(This is a guest post by Dr. Rachael Keilin a Lap Band surgeon in Texarkana, TX.)

There are a great many memorable quotes from that great paragon of southern female friendship, “Steel Magnolias”. But my favorite was said by Clairee, when viewing the mayor’s wife in her new dress from the back: “It looks like two pigs fighting under a blanket.”

I know everyone reading this (or at least I hope it’s not just me) has experienced something like this situation. You try on an outfit, or add a belt, but it just doesn’t fit well because it causes a tight spot and your tummy (hips/butt/thighs) bulges out around it. Something that doesn’t fit just doesn’t let the outfit work, no matter how beautiful or expensive or perfect you might think it is.

Many of our patients think that making their gastric band tighter and tighter is like trading up from a Gap canvas belt to a Neiman Marcus alligator belt. If it’s tighter, it must be better. But the Lap Band works a lot like the sabotaging accessory when it’s too tight. Instead of allowing you to eat three small meals a day without being hungry, an overly tight band forces you into bad habits which will ultimately undercut your weight loss.

A Lap Band that’s too tight doesn’t allow very much through – and what goes through easily tends to be junk food. Ice-cream and chips will almost always go through because they are slick and greasy and largely liquefied by the time they reach the band. Steamed veggies and grilled chicken need a fairly open band to pass through well. Which of those food groupings are more likely to help you achieve your goals? (Hint: not the ones found in the snack aisle at the grocery store).

So instead of focusing on how much better you think the band will be if it’s tighter, try thinking about what actually “flatters” your stomach, i.e., what actually lets you use the band to help you lose weight. Eating three protein rich meals per day will keep you satisfied far longer than frequent grazing on high-carbohydrate junk food. And eventually eating all those healthy, satisfying meals will let you wear the clothes you want to …and look great in them. Then it’ll be bye-bye pigs in a blanket, hello perfect ten in a miniskirt. Remember, the band is not supposed to cause surgical bulimia. It’s not supposed to keep you from being able to eat. It’s supposed to allow you to diet without suffering from the hunger and cravings that dieting usually entails.

(This is a guest post by Dr. Rachael Keilin, a Texarkana, TX Lap Band doctor .)

Today was a particularly fun day in my office. A patient who is 3 years out from having her band came in with her two week old son to get an adjustment. The baby had tons of hair and precious feet, which made for a nice break in clinic. We laughed at her husband’s eagerness to have baby number two while her better memory of recent events suggested to her that an only child would be just fine.

But it was the other four phone calls I received that prompted me to write this note: four phone calls from women who had lost over 50 pounds who said that they were feeling a bit too much restriction and could they come in for an “unfill”. Four follow-up calls to say, “uh, scratch that……be seeing you in a few months during third trimester.”

I vaguely remember some mention in medical school about the link between infertility and being overweight. But never has it hit home like it has with my Lap Band patients. Countless women who never had regular menstrual cycles, who give me the stink eye when they come in for follow-up because now they are as regular as clockwork (with the bloating and salt cravings nobody had missed). Stories like one of my four patients today who had adopted three children having been told after multiple rounds of fertility treatments that she would never conceive. She’s happy…. but never imagined herself in either a size eight or with a fourth child on its way. I’ve got several older moms with teenagers at home, who forgot my warnings that the first sign of renewed fertility could be a positive pregnancy test. One has twins on the way, but is grateful for her built-in babysitters.

There are many causes of infertility, some of which cannot be reversed by weight loss. But since obesity is such a strong contributor to the hormonal imbalances that make infertility more likely, then I have to warn all women interested in weight loss: beware!! You might just have an “oops!” moment in your future.

Every Lap Band surgeon will tell you that to best lose weight after your Lap Band surgery, you need to change your eating habits.
You’ve developed habits over the course of your life that have led to poor eating behavior and the gastric band procedure will help you change those habits, but you have to make a conscious effort to change things.
We tell patients you that they need to work with the Band to change the following:

1) How much you eat with your gastric band.

Remember that the gastric band is meant to help you slow down your food and your eating. It is not meant to stop your from eating. This subtle point may take some time to to learn. Don’t test the Band. This isn’t about how much you can eat. It’s about how little you can eat. The Lap Band will help you with your hunger. You want to stop eating when you are not hungry. Don’t keep eating until you are feeling overstuffed and really full.

2) How you eat after your gastric band surgery.

You are going to to have to learn how to eat much more slowly than you are used to. Here’s a few tips to get yourself to slow down your eating:

3) What you eat with your Lap Band in place.

Just because you had your Lap Band surgery doesn’t mean you can eat whatever you want. Remember to eat healthy food. That doesn’t mean you can never have junk food, sweets, ice cream, or something like that. But you need to really reduce the intake of unhealthy food. The band will help you with your hunger so that you aren’t driven by hunger and find yourself needing to snack often. You want to eat a fair amount of solid food that will slowly move through your Band. A good meal has about 4 ounces of a protein source such as meat, fish, or chicken and then a small amount of green vegetables. Focus on getting protein and healthy vegetables and reduce your intake of carbohydrates such as “snack” foods like chips, crackers, and processed food.

The Lap Band will help you lose your weight, but remember to work with it!

