Great services are not canceled by one act or by one single error.
-Benjamin Disraeli
Beginning in the 1970s and maybe even the decade earlier, Americans as a whole seemed to shift toward a more self-indulgent, self-absorbed, "me first" way of thinking. Subsequently, our entire culture has followed that trend. The measure of an individual's worth has become more about what they have than who they are and what they do for others. So, what does this have to do with bariatric surgery? The answer is-everything.
The obesity epidemic is in many respects the direct result of our cultural shift toward self-gratification and our prosperity as a nation. Self-indulgence has not only become acceptable, it is encouraged: witness the "super-size me" phenomenon. When an individual comes to the realization they need help with their obesity and chooses bariatric surgery, they are actually bucking the system. The surrounding culture doesn't change. The patient may be personally committed to making major lifestyle changes, but all of the outside influences that helped promote their obesity are still active. This may even include the opinions and behaviors of the people who are closest to them.
Perhaps the most important determining factor in the success of any AGB patient beyond their own personal commitment is the understanding and support of those with whom they live and work every day. Without a support system, the pressures of day-to-day living within an environment that hasn't changed will frequently lead to failure. This places a pretty heavy burden on spouses, family members, and coworkers, and is something that should be addressed before the final decision to have AGB surgery is made.
Family Stress
You've read repeatedly in this book that obesity is a disease. When confronted with other diseases such as cancer or heart problems, families seem to be drawn together to face the adversity. "Mom has cancer!" or "Dad has had a heart attack!" are family rallying cries. So why is it that obesity, and bariatric surgery specifically, often divide families rather than unite them?
There are a number of possible explanations. First, your family member didn't all of a sudden contract obesity. They've had it for years, so what's the big deal now? Second, despite all evidence to the contrary, most people still believe that obesity is a self-inflicted condition -a choice, not an illness. Finally, since multiple family members often suffer from the same problem, it is not unique. Why should one person receive treatment for something that everyone else seems to be able to live with? It sounds like some more of that "me first" attitude again, doesn't it?
In some families everyone seems to be jockeying for recognition, often oblivious to the needs of those they should be closest to. This can create some major conflicts if one person is suddenly getting all the attention. Considerable resentment and jealousy may develop between sibling and parent or between husband and wife. In short, change causes stress, especially if the relationship is already strained.
Over time these stresses can even reach the breaking point. It is widely recognized that divorce is more common among couples where one partner has undergone bariatric surgery and lost a significant amount of weight. But it is totally illogical to assume that weight loss was the only factor. A far more likely explanation is that relationships that are already damaged simply fail to adjust when subjected to the additional strain.
Before considering bariatric surgery, a prospective patient should have a heart-to-heart conversation with every member of their family. Depending on their level of maturity, even children as young as six should be made to feel that they are a part of the decision. They need the chance to express their fears, which will give you the chance to reassure them. Older children, particularly teenagers, are often less willing to express their concerns. If they are old enough to understand, you should discuss specific health issues with them and your reasons behind your decision to have AGB surgery. At the same time you will need to explain that this is not going to change only the way you eat but also the way the family eats.
You and your spouse should sit down together and discuss how having an AGB in the family is going to affect them and everyone else. In fact, this is the first conversation you should have. One of the most important questions I ask each patient during their initial consultation is what their husband or wife thinks about their having bariatric surgery. Sometimes the answer is obvious by virtue of the fact that the spouse has actually accompanied them to their appointment and is there to provide support. Occasionally, both husband and wife even make joint appointments because they are both potential candidates for the AGB. Generally this is a good thing, because it signals that they are in support of each other right from the start. While that is usually a good thing, it is not always the case, as you'll see later.
It is somewhat unusual to find that a spouse is not supportive of the other spouse's decision to get a band, but every now and then I'll have a patient tell me that their husband or wife doesn't think they should need to resort to something as drastic as bariatric surgery. This may be because they fear the risks of the operation, or perhaps they are just skeptical as to whether the procedure will work. They usually suggest that the patient simply try harder to lose weight through dieting and exercise. Interestingly, I have heard a number of patients say that the reason their spouse objects is that they fear they will leave them for someone else after they lose weight.
