Posts categorized "Gastric Band, Lap Band Surgery" Feed

From NYT - Why WLS Works When Diets Don't

Don't shoot the messenger, I'm sharing this for my blog's historical reference because it's AMAZING INFORMATION -- and even if you "don't agree," because it's not your experience, it's science!

Via New York Times - https://nyti.ms/2kBVirc

Bariatric surgery is probably the most effective intervention we have in health care,” says Laurie K. Twells, a clinical epidemiologist at Memorial University of Newfoundland. She bases this bold claim on her experience with seriously obese patients and a detailed analysis of the best studies yet done showing weight-loss surgery’s ability to reverse the often devastating effects of being extremely overweight on health and quality of life.

“I haven’t come across a patient yet who wouldn’t recommend it,” Dr. Twells said in an interview. “Most say they wish they’d done it 10 years sooner.” She explained that the overwhelming majority of patients who undergo bariatric surgery have spent many years trying — and failing — to lose weight and keep it off. And the reason is not a lack of willpower.

“These patients have lost hundreds of pounds over and over again,” Dr. Twells said. “The weight that it takes them one year to lose is typically back in two months,” often because a body with longstanding obesity defends itself against weight loss by drastically reducing its metabolic rate, an effect not seen after bariatric surgery, which permanently changes the contours of the digestive tract.

In reviewing studies that followed patients for five to 25 years after weight-loss surgery, Dr. Twells and colleagues found major long-lasting benefits to the patients’ health and quality of life. Matched with comparable patients who did not have surgery, those who did fared much better physically, emotionally and socially. They rated themselves as healthier and were less likely to report problems with mobility, pain, daily activities, social interactions and feelings of depression and anxiety, among other factors that can compromise well-being.

Equally important are the undeniable medical benefits of surgically induced weight loss. They include normalizing blood sugar, blood pressure and blood lipid levels and curing sleep apnea. Although bariatric surgery cannot cure Type 2 diabetes, it nearly always puts the disease into remission and slows or prevents the life-threatening damage it can cause to the heart and blood vessels.

 

Even in the small percentage of patients who ultimately lose little weight after surgery, significant metabolic benefits persist, according to findings at the Cleveland Clinic. In a study of 31 obese diabetic patients who had not lost a lot of excess weight five to nine years after surgery, a “modest” weight loss of just 5 to 10 percent resulted in a reduction of cardiovascular risk factors and blood sugar abnormalities, Dr. Stacy Brethauer and colleagues reported.

For the two most popular surgical techniques — the gastric bypass and the gastric sleeve — “the metabolic benefits are independent of weight loss,” Dr. Brethauer said in an interview. Both methods permanently reduce the size of the stomach. However, the gastric band procedure, which is reversible, lacks these benefits unless patients achieve and maintain significant weight loss, he said.

Furthermore, as a study last year of 2,500 surgical patients at the Veterans Affairs Medical Center in Durham, N.C., found, those who underwent bariatric surgery had lower overall death rates up to 14 years later than comparable patients who did not have weight-loss surgery.

Experts in the field regard the reluctance of some medical insurers, including Medicaid programs in many states, to cover the cost of bariatric surgery as a penny-wise, pound-foolish position. Failing to reverse extreme obesity can end up costing far more per patient than the typical $30,000 price tag of bariatric surgery — sometimes even millions of dollars more.

 

Counter to popular impressions that most people treated surgically regain most or all the weight they lose initially, the latest long-term research has shown otherwise. In a decade-long follow-up of 1,787 veterans who underwent gastric bypass, a mere 3.4 percent returned to within 5 percent of their initial weight 10 years later. This finding is especially meaningful because the researchers at the V.A. center in Durham were able to keep track of 82 percent of gastric bypass patients, a task too challenging for most clinics.

The study, by Matthew L. Maciejewski and colleagues published in August in JAMA Surgery, found that 10 years later, more than 70 percent of surgical patients lost more than 20 percent of their starting weight, and about 40 percent had lost more than 30 percent. Gastric bypass, an operation called Roux-en-Y, resulted in a somewhat greater weight loss at 10 years than the newer gastric sleeve surgery and significantly more than the adjustable gastric band (Lap-Band) surgery, which “has fallen out of favor in the last two or three years,” Dr. Maciejewski said.

