Weight Management
What is It.
Causes of Obesity
Major Health Risks associated with Obesity.
Treatment Options
Non Surgical
BioEnterics® Intragastric Balloon System
Surgical
BioEnterics® LAP-BAND® System
What is Obesity
Obesity is the excess accumulation of body fat
The World Health Organization in 1997 declared obesity as a disease.
More than 1 billion people worldwide are overweight and at least 300 million of them are obese.
An estimated 115 million of the people will develop serious medical conditions including diabetes, heart disease, stroke, sleep apnea, hypertension, severe knee and back pains, and cancer.
In the Philippines, there are more than 3 million overweight and obese Filipinos and more than 600,000 of them are morbidly obese.
In the United States and Australia, 60% of the population is overweight and obese.
Causes of Obesity
Obesity could be a combination of the following:
The genes you inherited from your parents
How well your body turns food into energy
Your eating and exercising habits
Your surroundings
Psychological factors
Major health risks
Compared to people of normal weight, obese people have a 50% to 100% increased risk of dying prematurely
Diabetes
Joint problems (e.g., arthritis)
High blood pressure
Heart disease
Gallbladder problems
Certain types of cancer (breast, uterine, colon)
Digestive disorders (e.g., gastroesophageal reflux disease, or GORD)
Breathing difficulties (e.g., sleep apnea, asthma)
Psychological problems such as depression
Problems with fertility and pregnancy
Urinary Incontinence
Shorter Life Expectancy
Risks to psychological and social well-being
Negative self-image
Social isolation
Discrimination
Difficulties with day-to-day living
Normal tasks become harder when you are obese, as movement is more difficult
You tend to tire more quickly and you find yourself short of breath
Public transport seats, telephone booths, and cars may be too small for you
You may find it difficult to maintain personal hygiene
Treatment Options
Non-Surgical Treatment
Dieting, exercise, and medication have long been regarded as the conventional methods to achieve weight loss. Sometimes, these efforts are successful in the short term. However, for people who are morbidly obese, the results rarely last. For many, this can translate into what's called the "yo-yo syndrome," where patients continually gain and lose weight with the possibility of serious psychological and health consequences. Recent research reveals that conventional methods of weight loss generally fail to produce permanent weight loss. Several studies have shown that patients on diets, exercise programs, or medication are able to lose approximately 10% of their body weight but tend to regain two-thirds of it within one year, and almost all of it within five years**. Another study found that less than 5% of patients in weight loss programs were able to maintain their reduced weight after five years*.
The BIB® System or BioEnterics® Intragastric Balloon System is a conservative, non-surgical, non-pharmaceutical aid in the treatment of obesity and weight reduction. Click here to find out more about Bioenterics Intragastric Balloon (BIB) System.
Surgical Treatments
Over the years, weight-loss surgery has proven to be a successful method for the treatment of morbid obesity#. Options included are:
BioEnterics® LAP-BAND
Laparoscopic Gastric Band
Laparoscopic gastric Bypass
Sleeve Gastrectomy
Stomach stapling or Gastroplasty
Malabsorptive procedures
Fortunately, surgical options have continued to evolve and we are pleased to be able to offer patients the BioEnterics® LAP-BAND surgery. This procedure is the least traumatic and the only adjustable and reversible obesity surgery available in the United States. The LAP-BAND System provides a unique tool that can help you achieve and maintain significant weight loss, improve your health, and enhance your quality of life. Click here to find out more about Lap-Band Surgery.
BioEnterics® Intragastric Balloon System
What is the BIB® System or BioEnterics® Intragastric Balloon System
How Does the BIB® system Work?
How is the BIB® System procedure performed?
Who is the BIB® System suitable for?
How Long Is the BIB® System Balloon Used?
What Happens if the BIB® System Balloon Deflates Spontaneously?
How Will the BIB® System Balloon Be Removed?
How Much Weight Will I Lose with the BIB® System?
How does weight loss occur?
What Unpleasant Effects Are Possible with the BIB® System?
Complications
FAQs
What Is the BIB® System?
The BIB® System or BioEnterics® Intragastric Balloon System is a conservative, non-surgical, non-pharmaceutical aid in the treatment of obesity and weight reduction. The BIB® System is a soft, expandable, high quality soft silicone balloon that is placed inside the stomach via a camera that enters through the mouth and into the stomach.
Once inserted in the stomach, the empty thin smooth elastic balloon is filled with sterile saline with 500 cc of water (to a diameter of 13cm).
When full, the balloon is too large to pass into the bowel and will now float freely in the stomach.
The Gastric Balloon can help you take control of your weight without the risk of surgery or drugs. Used in harmony with a medically supervised nutrition plan and behavior modification program, it can help you achieve and maintain the health and aesthetic benefits associated with weight loss.
Worldwide, the Gastric Balloon is a clinically accepted tool in reducing excess weight. Clinical trials show that it is more successful than conventional diets, weight loss programs and medications. It has been used in Europe for more than ten years, and globally accepted worldwide.
How Does the BIB® system Work?
The balloon fills a large portion of the stomach, and therefore reduces the capacity of the stomach.
This creates a feeling of fullness for the patient and does not allow for overeating, therefore allowing the patient to effectively diet without feeling continuously hungry.
How is the BIB® System procedure performed?
The procedure is done as an out-patient procedure at Beverly Hills Medical Group. No Hospital stay is required.
Our Board Certified Gastroenterologist performs this procedure in conjunction with an anaesthetist and trained nursing staff.
The balloon is introduced into the stomach through the mouth without the need for surgery. The physician inserts an endoscopic camera (gastroscope) into the stomach. If no abnormalities are observed, the physician proceeds with the placement of the balloon through the mouth and down the oesophagus into the stomach. Once the balloon is inside the stomach, it is filled with sterile saline through a small filling tube attached to the balloon. Once filled, the doctor removes the tube by gently pulling on the external end, leaving the balloon inside the stomach.