In addition, family members are often unfamiliar with the AGB procedure and the program that goes along with it. They tend to become more supportive once they have a better understanding of the whole program. To help this process along, I encourage every patient to bring their spouse with them to one of our support group meetings before their surgery. The contacts they make and the stories they hear are usually enough to change the mind of even the most cynical of partners. Gaining their support is an important part of preparing the patient.
Providing Support as a Spouse
If you are the husband or wife of an AGB patient, throughout this book you've read about changes in thought and changes in behavior that ultimately change the patient's life. While I may have made it seem like these changes occur only to the person who has the band, that is far from true. Everyone around them will experience change to one degree or another, and as their spouse you will be affected most of all. The changes you will be asked to make are likely to cause you to become more than just a little uncomfortable.
You will, out of necessity, eat differently. You may also be compelled to exercise, and you'll probably lose some weight yourself. These facts may make you less than excited about your spouse having AGB surgery. But, if you think about it, you should welcome these changes as positive side effects for yourself. Here's a chance to make many of the changes that you have been meaning to make to improve your own health. If you choose to fight these changes, the result will be to slow or even reverse your spouse's progress. And you will likely add to the stress both of you endure in the process.
It isn't always easy to be the supporter in the relationship, but for a while that is likely the way it will seem. Most husbands and wives are enthusiastic supporters of their spouse's efforts, but even if you are their biggest "cheerleader" you will occasionally say or do something that your partner will perceive negatively. Try to avoid anything that could be interpreted as judgmental or critical, especially during the first few weeks after surgery and immediately after an adjustment.
Your spouse will be especially sensitive to almost anything you say during those times. Understand before you say something that your husband or wife is likely to be feeling pretty insecure about the whole process. They don't want to disappoint you or others around them, and they remain uncertain not only of their own success but also of whether the things they are experiencing both physically and emotionally are normal.
In an effort to minimize the damage, the first thing you need to do is dedicate yourself to being a better listener. Nothing says you care more than spending time just listening. Women especially like to have someone to talk to, and one of the most common complaints they have about their husbands is that they don't listen. By the way, if you jumble the letters in the word "listen" you can make another six-letter word that is very closely related. That word is "silent." It is very hard to listen when you are doing all the talking.
One of the things that band patients are particularly sensitive about is spitting up, particularly during meals. They are often extremely embarrassed by it and may even refuse to eat with the rest of the family because they're afraid that they won't be able to control it. Almost anything that you say during an episode of spitting up will be viewed as either critical or patronizing. Even an off-hand gesture can be interpreted as disgust or frustration.
What your banded partner needs is encouragement. Let him or her know that you understand the extremely challenging process of learning to eat differently. One thing you can do to demonstrate your understanding of their situation is to change your own eating style. It is very difficult to accept the idea of always being the last one at the table still eating. You should make a special ef fort to slow down and take smaller bites. When you finish eating, stay at the table until your partner has also finished. If he or she gets up and goes to the bathroom to spit up something they ate, don't assume they are finished. They will likely be back, and you will be sending the wrong message if they come back to an empty table.
Husbands can send an especially powerful and supportive message to their wives that are struggling to adjust to the band. Just by doing something simple without being asked, such as cleaning up in the kitchen or offering to fix dinner, you will let them know you understand what they are going through and want to help. Whatever you do, don't go running after your spouse to help them in the bathroom. They not only don't need your help, they don't want you to witness the process.
Along that same line, you need to recognize that there are certain foods that almost all band patients have trouble with, such as steaks and chops, as well as most kinds of bread. If you insist on always going out to your favorite steakhouse, your spouse is going to get pretty tired of the shrimp cocktail and the soup of the day. Seafood, chicken, and pasta generally go down much more easily than red meats. And while you're out to dinner, remember that alcohol has more calories than any other food. Don't order a bottle of wine with dinner unless you plan to drink it all. Your partner doesn't need the extra calories and should not be drinking while they eat, so try not to add any unnecessary temptation.
