Weight Loss Surgery Program

DIETARY GUIDELINES

FOR

LAPAROSCOPIC GASTRIC BANDING^©

“LAP-BAND”

This booklet has been designed to help you, your family and your friends learn about the dietary guidelines for laparoscopic adjustable gastric banding.  In order to be successful losing weight and keeping it off, you must learn how to modify your eating behavior permanently.  The goal of laparoscopic adjustable gastric banding surgery is to help you change your eating habits in order to promote weight loss and weight maintenance.

The surgery is only part of the treatment. Your commitment to a healthy diet is the most vital part of the treatment.  The diet you follow after surgery and for the rest of your life will determine your ability to control your weight.

The laparoscopic adjustable gastric banding diet is different than any other diet you may have followed in the past.  It will progress through a series of 4 stages.  You will eat smaller portion sizes than you are probably used to and you must eat on a regular schedule.  If you overeat, you may become sick to your stomach and vomit.  After the surgery, many people feel full after eating small portions of food.  You will start to learn when you feel full over time. 

It is important to note that many other diet progressions may be available online, or from others who have had the laparoscopic adjustable gastric banding elsewhere. Please keep in mind the diet progression recommended by your dietitian is what we see as the most appropriate diet.

For the first 6 weeks, your total food and liquid intake will be limited to approximately 600-1200 calories per day.  Once you have finished the diet progression, you will consume three to five meals per day.  Your dietitian will design a meal plan for you that is adequate in protein and calories.

It is very important that you keep all of your follow-up appointments with the dietitian and physician.  The people that keep regular appointments have the greatest chance of successful, safe weight loss and maintenance.

Preparing for Surgery

One of the most important components of laparoscopic adjustable gastric banding surgery is learning new eating habits.  During your visit with the dietitian you will review your past diet, weight history and exercise patterns.  You will be asked to keep a food record to help identify problems that we will work together to solve.

Techniques to help you learn a new way of eating will gradually be introduced.  The dietitian will discuss the diet progression for laparoscopic adjustable gastric banding during your visits.  Feel free to ask any questions you may have.

• Keep nibbling to a minimum - Continuous nibbling and snacking on high calorie foods and beverages can cause you to gain weight.  Do your best to make healthy choices
• Be aware of why you are eating - Eating because of boredom, depression, anxiety, happiness or just something to do can result in weight gain.  Talk to your dietitian about learning new activities you can do rather than eat during these times. Some people also find it helpful to involve a therapist to help deal with an emotional dependence on eating.
• Keep a positive attitude - Permanent weight loss requires a change in food attitudes.  Try to stay positive about making healthy food choices before, during and after your surgery.
• Special occasions - Holidays, vacations and social occasions can be very difficult situations when you are trying to lose weight.  Your dietitian will work with you to tackle these difficult times head on.
• Stay active - Exercise burns calories, helps control your appetite and can relieve stress.  Our experience with people who have had laparoscopic adjustable gastric banding shows that those who are most successful at weight control are those that exercise regularly
• Vitamins ARE important - After the surgery you will be placed on a diet that cannot meet your needs for all vitamins and minerals.  Be sure to take a multivitamin and calcium supplement every day!

BEHAVIORAL TECHNIQUES:

Trying some behavior modification techniques may help you increase your long-term success after the laparoscopic adjustable gastric banding.

Make food less visible in your home

• Store all food out of sight.  Try to keep food off of the counters
• Put your favorite foods in hard to reach places
• When serving meals, keep pots or serving platters on the stove - not on the table
• Store leftovers immediately after meals or immediately throw them in the trash

Modify your food shopping habits

• Avoid grocery shopping on an empty stomach
• Make a shopping list and stick to it. 
• Shop the walls.  Avoid temptation by avoiding the aisles.  Most whole foods are found along the perimeter of the store.
• Buy only the items that are necessary for you and your family
• Avoid buying food items for other people that you may eat.

Slow your eating down

• Eating slowly is very important after you have your surgery.  If you eat too quickly, you may vomit.  Start to become aware of eating patterns before surgery and modify the pace of eating. Try some of these tips to help slow yourself down:

Portions are important

• Carefully weigh and measure all portions before eating. Start measuring portions prior to surgery to familiarize yourself with what a healthy portion looks like.
• Put all extra food away before eating
• Use small dishes and glasses.  This will make your portions look bigger
• Cook just enough
• Practice leaving something on your plate even before you have surgery.

Make eating an isolated activity

• Choose a spot at home just for eating.  The best bets are the dining room or kitchen table.
• Make a rule to sit whenever you put something in your mouth
• Avoid doing other activities while eating.
• Relax while eating.
• Become aware of hunger and fullness prior to surgery as well as following surgery.

Plan ahead

• Plan what and how much you will be having for lunch or supper
• Many find it helpful to purchase a “cooler” or insulated bag for food transport and help in planning meals.

Try activities that you can do instead of eating

• If you usually eat when you are upset, anxious or depressed, try music, a bath or shower, a walk, yoga, meditation or anther form of relaxation.
• Make a list of 20 things you like to do or would like to try that don’t involve food.  Try them out.
• Practice your new habits on a regular basis.  It may take a while to develop the new habits and feel comfortable doing them

Avoid the following behaviors:

• Drinking with meals – Drink 30 minutes before or 30 minutes after a meal
• Picking or grazing throughout the day – Eat regularly scheduled meals
• High calorie beverages – Choose non carbonated, sugar free beverages

Your weight is a result of the balance between the foods you eat and the amount of calories you body burns in physical activity.  As you lose weight after laparoscopic adjustable gastric banding, you may find it much easier to get around.  Take advantage of this new freedom!  The more active you are, the more quickly you will lose weight. 