Placement of the balloon takes approximately take 20 minutes, after which you will be monitored by specialist nursing staff in the recovery bay. As this is a “day-only” procedure, you are generally able to be escorted home within two hours after balloon insertion. Although in certain countries like the Philippines, patients are recommended to stay in the hospital for one day for patient care and support.
Who is the BIB® System suitable for?
The BIB® System is designed to assist with weight loss in people who are at least 40% above their ideal weight and who have failed to obtain prolonged weight loss with other weight control programs.
The BIB® System may be particularly useful for people considered too overweight or at increased risk for vital surgery. The use of the BIB® System to successfully reduce weight prior to surgery may help reduce the risks associated with surgical procedures on overweight patients.
How Long Is the BIB® System Balloon Used?
The balloon currently can be used for six months. Longer periods of use are not recommended. Over time the acidic content of the stomach will weaken the balloon material and cause the balloon to deflate. Should your physician recommend use of the balloon for longer than six months, it is necessary that the balloon be replaced with a new one when the six-month interval has been met.
While you are using the balloon, your physician may prescribe a course of oral medication to reduce your stomach acid (this may reduce the possibility of stomach irritation and damage to the balloon).
What Happens if the BIB® System Balloon Deflates Spontaneously?
Your physician will place a coloured dye inside the balloon called Methelyene Blue. This will help you clearly identify early deflation or leakage as it will change the colour of your urine.
The balloon is small enough that it may pass through the intestines and leave the body naturally, but there have been some cases in which it has had to be removed from the bowel surgically. If you suspect a deflation, you must notify your physician immediately.
How Will the BIB® System Balloon Be Removed?
The balloon is removed in the same way it was placed, via the oesophagus and mouth.. Using an endoscopic camera, the physician will introduce a catheter through the mouth and into the stomach. The balloon will then be punctured and deflated. Once the balloon is deflated it can be grasped and removed.
How Much Weight Will I Lose with the BIB® System?
It is important for you to understand that the BIB® System is an aid to weight loss and must be used in conjunction with a diet, exercise and a behaviour modification program. Therefore, the amount of weight you lose will depend on how closely you follow your diet. How long you maintain weight loss will depend on how completely you adopt long-term lifestyle changes involving eating behaviour and exercise.
How does weight loss occur?
Weight reduction begins immediately and proceeds as follows (mean data based on several clinical studies):
Weight loss up to 40 kg
Mean weight loss 15 kg
Excess weight loss 40%
BMI decrease 5 kg/m2
Diet Patients who adhered to a diet of 1000-1500 kcal/day lost an average of 18 kg; those who did not managed only 9.6 kg. Thus the balloon helps those who help themselves, since the usual weight loss principles still apply: avoid carbohydrates and fats, and reduce general caloric intake.
What Unpleasant Effects Are Possible with the BIB® System?
It is very likely that the presence of the balloon in the stomach will cause nausea or vomiting for a few days after placement. Your physician will prescribe medication to help minimize these potential effects.
There exists the possibility that you will lose only a small amount of weight or lose no weight at all while using the balloon. Of course, as stated earlier, your commitment to dietary and behavioural changes is a pivotal factor in the outcome.
There is also the chance that unhealthy, uncontrolled weight loss will occur and create adverse health consequences. Be sure to speak with your physician about this.
Complications
Every kind of treatment has its own possible problems. Fortunately, they are not in this case life-threatening.
Balloon intolerance (5-7% of patients). Symptoms are permanent nausea and vomiting, and sometimes pain. If this cannot be adequately relieved, the balloon must be removed.
Rarely (1%) there can be erosion and ulceration of the stomach, mostly if the patient ignores the instruction to take omeprazole.
Spontaneous rupture of the balloon (2%). This is manifested in green colouration of the urine. The fact is that we purposely add blue medical dye (methylene blue) to the water during balloon inflation, so that if the integrity of the balloon is compromised the dye is absorbed in the intestine and then discharged with the consequently discoloured urine. Generally it is not dangerous, as the empty balloon usually moves along the intestinal tract and is naturally excreted by bowel movement. Nevertheless, cases have been documented of intestinal obstruction by a ruptured balloon, meaning that in case of balloon leakage the patient must inform his/her doctor urgently. The doctor decides whether to remove the leaking balloon or to await its natural evacuation.
Insufficient or negligible weight loss. This becomes more probable if the patient fails to follow therapeutic recommendations.
Feeling of excessive heaviness in the stomach.
Heartburn.
FAQ's (FREQUENTLY ASKED QUESTIONS)
Q: How much weight will I lose?
A: ou can experience significant weight loss averaging between 22-30 kilos; however, your results will depend on how well you follow the program and adjust your eating habits.
Q: Will I be able to feel the balloon in my stomach?
A: There will be discomfort during the first few days. After that, the primary sensation of the Intra Gastric Balloon is a feeling of satiety.
Q: Are there side-effects or complications with the Intra Gastric Balloon?
A: The first three days will be very difficult. Cramping, nausea and vomiting are normal and should be expected. It is very important that you follow your doctor’s instructions. Medication will be given to help ease the discomfort.
Q: How long will it take to recover after the procedure?
A: You should plan at least three days of inactivity to recover from the procedure. You will be able to resume normal activity sooner or later than this depending on how quickly your body adjusts to the Intra Gastric Balloon.
Q: How will the weight-loss results compare with other diet programs?
A: You can expect to lose more weight with the Intra Gastric Balloon. Because the Intra Gastric Balloon gives you a feeling of satiety, you are better able to control your eating and make healthy changes in your habits.
Q: Does the Intra Gastric Balloon require frequent visits to my doctor after the procedure?
A: The follow-up program is critical to success of the balloon and in learning new lifestyle skills. You will meet with your physician and support team at least monthly while the balloon is in place. During this time your progress will be evaluated and you will learn valuable principles of health, nutrition, and exercise that will provide you a foundation for long-term success.