Getting regular exercise is critical to the success of every AGB patient, and that often represents a major lifestyle change. A person who may have been more or less sedentary for many years is likely to require a lot of encouragement when they start an exercise program. That doesn't, however, mean you should go out and buy a family membership at the local fitness center. In fact, doing so may backfire on you.
Extremely obese people are often intimidated by those types of facilities and see themselves as being totally out of place. They frequently sense that all of those slim and trim people are watching them while they struggle just to stay on the treadmill. In some cases it doesn't matter how much you encourage them, they simply won't go.
The better solution is to offer to exercise or at least to walk with them. Everyone enjoys walking more if they have a partner, and it will give you regularly scheduled quality time together. Notice that I said regularly scheduled. If you don't schedule a time for exercise, it simply won't happen. So make it a priority in your own schedule, not just a once-in-a-while effort. Your spouse will feed off your example.
The Enabler
Generally the term "enabler" is used to describe someone who supports the addiction of another person. Whether it's a drug or alcohol addiction or compulsive behaviors like gambling, the enabler helps keep it going. Obesity is really no different. It's an addiction to eating, and most morbidly obese people have one or more enablers in their circle of friends and family who make it easier for them to continue those behaviors that contribute to their weight problem. Experts will tell you that trying to help any addict "kick the habit" is extremely difficult unless you also address the enabler. So, for any patient to be successful, it is necessary for their enablers to recognize their role and become agents for change.
It has been my experience that every band patient goes through times of doubt and frustration, and not uncommonly these feelings manifest themselves as anger or withdrawal. Your natural reaction will very likely be one of sympathy. Sympathy may lead you to some form of pampering to express the fact that you care about them and don't like to see them hurting.
But pampering will only serve to verify their feeling of being a victim of some cruel torture test. If they get enough pampering, the patient will continue those behaviors that generated the sympathy rather than pursuing the new lifestyle goals they previously committed to. If you provide sympathy and pampering, your role will quickly deteriorate into that of an enabler.
Don't misinterpret this idea of withholding sympathy as a license to be unkind. That is not what I'm saying at all. It's important to make a distinction here between sympathy and compassion, and between pampering and caring. It is critical for your band patient to feel as though you care about their struggles and that you have compassion for them as they strive to adapt to a totally unfamiliar situation. Only then will they be comfortable sharing their problems and fears with you and others who are close to them.
Once again, this is a place where you need to be a good listener, not a bunch of advice. They also need for you to be honest with them. It's okay to tell them if you believe their behavior is sabotaging their original plan, but do so with compassion. And no matter what, you need to stand firmly behind them, providing encouragement and re-emphasizing the importance of their primary commitment. That is the best way to demonstrate your compassion and caring spirit.
None of this is going to be easy. The whole process of providing appropriate support may feel foreign to you until you've done it for a while. So, to help you get started, I would recommend that you have an open discussion with the band patient regarding your role in the process before any crisis occurs. Be proactive. Let them know how you intend to support them, and get them to agree with your approach in advance. When the time comes for you to take on the role of "plan advocate," you can do so without feeling guilty. Having a game plan for those difficult times that are bound to come is the surest way to avoid becoming an enabler of destructive behavior.
What Can We Do to Help?
G. Dick Miller, Psychologist
I took a handicapped friend out to dinner. My handicapped friend is gaining weight. And his health is seriously deteriorating because of problems with his brain, a condition aggravated by the weight gain. Other people went with us, and we all know about our handicapped friend's problem.
So what did the people who came along do? First of all, the group insisted on going to dinner at a place known exclusively for its huge, familystyle portions of fried chicken, mashed potatoes, and home-baked rolls with butter and honey. When we got there, the dinner conversation started with taking a cooking course. Then it shifted to the new specialty grocery store that had just opened and the variety of foods we "love" there-foods "to die for."