Ask your doctor before beginning any strenuous program, particularly in the first three months after surgery.  Try some of these suggestions to increase your physical activity.

1. Walk more.  Walk the dog, go for a walk with a friend, a neighbor or the children.  Walk whenever you can.
2. Take the bus or car less often.
3. If you take public transportation, get off a few stops early
4. Take the stairs instead of the elevators
5. Park your car far away at shopping centers and walk through the parking lot
6. Take a "walking break" at work instead of a coffee break. 
7. Do some yard work, gardening, or household chores that require brisk movement
8. During foul weather, get exercise by walking in the mall
9. Look for easy and fun new ways of exercising with your new body! Before surgery, make a list of fun and exciting classes you might take, such as ballroom dance or water aerobics.
10. Check exercise videos out of the library and make note of some of the simpler toning exercises you could do. Plan a routine based on this.

FREQUENTLY ASKED QUESTIONS:

Should I purchase anything for after the surgery?

Yes!  Measuring cups measuring spoons and a food scale are necessary to determine the exact portion sizes of the food you eat and drink.  You should also purchase a high protein, low sugar drink so you have it on hand and are familiar with the taste.

How much weight can I expect to lose?

Your weight loss will depend on how closely you follow the diet after your surgery and the amount of physical activity you do.  It is possible to gain weight after lap band surgery. 

What are the side effects of laparoscopic adjustable gastric banding?

Some people may experience nausea, vomiting, constipation and/or food intolerances.  Some individuals report that they can no longer tolerate foods such as red meats, chicken, pasta and untoasted bread.  Every person is different, and what one person can tolerate, another may not.  A careful food record can help your dietitian or physician sort through the foods that may be problematic.

As you try new foods after surgery, you may have trouble knowing when you are comfortably full.  Nausea may be your first indication of fullness.  Don’t let this alarm you.  It will take time for your body to adjust to the stomach's smaller size and return to a normal "full" feeling.  You may feel pressure in the center of your stomach or pain in the shoulder area or upper chest when you are full.  Initially you may only be able to tolerate 2-3 teaspoons of food at one time.

What will I eat when I go to a restaurant?

Restaurant eating will be a very different experience for you after the surgery.  Ask the waiter to prepare your food in a low fat manner.  Be prepared to bring much of your meal home in a doggie bag.  Try some of these dining out tips

• Call the restaurant in advance for a preview of the menu.  Don’t be afraid to ask for special orders
• Try ordering one dinner and splitting it with your friend or spouse
• Try ordering two appetizers instead of a full meal
• Ask that your food be broiled or baked with no added butter or fat
• Ask that bread and rolls be removed form the table
• Concentrate on talking and listening to the conversation.
• Be cautious about the calories in alcohol
• Remember, the children’s menu is not always the answer for smaller portions.
  Children’s menu foods are often laden with fat calories.

How can I have fun at parties or weddings if I cant eat a lot?

Try to focus on the social aspect of the event.  Position yourself away from the food table and catch up with friends or get on the dance floor.  Scan the buffet in advance and make a plan as to what you will eat. If it is a served meal, call the facility ahead of time and ask what they will be serving. You may allow yourself one or two healthy appetizers and a smaller portion of the meal. Your dietitian will provide you with many tips to make parties and events easier to experience.

If I get upset and want to eat, what will I do?

If you get upset, don’t keep it bottled up inside, try and talk it through with someone.  Try different ways to handle your stress, through exercise, reading or other activities. You may consider a mental health professional if you feel you need additional assistance in dealing with stress.

The Lap–Band Support Group

As a patient considering weight loss surgery, you will meet with many of the experienced health care professionals on our team.  We also recommend that you speak with individuals who have already experienced the surgery.  For this reason we encourage all pre-surgical patients to attend our support group.  No appointment is necessary.

When:             The second Tuesday of each month

Time:              6:00-8:00 p.m.

• The first 45 minutes of this group is dedicated to a topic related to lap banding and diet.  The remaining time is dedicated to new patient discussion and feedback.

Where:            Bayles Conference Room, Brigham and Women’s Hospital 

• Take the main hospital corridor (the Nesson Pike) to exit 7A. Take the elevators to the 3^rd floor. Exit to the left. Walk down the hallway. Bayles is toward the end of the hallway on the left.

Cost:               Free of charge to BWH and Faulkner surgical candidates

The Preoperative Weight Loss Group

As a patient considering weight loss surgery, you may be asked to participate in a medically supervised weight loss program by your insurance carrier OR your surgeon may recommend that you lose weight before your surgery.   For this reason Brigham and Women’s Hospital has formed a preoperative weight loss program.       

When:             The second, third and fourth Wednesday of each month

Time:              6:30-7:30 p.m.

Where:            Anesthesia Conference Room, Brigham and Women’s Hospital

 

• Enter at the 75 Francis Street entrance.  Bear to your right down the Brigham and Women’s “ground pike”.  You will see the Connors Center for Women and Newborns elevator on your left.  If you walk past the copper statues, you have gone too far.  Take the elevator down to L-1.  Exit the elevator; you will see a sign pointing to the Anesthesia Conference Room.  The room is located at the end of the hall on the right hand side.

 

Cost:               Free of charge to BWH and Faulkner surgical candidates