounds or even fifty pounds to lose, weight loss surgery is not an option. Patients considered for WLS must be at least 100 pounds overweight and have a BMI of at least 40. Sometimes patients who are about seventy-five pounds overweight with a BMI of 35 are considered if they also have a combination of certain co-morbidities such as hypertension, diabetes, or sleep apnea.

When most people think of weight loss surgery, they think of gastric bypass – a procedure that reroutes the digestive system causing rapid weight loss. Unfortunately gastric bypass also often leads to nutritional deficiencies that can cause severe health complications.

Another type of weight loss surgery often performed is called gastroplasty. Gastroplasty is similar to gastric bypass because it reroutes digestive system, but it also restricts the amount of food that can be eaten by making the stomach smaller.

Neither of these procedures is reversible. Both gastric bypass and gastroplasty a five to six inch incision and a hospital stay of three to four days. Potential side effects resulting from these types of weight loss surgery include “dumping syndrome” which is a combination of nausea, chest, and abdominal cramps, sweating, and diarrhea. Other risks and complications include malabsorption, vitamin deficiencies, and chronic abdominal pain. These symptoms are often avoided by eliminating foods that are high in sugar and fat from the diet.

A serious and potentially fatal complication of both gastric bypass and gastroplasty is called an anastomotic leak. An anastomotic leak occurs when there is a leakage at the staple line. This potentially fatal complication is often difficult to diagnose and requires immediate hospitalization. Fortunately, for the majority of weight loss surgery patients, this rare complication occurs in less than two percent of cases.

The potential risks and complications of gastric bypass and gastroplasty are enough to scare many morbidly obese patients away from what is often a life-saving surgery that results in weight loss and lowers the patient’s risk of heart disease, diabetes, and other potentially life threatening diseases.

But what is a weight loss surgical procedure was available that was minimally invasive, performed by laparoscope, did not cut or rerouted any internal organs, and was completely reversible? Over 70,000 patients worldwide have chosen such a weight loss surgery, and I was faced with this question last summer. It didn’t take long for me, after an entire lifetime from childhood to adulthood of being on the weight loss rollercoaster, to decide my answer was a definite “Yes.”

Exactly what did I say “Yes” to? I said “Yes” to a weight loss procedure, approved in the U. S. by the FDA in June 2001, called the Laparoscopic Adjustable Gastric Banding Procedure or Lap-Band. On May 10, 2004, I underwent this weight loss procedure. Today, almost four weeks later, I have lost twenty-seven pounds.

The Lap-Band is a hollow band made of sylastic. The band is placed around the upper third portion of the stomach to create a pouch that initially holds 2 ounces of food, and eventually holds up to 4 to 6 ounces. Creating this restricted stomach space in the upper portion of the stomach causes a longer lasting feeling of fullness because the nerves that signal the brain when you’re full are located in the upper area of the stomach. The band further works by slowly allowing the food you eat to be released into the lower portion of the stomach for digestion.

Attached to the band is a tube that ends with a port attached to abdominal muscles just below the ribs. The purpose of the port is to provide access to the band to add saline which slowly fills the band, causing increased restriction of the stomach.

Immediately after surgery the band is empty. About six weeks after Lap-Band surgery, or whenever a plateau in weight loss is reached, the surgeon adds a small amount of saline in the band. While the band can hold about 4 to 5 cc’s of saline, only small amounts of saline are added each time. The amount of “fill” in the Lap-Band, and the amount added during each fill vary according to individual patient circumstances.

The Laparoscopic Adjustable Gastric Banding Procedure is performed under anesthesia in a hospital operating room. During surgery three to five one-half inch to two inch incisions are made in the upper abdomen. Barring complications, the procedure takes about one hour to perform.

All patients undergoing this procedure should be aware of the possibility of complications such as adhesions from previous surgeries which may make a laparoscopic procedure impossible. In this case, the surgeon will convert to an open procedure with a five inch incision and longer recovery period.

Many surgeons allow patients to return home the same day; however, other surgeons require patients to stay overnight with release from the hospital about 24 hours post surgery. Although most Lap-Band patients feel quite well after two or three weeks, full recovery takes six weeks.

When you are ready to leave the hospital, you may receive a visit from the hospital dietitian who will go over the required diet for Lap-Band patients. It’s important to fully understand the Lap-Band diet before you decide on this type of weight loss surgery. The first 3 to 4 days following Adjustable Gastric Lap-Band surgery patients must follow a clear liquid diet. Failure to follow the prescribed diet can cause complications such as band erosion or slippage that require additional surgery.

If you are a regular coffee, tea, or soda drinker you should be aware that no caffeine is permitted for the first three months after surgery. Carbonated beverages; both diet and regular may cause gas, bloating, and an increase in stomach size due to the carbonation and are not recommended at any time for Lap-Band patients.

The second phase of the Lap-Band diet consists of 5 to 6 weeks of a modified full liquid diet; the key component of this phase is consuming two ounces of a protein shake every hour for ten to twelve hours a day with two ounces of other liquids such as soup, baby food, or sugar-free gelatin three times a day.

During the second six weeks following Lap-Band surgery patients may eat food that is shredded in a food processor prior to eating. The basic foods on the Lap-Band diet include meats or other forms of protein, vegetables, and salads. The Lap-Band diet does not include most bread, potatoes and other starchy vegetables. The length of these phases may be altered according a patient’s personal weight and weight loss goals – my first phase is five weeks, followed by a two week second phase.

