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BANDING PROGRAMME
NETCARE ST ANNE’S HOSPITAL
NEWSLETTER 2 of 2010
How time flies – it is again time for our latest update on the banding newsletter.
The news from the Banding Team is that we have now got 182 patients who have undergone
a Laparoscopic Adjustable Gastric Band. We have now also introduced the Laparoscopic
Sleeve Gastrectomy and for more information on this please visit the website which gives a
complete and detailed overview of this operation (www.kznsurgeons.co.za).
The Laparoscopic Sleeve Gastrectomy to date is being offered to those patients who have
had the full benefit of the Laparoscopic Adjustable Gastric Band but have run into problems in
the form of an erosion. These patients face the dilemma of having to have the band removed
and then possibly going back to their original weight which is really very unacceptable where
they have lost their weight and had all the health benefits of having a normal body mass
index. For these patients the Laparoscopic Sleeve Gastrectomy has been introduced and it is
certainly gratifying to know that a band erosion is no longer the end of the road for them.
The happy outcomes still far exceed the unhappy ones which are the band erosions or the
stomach slippages and in essence it remains very exciting as a Team to see patients walking
in at goal weight or even lower who 2 years before had never thought they would move out of
the ranks of being morbidly obese.
One remains absolutely grateful to Anlie Evetts for her sterling work in putting together this
our second newsletter as well as being available and giving all the support to the patients in
the pre and post op periods.
Here’s wishing all the band patients well and do keep in touch.
Kind regards
Dick Brombacher
SIXTY-one percent of South Africans are overweight, according to a survey released on
Wednesday the 7th of September 2010. Cape Town was the worst affected with 72 percent of
those surveyed there overweight, obese or morbidly obese. This was followed by Pretoria (68
percent), Johannesburg (59 percent) and Durban (52 percent). GlaxoSmithKline interviewed
500 people in the study. Of those surveyed, 47 percent said the government should play a
more active role in targeting obesity, and 46 percent felt obesity would economically affect
South Africa. The survey found that 60 percent of obese, and 62 percent of morbidly obese
people considered themselves merely overweight; 49 percent of South Africans did not
exercise; 71 percent had never dieted; and that lifestyle, food, poverty and demographics
played a role in the weight of the nation. Of those interviewed, 65 percent had the perception
that healthy food was more expensive than unhealthy food; 39 percent looked at cost when
purchasing food; and 87 percent ate a home cooked dinner. SAPA, 9 September 2010.
Understanding the problem is half the battle won. Dr D. Brombacher a resident General
Surgeon at Netcare St Anne’s with one of his specialties being performing Gastric
Banding Surgery (A procedure that reduces the capacity of food intake) has made a
huge impact on changing peoples lives that have been living with obesity. Not only do
these patients no longer have the urge to be eating so much anymore but they also get
educated in ensuring that they change their lifestyle and diet to give them a new lease
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on life. The Dietician and other team members all play an important part in their lives to
ensure that they follow a healthy diet and to ensure that their weight loss is
sustainable.
Louis Joubert
Hospital Manager
Netcare St Anne’s Hospital
NEWS FROM THE EAST
Taken from research done in Singapore by Ganesh, R et al (2006) on their review of the first 5
years of their experience of Laparoscopic adjustable gastric banding (LAGB) for severe obesity,
the following is noted:
-
-
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The BMI threshold for the diagnosis for severe obesity has been reduced in Asian patients
(from ≥ 40.0 to 37). (Asian patients have differing fat distribution and increased
susceptibility to obesity related diseases at lower BMI’s).
In many Western countries, obesity is overtaking cigarette smoking as the leading
preventable cause of premature death.
Bariatric surgery offers the only realistic chance of long-term weight reduction and
resolution / improvement of co-morbidity for the majority of severely obese patients.
The LAGB is likely to become the most popular bariatric surgical procedure worldwide.
LAGB is the most frequently performed bariatric surgical procedure in Singapore, Europe
and Australia. Even in the huge USA market, where the other surgical procedures are well
established and where LAGB was not approved by the FDA until 2001, the use of LAGB
is increasing rapidly.
