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We encourage you to study the following information carefully.  It will answer many of the questions that you have about the Lap-band and how it will affect your life.

LAPBAND PRE-OPERATIVE EDUCATION

12 Important Points to know before surgery

Pre-Operative Diet

HOW DOES THE LAP-BAND WORK?

The lap-band is like a belt wrapped around your stomach that divides it into an upper smaller pouch and a lower larger stomach or pouch. With a smaller stomach, you will feel full sooner, and then food will move slowly into your lower stomach as it is digested. That is how you lose weight.

Surgery is not a quick fix or magical solution. This operation is only a tool that will HELP you lose weight. You are an important part of the process. Managing your food intake and exercise is a big job. It takes a lot of commitment on your part and a lot of support from others.

LAP-BAND surgery is a great tool to help you significantly change the way you live your life. You will only be able to eat very small amounts of food very slowly, if you get your band adjusted when prescribed.

The lap-band is around your stomach not your brain. If food has become a source of comfort or a stress reliever for you, then you have a complicated relationship with food that does not instantly change after surgery. You are not alone, remember that we are here to support you, but if you think you need formal professional help like psychological-motivational therapy, it is valuable.

WHAT WILL I EAT?

You will start with a liquid diet and move slowly towards eating solid food again. Your stomach needs time to heal, and you have to go easy on it.

• Drink small sips of clear liquids or soup broth
• Drink skim milk and protein drinks
• Eat yogurt that is low in fat and sugar free
• Drink lots and lots of water

After this, you will gradually move from liquids to soft or pureed foods:

• High-protein foods like pureed, skinless chicken or fish
• Mashed potatoes
• Easy to swallow vegetables (very well cooked)
• Avoid all high-fat and high sugar foods

How long it will be before you can eat solid food again varies. Your new diet will depend a lot on what your body can handle. But it is VERY important that you follow the diet plan laid out for you.

Eating the wrong foods or eating too much can cause vomiting, and this may cause your stomach pouch to stretch, and the band may slip.

TAKING PILLS

You may have to crush or break up some of your medications. But you can not do this with all kinds of pills. So go down your list of pills with your physician to make sure that it is OK. Large pills can get stuck in your stoma, and you may throw them back up.

Remember to take your pills on an empty stomach and follow them with food. This will help push the pill through the band and avoid an irritated pouch. If you do it the opposite way, food in your pouch will not allow the pill through until it dissolves. The risk or irritation increases in these cases.

POST-OP LAP BAND NUTRITIONAL GUIDE

LIQUID DIET ONLY (2 weeks)

DO NOT EAT ANYTHING SOLID DURING THE FIRST 4 WEEKS FOLLOWING SURGERY. And remember NOT to drink carbonated beverages for at least 4 months post-op; carbonation can cause the pouch to enlarge. Ask us later how to introduce them.

Why liquids only?

By consuming liquids only, you will prevent overfilling or stretching of your new stomach pouch. This gives the stomach wall the chance to heal around the band, thereby decreasing the chances of your band slipping.

What is a liquid?

A good rule of thumb is that a liquid is anything that can be sucked through a straw. If it won’t fit, it’s probably not a liquid. Do not use a straw; it introduces a lot of air into your stomach pouch and can make you nauseated and uncomfortable.

During the first month, we want you to flush everything through the pouch by following a liquid diet and by introducing soft foods little by little; drink with your “meals” if needed during the first month.

One month after surgery you will start introducing solids.  At this time we are ready to put your band to work. Drink fluids before eating your meal and stop as soon as you start eating.  Continue drinking one hour later. Drink as many fluids as you want between meals, but do not drink anything with more than 10 calories.

The primary concern in the first month is allowing your stomach to heal, preparing you to start progressing your diet to thicker, denser foods. After this month, we want the band to limit the amount of food you eat, and we can plan on adjusting your band at 6 or 8 weeks.