Q: Does the Intra Gastric Balloon limit activity?
A: The first week you should not plan any heavy activity. Once your body has adjusted to the Intra Gastric Balloon, you can continue your normal activities. Starting a regular exercise program is highly recommended and will improve your success.
Q: What happens if the Intra Gastric Balloon leaks?
A: If the Intra Gastric Balloon leaks, you will notice a change in your urine colour (it will be greenish). Although very uncommon, this can be a serious situation. If you notice a change in urine colour, you must call your doctor immediately. If the Intra Gastric Balloon deflates, it will need to be removed by your doctor.
Q: Can I drink alcohol?
A: Alcohol in moderation is fine.
Q: Can I eat anything I want? Are there any food restrictions?
A: You will not feel like eating as much as you used to. In addition, if you eat fatty foods or sweets, you may feel sick. Excessive overeating while the balloon is in place can be dangerous and can result in a serious medical condition.
Q: How is the Intra Gastric Balloon removed?
A: The Intra Gastric Balloon is removed through the mouth in the same manner it was inserted. The 20-minute procedure is performed under Intravenous sedation or a General Anaesthetic.
Q: Must I participate in the follow-up visits to be successful?
A: The Intra Gastric Balloon is not a magic pill, but a tool to change your lifestyle. Taking part in the program will give you the education and support to change your lifestyle habits and have a better chance for long-term success.
Lapband Surgery
What is the Lapband System?
Minimally Invasive Approach
Least Traumatic Procedure
Adjustable Treatment
The LAP-BAND Advantage
What is The Procedure for Lapband Surgery?
What to Expect at the Day of Surgery
Living with the Lap Band System
The First Few Weeks After Surgery
The First Year After Surgery
Optimizing Your Weight Loss Through Adjustments
Continued Well Being with the Lap Band System
FAQs (FREQUENTLY ASKED QUESTIONS)
What is the Lapband System?
![[image]](images/gastric-balloon-2.jpg)
Approved by the FDA in June 2001, the LAP-BAND® Adjustable Gastric Banding system is named by the FDA Office of Device Evaluation as “One of the Significant device Breakthroughs” which is the preferred choice for the minimally-invasive surgical treatment of morbid obesity in the United States. It induces weight loss by reducing the capacity of the stomach (without cutting of intestines or stapling of the stomach), which restricts the amount of food that can be consumed. Since its clinical introduction in 1993, more than 600,000 LAP-BAND procedures have been performed around the world. In the Philippines, LAP-BAND® surgery started in 2004.
Lap Band- Click on the image for an enlarged image.
Minimally Invasive Approach
During the procedure, surgeons usually use laparoscopic techniques (using small incisions and long-shafted instruments), to implant an inflatable silicone band into the patient's abdomen. Like a wristwatch, the band is fastened around the upper stomach to create a new, tiny stomach pouch that limits and controls the amount of food you eat. It also creates a small outlet that slows the emptying process into the stomach and the intestines. As a result, patients experience an earlier sensation of fullness and are satisfied with smaller amounts of food. In turn, this results in weight loss.
Least Traumatic Procedure
Since there is no cutting, stapling or stomach re-routing involved in the LAP-BAND procedure, it is considered the least traumatic of all weight loss surgeries. The laparoscopic approach to the surgery also offers the advantages of reduced post-operative pain, shortened hospital stay and quicker recovery. If for any reason the LAP-BAND needs to be removed, the stomach generally returns to its original form.
Adjustable Treatment
As opposed to other types of weight loss surgery the LAP-BAND is adjustable and can be easily adjusted after surgery to meet patient’s requirements. The diameter of the band is adjustable for a customized weight-loss rate. Your individual needs can change as you lose weight. For example, pregnant patients can expand their band to accommodate a growing fetus, while patients who aren't experiencing significant weight loss can have their bands tightened.
![[image]](images/gastric-balloon-6.jpg)
Click on the image for an enlarged image
To modify the size of the band, its inner surface can be inflated or deflated with a saline solution. The band is connected by tubing to an access port, which is placed well below the skin during surgery. After the operation, the surgeon can control the amount of saline in the band by entering the port with a fine needle through the skin.
Click on the images for enlarged images.
The LAP-BAND Advantage
Minimal Trauma
Least invasive surgical option
No intestinal re-routing
No cutting or stapling of the stomach wall or bowel
Reduced patient pain, hospital length-of-stay and recovery period
Fewer Risks and Side Effects
Significantly lower mortality risk than other obesity surgery procedures
Low risk of nutritional deficiencies associated with gastric bypass
Reduced risk of hair loss
No "dumping syndrome" related to dietary intake restrictions
Adjustable
Allows individualized degree of restriction for ideal, long-term weight loss.
Adjustments performed without additional surgery
Supports pregnancy by allowing stomach outlet size to be opened for increased nutritional needs
Reversible
Effective Long-Term Weight Loss
More than 600,000 LAP-BAND procedures have been performed around the world (as of July 2008, with the U.S. performing close to 4,000 procedures a month).
For the BIB, More than 100,000 procedures performed
Standard of care for hundreds of practices around the world
More than 1600 scientific publications with more than 10 years follow up
What is the Procedure for Lapband Surgery?
The LAP-BAND System is usually placed laparoscopically while you are under general anesthesia. While you may be in the operating room for two to three hours, the surgery itself typically takes about an hour. First, the surgeon makes a few very small incisions in the abdominal wall and secures "ports" in these incisions to accommodate long, thin surgical instruments. A narrow camera is also passed through one of these ports so that the surgeon can view the operative site on a nearby video monitor. A small tunnel is made behind the top of the stomach to let the LAP-BAND System device through and allow it to be wrapped around the upper part of the stomach, like a wristwatch. The LAP-BAND System is then locked securely in a ring around the stomach. This creates your new, smaller stomach pouch. Also, to help hold the LAP-BAND in place, stomach tissue is folded over it and stitched together. The rest of the lower stomach will stay in its normal position. Then, the small access port, which is used for LAP-BAND adjustments, is fixed just underneath the skin. The access port is used by the surgeon to inject saline (sterile salt water) into the LAP-BAND when you have an adjustment. The LAP-BAND System is usually left empty for the first 4 to 6 weeks after surgery.