Although initial weight loss may be slower, the eventual weight loss achievable with close
supervision is very similar to that reported with gastric bypass and gastroplasty.
The main disadvantage of LAGB is that follow-up needs to be more intense for band
adjustments.
Seeing the transformation in the lives of many of our patients as they lose weight justifies
the intense effort put into this programme.
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Rapid Review: It’s estimated that more than 180 000 Ontarians (Canada) are morbidly obese (BMI ≥
40, or at least 35 kg/m2 with co-morbid conditions like diabetes, high blood pressure, high
cholesterol, sleep apnoea). Where diet, exercise, behaviour modification or medications have not
been successful, bariatric surgery may be considered as an intervention.
Ontario Health Technology Advisory Committee (OHTAC) met in Sept 2009, for an evidence-based
review on the use of bariatric surgery for the treatment of morbid obesity. Due to concerns over the
safety over complications following LAGB insertion, safety was the focus of this rapid update.
Some of the findings:
- Some of the studies steered higher risk patients into their LAGB arms instead of the LRYGB
(Gastric bypass) arms.
- Follow-up periods varied across studies (LAGB were followed up longer and more
frequently than LRYGB)
- Complications were defined differently across studies (e.g. some studies considered LAGB
slippage, erosion and port problems to be “major” complications, others considered them
“minor” complications).
- Some studies switched techniques or carried out device modifications midway (e.g.
perigastric vs pars flaccida technique where the latter appears to have less slippage)
Conclusions:
- Short-term complications are lower with LAGB than with LRYGB.
- Long-term complication rates (e.g. band slippage and erosion) vary considerably (procedure
chosen can play a role).
OHTAC recommendations (shortened):
- Bariatric surgery should be considered an effective technique for the treatment of morbidly
obese people in whom prior non-surgical approaches to weight loss have failed.
- Adjustable gastric banding should be made an insured service (!!!)
DIET WISE
Anlie Evetts
RD (SA)
Lets start at the very beginning – you’ve made the big decision, gotten the all clears and you
are going to get the LAGB !
How can you best prepare yourself even before the operation?
Firstly your medical health is very important. If you are diabetic, you must ensure that you get
your blood sugars under control. Do not adjust your medication without your specialists input.
As smoking slows healing and increases the risk for blood clots, infections and other serious
complications after surgery, you must stop smoking at least one month before and after
surgery (ideally permanently). Also avoid garlic, Ginseng and Ginkgo Bilobo for at least two
weeks pre-op, as they can increase bleeding tendencies. Confirm with Dr if you are taking
Warfarin, for specific instructions. Avoid Aspirin and aspirin containing products for two weeks
before surgery.
Follow the green diet for three days prior to surgery to make the liver easier to manoeuvre
during surgery (a fatty liver makes surgery more difficult). Do not take anything after 12
midnight pre-op.
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You can also get yourself ready by starting to practice the new way of eating:
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Check your portion sizes (go for smaller plates and servings)
Make sure you have three meals a day
Switch to sugar-free drinks and limit fruit juices (if you have them – dilute 50:50 with
water)
Become aware of your environmental cues, try to reduce or manage them where
possible, learn to plan ahead if possible
Take your time over meals and get into the habit of chewing your food very well
Check your food choices (not “last meal” mentality)
Protein will be needed for recovery, so choose your meals wisely up until the three
days before – think “nourishing” and “healthy”
Cut back on intake of sweet and oily things (see green diet) – you are getting your
body ready for surgery
When making healthy meals at home, start freezing extras in case needed later
(small serving quantities)
Make sure you have enough fluids daily (between meals, sipped and not gulped)
Avoid alcohol
Start your exercise routine, if you are not already active
Get what you need post op (e.g. vitamin and mineral supplements)
After the operation it is important to follow the various diet stages.