WEEK ONE AND TWO

LIQUID DIET (consume liquids which are low in fat, sugar, and calories)

The restriction you feel after surgery is from the fit of the band around the stomach and from any swelling you may have developed from the surgery. You may not feel full after a liquid meal. This is expected! We want the fluids to travel through the banded area quickly.

Sip liquids slowly and drink water or other non-calorie, non-carbonated beverages between meals. Do not use a straw to drink your liquids. You may use a spoon in order to control the size of your intake.

Alcohol is very high in calories and sugars and may prevent your body from burning fat. Additionally, it is absorbed in your stomach and is an irritant. This is not to say that you will never be able to have a cocktail or wine with dinner. Moderation is the key.

DON’T eat any solid foods or soups containing solids such as meats or breads

DON’T gulp any liquid

Please check out the menu choices for ideas on what you can have during this stage!

WEEK THREE AND FOUR

SOFT FOODS

FOOD CHOICES

You should eat foods which are moist and mushy and that can be crushed with your fork. At this point you may have started feeling hungrier. Continue to flush foods with liquids; however, you may start to notice a difference in the amount of time you stay full following a meal. It is important to eat slowly and practice chewing your food very well. Listen to your body, and try to start picking up on the signals that you feel.

EATING BEHAVIORS:

Remember to eat slowly and try very small portions to start. You may notice a feeling of fullness after eating small portions of soft foods. If you do not feel full, don’t panic; your first adjustment is right around the corner. Drink plenty of non-calorie beverages between meals.

Start learning the “new eating habits,”  and focus on introducing protein first at every meal followed by vegetables and a small carbohydrate last. Avoid drinking and eating at the same time, and limit your portion size to less than 1 cup per meal.

DON’T eat any fibrous foods such as raw vegetables or tough meats

DON’T eat any fast foods or concentrated sweets

Why protein?

• Protein is needed in order for you to heal following surgery, and it is the fuel that your body uses to repair tissue.
• Protein carries fewer calories if it is a “lean” meat.
• It helps maintain muscle mass.
• It fills you up sooner.
• It keep you feeling full longer because it is denser and broken down by the body more slowly.
• You do not need to strive to reach a certain amount of protein; just put it first in each meal.
• It improves immunological system.
• It helps control hunger.
• It slows down the uptake of sugars.
• It helps you lose weight.

Please check out the menu choices for ideas on what you can have during this stage!

WEEK FIVE AND BEYOND…

SOLID FOOD

You are ready to introduce solid food into your diet. Before your adjustment you might be able to eat like you did before surgery and feel hungry. When you reach a point where you have good restriction (it can take from 1 to 4 fills), you start experiencing satiety, a feeling of fullness and satisfaction after eating small portions of solid foods.  You should be eating less than before surgery after your adjustment.

It is important to move to solid foods and eat the most nutritious and solid food choices at each meal. By eating solid foods you will maximize the effectiveness of the band.

You can start eating a normal well-balanced diet, but it is important to start following the lap-band “NEW EATING HABITS”:

You may or may not identify foods that do not work well for you during this stage.

Slowly consume a small portion of low fat protein food and vegetables 3 times a day.

Space these solid meals 5 hours apart.

Chew all solid foods to a mushy consistency.

Do not drink liquids during or shortly following a meal.

Remember to eat very slowly, chew thoroughly, and take very small bites.

You should spend 30 at the most 45 minutes eating each meal.

Stop eating as soon as you feel full.

Once solids are started, you should experience a feeling of fullness. This is how you will eat permanently.

Avoid any fast foods or concentrated sweets.

Please check out the menu choices for more dietary guidelines!

EAT protein first, followed by vegetables, and a small carbohydrate last.

Unfriendly foods

Foods that you may find difficult to tolerate:

Red meats, breads, rice, and pasta (angel hair pasta is usually well tolerated)

WEEK SIX

ADJUSTMENT

At this point, you will be evaluated for an adjustment. We will consider your eating habits and patterns, your weight loss, and feelings of hunger to determine whether you are ready.

Your first adjustment will be around 6 to 8 weeks post-op.

