Colleen Cook from Bariatric Support Centers International was on Weight Loss Surgery Radio last week with Cher Ewing and Jeff Cadwell. She had weight loss surgery back in the late nineties and discovered that there was no real support system in place for the patients - so she created one. Anyway, they’ve done a close look at their client’s who successfully reach their goal weights and these are the principles they’ve found in common.
Oooooooh, this is sooooo interesting. One of the things I really want to do after I get my Lap Band is go diving. I’ve never been SCUBA diving in my life, and living so close to the beautiful waters of Mexico, I really want to at least once. Just once. Maybe twice. Anyway, I found this fascinating article about bariatric surgery and diving. It covers all of the weight loss surgery techniques and the risks to divers from each.
The news for bandees is good:
Adjustable Banded Gastroplasty or “Lap Band” isanother more restrictive procedure which reduces the size of the stomach. Following the surgery, the patient’s stomach may only hold 1-2 tablespoons in volume. This method drastically reduces the amount of food the patient can consume at any one time; digestion continues normally; and nutritional problems such as anemia and osteoporosisare almost nonexistent. The patient does not require as much ongoing medical supervision or dietary supplements.
Patients choosing this procedure must be very selective about the food they eat: since absorption is not altered, any foods high in calories, sugars and fat will have the same affect on the body as they did before the surgery. If a patient consumes too much food or large pieces of food, vomiting can result.
After surgery, some patients experience chronic acid reflux. Reflux and regurgitation of fluid and gastric liquid can present problems for a diver in the “head down” position, such as during descent. Divers can manage problems of regurgitation or vomiting through proper dietary considerations and possibly medications.
The estimation of “1-2 tablespoons in volume” is pretty extreme. In truth, you’ll be eating 6 to 8 ounces of food per meal - or a “half glass” of food as Dr. Paul O’Brien likes to put it. In the real world, that’s the equivalent of a McDonald’s Double Cheeseburger and a small order of McDonald’s Fries. Of course, you won’t be eating at McDonald’s if you want to lose weight, but you can see where a meal of that size would be perfectly satisfying emotionally. And of course, with the Lap Band, you’ll be quite full as well.
So, for me, it’s to Mexico for my Lap Band surgery, and then hopefully, one year later, back for a SCUBA trip. I can’t wait. Palancar Gardens - here I come!
This is a clip from National Health Journal with Dr. David Davtyan of the Beverly Hills Weight Loss Clinic. It has good animations - at least one of which I have seen before - including an animation of how the inner ring fills up to make the band adjustable. Dr. Davtyan is a Lap Band patient as well, and feels like that has really helped him to understand how the adjustability works best.
There’s a blog post that I’m sure a lot of people who are researching Lap Bands right now are seeing in which a young woman is telling her tale of getting Lap Band surgery in Mexico four years ago. At that point in time, surgeons weren’t doing fills for the patients of other surgeons, so she had to fly to Mexico everytime she needed a fill - a situation that has now changed. Anyway, she expresses the idea that had she not needed to fly to Mexico for a fill, she would have had fills several times a month, rather than over the course of several months. This isn’t accurate - you wouldn’t have fills several times a month. According to Dr. Paul O’Brien, who is the Director of The Centre For Obesity Research and Education at Monash University in Australia, you’ll have your first adjustment 4 weeks post op. At that point, you’ll have adjustments every two weeks or so, until you hit what he calls “the green zone”. It takes about a week to determine how the particular fill is affecting you and most physicians prefer to have a little more data before they proceed again. Once you hit the green zone, the time between adjustments stretches out from four weeks, to six weeks to three months, to six months. It just depends. I’ve talked to a few people who have lost all of their weight with four or five adjustments. Some people require more.
For those of you who are new to this - the port is located somewhere just to the side of your belly button. Fills are simple and painless. You lay down a table, put your hands behind your head and life your legs slightly. That causes your tummy muscles to tighten up and the physician feels for the port. Once found, they swab the area to clean it, spray a local anesthetic on it (no shot) and do a quick injection. They withdraw all the saline from your Lap Band so that they are sure how much is already there, and then inject the full new amount. It’s all over in under two minutes.
Here’s a video of a Lap Band fill being done:
Here’s Love My Lap Band Interviewee Lorraine Kay talking about her fill (among a few other things). Now, Lorraine’s experience involves a barrium X-ray so they can check things out a little more thoroughly, and that’s more likely to happen with someone whose procedure is being covered by insurance. Still, she makes the point quite well that it’s quick and simple.
And here is Becca getting a Lap Band fill in her physician’s office:
Fill Centers USA has 30 locations around the nation and has an entire post-operative support program. They handle fills, and provide the post-surgical support helping you learn to use your Lap Band to the most positive end possible. One of the things we know, is that people who have post-surgical support lose more weight, and have an all around happier experience. So, if you’re contemplating surgery in Mexico, this is an option you should consider.