 

Bariatric surgery, regardless of the method used, is also much safer nowadays than it was even a decade ago, said Dr. Jon C. Gould, a surgeon at the Medical College of Wisconsin in Milwaukee who wrote a commentary on the V.A. study. However, he noted, the surgery is “vastly underutilized,” to the detriment of patients’ health and the nation’s health care costs.

“Less than 1 percent who would qualify for bariatric surgery are actually getting it,” Dr. Gould said. “Although the vast majority have health coverage, insurance companies and many Medicaid programs put it out of reach for most people by demanding that they already have several obesity-related health conditions and are taking a slew of medications to control them.”

 

For example, he said, to be covered for bariatric surgery, Wisconsin Medicaid requires that a person with dangerously high blood pressure has to be taking three or more medications for it and still not have a normal pressure.

He cited a further deterrent to bariatric surgery: “a perception that it’s dangerous and doesn’t work,” beliefs countered by the research findings cited above. Most of the surgeries are now done laparoscopically through tiny incisions.

 

Given the well-documented safety and effectiveness of bariatric surgery, it is now increasingly being performed in people whose obesity is less severe — those with a body mass index (B.M.I.) of 35 or perhaps even less — but who have a metabolic disorder like Type 2 diabetes related to their weight.

In recent years, the profession has promoted what Dr. Gould calls “centers of excellence,” where 100 or more bariatric operations are usually done in a year. Practitioners at these centers “learn from experience, share their knowledge and push for quality improvements,” he said.

Dr. Gould suggested that people interested in bariatric surgery seek out programs that have been jointly accredited by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery, which have combined forces to promote quality control.

While experts agree that money would be better spent on prevention than treatment, Dr. Twells pointed out that “we have yet to find a way to prevent obesity, and people whose health is compromised by their weight deserve to be treated by the most effective method we have.”

 

HEYYYYY #RosieO'Donnell The View - Lap band is “antiquated” Band Bashing and Hating

Via - The View & Rosie.com

  • Chris Christie in the news: The New Jersey Governor was recently seen at a GOP fundraiser showing off his 85 lb. weight loss from last year’s lap-band surgery. Whoopi said at first he said his weight was no one’s business. Nicollethinks if Chris Christie wants to run for President his health is everyone’s business as he has to have the stamina for the job.  Nicolle is a big fan of Chris Christie and observed that even Republicans who don’t want him to become president should “want our field to be as populated as possible, ruling people in not out.”  Rosie O didn’t think Governor Christie chose the right kind of weight loss surgery.  She said lap band is “antiquated” and in half the cases it has to be removed.  She recommended people who are interested in weight loss surgery do the research and choose what works best for them.  

Hey ROSIE - you gots a HATER. 

She thinks you WATCH HER CHANNEL. Check it. She sells coaching for regainers because bands work.   Riiiiiight?  Heyyyyyy.

I don't get it.  I just. don't. get. it.  


All Of Me - PBS Independent Lens

http://www.pbs.org/independentlens/all-of-me/


Katie Jay Keynote Speaking at Southcoast Center for Weight Loss - Video

Katie Jay of www.nawls.com was the keynote speaker at an event at Southcoast Center for Weight Loss in Wareham, MA yesterday.

She is amazing.  

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Thank you, Katie.  

Here we are -

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150 patients returned to the Southcoast Center for Weight Loss Saturday for a reunion as the group marked its own milestone: 3,500 patients since Dr. Rayford Kruger launched the unit nine years ago.It is now the largest and busiest bariatric surgery program in New England, with three surgeons who perform about 650 procedures at Wareham's Tobey Hospital a year.

 


Report: Some money in Lap-Band settlement to pay for billboards on weight-loss surgery risks

AP -  Report: Some money in Lap-Band settlement to pay for billboards on weight-loss surgery risks

LOS ANGELES — A company that promoted Lap-Band weight-loss surgery has agreed to pay $1.3 million to settle a false-advertising lawsuit, with some of the money going to billboards warning the public about the risks of weight-loss surgery, a newspaper reported Thursday.

From 2009 to 2011, five patients died after Lap-Band surgeries at clinics affiliated with the 1-800-GET-THIN ad campaign, according to the Los Angeles Times (http://lat.ms/11knLBS ).

