Adjusting the band
Whenever the subject of band adjustment comes up, most people think immediately of having fluid added to (or sometimes removed from) the band. However, success with the band also depends upon the type, texture and volume of food you eat and the calories you expendthrough physical activity. So really there is not one band adjustment, but three.
There are three phases you need to follow with your band to see weight loss results are:
- Energy intake (food)
- Energy expenditure (physical activity)
- The adjustment of the band itself
The doctor or nurse reviewing your progress will be interested in all of these factors – not simply the last.
Phase 1: Energy intake (food)
It is most important that you follow the nutritional guidelines at each stage of the post-surgical period. When we review your progress we will want to know:
- How much you are eating (should be small amounts)
- How often you are eating (3 small meals per day)
- Texture/type of foods you are eating (firm not soft)
- Liquids you are drinking (should be low-calorie)
- Are you separating eating and drinking (important to maximise weight loss)
Phase 2: Energy expenditure (physical activity)
To be successful with the band you need to be physically active. We will want to know whether you are walking regularly, how many steps you are managing and what additional physical activities you are doing.
Phase 3: Band reviews and adjustments
The first review
Your first band review takes place about 5-6 weeks after surgery and is usually carried out in one of our clinics. It’s at this review that a decision will be made whether to adjust the band or not. If you’re feeling satisfied with small portions, and you’re losing 1-2 lbs a week, we may not make an adjustment.
From previous patients, we know that people can become anxious about the gastric band adjustments. There is no need to worry though, and if you have any questions feel free to speak to us.
What happens at the clinic?
First we locate the band access port which will have been placed below the skin of your abdomen during your surgery. Then we add saline (a salt water solution) into the system with a special needle. This can cause momentary discomfort but it is usually entirely painless.
When the band adjustment has been made you will be asked to drink some water. This is so we can ensure you’re able to drink fluids and the band isn’t too tight.
Your diet after your adjustment
After your gastric band adjustment at the clinic, you’ll need to go back onto phase one: a liquid diet, for 3 days. This is to allow any swelling that could happen to reduce. Following these 3 days you will need to go onto soft foods for the next 3. After this you can return to eating normal foods.
It’s not always possible to get the correct level of satiety at the first adjustment. This is because the stomach tissue immediately under the band undergoes changes which can decrease the initial feeling of satiety. This is quite normal.
A second adjustment usually brings a much more sustained satiety, but there are occasions where a third or even fourth fill may be required to get the band to exactly the right point.
We allow 6 – 8 weeks between adjustments to give the band and yourself time to settle. You may feel as though the band isn’t working but after a while you’ll notice that you’re losing weight. Everyone is different. It’s sometimes tempting to compare yourself to other patients but you need to remember that it isn’t a race, and that each person is different so the outcome and feelings will be too.
There is a small risk that a clinic adjustment may not be achieved due to the depth or position of the port. This would require you to have an X-ray adjustment. We will try to accommodate you immediately if this is the case, but please note that this may require a further appointment.
X-ray gastric band adjustments
It is not our policy to expose patients to unnecessary radiation so although your aftercare package includes one X-Ray adjustment, it will only be used if we need to assess the positioning or function of your band.
What happens at an x-ray adjustment?
First we will ask you to swallow barium liquid. We’ll then make the adjustment and monitor the flow through the gastric band. By adjusting the amount of fluid that is in the band against the flow of barium, we can achieve the right amount of restriction.
Get to the optimal fill zone
Not tight enough?
If the band is not tight enough you will still be eating large meals, be looking for food and be constantly hungry. You will feel little or no sensation from your band.
If the band is too tight you will have difficulty swallowing, have reflux/heartburn and you may have frequent vomiting. You may also develop night cough and hoarseness of the voice because the contents of the new smaller stomach – being unable to pass through into the stomach – are regurgitated up into the voice box and the lungs. You may also develop maladaptive eating – chocolate, ice cream etc – because you are unable to tolerate solid foods. You may therefore have a very tight band yet be gaining weight.
The correct zone, sometimes called the green zone, is where we want you to be. Here you feel full early with small amounts of food, are losing weight and feel generally well. If you are in this zone and losing 1 – 2lbs per week, your band is correctly adjusted and does not need to be any tighter. People occasionally make the mistake of thinking that ‘more is better’ – that if the band is working well at one level of adjustment, it will work even better if we make it tighter. This is a serious mistake, tightening the band when it is not required can push you into the red zone – with all associated symptoms and complications.
How many adjustment will I need?
Sometimes individuals feel unhappy they’ve been given a larger band rather than the smaller one, thinking it’s a reflection of their size. This is not the case, the choice of band is made by the surgeon at the time of surgery. The decision is made based on the thickness of the stomach tissue. The thicker the stomach tissue, the larger the band needs to be.
People sometimes get very concerned when they know that the volume in their band is approaching the maximum and they still don’t really have enough restriction. But this is rarely anything to be concerned about. There is considerable individual variation in the amount of saline required to produce a given level of restriction; what may almost close the band in one person may produce scarcely any effect in another. So the simple message is that you must not worry about the amount of fluid in your band.