If you’re just investigating Lap Band surgery, I’d encourage to read Dr. Paul O’Brien’s book THE LAP BAND SOLUTION. He covers all of the basic information in a clear, concise, easy-to-read manual. He’s one of the premier experts on Lap Bands in the world, and has been formally researching their efficacy since the early nineties.
Poking around YouTube today, I found these three videos for Dr. Terry Simpson in Phoenix, Arizona. You may recognize his name from my blog - previously I’ve linked a podcast to a radio show he did with Cher Ewing and Jeff Cadwell for Weight Loss Surgery radio. He’s an interesting guy and I’ve enjoyed listening to him. At his website, he has a lot of podcasts that he links on different aspects of life with a Lap Band.
This first YouTube video covers eating in the weeks following a Lap Band procedure. The first few days, it’s warm liquids. After that, you can have some soft food like mashed potatos. Then you move on to solid food, and he gives a run down of what you should avoid. Lastly, he talks about how much you should eat, and the fact that you should sit down and eat it when you do. There is always plenty of good information with him.
In this video, he talks about how the Lap Band works. He has a animation of a Lap Band when the video first opens that is silent - so nothing has gone wrong with your computer.
I just watched FAT: What No One Is Telling You - a PBS documentary about obesity and weight loss surgery. They interview Dr. Lee Kaplan extensively and it’s always good to hear what he has to say. He does discuss just how complex weight gain is and states, for the record, that only 5% of people who have gastric bypasses get all the way down to a normal weight. Very interesting. They also interview Dr. Michael Gershon who talks about the gut being a second brain for our body. He even composes poetry to the intestine.
As a young man, Michael Gershon, professor of medicine at Columbia University, went against the wishes of his father and the advice of his professors who urged him to study the brain. Instead, he set off on an exploration of the bowel. Intrigued by some long-forgotten 20th century scientific discoveries about an independent nervous system in the gut, Dr. Gershon’s research uncovered how this sophisticated physiological wiring functions essentially as a “second brain.” The gut, it turns out, has a mind of its own and plays a major role in deciding when and how much we eat. When the brain in the head says eat less and in moderation, the “second brain” in the gut can override the brain in the head and propel us to eat more and without restraint.
Obesity expert Dr. Lee Kaplan and his team at Massachusetts General Hospital compare the body’s hunger drive to the human body’s response to running up six flights of stairs. You can force yourself to breathe slowly for a few seconds, despite this exertion, but ultimately your body will demand more oxygen and you’ll breathe faster. When it comes to decisions about how much to eat, a similar battle occurs between your conscious will and your subconscious. And if your subconscious brain wants more food, it wins and you eat more.
A study of gastric bypass surgery has led Dr. Kaplan to a compelling discovery about how the body regulates food consumption, and the hope that someday surgery can be avoided altogether. Dr. Kaplan has found that weight loss in surgery patients is not just a result of making the stomach smaller. The surgery actually reduces the feeling of hunger by cutting some of the nerves in the bowel, which changes the signals that flow between the gut and the brain. It also alters the way the hormonal system gets its information from food and sends it to the brain. “By manipulating the gut, even in a small way, we end up changing the communication to the brain and the brain acts differently to manage our weight and metabolism,” says Dr. Kaplan. His goal now is to completely replace surgery by developing medication that alters these intricate circuits in the same way that an invasive operation currently does.
They follow a handful of people who are losing weight - one of whom has a gastric bypass and loses 150 pounds over the course of the shoot.
A familiar face on television, actress Mary Dimino’s battles with food and dieting are the hysterical heart of her stand-up comedy. As the documentary opens, we see Mary sweating through one of her daily three-hour gym sessions on the treadmill. Acknowledging that it’s a lot of exercise, she explains, “I have to work just as hard, even harder, just to maintain this level of chubbiness.” Like many people who struggle with weight control, Mary has persistent fat cells in her body that were added during years of overeating. Now the weight may come off, but the cells remain — always hungry — constantly crying out for more calories and defying Mary’s willpower.
“There was something haywire,” says Rosie Delhi, whose words confirm the suspicion every fat person has from trying and trying to lose weight. A retired school principal, her bariatric surgery was, until now, a secret from everyone but closest family members. “You can’t believe how awful it is,” says Rosie, who yearned to play on the floor with her grandchildren and be able to get up again. “If I didn’t make a change, I was headed for a death sentence.” The rewiring effect of the bariatric surgery, which Dr. Kaplan has identified, seems to be helping Rosie to sustain her weight loss by helping to suppress her hunger impulse. Now her disciplined effort to maintain a healthy weight has a shot at success.
