The mind-over-matter conundrum


The  aim of all bandsters is to "hit their sweet spot", i.e. achieve perfect food restriction. The goal will initially be weight loss (generally for the first year), and thereafter maintenance of a reduced weight. Clearly for the former you will need slightly more restriction than for the latter, although what often happens is  that the initial period is also one of unlearning pathological eating habits and (hopefully) starting or intensifying a fitness program (i.e. increased energy expenditure).

I think it needs to be spelled out clearly that, certainly for the initial weight loss period, perfect restriction sometimes means being so tight that you experience some regurgitation of food, drink and saliva - known as "productive burps" (PBs). Patients who are horrified by this prospect and the consequent need to develop strategies to hide PBs from others in a social context (inevitably there are now US companies marketing fashion accessories that serve this purpose) are unlikely to find success with AGB implantation and should probably choose a different WLS strategy, perhaps involving a malabsorptive approach. While you should attempt to avoid a scenario where you regularly PB small quantities of food to ensure you don't cause damage to the placement of the band, it does happen to most bandsters at some stage in their journey so you need to be prepared while you are at your tightest restriction. Joining a support group, particularly an expert patient group like WLS info is the ideal way to compare notes with other bandsters on strategies.

Naturally, not everybody can realistically expect to to attain perfect restriction, and - confusingly - even if someone has hit their sweet spot at some time the restriction does not necessarily stay constant despite no change in filling volume!

Undoubtedly an adjustable gastric band can help most people to lose weight. Those that fail to achieve any meaningful weight loss generally do so because either they do not understand how the band works (I have met several patients who had not realised that, following the initial operation, several fills were required to achieve adequate restriction, and never having received the fills had written off their band as a con job), or because they fail to change fundamentally unsound eating habits.

It is definitely possible to overcome the limits imposed by a restrictive WLS approach by adjusting your intake to whatever will physically pass beyond the restriction while maximising the caloric content of what you can eat and drink to such an extent that you end up gaining weight rather than losing it (I know several patients struggling with this). A mindframe adjustment is a necessary part of the overall strategy!

At the end of the day the best approach is a holistic one which takes all factors -  headspace, eating habits, energy expenditure, restriction, financial considerations, support systems, etc, into account and relies on an honest and trusting relationship between patient and therapist(s) [surgical, medical and otherwise].