The proposed settlement still needs the approval of Los Angeles County Superior Court Judge Kenneth Freeman, who asked attorneys at a hearing Thursday to provide more information and resubmit their settlement motion before he gives the deal his OK.

Relatives of two of the dead patients, Ana Renteria and Laura Faitro, filed the lawsuit as a class action in 2011.

The lawsuit sought damages from several companies and two brothers, Michael and Julian Omidi, who court documents said owned and managed Top Surgeons, a weight-loss business.

John Hueston, an attorney for the Omidis, said the settlement was not an admission of wrongdoing.

“Under the agreement, our clients ... are dismissed without any admission of liability, and made no contribution whatsoever to the settlements,” Hueston said in a statement cited by the Times.

A lawyer for the surgery centers, Konrad Trope, said the action against the facilities was dismissed without admission of liability or financial penalty.

The proposed settlement will be paid only by Top Surgeons, one of the companies behind the GET-THIN operation, the newspaper said. The company did not immediately return a message from The Associated Press.

The lawsuits and other public documents showed that 1-800-GET-THIN was a marketing company that steered patients to a network of outpatient clinics, where thousands of weight-loss surgeries were performed.

The company used dozens of billboards — along with ads on television, radio and the Internet — to promote Lap-Band weight-loss surgery.

Some of the suits alleged that the clinics put profits above patient safety, employing physicians who were unqualified and allowing surgeries to be performed in unsanitary conditions, the Times said.

The proposed deal calls for $100,000 to be spent on billboard advertising throughout Southern California “intended to explain the risks of weight-loss surgery.” The agreement does not specify the language to be used in the ads but says it must be approved by the court.


Study - 47% Weight Stays Off Long Term After Gastric Band Bariatric Surgery - But...

Medpage -  Weight Stays Off Long Term After Bariatric Surgery

O'Brien PE, et al. "Long-term outcomes after bariatric surgery. Fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature" Ann Surg 2013;257:87-94.

Obese patients maintained about 50% excess weight loss for as long as 15 years after laparoscopic adjustable gastric banding, (LAGB), Australian investigators reported.

Experience at a single center showed an average of 47% excess weight loss in 714 patients followed for more than 10 years after LAGB, including 47% among patients followed for 15 years and 62% in a small group followed for 16 years, according to Paul O'Brien, MD, and colleagues, of Monash University in Melbourne, Australia.

A systematic review of published studies revealed a mean excess weight loss of 54% at 10 years and beyond for patients treated with LAGB or Roux-en-Y gastric bypass (RYGB), they reported in the January issue of Annals of Surgery.

The results also showed a marked reduction in late-occurring adverse events after LAGB, the authors added.

"Gastric banding is a safe and effective treatment option for obesity in the long term," they said. "The systematic review shows that all current procedures achieve substantial long-term weight loss. It supports the existing data that LAGB is safer than RYGB and finds that the long-term weight loss outcomes and needs for revisional surgery for these two procedures are not different."

Despite a history dating back more than 50 years, bariatric surgery has a paucity of long-term data to demonstrate durable weight loss. Most published studies have follow-up of less than 3 years. Systematic reviews have added relatively little in terms of long-term follow-up data, according to the authors.

O'Brien and colleagues introduced LAGB at their center in 1994, and have followed all patients by means of a dedicated bariatric surgery database. As of December 2011, O'Brien and co-author Wendy Brown, MBBS, PhD, also of Monash University, had treated 3,227 patients with LAGB.

The authors performed a prospective longitudinal cohort study of the patients. For comparison, they performed a systematic review of published literature on bariatric surgery. The focus was on long-term follow-up, 15 years for the cohort and 10 years for the systematic review.

The cohort had mean age of 47 and a mean presurgical body mass index of 43.8 kg/m2. The authors identified 714 patients followed for at least 10 years, including 54 patients followed for 15 years and 14 followed for 16 years.

  • The 10-year excess weight loss was 47%.
  • The authors reported that 26% of patients required revisions for proximal enlargement,
  • 21% for port and tubing problems, and 3.4% for erosion.
  • Band removal was performed in 5.6% of patients.

During the first 10 years of clinical experience, the revision rate for proximal enlargement was 40%, declining to 6.4% during the last 5 years of the study period. Patients with and without revisions had similar excess weight loss.