It is important to think about your Lap Band and visualize what it is doing as you are eating your meals. A great piece of advice is to think about your Lap Band as being like an hourglass.

Just like an hourglass slows down what goes through it, the gastric band slows down the food that goes through it. That’s why you fell more satisfied after a solid meal than after drinking liquids. The food “stays with you” by slowly going through your stomach. When it slows down, it fills up the small part of your stomach above the Band. The makes you feel satisfied and gets rid of your hunger.

This lets you think about what you should eat. Eat solid foods that will go through the Lap Band slowly. That will make the food stay in the top part of your stomach and make you feel satisfied.

At the same time, that means watch out if you are eating food that goes through the Lap Band quickly. That means things that are liquid in nature like juice, shakes, soups, chili, yogurt, ice cream, etc. If the meals that you consume are liquid, instead of solid food, it goes right through the Band, you won’t feel that fullness, and you will feel hungry sooner than you would like. The same holds food for very crispy food. Things such as potato chips or tortilla chips will go right through the Band. Why is that? What happens if you drop a tortilla chip on the floor and step on it? It will break into a lot of little pieces. The same thing happens in your mouth. When you chew a crispy food it breaks up into a lot of tiny pieces and these go right through your Band and the top of your stomach.

So if you eat crunchy and crispy food, or drink “liquid food” you are less likely to get that fullness of a satisfied feeling and freedom from hunger.

Think of your Lap Band as an hourglass. Let solid food slowly move through the Band and gain freedom from hunger.

Many bariatric physicians are surprised to find how many of their patients eat a lot of peanut butter and say that they do it for “protein.” It is true that peanut butter has protein however that is not the whole story. Tastes fabulous, makes great cookies, but as a protein source? So-so at best. Two tablespoons of peanut butter has 188 calories with 9 grams of protein but 12 grams of fat. Notice that there are more grams of fat than grams of protein!

Another point to make is that the protein is an “incomplete” protein. What does that mean? That means that it does not contain all 20 amino acids which are the building blocks of all of our muscles. Amino acids are the building blocks of protein and there are twenty amino acids our body needs.

Chicken, beef, milk contain all 20 and are considered complete. So for peanut butter make it as a complete protein source, you need to eat it with complementary proteins. That means it is incomplete by itself and you need to add a food source with the “missing” amino acids. This might include extra meat, fish, chicken, dairy, bread, rice or cereal. So if you say you are eating peanut butter for protein, for that to be complete, you need to add extra food with it.

So when all is said and done, you end up consuming almost 300 calories for only 9 g of protein with a bunch of fat to boot. Peanut butter snack crackers have even less protein; the average package of six only has about six grams of protein.

Compare this to cottage cheese, for instance. ½ cup of cottage cheese has 80-110 calories (depending on whether you get 1% or 4%), 14g of protein and 1-4g of fat. So lots more protein, half the calories and almost no fat!! Combine the cottage cheese with a little bit of sugar free jelly and spread it on whole wheat toast and you’ve got a delicious breakfast or snack with a whole lot more bang for your diet buck.

There are so many important tips and techniques to help people who have had Lap Band surgery achieve their ideal weight loss. But one item that comes to mind over and over again, is the issue of portion control.
We see too many patients expect the Lap Band to stop them from eating. They want to keep getting fill after fill and tighten their gastric band. They think the magic for weight loss is to get the band tight and then they won’t be able to eat.
That is not the way to do it.
One of our most important tips:
“Don’t eat until you area full and feel tight. Stop eating when you are not hungry!”
The whole point of the Lap Band is to help you with your hunger so you can eat less. Slow down, and allow yourself to eat just enough food that you are satisfied and not hungry. Do not keep eating until you feel full and feel tight. With time you will learn portion control. We have one patient who has had her Lap Band for over 5 years. She says she can gauge how much food she should eat down to a grain of rice! Now she is exaggerating (we think!), but the point is that Lap Band patients need to learn to stop eating before they get full, and to practice proper portion control.
Look at the picture above. Think about your stomach as a gas tank, and never fill it up. Get it about 80% full.

Many of my patients are confused about their Lap Band adjustment. They come in for their routine checkup and just aren’t sure where they stand. They don’t know if they are too tight, too loose, or just right. For me, one key thing to check, is to see if they are struggling. If I hear them say the word “struggle” than something might need to be changed in their adjustment.

If they say “I am struggling with my hunger” and they feel the need to eat more often, then they might be too tight.

If they say “I am struggling to get food down and have to be very selective in what I eat” then they are quite possibly too tight.

A couple of caveats. First of all, if someone is hungry all the time, their Lap Band might actually be too tight. This is because being too tight might make it so that they are having mostly liquids, mushy foods, and very crispy foods. Things like, soup, broth, yogurt, chili, chips, and crackers. These items might go through your Lap Band and through your stomach more quickly and as a result you end up felling hungry. So in some cases, someone who is often hungry may actually have their Lap Band too tight and need fluid removed from their gastric band.

The second note is that if you are eating too quickly or not chewing your food well, you might feel as if your gastric band is too tight, but it might be just right. We suggest the rule of 30. Chew each bite 30 times, and take 30 minutes to finish your meal.