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This Guideline is available as a printable PDF document in outline form. here

You are losing around 2 pounds per week.

If you are NOT losing 2 pounds per week
You may need an eating adjustment:
Are you eating 60 grams of protein a day?
Are you eating 25 grams of fiber?
Are you avoiding all liquid calories?
Soup can be sign of "soft calorie syndrome"
Alcohol contains a lot of calories about 7 calories per gram
It's also a stomach irritant
Fruit juice is just sugar water
Are you making healthy food choices from a wide variety of foods?
Are you avoiding soft foods?
You can't just eat what's easy!
Cheese is glorified fat
Are you drinking 6-8 glasses of water a day between meals
Are you eating too much junk
Chips, chocolate, nuts, ice cream, cookies and other highly processed junk foods are too calorically dense to be regular parts of a healthy diet. But don't avoid them completely to the point where you feel deprived.
Stay out of fast food places.
Are you getting in two servings of calcium daily?
Do you always eat the protein first?
then the vegetables and fruit
Meat or fish - 3 ounces - the size of a deck of cards
Vegetables 0.5 cup - the size of a small fist
Starch: If you eat the protein and the vegetables first, you don't need much
Avoid: rice, potatoes, pasta, bread
You might try avoiding artificial sweeteners
Some people think artificial sweeteners stimulate the appetite
They are HUNDREDS of times sweeter than sugar
They teach you to like things too sweet
There is no evidence that people who use them are any thinner than people who don't - except diet sodas.

Avoid most diet foods
Real food usually tastes better
Real food is more satisfying than low calorie substitutes
When you are only eating a tiny bit, the caloric savings are not that great
Use a teaspoon of real butter instead of a tablespoon of diet margarine
The body has no way to break down artificial fats
They may go into permanent storage
Some people think liposuction is the only way to remove hydrolyzed fats from the body.

You may need a behavior adjustment:
Are you eating only when you are hungry?
If you're not sure, drink 8 ounces of water and wait.
Are you eating only three meals a day?
Are you sitting down to eat?
Are you eating consciously?
No distractions, turn off the TV, put the book or newspaper away. Pay attention to your food and your companions.
Are you eating slowly?
Put the fork down between bites
Take 20 to 30 minutes to finish a meal
Taking longer might cause the pouch to begin emptying
Are you taking small bites?
Tiny spoon, chopsticks, cocktail fork and a small plate!
Are you chewing well?
Are you drinking with your meals or too soon after your meals?
Practice water loading between meals
You won't be thirsty if you are well hydrated before the meal
Are you stopping at the first sign of fullness?
Sometimes it's a "whisper"... not hungry... had enough
Hard stop v. soft stop
Do not eat between meals. Stop grazing.
Do not eat when you are not hungry.

You may need an activity adjustment:
Are you getting in 30 minutes of physical activity at least 3 times a week?
Over and above what you would do in the usual course of your day?
Could you make it 4 or 5 times a week?
Could you make it 45 or 60 minutes?
Are you taking advantage of opportunities to increase your physical activity?
Taking the stairs instead of the elevators or escalators?
Walking on the escalators instead of riding?
Parking your car further away from the entrance?
Getting out of the car instead of using the drive through?
Getting off the bus one stop before your destination?
Washing your car by hand instead of the car wash?
Playing with your children.

You may need an attitude adjustment:
Are you committed to your weight loss journey?
Are you totally honest with yourself about how much you are eating and exercising?
Log your food and activity for 3 days.
Are you using food inappropriately to deal with emotional issues?
Have you identified what the emotions are that drive your eating?
Can you think of more appropriate ways to deal with those emotions?
Are you willing to seek help from a qualified counselor?
Are you attending and participating in support group meetings?
Have you drummed up some support from your family and friends?
Have you dealt with saboteurs realistically?
Do you have realistic expectations about the weight loss journey?
Are you still obsessing about food, weight, dieting, eating?
Obsessive-Compulsive thoughts? Obsess about something else!
All or none, black and white thinking
Patience with the pace of healthy weight loss
Are you acknowledging your successes with non-food rewards?
Have you learned how to take a compliment?
Are you giving up diet mentality?
Stop weighing yourself several times a day or every day
Stop dieting
Stop depriving yourself
Stop defining food as "good" or "bad"
Stop rewarding and punishing yourself with food
How do you feel about all the changes taking place?

You may need a band adjustment:
You feel like you are making healthy food choices in appropriate portion sizes, but getting hungry between meals.
You can still eat white bread, fibrous vegetables and large portions.
You are having to struggle to lose
You are gaining weight in spite of eating right, exercising and having a good mind set.

You may need your band loosened:
There are times when you can't get fluids down.
You are vomiting/PB'ing too much
How much is too much?
Do you have frequent reflux or heartburn at night?
Do not lie flat or bend over soon after eating
Do not eat late at night or just before bedtime
Rinse your pouch with a glass of water an hour before bedtime
Certain foods or drinks are more likely to cause reflux:
Rich, spicy, fatty and fried foods
Some fruits and vegetables (some examples: oranges, lemons, tomatoes, peppers)
Baking soda toothpaste
Carbonated drinks
Eat slowly and do not eat big meals
If you smoke, quit!!!!!
Reduce stress
Exercise promotes digestion
Raise the head of your bed
Wear loose fitting clothing around your waist
Take estrogen containing medications in the morning
Avoid aspirin, Aleve and ibuprofen at bedtime
Tylenol is OK
Take an antacid (Pepcid complete) before retiring
Try other over-the-counter heartburn medications as well and see your healthcare provider

See your health care provider immediately (or call 911) if:
You have a squeezing, tightness or heaviness in your chest, especially if the discomfort spreads to your shoulder, arm or jaw or is accompanied by shortness of breath, sweating, irregular or fast heartbeat or nausea. These could be symptoms of a heart attack.
If your symptoms are triggered by exercise
If your pain localizes to your right side, especially if you also have nausea or fever
If you throw up vomit that looks like black sand or coffee grounds. Or if your stool is black, deep red or looks like it has tar in it. These are symptoms of bleeding and need immediate attention. (Note: Pepto-Bismol or other medications with bismuth will turn your stool black. Iron supplements can also make the stool tarry.)

From the book: "Laparoscopic Adjustable Gastric Banding: Achieving Permanent Weight Loss with Minimally Invasive Surgery."
by Jessie H. Ahroni, PhD, ARNP

Send me an email and I will be happy to email you this as a Printable PDF document.

E-mail: lapband@endofobesity.com