It isn’t uncommon for patients to want an adjustment to their lapband because they say it allows them to eat more. The first question we ask is, “Why are you eating more?” The typical answer is, “Because I can.”
My response is always, “Just because you can, does not mean you should.” Since the lapband’s job is not to restrict the amount of food you eat, do not leave that to chance, it’s your responsibility to make sure you measure your food. Part of personal accountability is to account for, to measure and know how much you are eating at a time. The lapband is empowering; if you eat an appropriate amount and make appropriate food choices, you will be satisfied for several hours. This results in either weight loss, or weight maintenance (if you are at your weight loss goal).
The purpose of the lapband is to assist you in losing weight, and this occurs only with active participation by you: you chose what to eat, you choose how much to eat, and you practice walking away after eating that amount. The lapband is a tool to allow you to eat less and have your appetite dimmed resulting in weight loss, or maintenance. It is a tool to help you adopt a healthy lifestyle — you still have the choices to make, but the lapband allows you to be satisfied with those choices.
“If I could eat less and walk away, what would I need this lapband for?” is a common question. Without the lapband, if you eat a small amount of food and walk away your appetite would rise within a couple of hours. You would find yourself hungry and wanting more food, possibly leading to unplanned snacking. If you willed yourself to withstand the hunger, your weight loss would gradually decrease. The lapband fools your brain into thinking you ate more than you did.
Think of it another way — the hypothalamus does not have eyes — it doesn’t know how much you ate, it doesn’t know if there is a lot of food around and you are not eating it, or if there is a band on your stomach. The hypothalamus reacts very simply to the stimulation provided by the upper part of your stomach. Stretch that thermostat, it thinks you are eating a lot. Do that consistently over time, and it behaves as if you are eating a lot all the time and will allow your body to release fat stores and not cause your body to go into a metabolic slow-down.
Conversely, if you go on a diet, without the lapband, and that part of the stomach is not stretched, your hypothalamus thinks you are in a famine. It doesn’t know that there is a lot of food around you. The purpose of stomach banding is weight loss. Patients who are successful do not “feel tight,” or “feel restricted.” Instead, successful patients report that they rarely have an issue with the lapband, they do not “feel restriction.” Successful patients come for adjustments when they notice that their appetite is returning between meals — patients who are not successful rely upon the lapband to tell them when to stop eating.
The lapband, in successful patients, is empowering. While, on occasions, the band is “fickle,” the proper way for the lapband to work is for it to allow you to eat less and not be moved by appetite.