I watched this dynamic and my stomach twisted. We were romanticizing food in the presence of someone we know is killing himself with the stuff. And while the new grocery store is beautiful and a fun place to visit for those who don't suffer weight issues, all this talk about food felt to me like we were talking about how great a recent cocaine snort was to someone who is trying to get off drugs.
I am aware that band patients will have to learn to deal with these and other social scenarios. But what I'm saying is that I'm not a friend to someone who is working to lose weight if I romanticize food with my language. I'm not helping if I insist on taking them to places where the food will tempt them to do things that are not in their best interest. Bringing them food that isn't in their best interest would also fit into the not helping category.
Some band patients are still obsessed with food and haven't dealt with the core issues driving them. It's going to take them some time to adjust. During that process, I don't have to police them, check up on them, or keep track of what and when they're eating. It would be in my best interest and theirs for me to "Let go and let God" (to borrow a slogan from the AA 12-Step program).
There are other ways I can help. I can change the way I talk so I'm not talking about food in tempting ways. I can suggest social activities that don't hinge on food. And I can find gifts or ways to express I care that don't involve food. If I want to help, I can treat food like the fuel it is, and stop being part of the process of enticement that had a big part of leading the person I care about into problems.
In changing myself, I may experience uncomfortable self-talk, some awkwardness as I try new things, some discomfort and inconvenience. The band person is going through these same things, and I'll tell you what I tell them. It's going to take some getting used to, and it's necessary to tolerate the discomfort in order to make any kind of change. But frankly, you'll not only be helping the band patient; you'll do yourself a favor, too.
The Band Couple
Earlier I mentioned that both husband and wife undergoing AGB surgery around the same time can be a good thing. They can provide compassion based on their own experience. However, "doing the band together" can also create some big problems. I would never recommend that the procedures be performed on the same day. If a postoperative problem were to develop with either patient, they could potentially need the undivided attention of their spouse. Even if there were no problems, it is still necessary to have someone around who isn't trying to recover from surgery.
I usually recommend waiting at least a week between procedures, and longer if possible. If your partner decides to get a band, please don't make the decision to get one, too, just to make things easier for them. That is a recipe for failure for both of you. Even if you are thoroughly committed to the band for yourself, I would still recommend that you wait until you are reasonably sure how your spouse is going to adapt to the band before going ahead with your own surgery.
The real problems with both partners getting an AGB at the same time occur when they are not equally dedicated to the process. If one is only half-heartedly committed to making the necessary lifestyle changes, their behavior will gradually undermine the efforts of the other. That is certainly not unique to AGB patients and weight-loss efforts.
If a couple decides to quite smoking at the same time, their collective commitment will last only as long as they both remain smoke free. As soon as one starts smoking again, the other is almost certain to follow. If either partner becomes unmotivated, eventually they both become coenablers.
Tynele's Story
My husband, his mom, and his sister all have bands, and I watched their progress as a bystander until I got a band myself two years ago. It has been different, that's for sure, and my little bit of progress hasn't come without a price.
I remember my husband got discouraged, and I thought he was impatient. But now I realize that there's a discouragement phase between the time you get a band and the time you see real progress. I lived in that place for quite a while.
I started at 306 and am now at 240 in two years. I remember how especially slow it seemed in the beginning. I lost 16 pounds pre-op, and at my six-week post-op appointment I'd lost only 2 more for a total of 18 pounds. At three months I was barely at minus 20 pounds. Back then, when I weighed in, I'd be up 1 or 2 pounds and the next time down 1 or 2. I do everything I'm supposed to. I don't drink with meals, I exercise with my husband, I drink water instead of soda, and I cut out between-meal snacks.
My husband has lost 166 pounds in just over a year. And I am pleased to talk about his weight loss. But my coworkers are band people and my family members have bands, and since at three months I'd lost only 20 pounds, I felt I wasn't doing well by comparison. Back then, I hated for people to ask about me. I tried to say, "I'm doing great," but people would press me for the actual pounds. When they heard my meager progress, I thought they assumed I was doing something wrong.
