Really Weight Loss Surgery?
I get asked if the AGB counts as bariatric surgery a lot. All bariatric procedures fall into one of two categories—restrictive or malabsorptive, or occasionally both—as I noted in the preceding chapter. A restrictive procedure restricts how much food you can eat whereas a malabsorptive procedure limits how much food can be absorbed during digestion.
A purely restrictive operation is what the adjustable gastric band is categorized as. The ability to tailor the level of restriction to the demands of each patient, however, distinguishes it from all other bariatric procedures. Most importantly, no extra surgery is required to make the modifications.
Every patient receives a bespoke fit thanks to the band's adjustment. The tightness of the AGB can be adjusted over time to accommodate changes in a patient's circumstances, such as pregnancy or other medical issues. This is a genuinely special feature that elevates the AGB to the status of the most adaptable surgical procedure for controlling obesity.
Contrary to conventional bariatric procedures, the AGB does not result in weight loss on its own. The AGB is what I frequently refer to as a pair of "crutches" for weight loss. Crutches can help a person with a broken leg remain mobility. Crutches do not, however, walk by themselves. They are merely the means by which the patient achieves the objective of ambulation. It is not enough for the person to purchase crutches and declare their desire to walk. In order to walk, they must also provide the energy necessary to operate the instrument.
The AGB is a device that obese patients use to take control of their weight, similar to crutches. The group offers advice, promotes healthier eating practices, and firmly opposes overeating. It serves as a training tool to assist the patient in achieving weight loss goals that they have been unable to reach via pure willpower.
The patient's willingness to alter the habits that led to their obesity will have a significant impact on the outcome. The band will enforce discipline if they are dedicated to changing their eating habits and way of life. Amazing outcomes can be attained with personal effort and the assistance of a knowledgeable team.
However, like with any training procedure, the success factors include both the student's drive and the caliber of the education. The AGB can be utilized to assist patients in controlling their intake of food once it has been correctly installed and calibrated. In this regard, the AGB differs from other bariatric surgery techniques, in my opinion. Instead, it is a very powerful tool for altering one's lifestyle in order to break the fat cycle.
Breaking the Failure Cycle
psychologist G. Dick Miller
The punishment paradigm has a failure cycle that goes like this: "Pay attention only to negative behavior, and if positive behavior exhibits itself, ignore it." That way of thinking is ineffective. Positive reinforcement and fast feedback are effective. The reinforcement must be more potent than the punishment in order for change to occur. In other words, the brain needs a positive emotional memory.
In the short term, eating well doesn't do anything to provide the brain a positive emotional experience. No one will compliment an overweight person on their good eating habits if they maintain them for a week, for instance. And it's very feasible that the overweight individual won't lose any weight after seven days of making healthy meal choices. This equates to dismissing positive conduct and applying the punishment paradigm.
However, when wearing the band, people are immediately aware that they are eating less and feel full rather than hungry. The first two weeks of taking diet pills are similar to being in a band. When you are satisfied and not driven by extreme hunger, it is simpler to refrain from abusing food. Naturally, the body
responds to diet pills in a short period of time, but the band is not subject to that restriction.
Additionally, the band keeps watch steadily and patiently, around the clock, every day of the week. It simply becomes easier to cease trying to avoid it after a while.
The fact that patients who used the band to lose weight did not do so because the band altered their eating habits should not be overlooked. The individual changed. Patients may oppose the band—and do—until they learn, through positive reinforcement, how to alter their thinking. The band is fantastic because it functions in spite of the patient's foul self-talk and disparaging remarks. Many banded people are not hungry, are aware that they consumed less food, are feeling better, and are in the process of changing, whether or not anyone notices. Nobody is forcing them to change; they already are, and they are conscious of it. And their perception of themselves is completely altered by this understanding.
I enjoy the band because it is very clear and consistently offers comments and encouragement. However, like with the use of any instrument, patients must be truthful in order to receive the proper fills and have the professional qualified to assist address nonworking thoughts.