Subsequent adjustments will be based on your need of more or less restriction. It is important to have these done as you lose weight. It is just like tightening your belt. Your stomach needs to adjust with you as your body changes.

If you feel you may need an adjustment, contact us to make sure it is the correct decision.

Some people do not need an adjustment because the band is tight enough already. Others need 2, 3, or more.

If you have an adjustment, your doctor will use a thin needle to inject saline into the port so it inflates the band’s inner ring. This tightens the band and narrows the stoma (passage from the small upper pouch to the rest of the stomach). How much saline is added (or removed) depends on what you need.

A band adjustment only takes around 10 to 15 minutes. The fills do not hurt much at all. It feels like a little sting.

A basic rule is that the band should be as loose as possible to achieve weight loss.

DIET AFTER LAPBAND ADJUSTMENT

You will be on a clear or full liquid diet advancing to solids slowly.

You should be able to tolerate liquids immediately following your adjustment; however, you will need to take small sips.

You may experience swelling following your adjustment that may take up to two weeks to fully subside. 

You should be able to tolerate solid foods within 2-3 weeks of your adjustment. 

If you are unable to do this, or at any point are unable to tolerate liquids, please let us know.

VITAMINS

If you eat a balanced diet every day, you may not need a daily supplemental multi-vitamin. We recommend taking one everyday. Since most of the multi-vitamin pills are fairly large and could block the small opening in your stomach pouch, you will need to select either a liquid daily multivitamin-mineral supplement (e.g., liquid Centrum) or two children’s chewable vitamins (e.g., Flintstone’s) each day. Another good option is Juice plus (chewable).

CAFFEINE

We don’t advise drinking any beverages containing caffeine. Caffeine tends to increase the acids in the stomach, causing irritation and heartburn pain. Caffeine is a diuretic (increases urination), which will increase the loss of water, certain vitamins, and minerals such as calcium, magnesium and potassium. Try decaffeinated beverages to replace the need. IF YOU HAVE TO HAVE AM CAFFIENE LIMIT IT TO 1-2 CUPS.

SOFT DRINKS

Carbonation from soft drinks can build up in the small stomach pouch and cause bloating or stomach irritation, which can be very uncomfortable. The carbonation can cause the pouch to enlarge. After 3-4 months from your surgery, if you want to try soft drinks, let the soda sit in a glass with ice for a few minutes so that some of the gas is released. You should only try sugar-free (diet).

EXERCISE

Exercise will be an important part of your new lifestyle. We know that by increasing your activity level, you are increasing the amount of energy your body expends. This results in increased weight loss. We also know that most individuals who successfully have maintained their weight for long periods of time are usually those who exercise on a regular basis. In addition, exercise will enhance the cosmetic result of your weight loss, diminishing the need for cosmetic surgery in the future.

30 MINUTES A DAY 3-5 TIMES A WEEK

START SLOW AND BUILD UP

A FEW THINGS TO REMEMBER

The lap-band is a tool to help guide you to permanent weight loss.

It is essential to understand that you will not achieve the desired weight loss without effort and support.

Lifestyle changes are required to be successful.

It is important to understand that “follow up” is imperative to achieve the desired weight loss.

Most important, we are here to support you.  You are not alone but we need your work to make this work!

FOLLOW UP- “THE KEY TO SUCCESS!”

Contact us one week post-op; we want to make sure that you are doing well, and whether your incisions are healed and you are following your liquid diet.

Contact us one month after surgery; we need to evaluate eating habits and patterns eating  protein first, followed by vegetables and a small carbohydrate last, your weight loss, and your feelings of hunger.

Contact us whenever you feel you need an adjustment and let us help you determine your need for further restriction. Adjustments are a great TOOL and should be used WISELY.  It is not as simple as wanting it tighter or looser. Please take advantage of our “vast experience.”  Over the years, we have learned that patients with the closest supervision or follow up have the BEST RESULTS long term.

Contact us at least every 3 months for the first year.  If more follow up is required, feel free to contact us more often.

