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Old May 2nd, 2012, 05:36 PM
Kyle Byron Kyle Byron is offline
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Lap-Band Gastric-Band Issues

Hello Fitness Pros.

I need some advice from anyone who has worked with clients who have a stomach band in place.

Client got up to about 430 lbs and got the band before hiring me... he was 397 in January, when we started.

Long story short, he's down to 387 and he feels like he needs the band tightened b/c he doesn't feel the fullness he used to feel. Apparently it's common to get the band filled a few times after the original placement.

My comments to him are highlighting that his average compliance is about 60% and he only trains a few times a week. Trust me, I lay this on gently.

I told him a smaller stomach isn't going to help him lose weight if he isn't training enough or eating well enough. Comments in Ryan's book helped me stand behind this.

I suggested a deal: If he goes 85% compliance with 5 hours of exercise each week, for a month, and if only loses 0-4 lbs, he can tighten the band

He brought it up again the next session saying he isn't feeling full or satisfied....

Is tightening the band going to help him? Let me know your thoughts please. Thanks!

Other Issues to note:
- Overall, his habits have improved a lot
- His GF reports he is binge-eating, but it's never reported to me
- client despises food journals so a lot of my assessment is guessing
- client trains hard when we are together and is committed to long term work together.
- client is also seeing a therapist, chiro, RMT
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Old May 2nd, 2012, 07:59 PM
Spencer Nadolsky Spencer Nadolsky is offline
Lean Eating for Men - July 2013
 
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ah jeez I hate the lap bands. A common problem among the patients is that they keep wanting the band tighter and tighter but then they end up having reflux because nothing will go past the band.

Honestly I have seen very few people who have had success with the lap bands. Either way they can be used as tools to help with the weight loss process but a lot of patients think they can rely on it.

I think you have a good plan - check out this link http://www.lapband.us/lap-band-diet.html

The patient needs to eat slowly and chew his foods till almost liquid consistency. This is to get the food past the lap band without getting stuck. Ironically this is the same thing they should be doing anyway to increase satiety. It also says to eat whole solid foods........ well duh!

Stick with your plan and you should be good. He may need to adjust the band but he should be following up with the doc to determine that. You will be the one helping with the nutrition as the doc might not help much.
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Old May 2nd, 2012, 09:03 PM
Kyle Byron Kyle Byron is offline
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Thanks for the advice Spencer! My plan is to con't coaching/training him and book a consult with his lap-band doctor, and attend said meeting.

Follow up question: the site suggests 3 small meals a day. That's like 1000-1300 calories? Is the plan to starve these clients? Like he must burn a ton of energy just walking around at 380 lbs. Plus semi-starvation isn't realistic - I don't think he has it in him to be that strict.
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Old May 2nd, 2012, 09:35 PM
Spencer Nadolsky Spencer Nadolsky is offline
Lean Eating for Men - July 2013
 
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You would be surprised how low the calories are that the bariatric surgeons put their patients on. Some do 800 calories. There is some literature that the bariatric patients do well with very low calorie but it can be debated. I think the habits are most important.
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Old May 3rd, 2012, 11:58 AM
yorik yorik is offline
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I looked into the lap band and was very impressed with the system except for the nutritional side. They said that lap bands are very good at preserving lean muscle mass, probably because food still gets reasonably well digested, just in smaller quantities. They do keep calories very low, since the band restricts quantities, but I was concerned with the food choices. Basically, they prescribed a reasonably healthy diet, but the choices weren't nearly as intelligent as what we learn on PN. (I actually referred their nutritionist to PN for a different take on things; she seemed willing to look in to it.)

I'm surprised your client is just debating with getting it tightened, not just doing it. The patients are supposed to have regular visits with the lap band staff, and the doctor would know if he really needs it or not. It's also possible, but unlikely, that his band has loosened. I don't know if this is a real issue, but they are inflated with saline solution. If the saline leaks, there will probably be no health issues at all, but the band will loosen.

It's also possible that your client learned how to "cheat" the band. even if accidentally. The doctor explained that large quantities of fluids with meals will tend to flush the food straight through the pouch and into the regular stomach, so the pouch doesn't fill and you don't get the fullness signals. You can ask about water intake with your client's meals.

In any case, I think coordination with your client's doctor is called for, but you might run into some conflicts with the staff nutritionist.

BTW, my insurance requires a client to be on doctor supervised weight loss program for at least 6 months before they'll pay for the lap band. During that time I found Lyle MacDonald's RFL diet and have lost about 90 pounds by cycling through it. I never actually needed the band.
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