What to Expect on the Day of Surgery
Although it's normal to be nervous, the day of your weight loss surgery is really an exciting day because it's a major milestone on your road to a healthier, happier life. Here is a general overview of how to get ready for your LAP-BAND surgery, and what to expect that day.
Preparing for Surgery
Before your surgery, your surgeon will discuss your procedure in detail with you. It is also very important to discuss your overall health and your health history. You need to let your surgeon know if you have any current/past health conditions, are allergic to any drugs, or have ever had a bad reaction to anesthesia. In addition, make a list of all the medications that you take, including aspirin, injections, all prescription and over-the-counter drugs, herbal supplements, vitamins, and recreational drugs, and give it to your surgeon.
Your doctor may also want you to meet with other medical experts, such as a dietitian and/or psychologist, to help you understand what will happen during and after the LAP-BAND surgery process. They will help you make certain that you are mentally and emotionally prepared for surgery and your new life with the LAP-BAND® System. Additionally, you will have a number of tests before your surgery to evaluate your general state of health.
On the day before your procedure, you will need to follow specific instructions to ensure all goes well the next day. Your surgeon and medical team will provide you with a complete list of instructions on how to prepare for the surgery. Here are two general guidelines:
Do not eat or drink anything after midnight. Your stomach must be empty for surgery to minimize risks during the operation.
Ask a friend or a family member to be at the hospital with you for comfort and support and to drive you home after the surgery. You may also want him or her to help you get settled at home.
What to Expect on Surgery Day
Please note that although this experience is typical, the routine at your healthcare facility may be different. You will be admitted to the hospital either the day before, or on the morning of your surgery. You may be in the operating room for two or three hours, but the actual procedure typically takes about one hour. Then you will spend a few hours in the recovery room. Once the anesthesia has worn off, you may feel some pain or discomfort, which can usually be treated with ordinary pain relievers. The hospital staff will help you get out of bed and start moving as soon as possible to help prevent blood clots, respiratory problems, and bedsores.
On the day after the surgery, you will likely have an X-ray. This allows your health team to see that the LAP-BAND is in the right place and that the new stomach outlet is open. You may be asked to swallow a liquid that can be seen on X-ray.
For LAP-BAND surgery, hospitalization is usually less than 24 hours. The hospital stay may be longer if there are complications or if the surgeon has to change to an "open" surgical procedure.
Post Surgery FAQs
You will likely have lots of questions for your surgeon about the LAP-BAND® Adjustable Gastric Banding System surgery itself, and what your life will be like afterwards. Here are some typical questions that our patients have had. Remember, if your question(s) is not answered here, don't hesitate to ask your surgeon.
Q: Will I be sick a lot after the operation?
A: The LAP-BAND limits the amount of food you can eat at one time. If you feel nauseated on a regular basis, it could mean that you aren't chewing your food well enough or that you aren't following the post-surgical diet rules properly. However, it could also mean that there is a problem with the placement of the LAP-BAND® System, so contact your doctor if you continue to get sick. You must avoid vomiting as much as possible because it can cause your small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the LAP-BAND® System, offsetting the effectiveness of your surgery. In some severe cases, damage due to vomiting can mean another operation.
Q: Will I feel hungry or deprived with the LAP-BAND® System?
A: The LAP-BAND ® System makes you eat less and feel full in two ways: first, by reducing how much your stomach can hold at one time and second, by increasing the time it takes food to get through your digestive system. After a small meal, the amount of which varies from person to person, you should feel full and satisfied for some time. If you follow the nutrition guidelines when you choose your food and then chew it well, you shouldn't feel hungry or deprived. Remember, the LAP-BAND ® System is a powerful tool to help you change your eating habits.
Q: Can I eat anything in moderation?
A: After your stomach has healed, you may eat most foods that don't cause you discomfort. However, since you can only eat a small amount at a time, it is important that you choose nutritious, vitamin-rich foods as outlined on this site and recommended by your surgeon and/or dietitian. Remember, if you eat foods that contain lots of sugar and fat or drink liquids full of empty calories (milkshakes, sodas), you will still be consuming more calories than you burn, and your weight loss with the LAP-BAND® Adjustable Gastric Banding System may be greatly reduced or even cancelled.
Q: Can I drink alcohol?
A: Alcohol has a lot of calories and breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss.1
Q: Can I go out to eat?
A: Order only a small portion, such as an appetizer. Try to eat as slowly as you can. It will help if you stop eating at the same time as your dinner companions. You might want to let your host or hostess know in advance that you cannot eat very much.
Q: Am I allowed to have my LAP-BAND opened for a special occasion?
A: While it might seem tempting and easy, your LAP-BAND should never be opened to eat a big meal at a special occasion. The LAP-BAND can be opened for medical reasons, though, such as pregnancy, when you will need to increase your nutritional intake.
Q: Does the LAP-BAND limit any physical activity?
A: The LAP-BAND should not hamper any type of physical activity. You should be free to do aerobics, stretches, and any strenuous exercise you enjoy once you've completely recovered, and your surgeon gives you the 'ok'.
Q: Do I have to be careful with the access port just underneath my skin?
A: The access port is placed under the skin in the abdominal wall, and once the incisions have healed, it should not cause discomfort or limit any physical exercise. The only sensation you may experience from the port occurs when you go in for adjustments. If you feel persistent discomfort in the port area, talk to your doctor.
Q: How do I get my LAP-BAND story featured on the Web site?