The systematic review consisted of 19 published articles, 24 data sets, and approximately 14,000 patients. The data included six sets involving patients with LAGB, nine sets for RYGB, five sets for gastroplasty, three for biliopancreatic diversion or duodenal switch (BPD/DS), and one involving fixed open gastric banding.

According to the authors, every study had deficiencies related to data reporting. None of the studies was a randomized controlled trial. One investigation was a prospective, nonrandomized, matched interventional study, and the rest were observational studies.

With respect to safety, one perioperative death occurred in 6,177 LAGB procedures, compared with 21 in 2,684 RYGB procedures (P<0.001).

Excess weight loss at 10 years averaged 54% with LAGB and RYGB, 53% with gastroplasty, and 73.3% with BPD/DS. The mean revision rate was 26% with LAGB and 22% with RYGB. Revision rates from individual data sets ranged as high as 60% with LAGB and 38% with RYGB.

"The longitudinal cohort study of the LAGB patients shows that they have achieved and maintained a loss of nearly half of their excess weight to 15 years," the authors wrote. "The validity of the 15-year figure of 47% of excess weight loss is reinforced by the pooling of all long-term data (≥10 years) and finding the same weight loss of 47% excess weight loss for the much larger group."


Allergan might sell off LapBand Arm - Surprised?

Allergan is considering selling out its Lap-Band arm of weight loss surgical devices -- after a rapid decline in sales and huge public perception fail.  Shocking, right?  Uh, no.

La-fi-allergan-lap-band-20121030-g

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Mini Squee - #YWMconvention #OAC

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On October 27th, 2012, during the Obesity Action Coalition "Your Weight Matters" Event at the Hilton Anatole
, there will be another first: the first annual OAC Awards!

Your friendly blogger was nominated in one of these categories, and I am thankful to you for that.  Thank you.  And, really, thank you.

I will be present at the events, dinner, ceremony, and of course the Walk From Obesity with at least $6000.00 in donations from Team MM + BBGC.  

Have I mentioned that there is still time to donate to Team MM + BBGC and I do not see your donation in yet?  

Go ahead, I will wait for you!

Thank you - and see you there? 

There is still time to register for the OAC event!  

Do. not. miss. it.

 Join the OAC event on Facebook!

 

 

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About the OAC Awards -

The following awards will be presented during the OAC Inaugural Your Weight Matters National Convention:

OAC Advocate of the Year - This award is given to the OAC Member who has lead the charge in taking on National, local and state advocacy issues. This individual should be a tireless advocate to advance the cause of fighting obesity and the individual affected by obesity.

Community Leader of the Year - This award is given to an individual who continually works in their community to advance the cause of fighting obesity. The recipient should be an individual who actively engages their community or with their constituency in spreading awareness of obesity and encourages others to get involved in activities that further the mission of the OAC.

Outstanding Membership Recruitment by an OAC Member - This award is designated for the individual OAC member who is an active membership recruiter in the OAC. The individual is a regular membership promoter and continually encourages membership in the OAC.

Outstanding Membership Recruitment by a Physician - This award is given to the Sponsored Membership Program participant (physician) that has recruited the most new members in the OAC in the 12 months prior to the Convention month. The recipient of the award has encouraged membership in the OAC by purchasing it on behalf of the patient.

Bias Buster of the Year - The OAC’s Bias Buster of the Year is awarded to the individual who has lead the charge to put the OAC on path to effect change in mindsets, policies and public perception of weight bias. This individual is both proactive and reactive in responding to weight bias issues and is an example to others on how to get involved as a Bias Buster.

OAC Member of the Year - This is the OAC’s highest honor and is awarded to an OAC member who goes above and beyond to help the OAC in its efforts to achieve its mission and goals. This individual is an exemplary OAC member and continually represents the OAC in impacting the obesity epidemic.

______________________________________________________

The Obesity Action Coalition (OAC) is set to host a ground-breaking educational convention on weight and health, the Inaugural “Your Weight Matters” National Convention. Join them in Dallas, October 25-28 for this ground-breaking Convention that will answer all your questions about weight and health! For more information, please visit www.YWMConvention.com.

 


Woman Suffers from Lap Band Surgery Gone Wrong - Wernicke's Disease

Neurological diseases sometimes occur (if very rarely) triggered in part by a weight loss surgical procedure for various reasons -- some avoidable -- some not, please don't hate.  (Says she who developed a cognitive disorder and intractible epilepsy after weight loss surgery.  Be kind.)  The woman in the following story developed Wernicke's Disease after gastric banding surgery in 2009.

