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FAQ
It is by nature that people tend to be utterly curious. No matter how much information is presented, what is oftentimes important is asking the right questions. We have compiled the following frequently asked questions for your review.
General Questions
More FAQ
General Questions
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A: Weight-loss results vary from patient to patient, and the amount of weight you may lose depends on several things. The band needs to be in the right position, and you need to be committed to your new lifestyle and eating habits. Obesity surgery is not a miracle cure, and the pounds won't come off by themselves. The adjustable gastric band is a tool to help you achieve weight loss and sustain that weight loss, but you have to use it to your advantage. It is very important to set achievable weight-loss goals from the beginning. A weight loss of 1 to 2 pounds a week (up to 3 lbs/week for someone with a higher BMI) is what we aim for (4-12 pounds in a month). Remember that you should lose weight gradually. Losing weight too fast creates a health risk and can lead to a number of problems. Losing weight faster often leads to a loss of muscle as well as fat. Your main goal is to have weight loss that prevents, improves, or resolves health problems connected with severe obesity.
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A: The adjustable gastric band limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well or that you are not following the diet rules properly. However, it could also mean that there is a problem with the placement of the band so you should contact us if this problem persists. Vomiting should be avoided as much as possible. We consider vomiting as unacceptable. It can cause the small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the band, which would reduce the success of the operation. In some cases, it would also require another operation.
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A: Gastric banding is performed laparoscopically and patients typically spend less than 24 hours in the hospital. We recommend that our patients take a week off from work, but most of our patients don't. We have many patients that have surgery on Friday and go back to work on Monday. We have had several patients that underwent surgery and went back to work the next day, and even one patient that went back to work the same day, but this is against our recommendations. We recommend that patients do not resume exercise or strenuous activity for 4 to 6 weeks after surgery.
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A: The studies involving the adjustable gastric band have shown that the results are comparable to that of the gastric bypass in terms of weight loss at about 3 years. With the gastric bypass, patients lose the majority of their weight in the first 18-24 months. Then they statistically gain 15% of the weight back, sometimes more (some gain all of the weight back). Band patients lose the majority of their weight in the first 3 years, but they do not usually gain any weight back unless they ask to have the saline removed from their band (deflate the band). You should focus on long-term weight loss and remember that it is important to lose weight gradually while reducing obesity-related risks and improving your health.
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A: Check-ups are a normal and a very important part of the adjustable gastric band follow-up. We see all patients in the office 1 week after surgery, then every 2 weeks for the first 6 weeks. Then all patients are seen on a monthly basis (or more often, as needed) for as long as you are still losing weight. When a patient is doing really well, we may let them go 2-3 months. Then the patients are seen every 1-12 months during the weight maintenence phase (more if needed). It is in your best interest to be seen at least once a year for life (more if needed).
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A: The adjustable gastric band does not affect or hamper physical activity including aerobics, stretching, strenuous exercise, or any other activity you choose.
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A: Adjustments are performed in our office. The first adjustment is preformed under fluoroscopy, so that the relevant anatomy can be clearly seen. A fine needle is passed through the skin into the access port to add or remove saline. This process most often takes only a few minutes. Most patients say it is similar to getting a flu shot and is virtually painless.
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A: There are no restrictions based on the access port. It is placed under the skin on top of the abdominal wall muscles, and once the incisions have healed it should not cause discomfort or limit your movements or any physical exercise. The only sensation you may have from the port is when you go in for adjustments. If you feel persistent discomfort in the port area, let us know as soon as possible.
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A: Although the adjustable gastric band is intended to be permanent, it can be removed if necessary. In most cases this can be done laparoscopically. The stomach essentially returns to its original shape once the band is removed. After the removal, though, your appetite will return to pre-surgical levels and you may soon gain back your original weight or even gain more.
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A: That is not always the case. As a rule, plastic surgery will not be considered until you are close to your goal weight (usually at a year or so after the operation). Ocassionally the skin will revert back to its original tone. You should give your skin the time it needs to adjust before you decide to have more surgery.
The real answer is that it depends. Whether or not someone requires plastic surgery typically depends on four things. First, it depends on how old you are. The skin of people in their 20's and 30's simply has better tone and elasticity than people in their 50's and 60's. The younger the person, the more resilliant the skin is. Second, it depends on how much weight you have to lose. If you weigh 500 pounds, there will just be too much excess skin and no matter how much weight is lost or how young the person is, this skin will not revert back to normal tone. This excess skin will need to be surgically removed. Third, it depends on how quickly you lose the weight. If you lose the weight slowly and gradually, you give your skin the best chance of catching up and your skin is healthier. People who have gastric bypass or duodenal switch where weight is lost too quickly, the skin cannot keep up. Plus, weight is lost so quickly (sometimes more than a pound per day in the beginning) that people are severely malnourished. The skin is malnourished and therefore loses it's tone and elasticity(the elastic part of skin is made of protein). In addition, when weight is lost so quickly, people are not only losing fat, but they are also losing muscle, which makes the numbers of lbs look great, but it is not healthy and skin has a tendency to hang.