A: It's great that you want to share your LAP-BAND story with others, so that they, too, can be inspired to make this life-changing weight loss surgery. All testimonials that are submitted will be reviewed, and any one of them may be highlighted on the web site at Allergan's discretion. We will notify you if your story has been chosen to be featured. If you update your story, it will be re-submitted. Remember, by submitting your LAP-BAND story, you agree to release your name and likeness for posting on the LAP-BAND Web site.
Q: Can I update my “LAP-BAND® profile” to illustrate my LAP-BAND story and my progress (pounds lost to date)?
A: As you continue to reach milestones during your LAP-BAND journey, we encourage you to update your LAP-BAND profile to track your progress. You can keep updating your progress, so that your profile accurately reflects how much weight you have lost at each point.
Living with the Lap Band System
The First Few Weeks After Surgery
During the first few weeks after surgery, you need to take the time to recover and to start adjusting to your new life with the LAP-BAND® Adjustable Gastric Banding System. A big part of your long term weight loss success will be your motivation and commitment to a new lifestyle that includes a new diet and exercise plan, routine check-ups with your surgeon, ongoing LAP-BAND adjustments, support group meetings, and more. However, be patient with yourself in the first weeks after surgery. You've already taken the biggest step - the first one. Now, it'll be a new life and lifestyle you create over time, not overnight. Your doctor will work with you to address your needs specifically. Below are some guidelines:
Recovery
Here are some key points for your recovery in the first few days and weeks.
First Days
You can expect some soreness, especially where the access port is, but it should subside (Please call your surgeon if the pain persists after a few days).
To prevent infection, your surgeon may tell you not to shower for a day or so after surgery.
Try to walk as much as you can comfortably, so that you'll regain strength and prevent blood clots, but take it slowly.
First Week(s)
During the first week after surgery, allow yourself to recover and get plenty of rest.
In about a week, you should be able to return to work, provided it's not physically demanding.
For more physically active jobs, allow yourself two to three weeks to recover.
Within four to six weeks, you should be able to resume all normal activity and start a new exercise program.
Note: Before engaging in any physical activity or exercise program, first consult your surgeon. Many surgeons see their patients weekly or biweekly during the first month after surgery, so you will be sure your recovery is going well, and have any questions answered.
Dietary Guidelines
After surgery, you'll need a new nutrition plan. You'll learn about the positive changes you can and need to make in your diet and lifestyle from your surgeon and/or dietitian. It's very important to follow your new eating and drinking instructions beginning immediately after the surgery.
In the first few weeks after your LAP-BAND surgery, you will be on a liquid diet since only thin liquids will be tolerated by your stomach at that time. As you heal, you will gradually progress to pureed foods (three to four weeks post-op) and then soft foods (five weeks post-op). Finally, after about six weeks, you will be able to eat solid foods.
The First Few Days Post-Surgery
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It's extremely important to follow the eating and drinking instructions immediately after the surgery. This allows your new stomach pouch to heal completely and the LAP-BAND to stay in the right position.
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In the early weeks, it's crucial not to stretch the small stomach pouch above the LAP-BAND® System. Vomiting will do this, while also increasing the chance of stomach tissue slipping up through the band.
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Right after the surgery, you can take an occasional sip of water or suck on an ice cube. Don't take any more liquid than this, though.
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The day after the operation, you can take a little more fluid but only a small amount at a time. Besides water, you should also choose clear liquids that have an adequate number of calories. To prevent nausea and vomiting, do not drink too much.
Liquid Diet (1-2 weeks post-surgery)
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Your goal during the first few weeks is to protect the small stomach pouch so that you can heal properly. It can only tolerate thin liquids at this time. It's also important to stay hydrated by drinking lots of water (small amounts at a time).
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Other liquids recommended during this phase include:
Pureed Foods (3-4 weeks post-surgery)
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Now, you can start adding slightly textured foods. Think of the consistency of baby foods. This stage will help you transition to more solid foods later.
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Protein is very important for maintaining muscle while you lose weight. So, you should eat protein-rich foods first, and then move on to fruits and vegetables.
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Foods in this stage may include:
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Please note: In the first few weeks you may be able to eat foods that might not be allowed in your diet later, because they may contain too many calories.
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Remember, it's more important in the first few weeks to let your stomach adjust to the LAP-BAND than it is to lose weight. Also, your personal timing and progression into each dietary phase depends on your progress. In general, when it comes to your nutrition, you should follow the advice of your surgeon and/or dietitian.
Soft Foods (5 weeks post-surgery)
Your meals can now include tender, cooked foods like fish and ground turkey.
Now that you can chew, make it a habit to chew foods well.
If you have dentures, be sure to cut your food into small pieces and chew your food thoroughly. By not chewing properly, you may experience vomiting, stomach irritation and swelling. You could also have stoma obstruction (obstruction of the stomach opening created by the LAP-BAND® System).
Some products like bread, red meat, and rice may still cause you problems, so it is better to eat softer foods that are easier to digest. These might include foods such as moist white meat (chicken or pork) and fish.
If solid foods cause any nausea and vomiting, go back to the liquid diet you had earlier. Then you can slowly add soft foods and eventually transition to solid foods.
Always ask your doctor or dietitian for advice that is specific to you. Again, remember that vomiting may increase the incidence of band slippage, stomach slippage, or stretching of the small stomach pouch above the LAP-BAND®.
Your First Adjustment
The first adjustment usually occurs about six weeks after surgery, although the exact time varies from patient to patient. The LAP-BAND is designed to help you achieve steady and safe weight loss, so don't be in a hurry. You and your surgeon will decide when the time is right for you to have your first adjustment.
At your first adjustment appointment, you should expect to discuss your eating habits, exercise, and rate of weight loss. This will help determine if it's time for you to have a band adjustment. If it is, you can expect the following:
An evaluation of your pouch size and stoma size before adjusting the band (this isn't always done. Your surgeon may or may not evaluate your pouch size and stoma size before the adjustment.)
