This is one of the most common, and misunderstood questions regarding the Lap-Band. The lapband is not about “restriction,” that’s not how the lapband works.  We used to think it worked this way, but it doesn’t.

The band works when food passes by the lapband, not when food stays above the lapband. If food stays above the lapband too long the pouch can stretch, the esophagus can stretch, and people can end up with band slips and band erosions (the pressure from that amount of food).

We created a very thorough explanation of how the lapband works on one of my additional websites, and you can read it to get more comfortable with the lap-band.

The story of how we discovered how the lapband works assisted us in figuring out successful strategies for our lapband patients, and hopefully will help you become a successful lapband patient as well.

Early Evidence:
We used to think the band worked by restriction, keeping food above the band and slowly letting it through.  Because of that we told people not to eat and drink at the same time. In fact, it was one of our early rules about the band.  But we constantly take our patients who have been successful, and question them about their habits. We asked if they ate and drank at the same time– expecting that we would find none of them did.  It turned out most of them did. We were a bit shocked, because that didn’t fit the theory that the band was restrictive.

Next Evidence – the glass of wine:
We would always tell patients that alcohol is liquid calories, and if they wanted to lose weight they should abstain from alcohol.  We discovered most of our early successful patients admitted to drinking wine with dinner. So we set up a test.  We took two groups of patients who had the band: one group were people who do not drink alcohol (usually for religious reasons).  We took an equivalent group of patients (same BMI, same age group) and asked that they include one glass of wine at night for dinner.  Over the course of the first year after surgery the wine group lost an average of ten more pounds than the non wine group- and at 18 months more patients from the wine group had reached their goal (one glass, not two – when they started drinking two glasses of wine it negated the amount).  We don’t know why a glass of wine helps, but if you ask the people who had it, they told me that food went down easier, and they took more time with their meal and enjoyed it more.  That if they were a bit tight, wine made the band feel a bit loose. The looser the lapband, the more weight lost.

The Barium Burger – final evidence
Once a year we ask that patients get an upper GI to see how their band looks, or if they have reflux or heartburn to see us and we will want an upper GI. So we asked several of our successful patients to do more- to take some hamburger and let us add some barium to it to see how it went through their band. Then we put some barium in the middle of some chicken breast.  We also did this with people who came in and always asked the band to be tighter.  In the successful patients – the food with the barium (we use barium so we can see the food on x-ray) went zipping past the band.  In patients who had not lost the weight, but had tight bands- the barium stayed above the band for a while.

What we know now
The lapband works when food goes past it. This means the band has to be loose enough for food to go by quickly.  So our theory in 2012 is that when food goes past the band, if the band is properly adjusted, it will go quickly by and set off the mechanism that holds off appetite hormone production.

Hard to convince some
Some patients love tight bands, and early on they lose weight. Then we have to losen up the band because they get too dilated, develop heartburn, night cough, reflux, and they never get back to their “sweet spot.”  But their sweet spot was false. They didn’t rely on appetite suppression, they relied on being “full” with the band.  But full was the band was tight, nothing would go past quickly, and they couldn’t eat. That does not work in the long run.  Re-training people to know the difference between “being full” – which you should not feel with the band and “not being hungry in a few hours” is a big difference.

Some feel their experience is better- but it leads them astray.

Never hungry, Never full
Words to live by with the lapband. Never get too hungry, and never get too full.

But do I need a fill?
The real question is- do you need a fill. We don’t want you to feel “restriction” what we want you to notice is that small amounts of food are keeping you satisfied at the 2-3 hour mark.  Even between fills, successful patients learn that they have to adjust themselves during periods (like when the lap band doctor or staff is on vacation, or appointments are booked). For these times we recommend a highly regimented eating – with shake, snack, shake, snack, and dinner. For a list of snacks click here.

But I want to feel full – Consider plication
For these patients- a gastric plication is probably a better option than just a lapband – or both, in combination. Those who have had the band and the plication together can tell you that feeling full is a lot different than being hungry, and they like both. But some prefer one over the other.