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A: This is a fairly common feeling, especially for people with bands that are tight or just after an adjustment. During the day the water content in the body changes and this may cause the band to feel "tighter" some of the time. Most patients do not have any problems at any time of the day. Some women have also noticed that the adjustable gastric band feels tighter during menstruation (their period).
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A: The most important mechanism of how the band works is that it takes away hunger. The adjustable gastric band allows you eat less and feel full in two ways -- by reducing the capacity of your stomach and increasing the time it takes food to get through the digestive system. After a small meal, the amount of which varies from person to person, you should feel satisfied (not hungry). If the band is adjusted properly, you should feel full until your next meal. If you follow the nutrition guidelines when you choose your food and then chew it well, you will not feel hungry or deprived. Remember that the band is a tool to help you change your eating habits.
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A: One of the major advantages of the adjustable gastric band is that it can be adjusted. If your illness requires you to eat more, the band can be loosened by removing saline from it. Without saline in the band, it is like it is not even there and people can eat whatever they want. When you have recovered from your illness and are ready to lose weight again, the band can be tightened again by increasing the amount of saline.
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A: If you have had problems with fertility, becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. The adjustable gastric band is the safest surgery to have if you are considering having children. If you need to eat more while you are pregnant, the band can be loosened (so that you can get adequate nutrition to the baby). After the pregnancy, the band may be made tighter again, and you can resume losing weight. It is not recommended that you become pregnant with any other weight loss surgery (gastric bypass, duodenal switch, sleeve gastrectomy, VBG, or BPD) because there is no way to adjust these operations. Because you cannot take in enough nutrition to maintain yourself (losing weight), you cannot get enough nutrition to support a developing baby. Having any of these other surgeries places the pregnancy at "high risk." There is, therefore, a much higher risk of premature births, low birth weight, and birth defects with non-adjustable procedures.
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A: You do not need to take vitamins because your digestive system has not been altered physiologically (as in the gastric bypass). We do recommend that you take vitamins, however, because it is difficult to get the recommended daily allowances of vitamins with the typical American diet. At your regular check-ups, your primary care physician will evaluate whether you are getting enough vitamin B12, folic acid, and iron. [Please see nutritional guidelines in the program manual]
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A: You should be able to take prescribed medication. Most patients have no problems with taking medications, even a large number of pills. Rarely, some patients may need to use capsules, break big tablets in half or dissolve them in water so they do not get stuck in the band opening. You should always ask the doctor who prescribes the drugs about this. Please ask us if you have any questions.
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A: Order only a small amount of food, such as an appetizer. Or order a regular meal and ask for a take out box when you order. When the food comes, immediately put half (or more) of it into the take out box. Many patients state that they often get two or three meals out of every meal at a restaurant. Eat slowly. Finish at the same time as your table companions. Some patients will let the host or hostess know in advance that you cannot eat very much (this is a personal choice, but you will be given a card that states that you have had the surgery). Some patients have told us that some restaurants will make small portions for people that have had weight reduction surgery. Some patients have also told us that many of the buffet restaurants will give a discount for patients after surgery (because you can't eat that much). You will, hopefully, learn to change your perspective about food. You shouldn't concentrate on the food when you go to a restaurant. Rather you should spend more time concentrating on the people that you are with, enjoying their company. Also be aware that restaurant food is usually not as "healthy" as food prepared at home. We have many more tips for going out to restaurants, please ask us.
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A: There is no restriction on alcohol. Having said that, just remember that alcohol has a high number of empty calories. It also breaks down vitamins. A glass of wine or two, or other alcoholic beverage, however, is not considered harmful to weight loss. Many patients state that they feel the effects of alcohol with much less consumed than they used to (so they become "cheap dates").
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A: After your stomach has healed (the band has healed into place), you may eat most foods that don't cause you discomfort. However, because you will be eating only a small amount, it is important to include foods full of important vitamins and nutrients such as those recommended in the nutrition manual you will be given and as you are advised by your surgeon and/or dietitian. If you eat foods that contain a great deal of sugar and/or fat, or you drink liquids full of "empty" calories (such as milkshakes), the effect of the band and your weight loss efforts may be greatly reduced. Healthy eating will help you achieve the greatest amount of success.
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A: Each patient's surgical experience is unique. The adjustable gastric band requires effort from the patient to have proper exercise and diet habits as well as continuous monitoring by the attending physician. There have been cases where patients do not lose the weight expected but this is largely dependent on the person.