Adjustment of your LAP-BAND
Evaluation of your pouch size and stoma size after the procedure to confirm that the proper band adjustment has been made.
The First Year After Surgery
During the first year after your surgery, you'll become comfortable with your new lifestyle and understand how the LAP-BAND® Adjustable Gastric Banding System works. You'll have one or more adjustments, as you learn to truly listen to your body in order to maximize your weight-loss results. You will also know where to get the support you need.
Remember, the key to your success with the LAP-BAND is the commitment to a lifelong program that will help you meet and continue your weight loss and maintenance goals. This multifaceted LAP-BAND program will include:
routine check-ups with your surgeon
ongoing LAP-BAND adjustments if necessary
LAP-BAND -friendly nutrition and exercise plan
regular attendance at LAP-BAND support group meetings.
talking with your LAP-BANDweight loss management team honestly and following their advice.
Check-ups and Adjustments
Dietary Guidelines
Exercise Guidelines
Check-ups and Adjustments
It is recommended that as a LAP-BANDpatient, you see your surgeon every four to six weeks during the first year after your surgery. If you need any adjustments, they'll be performed during these visits. Over the first year, LAP-BANDpatients average five to eight adjustments. Your stomach needs to adjust with you as your body changes. A few people never need an adjustment, while others need five or more. It's all about making sure you are losing weight steadily and safely. Click here to learn more about adjustments.
Dietary Guidelines
Once you can eat solid foods without problems, you need to carefully follow your new diet:
Avoid drinking liquids during or immediately after meals as liquids tend to flush food through the stomach pouch. This prevents you from getting that prolonged feeling of satisfaction needed to help you eat less.
As always, staying hydrated throughout the day is important, however. Drink at least six to eight cups of water per day, and make sure you consume them between meals.
Chew your food thoroughly and eat small bites so that the food can easily fit through the opening to your stomach pouch. This will help you avoid the problem of food blocking the stomach outlet.
Only eat when you are hungry and no more than three small meals a day, but you must make sure that these meals contain adequate nutrition. Remember, your stomach can only hold about one-quarter of a cup of food, or two ounces, at a time. Stop eating when your hunger is gone or when you feel comfortable.
The general nutrition guide below can help you create good and healthy meals that contain adequate nutrients but low sugar and fat:
Good Food Choices
Breads and cereals
One small portion of low-sugar cold or hot cereal
Half to one slice of toasted whole wheat or rye bread each day.
Note: Some patients have difficulty eating bread
Meat, fish, poultry, eggs
One to two ounces of meat, fish, or poultry-or one egg each day.
Remove all visible fat from the meat.
Remove the skin from poultry.
Prepare the meat in ways that need very little fat. Grilling, steaming, microwaving, or boiling are all good ways to do this.
Note: Some patients have difficulty eating meat.
Dairy products
Milk and yogurt are calories in liquid form. However, these types of food have calcium, which makes them an important part of a healthy daily diet, so choose a maximum of 2 cups of skimmed milk or low-fat yogurt and 1 ounce of cheese a day.
Fats
Drinks
Drink as many calorie-free liquids per day as you wish (though not with meals).
Suitable drinks are tea or coffee (black) with low-calorie sweetener, water, non-carbonated beverages containing few or no calories
Some doctors have reported that carbonated beverages may contribute to enlargement of the small pouch and recommend they be avoided.
Foods to Avoid
Some foods deliver a concentrated supply of calories but little nutritional value. These foods should be avoided whenever possible. They include:
Common Problem Foods
Some foods have difficulty passing through the stomach opening created by the LAP-BANDand may cause blockage. These include:
dry meat
shrimp
untoasted or doughy bread
rice
peanut butter
fibrous vegetables like corn, asparagus, and celery
nuts
greasy or fried food
membrane of citrus fruits
Introduce these foods slowly and individually to see if you can tolerate them. Always be careful, chew well, and follow your surgeon's or dietitian's advice.
Exercise Guidelines
Incorporating regular physical activity into your daily routine is as important as following your nutrition plan. Often overweight patients become inactive because they have very little tolerance for exercise, psychological constraints such as fear of failure or pain, and in some cases, physical disabilities. After LAP-BAND surgery, aerobic activities-particularly walking and swimming-are generally the easiest for you to handle. You will need to consult with your surgeon and weight-management team to find out which activity is right for you.
Optimizing Your Weight Loss Through Adjustments
Adjustments
Getting Adjustments
Video Transcript
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Being able to adjust the LAP-BAND® Adjustable Gastric Banding System gives you and your surgeon control over your weight loss progress. If the LAP-BAND® is too tight, your surgeon can loosen it by taking out some of the fluid. If the LAP-BAND® is too loose, your surgeon can tighten it by injecting fluid into your access port. Only a clinician trained and authorized by Allergan can adjust your LAP-BAND® System. Never let an untrained clinician or a non-medical person do it, and never try to adjust your own LAP-BAND® System. You could cause bad reactions or damage your LAP-BAND® device.
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LAP-BAND adjustment animation
Click here to view the LAP-BAND adjustment animation.
When the LAP-BAND® Adjustable Gastric Banding System is first placed, your surgeon usually leaves it empty or only partially inflated. This gives your body the chance to get accustomed to your during the first few weeks after surgery. It also allows healing to occur around the new LAP-BAND site. It's critical during this time to avoid vomiting and/or putting any pressure on your new small stomach above the band. The first time the LAP-BANDis adjusted is usually four to six weeks after surgery, although the exact time will vary from patient to patient. During the first year, most patients get between five and eight adjustments. Sometimes, small adjustments are made over the years. During each adjustment, a very small amount of saline will be added to or removed from the LAP-BAND® System.