As a senior in high school, Rocky Tayeh utilized his budding talent as a journalist by producing a radio documentary on his battle with obesity. Raised in Brooklyn, Rocky laments the everyday temptation of food available in his neighborhood. “If I’m hungry at 4:00 in the morning, I just have to walk a block down,” says Rocky. “There’s a Dunkin Donuts here, a McDonald’s here, a fast food restaurant here, a Chinese restaurant and they deliver.” Despite the disapproval of his family and his own doubts about “taking the easy way out,” Rocky makes a decision to have surgery, loses 150 pounds and faces the prospect of a new life in college without the embarrassment, shame and stigma.
Carla Hurd has gained about 120 pounds over the last twelve years in her job as a marketing executive at Microsoft. Carla and her overweight husband David signed up for a comprehensive weight management program funded by Microsoft. Even with the no-holds barred support of all the best personal trainers, doctors, dieticians and psychologists and a profound motivation to get pregnant, her success in the battle to lose weight is elusive. In videotaped diaries, Carla tracks her uncontrollable urges and her struggle to resist the comforting temptations of food that calms her stressful life.
Public health nurse Pat Lyons, who describes herself as a professional fat woman, knows there is very little justice or sympathy for fat people. Pat’s mission is to uncouple the idea that physical fitness and activity is only useful in regard to losing weight. She believes everyone should be active, regardless of size, aiming to be as healthy as possible whatever weight you are. “There are happy, healthy people of all shapes and sizes,” she points out.
It’s broken up into little clips. The longest is about 10 minutes and the shortest about 4 minutes long. It’s easy to get through.
I realized I’ve never done a post on what Lap Bandees are most comfortable eating. I have Lorraine Kay’s YouTube clip where she talks about what she can eat, but perhaps I should expand on this a bit more.
Let’s begin by addressing how one loses weight with a Lap Band. Lap Bands make your stomach much, much, much smaller. Typically, your stomach holds about one liter of food though it can be distended to hold up to four liters - close to a gallon! At the top of your stomach are stretch receptors and when they are stretched, they signal your brain that you’re full. With the Lap Band, you’ll be eating about six to eight ounces of food per meal. Because your stomach is so tiny now, those stretch receptors will be activated quickly, and you’ll feel satisfied with a far smaller amount of food than you would have before the Lap Band.
What makes Lap Bands so much more effective than diet and exercise is the capability to keep weight off once you lose it. Ninety eight percent of people who lose weight through diet and exercise put it right back on in under two years. That doesn’t usually happen with Lap Bands. Those stretch receptors being stretched after each meal tell your body that food is plentiful and because of that, your body doesn’t crank down your metabolism the way it does on a diet. And because your body doesn’t crank down your metabolism, you keep the weight off that you lose. Brilliant, eh? I should add that you’ll be consuming about 1100 to 1200 calories per day. Your body’s new set point will be established when the amount of energy you are burning at your new size equals the amount of calories you are consuming - same as for everyone else.
For the sake of a visual comparison, you’ll be eating the equivalent of McDonald’s Double Cheeseburger and a small order of French Fries per meal. Now, needless to say, your surgeon doesn’t want you eating those two things, but McDonalds’ food is internationally available and the same size everywhere.
Anyway, the first week, you just don’t feel any hunger by and large, and you only consume clear liquids. The point of this is to not stretch your stomach in anyway in the first days. Be of good cheer - I have yet to hear anyone complain about being hungry that week. After that, you begin a journey that will lead to your first fill and the adjustment process.
What so many Lap Bandees love about their Lap Band is that they can eat almost anything within reason - at holidays, you’ll eat what everyone else does, just less of it. Bread is the most consistently problematic because it mushes up into a gloopy little ball and doesn’t pass through the clip very well. Lots of bandees find that fish quickly becomes one of their favorite dishes - even the people who hated it before. Red meat needs to be cut into tiny pieces and chewed slowly. Crunchy stuff goes down well. As, Lorraine Kay says - tacos with crispy shells, good. Tacos with soft shells, not so good. Nachos, first rate. Some bandees do very well with rice and pasta, others less so. I think it may largely be a matter of being content with just a few bites and moving on. White meats tend to be easy though some people have to be very careful with chicken. You can have ice cream, of course, but it’s calorie dense and goes through the band quickly - thereby defeating the entire purpose.
That’s the short version of it all. I’ll be doing a couple more interviews this weekend, I think. I’ll be sure to talk to the bandees about it, and I’ll let you know what they have to say. In the meantime, if you haven’t watched Lorraine Kay’s interviews on this site, I’d encourage you to do so. She’s someone who thinks and speaks for succinctly. She covers a lot of territory in her interview and you’ll have a much better idea of the road ahead by listening to what she has to say.