Contact us every 6 months for the second year.

Contact us annually; if you are several years post-op, you may still require adjustments.

If you are not losing weight as desired contact us.  We need to try to determine the problem and come up with a solution.

THE SCALE

 - Weighing is a good thing if done properly

 - Weigh yourself once a week only

 - Record your weights

 - Weighing yourself keeps you accountable and allows you to measure the distance to your goal

HOW MUCH WEIGHT CAN I EXPECT TO LOSE

It varies. Most people lose about 1 to 2 lbs per week for the first year, depending on how much weight you have to lose (it might be more). In the second year, the weight may come off even more slowly or stay the same for several weeks. Try not to get discouraged and look for “non-scale victories.”

NON-SCALE VICTORIES (NSV´S)

If you aren’t seeing progress on the scale, you have to look for progress in less obvious places. For instance, maybe you can fit into a pair of jeans that you haven’t worn in years. Or some health problems you had because of your weight are gone. The point is that a scale is not the only thing that can tell you how well you are doing.

SUPPORT GROUP

The support group is highly recommended for each patient.

GOOD LUCK!

We look forward to this journey together toward a new and healthy you. Please do not hesitate to call or e-mail us with questions. We are here to help you and to make your journey an easier one.

KEEP IN MIND

There will be days when you feel like you can eat anything and then days when you will have difficulty with a lot.

It has a lot to do with the time you have to eat, compliance with new eating habits, and stress.

One food may work one day and then the same food the very next day will not be tolerated.

Don’t lock your self in a box of food choices.

You enjoyed food before; you can still enjoy food.

It is all about developing a healthy relationship with food.

Eat to live don't live to eat.

 DIET AFTER LAP-BAND ADJUSTMENT

EACH INDIVIDUAL´S RESPONSE TO A LAP-BAND ADJUSTMENT WILL VARY.

Day of adjustment: clear liquids advancing to full liquids as tolerated *

Day 2: soft foods (start introducing soft proteins at each meal)

Day 3: soft foods advancing to solid foods

* If you come from out of town and clear liquids go through with little restriction, move on to soft food (day 2) before you leave. This may mean you need a further adjustment before you leave town.

You should be able to tolerate liquids immediately following your adjustment. You may experience swelling following your adjustment that may take up to two weeks to fully subside. Within 2 to 3 weeks of your adjustment, you should be able to tolerate solid foods. If you are unable to do this, or at any point you are unable to tolerate liquids please let us know.

If there is only a small amount of fluid that needs to be added; it may take time for your adjustment to “kick in.”  Patients sometimes report feeling little to no change in their level of restriction for one or two weeks. If after 3 weeks there is still no change let us know.

It is important to make sure that you drink plenty of fluids prior to your adjustment to “flush” your pouch.

Remember, it is very dangerous to eat quickly without taking time to chew your food well. Too much food at one time or big chunks of food can block your pouch outlet. You can avoid this problem by chewing your food well and eating small bites. If you do not follow these precautions, you are risking the possibility of a stomach obstruction or blockage, which may result in nausea, vomiting, stomach irritation, and/or stomach swelling. If you experience problems with solid foods or suffer from nausea or vomiting go back to a liquid diet.

If at any time you are unable to tolerate solid food, you need to rest your system for approximately 2 hours. After that time frame, start back on ice chips and Maalox (Maalox on the rocks) and slowly advance your diet. Advance your diet every day at the evening meal, when your restriction is more relaxed. This process may take a few days to allow your stomach to heal and the swelling to go away.

Please check out the menu choices for ideas on what you can have after an adjustment!

If you are experiencing coughing, burning, or reflux at night time, make sure you do not eat within 3 hours of the time you lie down at night. Before going to bed, you can drink at least 8 oz of fluid to help flush out the pouch. You may also need to take a Proton Pump Inhibitor or PPI such as Prevacid, Nexium, or Prilosec. Prilosec OTC is a good choice if you do not have a prescription already. The PPI should be taken approximately one hour after your evening meal.