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A: There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you eat less fiber. This should not cause you any significant problems. If difficulties do arise, let us know as soon as possible.
More FAQ
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A: You will need to attend an informational meeting to make sure this is a good choice for you. After that, you make an appointment and go for it.
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A. Most insurance companies now cover the gastric banding procedure. However, even companies that routinely cover the surgery may have groups and individual policies that exclude coverage for the treatment of morbid obesity. Be sure to check with your insurance company to see if you have such an exclusion. If you should be denied coverage you have the right to file an appeal (we will be available to help you with your appeal).
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A: Chances are, the group you are calling and the group that received the paperwork are not the same group. Take a deep breath and relax. Give it a few weeks. Then call your Doctor's office. Proceed to call every 2 weeks until you have an approval -- not every day. You will drive them and yourself insane.
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A: A liquid diet is required by most surgeons prior to surgery. It has been proven to shrink the liver and make the surgery safer for you. The first day is usually the toughest. You CAN do it. If you can't, what the heck are you having surgery for? It is 1-2 weeks out of your life -- keep your eye on the prize and go for it!
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- Minimally invasive surgery
- No cutting, stapling, or re-routing like other surgeries
- Stomach stays intact
- Digestive process remains the same -- food still passes through the lower stomach and the full length of the intestine (unlike gastric bypass surgery)
- Does not re-route the digestive tract
- Does not restrict the absorption of nutrients
- No "dumping syndrome" (sometimes seen with bypass surgery)
- Five or fewer tiny incisions in the abdomen (no large incisions)
- Band is adjustable -- increases satiety and encourages patients to gradually eat less
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A. You must be age 18 or older (younger patients will be considered on a case-by-case basis), and at minimum 75 lbs. pounds overweight, or with a Body Mass Index (BMI) of 40+ to be eligible for this surgery (or a BMI of 35+ with significant co-morbidity). You should be in reasonably good health and your health information should include any current or past medical problems. Patients with severe and irreversible medical problems may be considered ineligible for this surgical procedure.
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A. While other weight loss surgeries use cutting and stapling to achieve their effect, the adjustable gastric band procedure does not. No permanent changes are made to the body's physiology. Instead, the surgeon wraps the band around the upper stomach to create a small pouch. The stomach stays intact, and the digestive process remains the same.
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A. Yes, providing pre-op tests do not reveal any other problems.
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A. Generally, being allergic to medication is not contra-indicative to surgery. But we should know what allergy it is.
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A. It is important that you have a good understanding of what is required from you with the adjustable gastric band. We want you to have a thorough understanding of the procedure and care after the operation. Our experienced staff will assist you in learning about the procedure. Commitment to long-term dietary change is key to success with the adjustable gastric band. You must be committed to following up with office visits according to the schedule set for you. You must be able and ready to follow your doctor's advice on dietary changes.
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A. Once in position, an adjustment is done by inflating or deflating the band with a sterile saline solution through the access port located just below the skin.
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A. It is not a common occurrence, and can be caught and remedied early on as long as you listen to your body, and have regular follow-up. With the adjustable gastric band, follow-up care is extremely important to monitor the band's placement and position.
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A. After surgery, you will have to learn new dietary habits. While this new eating pattern is being established, you may expect some episodes of PB-ing (known as productive burping). You will be on a liquid diet for two weeks immediately following surgery, before more solid foods are reintroduced to your diet. Eating too much at one sitting, or eating improperly, can cause vomiting. Diarrhea is not uncommon during the first couple of weeks after surgery. While the anesthesia can often cause loose stools, the all-liquid diet for the first several weeks will generally result in diarrhea.
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A. Since laparoscopic surgery is minimally invasive, there is very little scarring. You will typically have 5 or fewer small incisions that usually heal quickly.
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A. Any gastric operation for obesity is major surgery and carries with it the risks that would go with any complex operation. Although the adjustable gastric band procedure is minimally invasive surgery, it is not without its own risks. Infections can develop around the stomach band or at the site where the reservoir is placed under the skin. The access port or the band may leak and may need to be replaced (although this is very uncommon). While the risk of dying during the operation is small (about 1 in 10000), there is a slight risk because of either a heart attack or a life-threatening blood clot passing into the lungs (pulmonary embolism).
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A. Reflux usually reduces after weight loss surgery. Obesity can put extra pressure on muscles that lead to acid reflux. Losing weight may reduce reflux. Also, the position of the band can help prevent excessive stomach acid from reaching and irritating the lining of the esophagus, which can also help reduce the effects of reflux.
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A. Complications are much less common than during the FDA clinical trials due to improved techniques. But the known complications include band slippage, band erosion, tubing leak, port infection, and esophageal dilation.
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It is important that you ask us any and all questions you have about obesity surgery and the adjustable gastric band.
