Bariatric Times - February 2009 - (Page 31) Bariatric Times • February 2009 Nutrition Perspective 31 There is an extreme example of noncompliance in a case report of a women who lost, and went on to regain, 40kg in the year following her surgery. She developed a way to empty her stomach by pushing her fist below her sternum and forcing the food in the upper pouch down to the lower stomach. Before she developed this habit, she would vomit if she ate too much, but after this, she found a way to eat as much as she did preoperatively and she gained back her weight.10 “Eating Zones” described by Favretti, O’Brien, and Dixon in 20029 and later in an article in Bariatric Times by Ponce7 is a useful aid for this situation. The zones use color-coded areas on a continuum, from yellow to green to red. The zones help to identify whether the correct amount of fluid is in the band. The yellow zone suggests adding fluid for a patient who is eating large meals and hungry between them. Being in the green zone means the band should not be adjusted for patients who experience early and prolonged satisfaction with small meals and are losing or maintaining their weight. Patients in the red zone should have fluid removed due to heartburn, swallowing difficulties, night cough, vomiting, or poor (maladaptive) eating behaviors. Patients can learn about the zones at the website www.lapband.com/life_after_surgery and clicking on “Optimizing your weight loss through adjustments.” In the instance of disagreement as to how to adjust the band, help patients to see for themselves how DEALING WITH NONCOMPLIANCE Just about every possible complication of LAGB, from failed weight loss to band prolapse to gastric erosion of the band, has cited noncompliance as a possible culprit.11 While looking at the issue of noncompliance, it is important to note the irony of the situation. Most of our patients have been battling the disease of obesity for many years, if not a lifetime, and have sought out surgery after having been unable to comply with dietary advice. If someone is going to go on a diet, that implies that one day they will go off of it— potentially gaining back any lost weight. Thus, the concept of dieting may indeed set our patients up for failure from the very start. Even the word diet can be a way of starting off on the wrong foot. There is no great substitute for the word diet but the terms lifestyle changes, guidelines, eating plans or programs, or modifying habits can be used and are perhaps better suited for this population. In my experience, it is best to be honest and acknowledge that it can be difficult to make changes and modify habits. Let them know that there are many resources available to them, including the band itself, to help. Make them aware, prior to surgery, of the two things that will specifically predict their success—following up with the program and making changes.2 One of the most common and frustrating situations can be the times when you and your patients do not agree about adjusting the band. Most likely this will be a situation where your patient wants the band tighter/fluid added, but you believe it should be made looser/ fluid removed. The concept of http://www.lapband.com/life_after_surgery http://www.carecredit.com
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