Right at first I had a lot of fills. And that was discouraging. I was hungry again two weeks post-op, like I didn't have a band. The first fill I couldn't feel any difference. The second one I barely felt a difference, and the same with the third and the fourth. I finally got a fill I feel comfortable with. I have never thrown up, although I have experienced the discomfort of food getting stuck because of too big a bite or not chewing enough.
There are big differences from watching someone with a band and having one myself. I've gained an appreciation for what band people go through. I remember thinking when I'd see my husband struggle with his food, "Why don't you just take a smaller bite?" But I found I had trouble adjusting to smaller bites, too. And it's more than just cutting the food into smaller pieces. I've found it's hard for me to chew enough even if I take smaller bites.
I exercise with my husband, but I was used to being the healthier one. Now he's catching up. He can outwalk me, and he couldn't a year ago.
Of course, now I notice a lot of positive differences at minus 66 pounds. Right before surgery my knees started hurting, and now they don't. We live in a hilly place and we can both walk the hills, no problem, when we couldn't before. But the most encouraging thing for me was getting remeasured. When I told the dietician I was discouraged about my progress, she told me that she encourages band patients to be measured at 3, 6, 9, and 12 months post-op. I was reluctant. But the difference in inches was surprising. I lost 3.25 inches in my upper arm alone, and that's a spot I'm concerned about. I'm one of the youngest band patients I know, and I have decided the best thing about losing so gradually is my skin has a chance to adjust.
Despite my discouragement in the beginning, I have no regrets. Even up to the day of surgery, I thought, "Am I doing the right thing?" As soon as I woke up I knew I'd made a positive change, and I still think so. And now my husband and I are trying to have a baby, which is something we've both always wanted.
The Physical Changes
You need to recognize the fact that band patients get caught up in the numbers. They generally measure their success only in terms of pounds lost, or a closely related measurement such as dress size for women and pant size for men. Part of your job is to acknowledge changes in those numbers when they share them with you and provide an element of praise.
Everybody likes to be congratulated when they do something positive, and that is particularly true when it comes to weight loss. You should remember to take advantage of every opportunity for praise. You might even want to have little celebrations whenever certain milestones are reached. Just don't send candy; it might sound good, but it sends the wrong message.
Every band patient gets excited about buying a smaller dress or a smaller belt, as the case may be. When your wife or husband comes home with a new purchase, seize the opportunity to make a fuss over their recent success. But, husbands, just a word of caution! Don't ask the size of that new dress. If she wants you to know, she'll tell you. Talking about women's dress sizes can be a very slippery slope for guys. You should just acknowledge that she looks great and leave it at that.
It can also be tempting to buy clothing for your spouse, but be careful. If you buy it too small, they'll think you are disappointed in their progress. If you buy it too big, you're in even more trouble. If you want to be safe, you should probably just give a gift card and let them pick out something for themselves.
Along with changes in weight and size come renewed energy levels and physical capabilities. I have had many patients tell me after losing only 20 or 30 pounds that they are now able to do things with their family that were previously not possible. They relate being able to go shopping at the mall, swimming with their kids, and even taking a hiking trip.
This raises the question, Should you actively look for things that you can now do together? The answer is both yes and no. You should not be afraid to ask whether they would like to join you in any activity, but don't assume that their answer will always be yes. They may still be uncertain of how much they can actually do. Whatever you do, don't plan a surprise camping trip in the mountains, or something similar, until you are certain that your spouse is not only capable but also would be excited about such a trip. If the activity you have planned ends up being beyond their capability, they will assume that they have disappointed you. That will likely discourage both of you from undertaking future activities together.