You may feel a pricking sensation during an adjustment, as the surgeon will use a fine needle to inject or withdraw fluid from your access port, which is located under your skin. The feeling is similar to the pinprick you feel when you give blood. Sterile saline is used to adjust the LAP-BAND® System. Saline is a type of salt water, just like your body's natural fluid, similar to tears.
Adjustments are done either in the surgeon's office or hospital using a palpation method (simply pressing down on the skin to locate the access port) or via X-ray equipment (fluoroscopy). The surgeon may also use fluoroscopy to guide the needle into the port or to evaluate your pouch size and stoma size after the adjustment. As you take a drink of a special liquid (usually called barium), your surgeon will be able to watch it travel down your esophagus into the small upper stomach pouch, through your stoma, and into your big lower stomach.
To get the best results, you may need more than one adjustment. The most common reasons for adjustments are not being able to eat without feeling uncomfortable or vomiting, being able to eat too much without feeling full, or not losing weight.
What is the Green Zone?
Video Transcript
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Get into "The Green Zone"
The LAP-BANDJourney is different for each person and the exact amount of fluid required to make the new stomach opening the right size is unique. An ideal "fill" level should be just tight enough to let you gradually lose weight. That means you should still be able to eat enough to get the nutrients that you need, while still reducing the overall amount you can actually eat.
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Continued Well-Being with the LAP-BAND® System
Video Transcript
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Your weight-loss journey with the LAP-BAND® Adjustable Gastric Banding System is a lifelong commitment that will help you reach and maintain a healthy weight. Always remember that your positive attitude, self-discipline, and the ability to plan ahead will be the keys to achieving your weight-loss goals. Here is an overview of long-term living with the LAP-BAND® System.
Your Weight-Loss Progress
Weight loss with the LAP-BAND is a gradual process. Most people lose about one to three pounds per week for the first year. In the second year, the weight may come off more slowly or you may even stay the same for several weeks. If you aren't seeing as much progress on the scale as you would like, don't get discouraged:
Look for "off-scale victories." These victories are things like being able to finally fit into that pair of jeans that you haven't worn for years, or seeing real improvements in weight-related health problems such as back and joint pain, diabetes and sleep apnea. Celebrate!
Click here for My LAP-BAND® Journey
Registering on My LAP-BAND® Journey means that you have a personal way to track your weight loss progress online! It will also help support you along the way by tracking appointments and milestones.
Continue to exercise. Keep in mind that regular exercise will build up your muscle mass (which actually weighs more than fat but helps burn more calories), and what you see on the scale will only be a part of the real picture of your health and fitness.
Keep a food journal. It can be a great tool to help you discover more about your eating habits and review with your weight management team for insights on how to make the most of your personal nutrition plan.
Attend support group meetings. Attending support group meetings (click here for information on Support Groups) can help you appreciate and celebrate your progress, and stay on track. Other patients may share similar experiences or even have suggestions for you. And, it's important to remember that you started on this journey to have a healthier, happier life.
Ten Important Rules for Living with the LAP-BAND® System
Following the food choices covered in detail in the previous section and the general guidelines below is critical to your success. These ten important rules for eating, drinking, and exercise below will help you get the best results with the LAP-BAND® System:
Eat only when you are hungry, and no more than three small meals a day.
Eat slowly and chew thoroughly.
Stop eating as soon as you feel full.
Do not drink while eating.
Do not eat between meals.
Eat only good quality, nutritious food.
Avoid fibrous food.
Drink enough fluids during the day.
Drink only low-calorie liquids.
Exercise/be active at least 30 minutes a day.
Rule 1: Eat only when you are hungry, and no more than three small meals a day.
Your new small stomach pouch can hold only about one-fourth of a cup of food. If you try to eat more than this at one time, you may become nauseated or vomit. If you routinely eat too much, the small stomach pouch may stretch. Frequent vomiting will cancel the effect of the operation and can also cause certain complications, such as stomach slippage. To avoid this, you need to learn to listen to your body and stick to your plan.
Rule 2: Eat slowly and chew thoroughly.
Food can pass through your new stomach only if it's been chewed into very small pieces. Always remember to take more time for your meals and chew your food very well.
Rule 3: Stop eating as soon as you feel full.
Once your stomach is full, your body receives a signal that you have eaten enough. It takes time, though, for you to become aware of this signal. If you rush through your meal, you may eat more than you need. This can lead to nausea and vomiting. Take time to enjoy every bite of your meal. Try to recognize the feeling of fullness-then stop eating at once.
Rule 4: Do not drink while you are eating.
The LAP-BAND® can work only if you eat solid food during your three meals. You should not drink anything for one to two hours after a meal. This allows you to keep the feeling of fullness as long as possible.
Rule 5: Do not eat between meals.
After a meal, do not eat anything else until the next meal. Eating snacks between meals is one of the major reasons for weight-loss failure. It is very important to break this habit. If you have proper "fill" levels (you eat the right foods, slowly) you will not feel hungry in between meals. If you are still feeling hungry, this may be a sign that your LAP-BAND is too loose and you should tell your clinician.
Rule 6: Eat only good quality, nutritious food.
With the LAP-BAND in place, you should be able to eat only a small amount so the food you eat should be as nutritious as possible. Follow the nutrition guidelines in the previous section and specific instructions from your surgeon and/or dietitian. Also, ask your doctor or dietitian before you take any vitamin supplements.
Rule 7: Avoid fibrous food.
Food that contains many fibers, such as asparagus, can block the stoma. That's because you can't chew this food well enough to break it up into small pieces and your saliva can't break it down. Fibrous food should be avoided. If you would like to eat asparagus or other fibrous foods once in a while, then be sure to cook them well, cut them into very small pieces first, and then chew thoroughly.
Rule 8: Drink enough fluids during the day.
Drinking enough fluids is essential for staying hydrated and for flushing waste products out of your body. Individual needs will vary, but you should drink at least six to eight glasses of liquid a day. Remember: Drink only non-carbonated/zero calorie liquids such as water, tea, or coffee (without milk, cream, or sugar). Also, keep your food and drinks completely separate during the day.