I’ve covered caffeine a lot on this site. In fact, there is a whole category about it. The surgeons are split on the subject. Some don’t want you drinking any caffeine whatsoever, and some don’t mind. What I’ve noted in the past is that caffeine causes the blood sugar levels to spike in Type II Diabetics. Spiking blood sugar produces insulin and tells your body to store the energy you’re eating rather than to burn it. Atkins had long noted that people on his diet didn’t lose weight if they drank caffeine. Keep that in mind, and decide how much you value your morning Joe. Atkins now allows people to have one cup a day. If you’re a determined coffee or tea drinker, experiment to find out if there is a reasonable amount you can consume.
Some surgeons object to Lap Bandees having any alcohol at all - the feeling being that you are so restricted in the amount of calories than there are none available to waste on an alcoholic beverage. Dr. Paul O’Brien, of Monash University’s Centre for Obesity Research and Education, says that a glass of wine per day seems to do well by his patients. He’d encourage to check out Australia’s wines, as well.
As always, if there are any questions, pass them along. If you’re interested in reading more about why losing weight and keeping it off is so difficult, check these posts out.
Dr. Paul E. O’Brien’s name was one of the first I learned when I began investigating the Lap Band. He’s published innumerable medical studies on the Lap Band and is the author of THE LAP BAND SOLUTION: A PARTNERSHIP IN WEIGHT LOSS. I just received my copy today and will be reading it tonight.
Dr. O’Brien is a world-renowned authority on obesity, weight loss and Lap Bands and these are his very moderate rules for Lap Band weight loss success.
1. Eat three or fewer small meals per day.
The LAP-BAND works primarily by taking away your appetite. If it is adjusted correctly you should not feel hungry.You may eat up to three times a day. We don’t mind if you eat fewer than three times per day. Many people do not feel like breakfast and some will miss a midday meal. If you don’t feel inclined to eat, don’t eat. If you find you are getting hungry between meals, tell us. We will probably consider adjusting the band a little tighter.There is not much room for food, as there is a virtua lstomach rather than a real space above the band. As you eat, the food seeks a space and you need to keep that space quitesmall. Therefore each meal should be about the amount of food you can get into half a glass. If you eat more than that, you will not lose weight so easily and you will gradually stretch the stomach. This can lead to the need for a further surgery later on to reduce the enlarged stomach. The adjustability of the band is the key to allowing you to be happy with this small amount of food. If you find that
you are tending to eat more than that, tell us and we will consider adding more fluid to the band. Always use a small plate, put a small amount of food on the plateand always try to leave some. Remember the angels.They need their share.
2. Do not eat anything between meals.
No snacks, no biscuits with your coffee, no fruit, nothing. All food must be restricted to meal times.One of the most frequent causes for failure is the taking of snacks between meals. If you are getting hungry between meals and are tempted to have a snack, you must tell us. It is probably due to inadequate adjustment and you may need more fluid added to the band. Between meals you can only have zero-calorie liquids—water, mineral water, tea, coffee, low-calorie sodas.
3. Eat slowly and stop when no longer hungry.
When you have eaten enough, you will no longer be hungry, and signals from your stomach to your brain tell you that you do not need any more. These signals take time to be generated. Give them that time. Each meal should be stretched out over 15-20 minutes. If you eat rapidly, you will already have eaten too much before you realize that you have had enough. However, do not eat beyond 30 minutes. Throw away whatever you haven’t eaten at that time. That is the end of that meal and you must have nothing else until the next meal. Try to make each meal last for 15-20 minutes. Try to sense when you have had enough and stop before you feel at all uncomfortable. Use a small plate, put a small amount of food on the plate and develop the habit of always leaving some of it uneaten. Once the meal is finished, it is essential that you take no further food until the next meal time. This has to be avoided absolutely. The slow emptying of the stomach gives you a feeling of fullness, which should make it easy for you to achieve this. You must ensure that this indeed does happen.
4. Focus on nutritious foods.
Foods that are high in protein (meats, especially fish, eggs, dairy, lentils, beans and nuts) and foods that are high in complex carbohydrates (vegetables, some cereals) are best. Simple sugars are worst. Be careful with foods that are high in fats, as they are a dense form of calories. Be careful with fruits, as they contain quite a lot of sugar. The good foods can come from all the main food groups and include vegetables, meats, eggs, cereals and dairy. There is no need to focus unduly on the particular foods in fine detail. It is not rocket science. It is simply selecting foods that are good (protein and complex carbohydrates), being careful with those that are not so good (fats, alcohol) and avoiding those that are bad (simple sugars). And take a well balanced vitamin and mineral replacement each day.
5. Avoid calorie-containing liquids.
Any calorie-containing liquids will tend to flow past the restriction of the band and not give you any feeling of satiety. You are then more likely to take too much. You are only allowed to drink:
1. water.
2. mineral water.
3. tea or coffee (with low-fat milk if you wish but no sugar).
4.low-calorie soft drinks (but be careful with the gas).
An exception to the “no liquid calorie” rule is a glass of wine with meals, which we have shown is good for your health and good for your weight loss when taken in a modest amount.