I sometimes have patients phoning about dizziness initially, which is often related to
dehydration. Make sure you drink enough, but watch the quantities. You have to check how
YOUR pouch is feeling. Go for smaller quantities, but often. Remember to start off and
proceed slowly as the fullness sneaks up on you. Stop before you feel full.
By the time you get to the puree stage, you may feel more settled. Remember to only eat
when you are hunger and to stop when you are full. Fluids should be stopped 15 – 30 min
before meals and only restarted 30 – 60 min after meals. (The more “solid” the meal, the
longer it takes in the pouch, and if you overfill with fluid you may vomit).
Some patients find that the initial fullness they had after the op has worn off by week 5 – 6
and they have the urge to eat huge meals. Remember, the band is still settling in and you
only have a small pouch above it. If you overeat, you will do damage. Vomiting (frequent,
uncontrolled) at this stage is not good. If you are really battling, have 3 small meals, with
small snacks in-between, until your band is filled and you get the proper effect. HOWEVER,
make sure that you are eating slowly to make sure that your body has time to register that you
are getting full. Remember also that you are getting used to a totally new way of eating i.e.
you are now seeing the small plate of food that previously would have registered as “deprive”
on the diet scale of doing things. (See my book review later in the newsletter).
Once the band fill has taken place you will get the full effect. You will be able to cope and feel
satisfied with smaller meal portions. Check the guidelines, as these will now be very
important. I always tell my patients that I don’t like the word “rules” because true to human
nature, when we see the word “rules”, we want to break them….. right? In this case, one
could say it’s a case of look after your band, and your band will look after you !
When we look at studies done to explain why some patients didn’t have successful weight
loss after LAGB, they found that some patients were not aware of their own role, while others
couldn’t effectively turn their awareness into action. The practical implication of this is that
patients are all individuals and should not hesitate to make use of the multi-disciplinary team,
so that their post operative guidance can be tailored to ensure continued weight loss within
their individual situations.
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Geneen Roth’s book “Women, Food and God” takes a very fresh, powerful and candid look at
why people have compulsions with food. From her book:
“When you eat when you are not hungry, you are using food as a drug, grappling with boredom
or illness or loss or grief or emptiness or loneliness or rejection. Food is only the middleman, the
means to and end. Of altering your emotions. Of making yourself numb. “
She begins with her most basic concept that the way we eat is inseparable from our core beliefs
about being alive. She explains with various examples how people turn to food when they are
hungry for a connection to what is beyond the concerns of daily life.
It is not a book about “fixing” ourselves, but rather about being ourselves, about understanding
our beliefs and what shaped them.
“When you believe in yourself more than you believe in food, you will stop using food as if it
were your only chance at not falling apart”.
She examines “The Voice” in our head telling us we are no good and doomed for failure, as well
as other negative factors that set us up for failure (like needing to stay wounded and damaged
to be loved, resistance to change, staying stuck in unchallenged-outmoded ideas etc).
Although Geneen warns that labels can become excuses and exist because it is a relief to find
ourselves in descriptions, and should not be used to distance ourselves from a thorough
understanding of the behaviour we are naming, she divides compulsive eaters into two groups:
Restrictors and Permitters.
Restrictors believe in control (themselves, their food, their environment etc. For them deprivation
is comforting as it gives a sense of control and the chaos stays away (anorexia being the
extreme pole). They would be the ones who knew exactly how many calories, grams of fat etc,
were in what food item. They love lists and rules.
Permitters hate rules, guidelines and eating charts. They prefer going through life in a daze, so
as not to feel pain. Unlike restrictors who try to manage the chaos, Permitters merge with it. It’s
better to join the party and have a good time.
Restrictors react to perceived lack by depriving themselves before they can be deprived,
Permitters react by trying to store up before the bounty / love / attention runs out. They are the
ones from whom the (distorted) stereotype of “fat and jolly” is derived, because it often appears
as if they are having fun. They look like they are carefree, but only because they refuse to
include anything that that impinges on their protective orb of numbness.
Restrictors control. Permitters numb.