Rule 9: Drink only low-calorie liquids.
Drinks, including those containing calories (milkshakes, sodas), simply run through the narrow outlet created by the LAP-BAND. If you drink liquids high in calories, you will lose little weight, even if you follow all of the other dietary guidelines.
Rule 10: Exercise at least 30 minutes a day.
Since physical exercise consumes energy and burns calories, it is a very important part of any successful weight-loss program. Obviously, exercise can also help improve your general health. In addition to adopting a routine exercise program, you can increase your activity level in your everyday life. For example, stand rather than sit, walk rather than stand, be outside rather than inside, walk rather than drive, climb the stairs rather than use the elevator. If it's too hot outside to walk, go to the mall. It's as easy as finding a parking space away from the entrance to the mall and using the stairs, not the escalator! If you don't have time before or after work, take ten minutes out of your lunch break and walk then. Remember that you should always check with your doctor about the amount and type of exercise that is best for you.
Annual Check-Ups
It is typical for follow-up visits to be scheduled every three to six months during the second and third year after surgery, but you should have an office visit with your surgeon at least once a year to check up on your progress and your LAP-BAND. This is just as important as having your annual physical exam.
Complications and Who to Call
If you have any problems during your recovery or at any time after LAP-BAND Adjustable Gastric Banding System surgery, please call your surgeon. Call right away if you have:
A fever of 101 degrees or higher
Sudden shortness of breath or chest pain
Pain, redness, or swelling in one or both of your legs
Nausea or vomiting
Severe pain in your belly
Pain, swelling, or fluid leaking from your cuts
You should also call your surgeon if you experience anything that you think or feel is unusual. If something just feels wrong, don't be afraid to call.
In the case of a medical emergency or when you are out of town, you will need to go to the nearest emergency room facility. You should let the medical personnel there know that you have a LAP-BAND implanted.
FAQs (Frequently Asked Questions)
Q: What are the benefits of the LAP-BAND versus other types of weight loss surgery?
A: Unlike the gastric bypass, the LAP-BAND doesn't involve any stomach stapling, cutting or intestinal re-routing. It can help you achieve steady, healthy and safer weight loss, with a shorter recovery time. And although the LAP-BAND® Adjustable Gastric Banding System is not meant to be removed, it can be, in some cases laparoscopically. Surgeons report that the stomach generally returns to its original shape once the LAP-BAND is removed. After the removal, though, you may gain more weight.
Q: How long is the average recovery period?
A: The average hospital stay is less than 24 hours. Typically, it'll be about a week before you can go back to work, and about a month to six weeks before you can start exercising again. In the case of open surgery, or if there are complications, recovery may take longer.
Q: How many LAP-BAND adjustments are suggested?
A: Don't be in a hurry to have multiple band adjustments - this is a long-term weight loss management program. Your adjustments depend on your individual case and considerations such as how fast and well you are healing post-surgery. Many patients have between five and eight adjustments within the first year after surgery, while others may have only a few. However, adjustments are customized to meet your individual needs. Don't be in a hurry to have an adjustment, as one of the major benefits of the LAP-BAND is a steady, healthy and safe weight loss.
Q: What fluid is used to fill or adjust the LAP-BAND® System?
A: Sterile saline (salt water similar to tears) is used to fill or adjust the LAP-BAND. Saline is used commonly in medical applications as a filler, hydration and cleansing solution.
Q: Will I need to take vitamin supplements?
A: You may. It's possible to not get enough vitamins from three small meals a day. At your regular check-ups, your specialist will evaluate whether you are getting enough vitamin B12, folic acid, and iron. Your surgeon may advise you to take supplements.
Q: Why are diet and exercise important after having the LAP-BAND procedure?
A: Remember that weight-loss surgery is not a quick fix. The LAP-BAND is a powerful surgical tool that can help you lose weight, but your motivation and commitment to a new lifestyle are the real keys to your success. If you don't follow the post-surgery nutrition and exercise guidelines, your weight loss success with the LAP-BAND may be greatly reduced. For example, you should NOT drink any liquids with your food. Liquids pass straight through your upper stomach pouch and into your system. There, you absorb their 'empty' calories (high calorie drinks such as milkshakes or soda), and you won't feel full. Therefore, you may not lose as much weight as you could. In addition to the new nutrition plan, regular exercise helps you lose even more weight, and most importantly, it will also help improve your overall health and wellness.
Q: Can the LAP-BAND be removed?
A: Although the LAP-BAND® Adjustable Gastric Banding System is not meant to be removed, it can be, in some cases laparoscopically. Surgeons report that the stomach generally returns to its original shape once the LAP-BAND is removed. After the removal, though, you may gain more weight.
Q: What are the risks and complications associated with LAP-BAND surgery?
A: As with any surgery, there are risks associated with the LAP-BAND procedure. These include the standard risks of any surgery, such as infection. Other risks include, but are not limited to, nausea and vomiting, band slippage, band erosion, and access port problems.
Q: Can I become pregnant after the procedure?
A: Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. In addition, the LAP-BAND’s adjustability feature supports pregnancy. If you need to eat more while you are pregnant, the LAP-BAND can be loosened. After pregnancy, the LAP-BAND may be made tighter again and you can resume losing weight.
Q: Does the LAP-BAND require frequent visits to the surgeon after surgery?
A: Check-ups with your surgeon are extremely important and highly recommended before and after the procedure for long-term success. During the first year after surgery, patients typically visit their surgeons every four to six weeks, although that will vary from patient to patient. LAP-BAND adjustments can be made during these visits.
Q: Will I need plastic surgery for the surplus skin after I have lost weight?
A: This is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation since the skin will sometimes mold itself around the new body tissue. Give your skin the time it needs to adjust before you decide to have more surgery.
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