6. Exercise for at least 30 minutes each day.
This is at least as important as all of the other rules. Not only must you take in fewer calories, but you must use up more calories. Exercise will improve your general health as well. Initially, while you are severely obese, this can be difficult, but as your weight decreases, it becomes easier. As you become fitter and healthier, you get greater enjoyment from exercise. We understand that not everybody is sports-minded and exercise may be something quite new
for you. Start slowly and seek to build up activity progressively. Aim to put together 30 minutes or more of moderate-intensity physical activity on most and preferably all days. Walking is ideal to start off with. As your fitness improves, progress to more vigorous walking and even jogging, cycling, aerobics, swimming and light resistance training. As your weight comes down, your exercise capacity will increase and your general activities during the day
will increase. This is to be encouraged, and the more active you are, the better the result will be. Your exercise program should be aerobic. You should be puffing and, if you check your pulse, generally it should be up around 120-140 beats per minute. There are a wide range of activities that will allow you to achieve this. If you can manage it, a personal trainer or fitness consultant can be an excellent assistant. They can provide an individual program according to your specific preferences and lifestyle that is realistic and achievable. Regular exercise requires commitment. The more effort you put in, the greater benefits you will see and feel.
7. Be active throughout each day.
Think of movement and activity as opportunities and not as inconvenience. Try to be active every day in as many ways as you can. Make it a habit to walkor cycle instead of using the car. Become active in the garden and do things yourself instead of usingmachines. Avoid sitting down at all cost. You should see sitting down as an opportunity for activity lost. Try to spend as much time outdoors as possible. We tend to be more active when outdoors. Use a pedometer as a stimulus to you to show how your activity level is increasing. If you are using a pedometer, aim to get beyond 10,000 steps per day—this represents a very good level of routine daily activity.
8. Always keep in contact with us.
We want to follow you permanently. There will never be a time when we say that the job of
controlling your obesity is done and we do not need to see you anymore. There will always be a need to check your progress, monitor your health, check for nutritional deficiencies, make sure that you understand the rules, bring you up to date with new developments and adjust the volume of fluid in the band. There is always going to be a very small loss of fluid from the band over time. For example, if you had 3 ml of fluid present and we checked the volume after
a six-month gap, there would probably be about 2.7 ml present. This occurs because the balloon of the band is not totally impermeable. If 3 ml was the correct volume, you would be starting to get hungry and eat more with a volume of 2.7 ml. It is importantyou understand that this can happen and come back to see us for replacement of that small loss. This is the main reason that we want a maximum of six months between appointments.
Diets and exercise just don’t work - let’s face it. Fewer than 5% of people who lose weight through diet and exercise manage to keep it off. There are reasons for this, as I have written about before, that have nothing to do with self-discipline. You can’t lose weight and keep it off for some very sturdy evolutionary reasons - your body likes having all that handy-dandy energy just packed away for a rainy day. Or more precisely, a non-rainy season. So when you lose weight, after a certain amount, your body starts cranking down your metabolism. Youve been losing weight on 1200 calories a day? No more. That fifteen pounds you’ve lost that has you feeling svelte is gonna come right back, if your body has any say over the situation. And your body does have say over the situation. So, your metabolism goes down and your hunger level goes up. Your body floods you with chemicals that make you feel hungrier than you’ve ever felt. Oh, you think you’re just being undisciplined and you feel guilty for eating. But that’s not what’s happening. Your body is pushing you to eat, eat, eat, and it’s slowing your metabolism down so that you can pack the weight right back on. Good bye, little red dress. Hello, big black dress. Have you ever stood in the kitchen eating something, hating yourself for eating it because you’re actually losing weight, but you can’t stop because you’re so darn hungry? That’s normal. That’s your body functioning as it should. The curious thing is that obese people’s bodies functions normally when they’re heavy and their bodies cease to function normally when they lose weight. Factor in that we now know that around 75% of weight gain is genetic, and we’re all in a dire situation.
Look, there are lots of reasons to lose weight besides vanity - you’ll live longer. And if you’re like most people, you have family who love you and want you to live as long as possible. That right there is good reason to do it. You’ll be happier. And more physically comfortable. And you’ll probably earn more money. And have more sex. So with all those motivations, if losing weight was really possible, you would do it. Some of us master the literally Sisyphean task of weight loss and peel off 120 pounds or maybe more. But then, because of biological imperatives, we gain it back again. Over and over.
That’s where Lap Bands come in. Dr. Favretti, one of the first surgeons to work with Lap Bands, completed a 12 year study on the effectiveness of Lap Bands and the news is good - people don’t gain the weight back. The study covered over 1700 patients over twelve years both morbidly obese and super obese. The average weight of the patients started out around 260 pounds plus or minus 37 pounds with an average BMI of 42.6 - that’s our 5′3″ woman at 236 pounds or our 5′10″ guy at 292 pounds. At the end, they weighed on average 185 pounds plus or minus 60 pounds with an average BMI of 31.6 - putting our woman at 175 pounds and our man at 216.