Protein is especially important following Lap-Band surgery. After Lap-Band surgery the stomach will never hold more than 4 to 6 ounces per meal, so making every bite count is essential for healthy and nutritionally rounded weight loss success.

Lap-Band patients are advised to consume fifty to sixty grams of protein daily to avoid protein deficiency. Protein deficiency causes hair loss, fatigue, edema, muscle weakness, and a delay in wound healing. A lack of adequate protein may also lead to depression, anxiety, irritability, apathy, and other mental health conditions, as well as cause a number of physical health issues from gallstones to colds, headaches, low blood pressure, anemia, irregular hear rates, and, in extreme cases, death. A lab can measure the amount of protein in your blood by performing a serum albumin blood test.

Eating after Adjustable Gastric Lap-Band surgery means taking tiny bites, and eating very slowly. You should think of your new stomach as a “baby” stomach. You’ll be drinking protein shakes and relearning eating skills much the same way as a new baby eats formula (or breast milk), and slowly adds new foods from blended baby foods to chunkier baby foods.

Certain foods may never be well tolerated by Lap-Band patients. These foods include:

 

• Meats that are especially tough such as steak and pork chops. Some Lap-Band patients have difficulty digesting other meats that contain gristle such as hamburger.
• Oranges and grapefruits may not be tolerated unless the membrane is removed before eating.
• The seeds and/or skins of all fruits and vegetables.
• High fiber vegetables such as celery and sweet potatoes.
• Spicy foods.
• Fried foods.
• Certain spices including cinnamon, pepper, or onion or garlic salt.
• If you are unable to tolerate milk, it’s important to add other calcium and protein rich foods such as cottage cheese. Dry milk can be added to foods for added protein.

Any medicine you take may need to be adjusted following Lap-Band surgery since you will not be able to swallow pills that are aspirin-size or larger, or capsules or irregular-shaped pills. For me this has meant breaking a blood pressure pill in half, changing my tri-estrogen capsules to a cream form, and taking liquid antibiotics and painkillers for an unrelated infection.

Understanding Why You Eat

Behavior therapy or talk therapy is often beneficial for weight loss surgery patients. Therapy can help you to understand what food really means to you, and to realize when you eat and why you eat. Once you can begin to recognize the events in your life that trigger emotional eating, you can start to work on finding new ways to deal with those events.

The first day after my Lap-Band surgery I realized that I am a food addict. All I could think of was food. Television commercials for foods that didn’t even look good to me before surgery were making my mouth water. This hasn’t stopped, it’s less intense, but the desire is still there.

The first week or two, I felt like my life was over, after all almost every time I went out of the house, a trip for fast food for myself or someone in my family was included. I didn’t know how to just go to the store to buy what I needed without getting fast food, going to a restaurant, or buying something extra at the grocery store. My life was centered on food.

The third week after my Lap-Band procedure, I experienced a severe infection that was unrelated to my weight loss surgery. This infection required an extremely painful in-office surgery, and painful twice daily bandage changing. The first thing I thought I “deserved” after enduring such a painful procedure was something sweet and fattening to eat. Of course, I couldn’t satisfy my pain with food and I had to start learning how to deal with pain without using food as a sort of painkiller.

Yes, Lap-Band surgery eliminates hunger, and I know of many people who have had tremendous success, but it can’t undo a lifetime of emotional eating. If your surgeon doesn’t recommend a therapist, you may want to consider finding one yourself.

Weight loss surgery may be right for you if:

 

• You are at least 100 pounds overweight.
• Your BMI (body mass index) is 40 or greater.
• You have co-morbidities such as hypertension, diabetes, or sleep apnea.
• You have tried, unsuccessfully, to lose weight utilizing other diets and methods.
• You are willing and motivated to follow the prescribed diet and exercise regimen.

Certain patients, although they meet the weight guidelines, may not be suitable candidates for successful weight loss surgery. These patients include:

• Patients suffering from uncontrolled, severe psychiatric illnesses.
• Anyone addicted to drugs or alcohol.
• Medical conditions that make surgery unadvisable.
• Cancer patients who are not in remission.
• Most patients over 65, although this is not an automatic disqualification.
• Patients whose expectations are unrealistic. If you and your spouse are having problems and you think this surgery will make them love you more, this is probably not for you. Or if you think you can have this surgery without changing your attitude towards food and restricting your food intake, this surgery is not for you.
• Women who plan to become pregnant within one year.

Before bariatric surgery, extensive medical and psychological testing should be conducted to determine if a patient meets the guidelines and is a good candidate for successful weight loss surgery. Pre-op testing should include:

• Laboratory testing
• Upper GI.
• EKG
• Psychiatric interview and testing

If you think Lap-Band surgery may be the right choice for your weight problems, consult a weight loss surgery specialist in your area , l and learn everything you can about this procedure before you make your decision. Before I made my final decision to have the Lap-Band, I spent several months reading the postings of a large group of Lap-Band patients on an email list called DFW Bandsters. Although this list is for patients in the Dallas/Fort Worth area, where I live, a great deal of insight about what to expect before, during, and after Lap-Band is available here.

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By Tracee Cornforth, About.com

Updated July 16, 2009