A compulsion is a survival mechanism to protect ourselves from feeling what we believe is
unfeelable / intolerable.
Since Permitters use food to leave their bodies, they are not conversant in the language of
hunger and fullness. They eat because it is there and because they feel like it, not because their
bodies speak to them.
Her book deals in great detail about ending the compulsion with food. About listening what your
body (not mind) wants. Eat when you are hunger and stop when you have had enough.
Freedom from obsession is not about something you do; it’s about knowing who you are. It’s
about recognizing what sustains you and what exhausts you. It’s about being truly alive. Once
you glimpse the possibility of freedom, taste the ease of soaring, you can’t go back.
Note: ISBN: 978-0-85720-136-2
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EATING MINDFULLY
Compiled by Sarah van Niekerk, Clinical Psychologist
When asked about eating patterns and the triggers for emotional eating, many of the
patients with whom I’ve worked have commented on their difficulty discerning and
perceiving hunger signals and their sense of fullness and satiety. Indeed many have
commented on their difficulty distinguishing hunger from thirst from other internal
experiences, such as their shifting emotions. Further exploration often reveals a more
general pattern of difficulty with internal monitoring and regulation, including the
ability to identify and detect shifts in ones’ emotional states, resulting in difficulty
responding to the changing internal emotional landscape.
The pattern of compulsive over-eating as a form of emotion regulation is well-known
(whether we’re eating in response to anger, fear, anxiety, excitement or boredom), but
it would seem that such automatic patterns take hold in the context of poorer skills of
self-awareness. The following article, sourced in the Bariatric Times November/
December 2007, deals with the concept of mindfulness as a psychological skill and
tool that can be taught to bariatric patients, with positive effects on the maintenance of
adaptive lifestyle and weight-loss goals.
“Although bariatric surgical procedures are powerful tools in the treatment of obesity, patients
and healthcare providers alike can feel frustrated by the difficulties of actually
achieving postoperative weight loss objectives, particularly postoperative weight loss
maintenance. One result of these surgical interventions is to bring the feeling of fullness into
the patient’s consciousness in a dramatically amplified way. However, many obese patients
have learned to actively ignore their inner regulatory signals concerning eating. Well
established habits of disordered eating and dieting are supported by, and inextricably
connected to, a chronic lack of attention to the psychophysiologic experiences of hunger,
eating, and satiety. Although surgery can be extremely helpful in reversing these habits, it has
limitations in combating years of dysfunctional eating patterns. In order to fully benefit from
surgery, patients must retrain themselves to be attentive to their subjective experiences of
hunger, eating, and satiety. Learning to eat mindfully—with full attention to the experience of
eating—is an invaluable skill for individuals who have had, or are considering, bariatric
surgery.
WHAT IS MINDFULNESS?
The word mindful is synonymous with paying attention or taking care. Mindful eating can be a
powerful tool for individuals embarking on lifestyle changes. The Centre for Mindful Eating
published The Principles of Mindful Eating, which describes mindfulness as being composed
of three parts. The first aspect of mindfulness is deliberately
paying attention, without judgment, to one’s experiences. The second aspect of mindfulness
is cultivating an openness to, and acceptance of, all experience. The third
aspect of mindfulness is that it happens in the present moment.
Most individuals who have struggled with obesity for much of their lives are accustomed to
judging themselves, their food cravings, and their food choices. Consequently, these
individuals tend to experience strong emotional responses to anything involving food, eating,
or weight. This emotional activation can interfere with the ability to make deliberate, wise
decisions. Becoming a non-judgmental witness to one’s own thoughts and reactions is an
important step in creating the opportunity for change. When incorporating mindfulness, a
person begins to train the mind to non-judgmentally observe reactions during the stages of
meal planning, food preparation, and eating. This lack of internal self criticism supports the
ability to increase, sustain, and broaden his or her awareness, leading to more empowered
decisions with regard to food.