If you want to check your BMI, you can do so here at the Centennial Treatment Center For Obesity in Nashville, Tennessee.
I know all of you reading this think, “Oh no, I want to lose a lot more weight than that!” Well, of course you do, and as far as I can tell, you can. You do have to exercise though and to make that point, I’m going to quote Dr. William Lee of Blue Earth, Minnesota in the Mankato Free Press:
Lee said his patients can be divided into two groups, those who shed 6 to 8 pounds a month and patients who lose 10 to 15 pounds a month. “The difference between these two groups,” he said, “is exercise.”
So, just keep that in mind - you’re gonna have to buy a trampoline, a pair of Nordic Walking Poles or get yourself a backyard treadmill. And if you do, and if you follow the doctor’s directions, and get yourself into a support group, you’re going to have a really good shot at getting down to the tiny little person you’d really rather be.
While grabbing the embed code for Lorraine’s clip, this popped up as a similar clip. It’s a video clip of a doctor performing a fill on a patient. You can see the whole process is very quick and easy.
I just received this press release from New Jersey’s Bariatric Center’s Dr. Ajay Goyal on bariatric surgery and pregnancy. He says that pregnancy is safe for a Lap Band patient six months after surgery, though there may not have been enough weight loss in that time frame to prevent obesity related complications. Lastly, he says nutritional supplements are a necessity since you will be eating such small amounts of food.
New Jersey Bariatric Center’s Ten Guidelines to Follow for a Safe Pregnancy Post-Surgery:
1. Avoid pregnancy for one year after weight loss surgery
2. Take multivitamins (Vitamin A, B1, B12, Iron, Folic Acid)
3. Make regular appointments with your bariatric surgeon and obstetrician
4. Obtain regular blood test to check for vitamin deficiency
5. Eat multiple small meals a day (at least four meals per day) and spend 30 minutes to eat each meal
6. Eat high-protein, low-carbohydrates and a low fat diet
7. Take 30 grams of proteins in supplements
8. Drink plenty of water (40 – 60 ounces per day)
9. Continue regular low impact exercise for both body and mind
10. For lap band or realize band patients, one can remove the restriction by an adjustment if patients develop pregnancy related nausea.
“You don’t want to wait until they are adults and having heart attacks,”
Dr. Marc Bessler - New York Presbyterian Hospital
I’m looking around a little bit more on this subject of adolescents and Lap Bands. There seems to be a concensus that it’s an appropriate for surgery for kids starting somewhere around the age of thirteen. There have been a number of studies done and the results are all pretty positive - which is good news, I think. I’m sure more than a few of my readers were overweight as teenagers, and I’m betting it’s a painful way to go through some tough years.
Lap band surgery was performed on 53 morbidly obese adolescents between the ages of 13 and 17, according to the study. Most of the patients were girls. People are considered morbidly obese when their body mass index is at 40 or above, usually about 100 pounds overweight.
The patients in the study had a history of obesity for at least 5 years and many had conditions commonly found in obese adults such as high blood pressure, diabetes, and sleep apnea. They had also tried unsuccessfully to lose weight on numerous diet and exercise regimens, including medically supervised weight loss, according to the study. All of the adolescents were screened by a psychologist to ensure that they would comply with the study protocol.
The first conclusion of the article is that the Lap Band is safer than a gastric bypass:
“This study suggests that the lap band provides a safer and equally effective weight loss strategy compared to the gastric bypass,” said Evan Nadler, M.D., Director of Pediatric Minimally Invasive Surgery and Assistant Professor of Surgery at New York University School of Medicine, who is the lead author of the study. “This is good news for parents contemplating obesity surgery for their adolescent children. The bypass has serious risks and side effects associated with it and our study shows that the band provides similar weight loss benefits without the same risks.” Intestinal leakage and bleeding, blockage of the intestines, and severe nutritional deficiency are some of the side effects associated with the bypass procedure.
And then, the kids lose weight:
According to the study, twelve and eighteen months following their surgery, the average weight loss for each patient was about 50 percent of excess weight, a figure comparable to weight loss following a gastric bypass procedure. None of the patients regained any lost weight, which has occurred after gastric bypass procedures, said Dr. Nadler.
There were a few complications but they were all minor and did not require hospitalization:
Complications were found to be significantly less severe with the band procedure as well. None of the gastric band patients in the study had complications that required readmission to the hospital. Two patients experienced slippage of the band, two patients developed hiatal hernias, and one patient had a wound infection. All of these conditions were treated by outpatient procedures. According to the study, a few patients also experienced mild hair loss and iron deficiency which were treated with nutritional counseling and vitamin supplementation.
