Road Signs to Fullness

Volume One / Number Nine

Maladaptive Eating – "Loosening the Band to Lose Weight"

Bradley Schwack, MD

"I don’t understand. I have hardly been able to eat anything, yet I have been gaining weight. What are we going to do, Doc?"
"I want to loosen your band a bit."
"Are you crazy?!?!"

I have had this conversation time and time again in our offices. How can someone be gaining weight when band restriction is at an almost and complete maximum? Well, that may very well be the crux of the problem. There exists an entity known as "maladaptive eating." This occurs when the band is extremely tight and is often accompanied by reflux and food intolerance. Only certain very selective foods can slide down past the band. Sadly, most of these foods are high in calories and low in protein and nutritional value. So, no, I am not crazy—sometimes the answer to weight gain is loosening the band.

Maladaptive eating can be a problem and a surefire road towards weight gain. Maladaptive eating refers, specifically, to the intake of soft, mild foods that are partially digested in the mouth and/or slide down through the band, avoiding its restrictive component. Often accompanied by constant reflux/heartburn, nausea, and vomiting from being too tight, this kind of "maladaptive" eating is the only way to get foods in. Regular well chewed foods are impossible to eat due to the level of band restriction. Typical culprits include chocolates, chips, sweets, ice cream, and pudding. These foods lack nutritional value and protein.

They also possess massive quantities of calories. That is the sad truth—the easier it slides down, the worse it is for you. Often times, in maladaptive eating, one is left to eat just those easy breezy foods because the intake of anything more substantial is virtually impossible due to too must band restriction.

Therefore, what is the answer when weight gain is occurring in the face of high band restriction—loosen the band! Sometimes when I say those words to a patient, they look at me with daggers. However, it is the truth. With a drop less restriction well chewed high protein healthy foods can make you feel full and help you lose weight. With just a bit less restriction you can eat proteins (meat, fish, chicken), fruits, vegetables, and higher fiber foods with the same "early fullness" feeling. You will not only start to lose weight, but those nasty sensations of nausea, reflux, and general malaise will fade away.

We always have to remember, the band is a tool. It is one of many components involved in your current weight loss. This weight loss is dependent not only on the tightness of the band itself, but also on many other factors. Such factors include frequency of visits, our attentiveness to your concerns and issues, and your food choices. Just feeling "tight" is not enough to lose weight. A sense of fullness with less food is part of the equation, but we cannot forget that what you eat is sometimes more important than how much you eat. Therefore,keeping good food choices in your mind, all while frequently discussing these choices with our doctors, nurses, and nutritionists, will keep the band doing its job—getting those pounds off.

It is very discouraging to sense that your band is exceedingly tight and then, after such a miserable struggle, you get on the scale only to be disappointed. It, understandably, seems counterintuitive that loosening the band may be the answer. However, these are all important things to keep in mind the next time you look at your surgeon like he or she has 3 heads when she or he says, "Let’s loosen the band." Maladaptive eating is one of the key players in failure to lose weight after gastric banding surgery. Therefore, never get discouraged when you hit a plateau in your weight loss—we are all here to help you get over it and get you back on track.

Weight Loss "For Life": Reaping the Benefits of Probiotics

Despina Hyde, RD

Did you know your gut is home to trillions of microorganisms and bacteria? "Good bacteria"- or probiotics - provide many important health benefits. Literally, probiotic means "for life." So why are probiotics important after weight loss surgery? Recent research has shown that amongst other great benefits, probiotics can help with weight loss too! Some studies have found that the gastrointestinal tracts of healthy-weight people contain different types and balance of bacteria than that of overweight individuals. Most of us are aware that genetics, lifestyle and environment are all named important factors in the development of obesity. Now evidence suggests that your weight could even be affected by the bacteria in your gut. One study conducted by researchers at Stanford, with patients who had undergone Roux-en-Y Gastric Bypass, found that patients given probiotics had significantly greater weight loss than their counterparts. Another benefit: they had higher B12 as well!

Probiotics can be found in yogurt, kefir, cottage cheese, miso, sourdough bread, pickles and even wine! If choosing yogurt for your daily dose of healthy bacteria, be sure to avoid the high-sugar or fruit-on-the-bottom kinds (Greek yogurt is optimal for protein). Probiotics are also available in pill form, however, some studies suggest pills may not have enough active bacteria or provide the same benefits.

Probiotics are not for everyone, and are not recommended in patients who may be immunocompromised. A word to the wise: increasing your probiotic intake is not license to slack off on your healthy eating plan or exercise regimen!