You eat anything you want and you still lose weight!

My brother (18 months my junior) is a highly intelligent man. This was proven decades ago, when IQ tests performed while his teachers and parents tried to figure out why he was such a miserable little bugger showed a genius level IQ. I know that sentence sounds unsympathetic to my brother, but we were all miserable - our parents, his teachers, me, and my brother.

When I first talked with him about weight loss surgery, many years later, this highly intelligent and (by then) well-read man said, "Wow! So, you have the surgery, and then you eat anything you want and you still lose weight!"

Well, no. Not really. In fact, nothing like that.

During the 6 years of my weight loss surgery journey, I have (over and over and over again) witnessed bariatric patients who came out of the operating room after surgically successful procedures still wondering why they couldn't eat anything want and still lose weight. Their disappointing weight loss was and is a perpetual puzzle to them because somehow they had not grasped that behavioral change is required for weight loss success.

It's easy to label those patients as stupid or ignorant or deluded, or to blame their bariatric team for failure to properly educate those patients about what would be required of them both pre- and post-op. All of those things could be a factor.

In March 2012, almost 6 years since the start of my own WLS journey, I attended 2 sessions of a required pre-op nutrition and education class. My BMI then made me obese, but not morbidly so. I had gained weight after a complete unfill and was preparing to say goodbye to my beloved band due to medical problems aggravated by my band, planning to revise to vertical sleeve gastrectomy in the same procedure.

The dietitian leading the class was a perky, pretty 20-something girl, adorably pregnant, who had clearly never struggled with her weight before. Her slightly condescending attitude was hard to take, but about halfway through the class I thought I could understand her attitude. She had just named a long list of foods we should not eat after surgery (fried foods, candy, baked goodies, soda, alcohol, salty snacks, etc.) when I heard a woman nearby say bitterly, "I don't know. That seems like an awful lot to give up."

Since I had known the before and after of WLS, I was strongly tempted to respond to her, but I held my tongue (wisely, for once).

I don't know just why so many people think that WLS is magic, that you can eat anything you want and still lose weight, that you don't have to give up a single food or behavior or attitude in order to succeed. Maybe we can blame that attitude on the media, or maybe we can blame it on the deeply-entrenched denial that tends to go along with obesity. But the fact is, you can't eat anything and still lose weight unless you're dying of cancer or AIDs or some other fatal disease, and probably don't want to eat a single bite of anything anyway. And I'd trade dying of cancer for WLS sacrifices and success any old day.

Band Myth #6

#6 – THE MORE FILL, THE BETTER

I’ve heard bariatric surgeons comment that some band patients seem to be addicted to fills. I can identify with that because I had a good relationship with my band surgeon who not only administered my fills but gave me a lot of encouragement as well as answers to my many questions. I left each fill appointment with a renewed sense of commitment and hope. How can you not get hooked on something good like that? 

The problem with equating fills with weight loss success is that more fill is not always better. In fact, too much fill (which varies from one patient to the next, and also varies in a single patient as time goes on and the patient’s body keeps changing) can be downright dangerous. An overfilled band, and the side effects it causes (see #5 above), can lead to a complication like a band slip, esophageal dilation, or stomach dilation. While complications can come out of nowhere, most bariatric surgeons agree that too much saline in the band puts too much pressure on the stomach. Eventually something’s got to give. That’s often hastened by the patient’s efforts to eat around the problem, and it is absolutely not a guarantee of weight loss. I gained weight several times because of what’s called Soft Calorie Syndrome. My band was too tight and I was dealing with it by consuming mostly soft and liquid calories that offered little or no satiety.  

The human body is an incredible organism, capable of amazing feats of growth and healing that we take mostly for granted, but it’s not endlessly forgiving. Too much fill in your band, too many eating problems, too much inflammation and irritation in the upper GI tract, can compromise your body’s ability to recover from a complication like a band slip. Sometimes a complication can be treated conservatively, with an unfill and rest period, but sometimes it requires a surgical fix, including removal of the band. And after all you’ve gone through to get that band wrapped around your stomach, shouldn’t you be doing your utmost to treat it (and your body) with respect? 

Finally, the fill myth can cause us to overlook a very important guest at your WLS party….you. If you are going to succeed with your band, lose weight and keep it off and keep that band safe and sound inside you, sooner or later you will have to take personal responsibility for your success. Expecting your band alone to carry you to your goal weight is like expecting your car to safely deliver your child to school without anybody in the driver’s seat. And I sure hope that you are a very important person in your life!

Band Myth #5

#5: NO SIDE EFFECTS MEANS MY BAND ISN'T WORKING

 

Equating side effects with a properly working band is very common, and potentially very harmful. The two most significant signs of the band’s proper functioning are (1) early satiety and (2) prolonged satiety. Those signs are rarely expressed in large, bold, uppercase letters, such as

STOP EATING NOW!

Those signs won’t be accompanied by clanging bells or flashing lights, either. In fact, the less noise and distraction (such as “Why don’t I have stuck episodes?”), the more likely you are to be able to recognize early and prolonged satiety. 

Before I tell you why the no side effects = broken band worry is a sign of mythical thinking, let’s make sure we agree on the definition of a side effect, and how that relates to complications. A side effect is an unintentional or unwanted effect of a medical treatment, and it’s usually exceeded (or at least balanced) by the benefits (the intentional, wanted effects) of that treatment. For example, antibiotics can cause diarrhea. That’s an unpleasant side effect, but an untreated infection can have far worse consequences for the patient. Side effects can often be managed by tweaking or changing the treatment, and they are rarely worse than the original condition.  

 

A complication, on the other hand, is a more acute, serious consequence of a medical treatment, and usually needs a more aggressive approach, including surgery to fix the problem. Now let’s go back to the antibiotic example. An allergic, anaphylactic reaction to the antibiotic can be fatal without prompt medical treatment. That’s a complication, and it’s far worse than the original condition.  

So in the context of all that, it seems strange to me when bandsters long for side effects like regurgitation (PB’s), stuck episodes, and sliming. Instead of looking for more subtle clues from their bodies (like early and prolonged satiety), they go looking for problems, and worse than that, they tend to “test” their band with foolish eating and/or overeating, hoping to provoke a side effect that will signal to them that they really do have a band in there. One of the many problems with that approach is that it can also provoke a complication.