To someone not that familiar with the band this may sound like a stupid question. It may seem sort of like asking if your belt is too loose or too tight…how can you not know? Either your pants stay up or they fall down right? Well those with a band and those who adjust the bands know that this can sometimes be a difficult thing to figure out.
If you are hungry, eating too much (we will come back to this) and not losing weight your band is too loose and you need fluid added…right? Well not always. Often times it is what patients THINK they need, and what they come in for, only to leave with no adjustment and an appointment with the dietician…or even a defill (and an appointment with the dietician). It can be a tricky thing to figure out.
Sometimes the band may actually be TOO TIGHT rather than too loose and fluid needs to be removed. This is when we talk about being in the RED ZONE.
Signs that your band may be too tight or that you are in the Red Zone can be :
- you have difficulty with many solid foods (not just the ‘typical’ ones such as dry meats, rice, soft bread, some types of pasta, stringy vegetables etc.)
- you are slipping into the maladaptive eating pattern of consuming easy/slider foods (yogurt, soups, cheese, ice cream) because you fear getting food caught
- you are plateauing in weight loss due to the consistency of these slider foods (they cross the band more quickly so you are hungrier sooner) and the higher caloric content of many of these foods
- you may have heartburn
- you may have reflux of fluid up your throat at night
- you may have a night-time cough
If you have any of these symptoms it is likely that you are too tight, are in the red zone, and need to have some fluid removed. Few people ever want to have fluid removed because they fear they will gain weight. In actuality what happens is they are able to get back to eating small portions of solid, healthy, protein rich foods. These foods provide greater satiety and they can go longer without hunger on the small portions and therefore LOSE weight. Sadly I’ve had patients go months and even in a few cases years being too tight, suffering the side effects and not losing weight because they feared they would gain. Just remember: heartburn, reflux and difficulty with solids means ‘somethings up’ and you need to contact your clinic ASAP.
So what is the Yellow Zone? The Yellow Zone is where you usually end up post-surgery when all the internal swelling has gone down, you are hungry, eating more frequently, not losing weight and flipping out because you spent $$$ and fear you have wasted it (you haven’t..you just have to be patient. This is known by bandsters as ‘lapband hell stage’).
The signs that your band is TOO LOOSE and you are in the YELLOW ZONE are:
- you are hungry in less than four hours after a small, solid, healthy well-balanced meal
- you are eating more frequently to control the hunger
- you are not losing weight
Based on the types of food you are eating, the portion size, any issues you may be having and the amount of fluid already in your band your clinician will make a very well-educated guess as to how much fluid to add. Quite often people new to the band will want “a BIG fill so I will lose weight”. Any good clinician will explain that the amount of fluid needed varies for each individual and it is far safer and more effective to go up in small increments to find that ‘sweet spot’ where a small meal provides satiety for around four hours.
This brings us to the hallowed GREEN ZONE where your band is JUST RIGHT (this is starting to sound like a rather dry adult version of The Three Bears). This is where you want to be. Signs that you are in the GREEN ZONE are:
- You are able to comfortably consume a wide variety of healthy, solid foods
- You can go without hunger between meals for around four hours
- You are losing 1-2 lbs/week
- You are a happy camper 🙂
One of the most common comments I hear, and which always makes me realize that the scheduled 15 minute appointment is going to go into over-time, is “I need a fill because I can eat too much”. THIS IS NOT AN INDICATION THAT YOU NEED A FILL. Sometimes this can be a hard thing to get your head around. Remember this: the band is not there to make you stop eating. The purpose of the band is to control your hunger when YOU choose to EAT LESS. So when laypeople who have no idea what a ‘lapband’ is say “Oh! Thats the EASY way out!” (these are usually the same goons who say “heh heh! you said you’re a ‘lap dance nurse’?!”…funny) I want to scream. Many of you with a band realize that it is not easy to always make the right choices. It is not easy to always walk away after a small meal. And it is not easy to exercise on a regular basis…all the things that you have always had to do to lose weight. HOWEVER unlike with diets in the past, with the band when it is properly adjusted that gnawing hunger is well controlled. And it is THIS that helps you stick to your guns and do all those things that need to be done to get healthy again.
Remember, this is a tool that you own for the rest of your life and it can work remarkably well at controlling hunger when it is properly adjusted and used correctly for its intended purposes. If you are struggling with your band and feel it is not properly adjusted contact your clinic and get some help. Sometimes its a band adjustment that is needed….and sometimes a head adjustment….but either one should be properly and compassionately addressed by your clinicians.
Yours in health and fitness and one day at a time,