Wernicke's disease occurs at times with persistent vomiting after WLS, a study in Neurology (2007) states that in a review of cases a "majority of the patients (25 of the 32) had vomiting as a risk factor, and 21 had the classic Wernicke's triad of confusion, ataxia, and nystagmus. Other symptoms seen in these patients included optic neuropathy, papilledema, deafness, seizures, asterixis (bilateral) flapping tremor of the hands and wrist, weakness, and sensory and motor neuropathies."
  • A small number of cases, patients who undergo weight reduction surgery may develop Wernicke's encephalopathy, marked by confusion and problems with movement and eye control.
  • The cause is a thiamine (vitamin B1) deficiency and, if detected, can be easily corrected with dietary supplements. Untreated, it can be fatal and cause severe neurologic morbidity.

Shacka says she suffers from multiple health issues because of a lap band surgery she had in California back in 2009. It went horribly wrong.  And since then her independence is gone and her life has never been the same.

"At some point, I say I don't know what my life is supposed to be like now.  Like, where am I supposed to go?  Where do I fit in?," said Shacka.

But what is lap band surgery?

"They're a weight loss surgery where this band is placed around the top part of the stomach.  The bands have a balloon on the inside on the inner surface and through adjustments in clinic, the balloon can be tightened or loosened and help people feel full on a smaller amount of food," said M.D. Corrigan McBride of the Nebraska Medical Center.

Officials from the Nebraska Medical Center say health issues with weight are a common factor for patients battling weight gain and obesity.

"There's a certain percentage of patients that it's just not the right weight loss tool for them and they will elect to have the bands removed and converted to a different surgery," said McBride.

"I said I can't do this anymore, I need to go to the hospital.  This is not right, I'm still throwing up.  And finally I went in, and by then I had double vision and that's a sign of neurological disease," said Shacka.

Shacka also suffers from Wernicke disease—a form of brain damage.  She says this was a result of her surgery.  Through years of therapy, learning how to walk, speak and use her hands again, Shacka says her journey to better health isn't over.

"I beat the odds twice.  They told me I would be in a wheelchair for the rest of my life…and I'm walking.  They told me I would never do steps again, I went up four flights of steps with one physical therapist.  So I beat the odds and I need more additional help," said Shacka.

But through this traumatic experience, Shacka says she sees the bright side of it all.

"I met some wonderful, wonderful angels who've helped me to know what life is about.  I can't take that back and I would have never gotten it if I wouldn't have gotten sick," she said.

And her fight to spread awareness about the risks of lap band surgery keeps her motivated.

"You don't give up, and I'm not going to give up.  And I guess this is my way of not giving up and living life," she said.

Shacka plans to sue the doctors in California that did the surgery.  She's had some financial struggles raising enough money to hire a lawyer, but finally met that goal.  Now, she is trying to raise enough money to receive therapy and more medical treatment at Mayo Clinic. 

Clin Nutr. 2000 Oct;19(5):371-3.  Wernicke's syndrome after bariatric surgery.

 


FDA Warns Second LapBand Firm

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And here we go again!

Los Angeles Times -

"The FDA sent a letter to the owners of Lap-Band VIP, warning them to change their billboard and television marketing or face disciplinary action. The allegations were similar to those the agency made in December against 1-800-GET-THIN, another company that marketed Lap-Band weight-loss surgery.

Lap-Band VIP, based in Tarzana, has promoted its weight-loss surgery on television, the Internet and freeway billboards throughout Southern California. One billboard featured a photograph of a thin woman with the pitch:

"Tiffany lost over 100 lbs. Actual patient. Results may vary."

Results DO vary with banding!  

Those ads were misleading, the FDA said in a June 25 letter, because they failed to include adequate warnings about the surgery's risks. The agency said Lap-Band VIP "should take prompt action to correct the violations" or risk "regulatory action."


RHONJ Lauren Manzo on Bethenny - "I hated me."

Really. STOP.  "It was like an intervention?" 

STOP.

Did Lauren Manzo's gastric band made her "happy?"  No.  It does not work that way.  And, Bethenny, it's not up to you to tell her she looks "Uh-MAZING..." and that she doesn't "need to lose more weight."