Speaking of the Northwest Weight Loss Surgical Center in Everett, Washington (just half an hour from Seattle), I wanted to post the link to their insurance page which has tons of really good information about how to proceed with your insurance carrier.
Step 1 - Contact Your Insurance Carrier
Call the benefits coordinator at your human resource office and/or call the customer service line listed on your insurance card. State “I am inquiring about my policy benefits regarding the surgical treatment of morbid obesity. Is surgery for morbid obesity a covered benefit?”
If the answer is “no,” you may need an attorney to help you prove that it is medically necessary. We recommend you contact the Obesity Law and Advocacy Center (obesitylaw.com).
If the answer is “yes,” then ask what CPT procedure codes are covered and if this includes LAP-BAND surgery (CPT 43770).
Finally, ask them to send you a copy of their policy on the surgical treatment of morbid obesity (ICD 9 code 278.01).
You may use the list below to help you ask all the questions and to document the answers received.
Telephone number and extension called: _____________________
Is surgery for morbid obesity a covered benefit? Yes No
Which CPT codes are covered?
43770 LAP-BAND Yes No
Do you have a policy on surgery for morbid obesity that I can obtain?
What information do you require before authorizing the surgery?
a. Nutrition consult required? Yes No
b. Psychological consult required? Yes No
c. Medical clearance from your physician Yes No
d. Note from Surgeon Yes No
e. Documentation of weight loss attempts Yes No
f. Documentation of length of obesity Yes No
Ask whether you are required to see an in-plan provider for the LAP-BAND surgery or if you can be treated by a contracted provider such as Northwest Weight Loss Surgery Center. If your insurance plan requires an in-plan provider, and you want to use a contracted provider for your surgery, you may need to consult an attorney.
Get the full name and direct telephone extension of the person with whom you spoke.
The whole page is that informative. If you’re getting ready to call your insurer, take the time to really absorb what’s on this page. They also encourage you to read Walter Lindstrom’s article on preparing to deal with your insurance company - Maximizing Your Chances Of Getting Insurance Approval.
And lastly, as Mr. Lindstrom observes, if your insurer rejects your claim, call the Obesity Law and Action Center, because that’s when they have the best shot at overturning the denial. Right now, they have a success rate of 90% and work hard at making their services affordable for working class people.
This is interesting - a study being done involving 150 morbidly obese teenagers who are having Lap Band procedures to see if gastric banding is an effective means for dealing with teen obesity. I can’t imagine much worse than being an obese teen - it’s painful enough when you’re trim.
The nationwide study population will consist of 150 adolescents recruited from seven weight management centers. Twenty two participants will be recruited at UCSD Medical Center. Potential participants must demonstrate a history of obesity for at least two years and have failed more conservative non-surgical weight-reduction alternatives such as a supervised diet, exercise, and behavior modification programs.
“By addressing obesity at an early age, we may be able to avoid life-threatening conditions such as diabetes, cardiovascular disease, and depression,” said Horgan who has performed more than 1,000 gastric banding procedures. “In the long run this could potentially save billions of dollars now spent on obesity related healthcare.
On Dr. Ortiz‘ site, he has a testimonial from Cassie, a 13 year old girl who has had a lap band procedure, and who was apparently on the Oprah Winfrey show this year. Hopefully, I can find something on YouTube later. His Obesity Control Center will perform surgeries on people from 13 up. They have a host of psychological tests they put the kids through, and go from there. They also have a support group just for kids as well.
“It took more than a year to get our study approved, but since then, it’s gone very well.”
The FDA approved the procedure for adults in June 2001.
By this year, it was all Drs. Kevin Montgomery and Brad Watkins, weight-loss-surgery specialists, wanted to perform.
“We sat around one day saying we would never let someone in our family have gastric-bypass surgery performed on them, so why were we still doing it?” Watkins said. “With gastric bypass, you have to stay overnight in the hospital, and [Lap-Band surgery] is done laparoscopically as an outpatient procedure.”
The two recently opened the Northwest Weight Loss Surgery center, performing Lap-Band surgeries on adults. Seeing the problem of obesity in children, the two decided to join NYU, the Minimally Invasive Bariatric Center in Chicago and other facilities in conducting studies on youths.
The same basic standards apply to kids as apply to adults, however, in the case of the teens, the doctors are performing the surgeries at the hospital rather than at the surgery center.
The Northwest Weight Loss Surgery center will conduct up to 50 surgeries on youths 16 and 17 who have a body-mass index (BMI) of 40 or higher, or a BMI of 35 with a serious health problem related to obesity. The index is a height-to-weight ratio that provides a rough estimate of body fat. A normal BMI is about 25.
The center expects to perform the operations on youths over three to five years. Locally, though most adult Lap-Band surgeries are completed at the center, one requirement of the study is that all adolescent procedures be completed at the Kirkland hospital.
