The times they are a changing..........

By Adam Glasgow - 11/14/2016

“If you do not change direction, you may end up where you are heading.”  Lao Tzu, wisest of Taoist philosophers

I am often asked by patients if they should change course and typically they are referring to their surgery.  Should they convert from a Lap-Band to a Sleeve or Bypass, or from a Sleeve to a Bypass?   I even occasionally field inquiries from folks wanting to know if they can have a Lap-Band after their Sleeve or Bypass.  Now that Balloon is becoming more common, I am even asked if one can be placed after Lap-Band, Sleeve, or Bypass.

I will answer these good questions but only after restating, what for some will be obvious, but needs to be said over and over and over again.  Lap-Band, Sleeve, Bypass, and Balloon are just TOOLS to make the weight loss journey, the weight loss LIFESTYLE, easier but NOT EASY!  Just as it easier to do algebra home work with a calculator and even easier with a lap top—you still have to do the work!  The problems aren’t going to solve themselves.  A gym membership and a personal trainer are useful adjuncts to the weight loss effort but it really doesn’t matter how much you spend on either—if you don’t go to the gym and actually work with the trainer—then you can’t expect any benefit.

Whether you have a Lap-Band, Sleeve, Bypass, or Balloon, if you make poor choices, don’t exercise, and rarely come for follow-up then you are very unlikely to lose any weight.  On the other hand, if you make healthy choices-fruits, vegetables, and lean proteins and assiduously avoid carbs, as well as get 30 minutes of exercise at least three times a week, and stay engaged with the program through follow-up visits, Support Group attendance, and participation on the Facebook page then you will likely succeed.

Lap-Band, Sleeve, Bypass, and Balloon are just different ways to achieve the same simple goal: physical satisfaction with less food.  These procedures are done to help make QUANTITY control easier and NOT QUALITY control.  Ice cream is easy to eat and soda is easy to drink whether or not you have had a weight loss procedure.  The interventions are done on your stomach and NOT your brain!  What you eat, when you eat, how you eat remains a choice and your procedure is NOT going to make it for you.

In the morning you need to get to work.  You can walk, you can bike, or you can drive.  Is one a “better” way to go than another?  No, not really.  If work is a half mile from home, walking probably makes the most sense.  It is “free,” it is easy, and you get exercise and fresh air.  If it is 2 miles away then biking might be a better option.  It is certainly faster.   If you are facing a 20 mile commute then driving is probably the way to go but……you need to own a car, you need to have a license, and you need to be able to pay for gas.

Lap-Band, Sleeve, Bypass, and Balloon are very similar in that regard—they are just different mechanisms to help you get you where you want to go.  Some get you there a little faster but also require more of an “investment” and come with more risk.  This is very important to understand when contemplating a change of procedure.  If your initial procedure wasn’t a helpful tool, then it is very unlikely that your second procedure will be either.  Remember, the operations aren’t the magician, you are.  You need to be casting the spells and working the tricks—in other words making the good choices, getting the exercise, and coming for follow-up.

I have been doing weight loss surgery for more than a decade and for close to 2000 patients.  I have Lap-Band patients who have lost well over 100 lbs and kept it off for years.  I have Sleeve patients who weigh the same if not more than when they started.  I field calls from Bypass patients who have gained all of their weight back and now want a Lap-Band.  Again, the point is that—these operations are just tools and you have to use them to lose with them.  Sure, Sleeve and Bypass often result in the most rapid initial weight loss but there is little evidence that the sustained weight loss is significantly better with any particular procedure.  I have now done close to 40 Lap-Band to Sleeve conversions and the results are pretty much what you would expect: a third of the patients experienced no change—that is they really didn’t lose any more weight, behave any differently, and their Sleeve experience was sadly the same as their Lap-Band one.  Another third did okay which is to say, about the same as they did with their Lap-Band.  I saw someone the other day who had lost 100 lbs with their Lap-Band but then gained it all back.  They converted to Sleeve but after two years have only “re-lost” 50 lbs.  The operations are not magic.  What gives me hope is that a third of patients have gone on to do fabulously well with their “new” Sleeves.  They are losing weight, feeling good, and happy with their change.

The great challenge when contemplating a change is to discern who will benefit.  My general rule is that if you did not experience significant weight loss with your initial procedure, even if you regained, then you are very unlikely to experience it with a new procedure.  If you weren’t able to get ice cream and alcohol, and pizza and pasta,  and chips and pretzels out of your diet the first time around—it isn’t magically going to happen with a new procedure.  If you feel like you have achieved all that you can with your current procedure and that you are doing all that you can to “walk the walk” and “live the life” then certainly come see me so we can talk about change.  And remember what the wise man said….

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