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The second aspect of mindfulness is cultivating an openness to and acceptance of all
experience. Thus, mindful eating involves an awareness of the whole eating experience,
including emotions, thoughts, judgments, tastes, colours, aromas, and textures. By remaining
more receptive to the multi-layered experience of eating, an individual
can learn what foods might satisfy his or her hunger, be guided to stop eating by his or her
own inner experience of satisfaction and satiety, and, finally, experience the pleasures of
eating. Both preoperative and postoperative patients can benefit from learning what it feels
like to be satiated rather than “full.”
The third aspect of mindfulness is to put aside events from the past and thoughts and hopes
for the future, and instead focus for the moment on the here and now. Eating then becomes
the activity of the moment and the mind is fully engaged in it. The individual attempts to
recognize and let go of worry, anger, fear, rushing, or other mental states that distract from
the eating experience. By doing so, he or she can be truly attentive to his or her experiences
while eating and can be guided by the understanding of nutritional needs, hunger, and satiety,
rather than by hopes, fears, and past experience. The benefits of eating slowly and chewing
fully also become apparent.
To help patients bring the concept of mindfulness into their daily eating habits, they are
encouraged to adopt an understanding that they have the power to make their own food
decisions, even immediately postoperative. Although these choices may be extremely limited
at first, choice does exist. Awareness of choice is essential in encouraging the individual to
take control.
BRINGING MINDFULNESS TO PROBLEMATIC EATING
Long-term patterns of disordered eating can diminish an individual’s capacity to attend to
cues about appetite, enjoyment, and fullness. Many people, including postoperative
patients, find it difficult to stop emotional eating. This coping mechanism is not always broken
by surgery. Fortunately, using mindfulness to teach awareness of the emotional
states surrounding eating has been shown to be effective. Mindfulness skills are a critical
foundation for emotion regulation and distress tolerance. Frequently, mindful eating is taught
in conjunction with meditation and relaxing breathing techniques, which
increase the tolerance of difficult emotions. Furthermore, patients are encouraged to explore
new behaviours that may lead to the resolution of those emotions that they are currently using
food to relieve.
MINDFULNESS TRAINING FOR THE PRE-OPERATIVE PATIENT
Given its ability to bring awareness back into the eating process, mindfulness can be
especially helpful with binge eating in preoperative patients. There is still controversy
regarding the prevalence of eating disordered behaviour among the obese, as well as the
impact of this behaviour on postoperative outcomes. Many studies have found a higher
incidence of disordered eating in preoperative patients than in the general population, and
many bariatric professionals prefer that the patient address this behaviour prior to
surgery. While the prevalence of binge eating disorder (BED) is estimated to be
approximately 1.5 percent among females in the general population, a study by DymekValentine, et al., found that 14 to 27 percent of bariatric surgery candidates in their sample
met full criteria for BED. Powers, et al. found a BED prevalence rate of 16 percent in their
sample of 116 individuals presenting for surgery. Other studies have found a high rate of
“grazing” in preoperative patients.
Burgmer, et al. found that 19.5 percent of its preoperative patients were engaging in regular
grazing behaviour. Although grazing is not necessarily a diagnosable eating disorder, it can
still be classified as “disordered” or “mindless” eating, and can definitely lead to weight gain
both before and after surgery. For these reasons, it is important to consider more structured
preoperative interventions, such as mindfulness training, to help these patients following
surgery.
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Kristeller, et al. reported in their original study of 20 women who met criteria for BED that both
the rate of bingeing and the amount of food consumed during binges dropped significantly
following seven sessions of manualised mindfulness training. Furthermore, these participants
reported that their control over eating, mindfulness, and the recognition of hunger and satiety
cues increased, while their levels of depression and anxiety decreased. The authors also
showed that the magnitude of binge eating decreased substantially with mindfulness training.
They found that the strongest predictor of improvement in eating control was the amount of
time participants reported engaging in eating related meditations.
Patients who have learned to practice mindfulness often report that it is impossible to engage
in binge eating behaviours when they are eating mindfully. Typically, participants
in mindful eating programs report a greater sense of control over their eating behaviours.