 


Celebrate Vitamins Multi-Complete Chewable with Iron - ORANGE

323522_2375149292790_1072296476_2628755_330138009_oA box from Celebrate Vitamins just arrived.  I opened it within seconds of it's drop at my door because I love mail. 

Seeing the Fed Ex or UPS man makes Beth a happy girl. (When you don't get out much, it takes little to please you.  Don't discuss this.)

In the box, a bottle of Celebrate Multi-Complete Chewable with Iron (Orange) which is a brand-new flavor from Celebrate!

Now.  Let's talk.

My favorite Celebrate Multi in terms of TASTE is the PINEAPPLE STRAWBERRY.  I would do bad things to get more.  I adore these chewables.

But, this -- this chewable -- is a multivitamin complete!  That means -- it's got iron in it.  36 grams of the good stuff. 

It's formulated particularly for gastric sleeve patients, but gastric bypass patients could also take it to avoid taking a separate iron supplement. 

You know your WLS is getting more special when you get your own vitamins.  Mmm hmm!

Continue reading "Celebrate Vitamins Multi-Complete Chewable with Iron - ORANGE" »


Gastric bypass helps curb temptation better than banding?

A small study was done on roux en y gastric bypass patients and gastric band patients in the UK, to test the temptation of naughty foods on both types of post ops. 

Reuters -

After surveying patients who had either type of surgery, and performing brain scans on several dozen of them, Dr. Tony Goldstone of Imperial College London and Hammersmith Hospital and his colleagues found that even deep down in their brains, the gastric bypass patients seemed to like high-calorie foods less.

"The results suggest that gastric-banding patients had to exert quite a lot of self-control over their eating behavior. Banding patients also had higher concern about their weight," Goldstone told Reuters Health.

In contrast, gastric bypass patients "don't feel they have to exert as much cognitive control over what they're eating," said Goldstone

Although I don't have a gastric band, I have lived seven and a half years with a gastric bypass, married to a man with a gastric bypass -- who's mom and sister who have had a gastric bypass.  I would agree with this study for myself -- the gastric bypass did shut down a lot of the mind-gut connection for me.  

Why?

Honestly, gastric bypass can cause such serious distress when eating so-called tempting foods, that once we DO try them again?  (And, we do!)  

We may make that cognitive connection that food = discomfort = sick = don't do that again.  Certainly it doesn't always work, and we might continue to eat foods that cause us distress because We Are Human and make mistakes and food sometimes just appeals to us too much.  Also, gastric bypass has a funny way of making some foods appeal to us, make us sick ONE TIME, and the the NEXT TIME?  We have zero reaction.  

This is a sticky situation -- and it's a gastric bypass food roulette.  Many of us have a list of foods that cause a reaction every single time we try them, or just sometimes, and a list of perfectly safe foods.

Not everyone has a reaction to food -- some gastric bypassers get by with no reaction to any food, ever -- and love to announce this -- but they're crazy and we don't talk about them.  (I'm kidding.)  

I would say that banders have it rough when it comes to food choices -- they don't get the hand-slap fun that bypassers do.  This cognitive "don't eat that, it will make you sick" fun of the gastric bypass is a big part why people choose to have the roux en y to begin with.  This is a big reason why I did not have a band.  I know what I would be doing.  "Hello, ice cream.  I have missed you."  

My MRI reactions would be food-gasming over Mint Chocolate Chip again.  Which, right now?  I have COMPLETE aversion toward -- because of the gastric bypass.

Foodgasm-new-8


Eight Rules of Eating With A Band

The following is via Bariatric Times -- and found some interesting and important bits for banders, and while it's written for a professional, there are some VERY good pointers for YOU.  Keep in mind -- this is an Australian surgeon -- there may be differences in your post op care AND PLEASE LISTEN TO YOUR DOCTOR. 

The “Eight Golden Rules” via Lap Band Australia

 

These eight golden rules must become part of each patient’s life. The effect of the LAGB procedure on hunger facilitates a patient’s adherence to the rules, making it more likely that he or she will follow them. However, achieving positive results with LAGB requires a working partnership between the physician and patient. Adhering to these rules is the patient’s part of the partnership, and he or she ultimately is responsible for the success or failure of weight loss following LAGB.

Continued ...

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