One of the things we do is confuse obesity with immorality. We see excess weight, even in children, as evidence of moral failure and dump enormous amounts of shame on the obese. It’s sadistic, literally. Shaming people for situations they have very little control over is incredibly manipulative and destructive. To my mind, the more kids we can pull out of that cycle early, the better we are as a culture.
I’m going to do more reading on teenagers and Lap Bands. This is interesting stuff.
Lots of interesting stuff in this article from Myrtle Beach Online - it even addresses the mortality rate of an experienced gastric band surgeon versus an inexperienced one (hint - make sure your surgeon has performed more than 20 procedures). Mostly, though, it’s about how effective weight loss surgery is at sending diabetes into remission, and how much safer the Lap Band procedure is as opposed to the gastric bypass procedure. Lap band procedures have a success rate of 76 percent curing diabetes II.
Four years ago, Dr. Donald Balder of Conway Medical Center’s Weight Loss Center began performing weight loss surgery to treat diabetes in patients.
A recent landmark study out of Australia provides the strongest evidence yet that weight-loss surgery can send Type II diabetes into remission.
The Journal of the American Medical Association published the results of a study in January that stated patients who underwent surgery to reduce their stomach size were five times more likely to witness a disappearance in their diabetes over the next two years than patients undergoing standard c
That’s impressive. Patients who undergo weight loss surgery are five times as likely to see a remission in their diabetes as people who use standard treatment - ie, drugs, diet and exercise.
What I didn’t know was that a lot of doctors had concerns that since the Lap Band procedure is so much less dramatic than gastric bypass that it might not work as well. However, that has proven to not be the case.
According to Balder, many doctors felt that the newer lap-band procedure, which has been done in Australia for more than a decade, wouldn’t resolve diabetes as effectively as gastric bypass surgery.
“We feel as though there’s some sort of hormonal changes that go on when we staple the stomach, which is why they didn’t think the band would cause the same changes,” he said.
“But the band has caused the same changes without the increased risk of death and all of the complications of weight loss surgery.”
And:
Gastric bypass, which has been studied extensively in the United States, has a cure rate for Type II diabetes of about 84 percent.
Susan Michaels of Loris is a local patient whose diabetes is now remission and who is off insulin.
One of these patients is Susan Michaels of Loris, who had Type II diabetes for five years and took insulin as well as two types of blood pressure medication. After finding that dieting and exercising proved unsuccessful in her attempts at weight loss, Michaels read about the link between diabetes and weight-loss surgery in the newspaper.
“I turned 50 last year and just thought after 25 years of being obese I needed to do something other than what I have done,” she said. Since her lap-band surgery at the Weight Loss Center in May, Michaels has lost 54 pounds and no longer needs insulin.
“It’s a wonderful feeling to no longer need diabetes medication. I exercise easier and eat so much less than I did before banding. I am now down to one blood pressure medication and may be off that by the end of the month,” Michaels said.
“I do not have to say I’m diabetic anymore. I feel so much better about my health and am still working on losing even more weight,” Michaels said
And the numbers are here:
Blood tests showed diabetes remission in 22 of the 29 surgery patients after two years and an average weight loss of 46 pounds, while only four of the 26 patients in the standard care-group eliminated their diabetes, losing an average of three pounds.
“This new study that comes out of Australia is very remarkable in that it has a nearly 76 percent cure rate for Type II diabetes, which is an extraordinarily high cure rate for a difficult disease,” Balder said.
And for people who are lower weight and have Class 1 diabetes, it’s even more effective. One hundred percent of those people saw their disease remission. Insurance isn’t likely to pay for that now, but hopefully, with enough people challenging that, it will change.
Weight-loss surgery can help patients with Class I diabetes, or a body mass index of 30 to 34.9, and Class II diabetes, or a body mass index of 35 to 39.9, although weight-loss surgery is currently focused on morbidly obese patients, Balder said.
“Another study in Australia done on people with Class 1 diabetes showed that folks who had lap band at that weight all lost their diabetes, but unfortunately we haven’t gotten insurance to pay for that smaller weight category here yet,” Balder said.
It has taken me a few weeks to cover this, but it did need to be covered. Diabetes is terrible disease. Both my mother and my grandfather died in their early sixties from heart disease because of it - it’s not to be taken lightly. Lorraine Kay, whose interview I will have up today, is legally blind because of her diabetes. The costs to that disease are tremendous. This research is very, very good news.
It’s a beautiful day in Los Angeles. The sky is that bright, bright blue and the sunlight is beaming off the clouds. Flowers are blooming like mad and it’s baby plant green everywhere you look. The wind is a bit brisk, so allergies are acting up everywhere. But I’m going out for a walk and it should be a lovely one. I hope you get a nice nature break as well.
Palancar Gardens - here I come!