How tight is too tight ?

Ok so i dont spend much time on OH , dont care for them too much. But they have quiet a few good articles on the site today .
http://www.obesityhelp.com/forums/lapband/ADJUSTMENTS-Life-with-an-Adjustable-Gastric-Band-How-Tight-Is-Too-Tight.html

I am a bariatric surgeon who does gastric bands, and I have done a lot of them—over 1500 in the last four years. As you can imagine, I have had many thousands of conversations with patients after surgery regarding whether or not they have reached their “sweet spots.” When I ask a patient if he or she needs an adjustment, the answer is universally a resounding “Yes!” From the patient’s standpoint, more restriction always seems appealing, because it’s only logical that it would equate to greater weight loss, right? In actuality, nothing could be further from the truth.

What we are talking about here is over-restriction—the point at which a band becomes so tight that healthy, high-protein foods are no longer an option. Instead, the patient gravitates towards calorie-dense, high-carb soft foods: things like chips, pretzels and ice cream that taste really good and slide down really easily. I call this soft calorie syndrome. Patients who have this syndrome have suboptimal weight loss because they are not getting enough protein; their daily calorie intake can actually be too high, even though they can barely eat any solid food. This is because of these calorie-dense soft foods that don’t keep you full for any length of time.

When I see patients in this zone, usually they have gained weight or remained weight-stable since their last visit. It can be very difficult to convince a patient who hasn’t lost any weight that the band needs to be loosened and not tightened. What I always tell them is that they need to be loose enough to eat three-quarters of a cup of solid protein at one sitting. Meat is ideal. In fact, in my experience I find that band patients who are loose enough to eat most meats lose the most weight.

So keep this in mind when you are seeing your surgeon. Be straightforward and honest, and don’t try to skew things so that you end up getting more saline in your band. If you are over-restricted, you will be less successful in your weight loss and at higher risk for a slip or an erosion. You can be successful without being super-tight!

Trace W. Curry, MD, is medical director of the Center for Metabolic & Bariatric Surgery and JourneyLite of Cincinnati. Visit www.thebanddoctor.com.

December 2008