Given these findings, mindfulness training may prove to be an effective tool in assisting
weight loss surgery patients who struggle with binge eating, which would in turn greatly
benefit patients’ health, wellbeing, and weight loss results, both preoperative and
postoperative.
MINDLESS DIETING
As noted, disordered eating comprises a wide spectrum of behaviours that prevent one from
becoming aware during the meal. Compulsive dieting, at the other end of the spectrum, has
an equally deleterious impact on an individual’s ultimate ability to regulate his or her eating.
Chronic dieters often have complex views of, and barriers to, the integration of hunger and
fullness cues. It is not uncommon for the caregiver to
meet resistance from an individual who has had an extensive dieting history. Diets utilize
external guides, such as caloric content, portion size, or planned or pre-packaged meals, to
dictate food choice. These experienced dieters may be externally motivated by the specific
numerical weight that they see on the scale.
Following surgery, the restrictive postoperative meal plan and the tendency for patients to
focus on the number on the scale can reactivate the same dysfunctional beliefs and views of
themselves and their weight loss efforts. Moreover, individuals who have a history of chronic
dieting may not trust their own internal cues and may believe that listening to them is what
causes weight gain. These individuals are actually unable to include their subjective
experience in their decisions around eating and can feel controlled by the weight loss plan,
rather than feeling in charge of their own food choices.
Exploring, accepting, and learning to utilize body cues is an evolving process that increases
with practice. Even though it is an essential aspect of healthy eating, diet-fixated individuals
may find it challenging to consider the possibility of eating with awareness and making food
decisions based on internal awareness, hunger, satiety cues, and their own wisdom. Feelings
of anxiety may surface when an individual is asked to be aware of hunger. During counselling,
patients may disclose a personal narrative in which, during much of their lives, they have felt
that their weight status and wellbeing has depended on their ability to suppress their
awareness of hunger and fullness. In fact, these individuals may have difficulty paying
attention to any emotional distress or discomfort. Incorporating mindfulness training may offer
these diet-hardened individuals a new tool to include subjective information regarding food,
fullness, and eating into their decision-making process.
It is important for the bariatric clinician to remember that patients may need a great deal of
help learning to mindfully respect the new feelings of fullness that are generated by the
surgery. Postoperative patients still have ingrained habits of ignoring fullness and will
gradually do so after the surgery unless they can learn to honour and guide themselves with
this experience. As an additional benefit of mindfulness, taste satiety, which can lag far
behind fullness—especially for the postoperative patient—is increased by actually paying
attention to the whole experience of eating. Mindfulness helps people derive more pleasure
from eating and reduces the need to continue eating beyond fullness.
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CONCLUSION: MINDFUL EATING IS HEALTHY EATING
Mindful eating can be the cornerstone of a new relationship with food for the bariatric patient.
Awareness of the present moment often helps an individual gain insight into achieving
specific health goals. This happens in part because he or she becomes more
attuned to the direct experience of eating and his or her own feelings of health and wellbeing.
Introducing the concept of mindfulness systematically to individuals pre- and postoperatively
may benefit many patients.
These concepts are uncomplicated and accessible, and yet their impact on an individual’s life
can be profound. As is commonplace now, patients are also asked to have between 3 and 12
months of a nonsurgical, structured weight loss program prior to bariatric surgery. Weaving
these principles into existing programs for people battling overeating or eating disorders prior
to surgery can facilitate a more joyful eating experience, one of our primary life pursuits.
As new research emerges, mindful eating can be seen as a viable option in helping to satisfy
these requirements. Patients will inevitably benefit from this training after surgery, especially
as they begin to feel hunger again and a wider range of food choices
is available to them.
Additionally, the individual may apply these concepts beyond food, allowing them to help
shape a new approach to daily life in general. Promoting broader integration of these
principles can assist in improved self care after weight goals have been achieved. Mindful
eating training has been shown to promote self acceptance, which is necessary for our
patients both before and after weight loss surgery, to help them achieve maximum success”.
