Lap-band installation does not come with brain surgery. That is, your brain is not suddenly tuned in to how to work with the Lap-band. You will make mistakes. You will crave things that are not conducive to weight loss. You will discover you can eat more some days, and you will. On other days you will attempt to eat more than you should. This book is not brain surgery either; this book will hopefully explain how you can live with the Lap-band to maximize your weight loss. But know that if you are like most patients, it is a learning curve. You will know it, and experience it, and make it your own — but it will come in stages.

There are those rare Lap-band patients who are compulsive about following the program, and they measure portions, exercise when they should, and eat the healthy foods first. Those patients have two names: they are either referred to as good patients, or pains in the neck. Most people are not like these patients.

Why do I call such people a “pain in the neck?” Because of Simpson’s rules of predictive behavior for postoperative patients. We will preface the rule by giving you the scientific facts as we know them — there are no psychological tests, no set of behaviors, no psychological disease that can predict how a patient will perform following weight loss surgery. While insurance companies demand that their patients undergo an examination by a psychologist or psychiatrist prior to surgery, this is nothing more than a roadblock. There is one particular psychiatrist in my town who routinely writes that this patient would do well with four more sessions of behavior modification to insure they will comply with the post operative plan, and have success for weight loss. We have tracked these patients who have undergone the recommended treatment, and have found they are no different than any other patient.

So, given that we have no means of determining who will succeed and who will fail, here is my simple observation: if the office staff states that the pre op patient is a “pain in the neck” and bothering them, and rude, and demanding, and seems unwilling to follow rules — that patient, when operated on, will turn out to be one of the best patients in the practice. They will not only be compulsive about their eating behaviors, they will, by example, be an outstanding patient. The opposite, by the way, is also true. Patients who state that they will do “anything” you ask of them, that they will attend every support group, that you are the world’s greatest doctor, and they just love you — will, in fact, find a way to sabotage their operation — in one way or another.

Many Lap-band patients believe that the surgery will allow them to simply eat less

Again, most people, by nature are not compulsive, and many patients have the false sense that the procedure will allow them to simply eat less, and as such they will lose weight. While this is mostly true, what they have to learn is sometimes difficult to really put your arms around:


  • You will be eating less than your friends, significant other(s), and family
  • You will want to eat more than you are, even though you will have plenty of nutrition
  • You will find you can eat even more, and be like everyone else, if you drink while eating
  • You will discover you can eat all the ice cream, yogurt, French fries, Wheat Thins, potato chips, and assorted other things, without restriction
  • The Lap-band will not determine what you eat
  • The Lap-band, if not adjusted properly will not only be of minimal assistance to decrease calorie intake, and will be nothing more than an expensive piece of plastic.

So often people have to go through a few stages before learning how to live with the Lap-band. Some go through these stages in a weekend, some over a few months, but they are pretty defined. Much like the stages of death and dying, there is a bit of mourning here.

Personal accountability – the only way to lose weight is to eat fewer calories

You have to recognize that if you want to lose weight the only real way to do this is to eat fewer calories. There are no exceptions to this. A Lap-band weighs a few ounces, and will not cause you to weigh fifty or even ten pounds less by itself. You, and you alone, are responsible for your calories. Personal accountability, is a favorite term for this approach — your weight gain isn’t your mom’s fault, or your father, or your ex wife. Stress doesn’t cause you to eat more, you make that decision. It isn’t because you had a hysterectomy, injured your knee, had your thyroid removed — it is because you choose to eat more calories than you burn. This is the first very simple key to understanding that patients have to come to.

Lap-band surgery helps you manage what you eat

After personal accountability there has to be a way to manage what you eat. This is where the Lap-band helps. We will return to the Lap-band’s role, before the procedure can do its job, you have to do yours.

My good friend, Lap-band patient, and fellow author, Jessie Ahroni has identified stages of banding:

  • Discovering the Lap-band
  • Wondering if this is for me
  • Investigation
  • Doing serious research
  • Joining a support group
  • Getting hopeful
  • Finding a doctor
  • Shock at the price
  • Deciding to do it
  • Making the arrangement
  • Wondering if you made the right decision
  • Getting nervous
  • Going ahead with it
  • Waking up and wondering what the hell you did to yourself
  • Post-op discomfort
  • Month of liquids — not being able to strictly adhere
  • Wondering if you’ve been scammed again
  • Seeing a little success
  • Getting your first fill
  • Changing your eating habits

Having Lap-band surgery is a journey; it is not an end in itself.

Unlike any diet you have been on, or whatever gimmick you have bought — the Lap-band is the start of a journey, and unlike other programs — this procedure will help you to reinforce changes you to make that are necessary for long-term, healthy weight loss and maintenance.