The band becomes the most important tool to create an environment in which it is much easier for patients to treat themselves well and make wise decisions when all the components of a comprehensive band program are present. These include the doctor to make adjustments to the band, the dietitian to act as an eating guide, the exercise therapist to provide coaching and encouragement to exercise, and a psychologist to help patients change their thinking. The band is the primary instrument for assisting patients with weight reduction in ending their cycle of failure.
Using the AGB as a Tool to Change Behavior
The AGB sounds like a miracle cure for the obesity problem because of its capacity to limit the amount of food consumed and the absence of hunger. But it's not quite that simple.
The definition of insanity is sometimes cited as being the act of doing the same action and expecting a different outcome. When we consider all of the different things people do in an effort to lose weight, that is especially relevant. Nothing actually works unless it is coupled with a genuine modification of behavior and an associated alteration of lifestyle. The AGB's effectiveness as a tool for weight loss depends on how each patient uses it to bring about the necessary changes.
At least not in the traditional sense, the AGB is not a diet. You should be able to consume almost any food when the band has been correctly fitted; you just can't eat as much. To ensure optimum nutrition, it becomes essential to make wise food decisions. However, the AGB's ability to help you lose weight is ultimately more dependent on how you eat than on what you eat.
The strong human tendency to revert to comfortable behavior patterns that have been built over many years is rarely undone by willpower alone. In order to make a big shift, there typically has to be both positive reinforcement for the new conduct and a severe penalty for continuing the old behavior.
Continuous limitation is provided by the AGB, which gives quick feedback for bad eating habits. The band will alert you if you eat too quickly, take a bite that is too big, or try to overeat. It maintains order like an invisible "drill sergeant" would. Because of this, we now jokingly call our Comprehensive Weight Management Program "Dietary Boot Camp."
The band will make you miserable if you don't eat mindfully and completely chew everything you eat. An excessively large or improperly chewed mouthful will feel
as though it were hung up. The esophagus contracts hard in an effort to force the bite through the band's small aperture as a result of the trapped food. This painful spasm is typically felt in the chest and is highly uncomfortable. Frequently, the neck or back are affected by the pain. A lot of frothy mucus is typically produced along with it, and it soon accumulates above the blockage in the esophagus. As the body tries to lubricate the mouth, salivation may also get worse there. Many band patients refer to this as "sliming."
The mucus and any previously swallowed food will eventually come back up with it. There isn't much, if any, digestive acid present, thus this isn't actually vomiting. It sounds more like an unprompted regurgitation. This spitting up is referred to by some patients as a "productive burp."
You will experience the same effects if you eat too quickly. If bites aren't chewed fully, even small ones will cause issues. It's important to take your time when eating with the AGB. You should make it a habit to put your fork or spoon down on the table after every bite. This deliberate action serves as a prompt to slow down. The "drill sergeant" will remind you if you fail to do so.
List of Suggestions for Successful AGB Eating
Enjoy your meal slowly.
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Approximately the size of the tip of your index finger, take little bites.
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Take your time with each bite.
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As you eat in between bites, put your fork down.
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Almost every patient with a band has experienced the discomfort brought on by eating too quickly or taking excessively large mouthful. The majority of people have also experienced the humiliation of having to get up from the table when the bite they just swallowed comes back up. Even though it's unpleasant, for many people this is just the push they need to stop their previous eating patterns.
Summary
A tool for losing weight is an adjustable gastric band. It must be positioned properly first. Then it needs to be modified correctly. Finally, it necessitates ongoing supervision and encouragement as new eating habits result in a lifetime shift.
The AGB and procedures that we generally describe as bariatric surgery are very separate from one another. With this method, weight loss does not happen automatically but instead requires considerable alterations in behavior and way of life. We will discuss who is a good candidate for the AGB and why, as well as what kind of support programs are required to achieve long-term success, in the following two chapters.