Steps for Individuals to Eat more Mindfully
• Mentally arrive at the meal. This often means decreasing external distractions while
eating, such as television, phone, computer, or driving.
• Attempt to focus on the benefits of a food selection – how eating that specific food will
help him enjoy the bite, meal selection, or feelings of health that may arise during the
change process.
• Create a committed practice to eat in a more mindful way. The use of the word practice
indicates that there are normal and expected setbacks that are part of eating mindfully but
the intent is to return to the bite before them.
Steps to Assist Providers in Bringing the Concept of
Mindful Eating to Bariatric Patients
• Take steps to create a culture free of judgment with regard to dietary change. Often this
requires bariatric programs to shift their focus away from specific weight goal outcomes
and rely on other objective measures, such as sense of control with food, feelings of
health, and reduction in the severity of co-morbidities.
• Review the tone of educational programs and handouts. Encourage increased freedom
and personal choice with regard to food and lifestyle issues to resolve emotional
polarization of food beliefs and foster objective self-assessment
skills regarding health.
• Routinely include mindful eating training in both pre- and postoperative phases of
bariatric interventions.
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REFERENCES
1. The Centre for Mindful Eating. Principles of Mindful Eating. 2005. Available at
www.tcme.org.
2. Linehan M. Cognitive-behavioural treatment of borderline personality disorder. New York:
Guilford Press; 1993.
3. Gotestam KG, Agras WS. General population-based epidemiological study of eating
disorders in Norway. Int J Eat Disorders 1995;18:119–26.
4. Dymek-Valentine M, Hoste R, Engelberg M. Psychological assessment in bariatric surgery
candidates. In Mitchell JE & de Zwaan M (Eds). Bariatric Surgery: A Guide for Mental Health
Professionals. Oxford (UK): Routledge. 2005:101–18.
5. Powers PS, Perez A, Boyd F, Rosemurgy A. Eating pathology before and after bariatric
surgery: A prospective study. Int J Eat Disorders 1999;25:293–300.
6. Burgmer R. The influence of eating behaviour and eating pathology on weight loss after
gastric restriction operations. Obes Surg 2005;15(5):684–91.
7. Kristeller J, Hallette C. An exploratory study of a meditation-based intervention for binge
eating disorder. J Health Psychology 1999;4(3):357–63.
ABOUT THE AUTHORS
Terri Elofson Bly, PsyD, conducts preoperative psychological assessments for surgical weight
loss programs in the Minneapolis-St. Paul area and leads several monthly bariatric support
groups.
Megrette Hammond, MEd, RD, CDE, is a registered dietitian and diabetes educator with
Wentworth-Douglass Hospital in Dover, New Hampshire, and the Executive Director of the
Centre for Mindful Eating (www.tcme.org).
Roger Thomson, PhD, is on the faculty of Northwestern University Feinberg School of
Medicine and is Codirector of Integrative Health Partners, a practice group which offers
mindfulness-informed psychotherapy and courses in mindful eating. He can be reached
through his website, www.integrativehealthpartners.org.
FEEDBACK FROM A FELLOW BANDIT
Hello fellow Bandits
My name is Di and I’ve been asked to put my ten cents worth in regarding food and life of a
“bandit”.
Firstly you need to know two things:
1) Food is not the enemy, we are, we make it bad!
2) Slow and steady wins the race.
For my son and I it’s been a challenging experience. We’ve discovered that it’s not the
amount of food for us, but it’s rather the tastes and textures that attract us. It’s hard to tell you
what to eat because as you know, depending on how tight your band is, depends on what you
can consume.
Steamed food seems to work well for us. It isn’t tough and seems to be tastier, especially
when Blaine sneaks the herbs and spices in!
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Gluten – this is no good for a bandit – it’s like eating a whole potato – it seems to expand in
your stomach and make you more uncomfortable and want to vomit. Sushi is loaded with
gluten.
For low fat options, try fat-free plain yoghurts as dressings, use Weigh Less option sauces
and gravies if you need to reduce the dryness of food. (You will get used to the taste - trust
me!)