Never take medications directly before lying down at night. This does not allow enough time for the pill to pass through the stoma and empty into the larger stomach.

LAP-BAND ADJUSTMENTS/FILLS

1. When do I need an adjustment?

Everyone requires a different restriction level and adjustment schedule for optimal results. There are several indicators that may alert you to schedule an appointment:

• No weight loss for more than 3 weeks
• Ability to eat more food during a meal than usual, eating larger and larger portions 
• Feeling hungry less than 4 hrs after eating a meal, in which you ate SOLID FOODS and protein first, followed by vegetables, and a small carbohydrate last
• Ability to eat foods that you were unable to eat before (i.e. breads, fibrous vegetables)
• Increased appetite, snacking or feeling hunger sooner, and being able to eat more than 1 cup

The GOAL is to have you eat between ½ to 1 cup of solid protein and vegetables; it keeps you full to the next meal. You do not have to be too tight or too loose, we need to work on the right adjustment for you! If you are satisfied with the amount of food, it is a good restriction.

* If you have at least 2 of the above, this may mean that you need more restriction. Please contact us to determine that. If you are several years post-op, you may still require adjustments.

LONG-TERM FOLLOW-UP IS THE KEY TO SUCCESS!

2. How do I know I have been properly adjusted?

Three small meals a day should satisfy you while maintaining a target weight loss of 1-2 pounds per week. The lap-band helps you eat less by restricting your stomach capacity and increasing the time it takes to digest food. If you choose your food wisely and chew it properly, you should not feel hungry or deprived.

3. Can I be over-adjusted? If so, how will I know if I am?

Yes, you can have too much saline in your band. Tighter is not always better! Indicators that you may be over-adjusted include:

• Difficulty swallowing food or saliva
• Regurgitation
• Waking up at night coughing or vomiting
• Frequent reflux/heartburn

4. Why do I feel more restricted in the morning than at night?

There are several theories because nobody knows for sure; however, it is a very common complaint. Mucus accumulation when you are lying down with no gravity to assist its movement through the esophagus is one explanation that responds to warm liquids in the morning like “hot” tea. This may also result from pouch irritation from going to bed with a full stomach, stress, medications, traveling, etc. These will improve with sips of Maalox in the morning. Finally, your esophagus muscle tightens when not used overnight. It must work to push food down through the band and needs some time to “warm up” in the morning. This situation subsides on its own.

5. Why are adjustments important?

Adding or removing saline from your lap-band system is necessary for continued success. This unique feature provides the right level of restriction for your individual needs.

 6. What if I am not loosing weight?

• You might just be experiencing a plateau; just keep doing the right things and see if you can come out of it.
• LOOK at your EXERCISE to see if you need to increase it.
• EVALUATE your “new eating habits.”  Keep a journal for few days and write down EVERYTHING that goes in your mouth. Sometimes we think we are choosing the right foods, and we might NOT be! 
• If you get hungry between meals, check your eating pattern (protein first, followed by vegetables, and a small carbohydrate last). When we eat a diet high in carbohydrates, we are hungry most of the time

A PROPER LAP-BAND ADJUSTMENT

A WELL-ADJUSTED BAND WILL GIVE YOU: 

1. Good weight loss:

•  approximately 1 to 2 lbs per week

2. Ability to eat most solid foods:

• except thick breads, dry or tough meats

• if you thoroughly chew food and eat slowly

• comfortably eat a small selected solid meal

3. No limitation of liquids:

• except during meals

• never drink high calorie liquids

SIGNS AND SYMPTOMS THAT YOU ARE “TOO TIGHT”

• Nocturnal coughing
• Drinking/eating “empty” calories to make up for nutritional needs
• Reflux
• Regurgitation or persistent vomiting
• Eating only “mushy” foods

Call your physician if you are experiencing any of the above. You may be overfilled.

We hope this document is helpful.  If you have any questions, please let us know!

To download this guide click here.