Portions – Dishing up small portions is always difficult. I’ve found dishing up in a saucer / side
plate with a teaspoon helps (no, I haven’t lost my mind). If you’re still hungry after that and
haven’t vomited, you either need to see Dr Brombacher for tightening or you ate too fast and
didn’t give your body time to register the food.
Hydration – Very important this, especially since we are re-entering a warmer season. I’ve
found that instead of milling over breakfast in the morning when I wake up, I can drink up to a
litre of fluid over a period of an hour. I use a straw as it stops me from gulping down more
than I can cope with and causing discomfort. I like cranberry juice and water it down half /
half.
Those of you who are having a problem eating meat – “sorry for you”, seafoods are a good
option – NO FAT. Try tuna in 2-min noodles, calamari steamed also just slides down and try
and avoid yet again the oils / butters / tartar sauces. Instead try herbs and sea salt and maybe
lemon juice if you don’t get reflux or heartburn. Poached eggs sometimes goes down well too,
helps with protein replacement.
Salads are good food for the warmer weather. When making your salad chop everything up
finely – makes it easier to chew and less chance of some stray lettuce leaf getting stuck! Use
balsamic vinegar as a flavourant or low fat mayo. Avoid tomatoes as the skin doesn’t break
down so well. Put different things in, don’t stick to the norm. Try Rocket to give a peppery
taste, lentils and sprouts for texture and sweet peppers for a sweet taste.
Okay, enough about food now. I often get phone calls from fellow bandits about the following
two topics: Hair loss and constipation.
Constipation – the solution – Benefibre – you get it at Clicks and it’s a colourless, tasteless
powder that I even put in my tea twice a day and it works like a charm. Even if you put it on
your food, you won’t taste it or see it! Prune juice also works, but that’s like swallowing
medicine to me!
Hair loss – every women’s nightmare! The expensive solution – Omega 3 & 6 capsules daily.
The cheap option that works well – linseed / flaxseed oil, about a teaspoon a day, but please
remember to take it on an empty stomach in the morning to allow it to “pass” through and
avoid food for about ½ hour so as not to vomit it up.
Well that’s about it from me – for now.
See ya
Dianne
12
QUESTIONS AND ANSWERS
Is it true that I’ll never be able to enjoy my food again? No – if anything, because you are
eating slower and being more conscious of what you are eating, you will enjoy your food more
after surgery. Patients find the flavour is more pronounced, they enjoy their food more
because they can be picky and don’t have to feel guilty. (And, yes, you can have a social life).
Are the band adjustments painful? No, it really is just a brief scratch of the skin with a small
needle and then some mild discomfort as pressure is put on the access port. It takes a few
minutes and no anaesthetic is required.
Can I fly with my band? Sometimes there are small bubbles in the band that don’t matter at
normal pressure (ground level), but when flying the cabin pressure may be inadequate and
some people may find their band is slightly tighter when flying (more difficult to swallow solid
food). This normalises when one is back on the ground. Incidentally, you will not set off any
scanners etc with your band.
How long can my band last? Life long if well maintained.
Can I still burp after the band? Yes. If it is a problem being able to burp initially, it will
improve after the first couple of months.
When I reach my goal weight, must I remove the band? No, remember the band is
adjustable. Fluid can be removed, so your portion sizes can be adjusted and you will find that
you will plateau around your goal weight. Most banded patients can regain their lost weight if
the band is removed.
Why must I walk after the operation? Deep vein thrombosis (DVT) or blood clots which
could lead to lung (pulmonary) embolism (PE) are complications that could occur after
surgery. It is very important to keep the circulation moving and walking is one way to do this.
You will be required to get up and walk shortly after surgery, while you are in hospital and you
must continue this at home to minimize your risk. If you have swelling and pain in the leg, or
red and discoloured skin on the affected leg, contact doctor. Symptoms of PE include
shortness of breath, chest pain, coughing – again contact doctor.
Check the website for more info: www.kznsurgeons.co.za
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