I frequently get asked whether there are any physical restrictions when a person has an AGB. The short answer is no, none that I am aware of. I have had patients ride horses and motorcycles, run marathons, and scuba dive following AGB surgery. Obviously, no major physical activity should be undertaken until the surgical wounds are completely healed-usually a couple of weeks. But before you drag your spouse out into the ocean for a dive to 60 feet, I would suggest that you ask their surgeon about whatever activity you may have planned. You also need to make sure that both of you are physically fit enough to take on the planned activity.
Renewed interest in sexual activity is also common in both men and women who lose weight and regain their positive self-image. While this can be a source of mutual enjoyment, like the other changes we've discussed, it is likely to be a gradual process. Once again, the best way to deal with this subject is to have an open and honest dialog between you and your partner. You may even want to use the fact that this subject was mentioned in this book as a graceful means of starting the conversation. When you do, remember that although your spouse may have changed physically, he or she is still likely to be experiencing a significant amount of emotional stress. Depending on how long it has been since they last experienced sexual intimacy, it may take a while before they are comfortable.
Along with a renewed interest in sexual activity, many young AGB patients also experience an increase in fertility. Morbid obesity is a common cause of menstrual irregularities and failure to ovulate in women, as well as low sperm counts in men. Weight loss can often improve these problems, allowing previously infertile couples to become pregnant. A woman who is in her childbearing years should consult with an obstetrician/gynecologist regarding her ability as well as the advisability of becoming pregnant, whether she is the band patient or her husband is the one losing weight. Obviously, not everyone who loses weight is able to get pregnant, but for those who are, it can be one of the greatest benefits of weight loss they will ever receive.
While successful weight loss often improves self-esteem, the excess Baggy skin that results from shrinking fat stores can profoundly damage some people's self-image. Because the early excitement is always based on pounds lost, this side effect is often overlooked by others, but not by the patient. In response to a compliment about how good she looked after losing nearly 100 pounds, one patient said, "You should see me naked!"
When your spouse asks whether you think they look older because of their hanging chin or other sagging parts, you will need to be particularly tactful. Your response should be along the lines of, "Well, we knew all along that with your successful weight loss the skin might seem a little lose in some areas."
This is a plain vanilla answer, so as you are saying the words you should anticipate a follow-up question. "Do you think I should have plastic surgery?" Now they are getting to the heart of the matter. You should recognize that, like any subjective question, there is no right answer. If you say yes, then you've not only given your approval, you've also indirectly implied that you don't like the way he or she looks now. If you say no, then you come across as not caring or perhaps just cheap!
A subjective question requires a subjective and diplomatic answer. Try simply rephrasing the question with a response such as "I think you look great just the way you are, but if you feel strongly about it and you want to look into your options, that's okay with me." In this way you are neither agreeing nor disagreeing. Instead you have empowered your partner. You've given your permission to get more information.
Conclusion
Learning to live with someone who has a band sounds like a terribly arduous task. However, for most spouses and family members, it turns into a true labor of love. The feeling you will have as you watch your husband or wife, or your mom or dad, emerge from a lifetime of obesity is worth whatever sacrifice you are asked to make.
What's more, once you realize that obesity is a disease that can be conquered, and that you can play a significant role in that effort, you won't see it as something that you have to do. You'll see it as something you have the privilege of doing.
Resources
Body Mass Index (BMI) Information
Determine your BMI by taking your weight in pounds and your height in inches and finding your corresponding BMI on the table on the following page.
Books and Publications
Eating Well After Weight Loss Surgeiy by Part Levine
Fit From Within: 101 Simple Secrets to Change Your Body and Your Life by
Victoria Moran; a series of essays aimed at helping forge a new relationship
with food, exercise, our bodies, and our lives.
LaparoscopicAdjustable Gastric Banding by Jessie H. Ahroni, Ph.D., A.R.N.P.
LAP-BAND® for Life byAriel Ortiz Lagardere, M.D., F.A.C.S.
Online Support Groups
Bandsters
health.groups.yahoo.com/group/Bandsters/ For those who have had or are considering band surgery.
Smart Bandsters
health.groups.yahoo.com/group/SmartBandsters/ For those who have had or are considering band surgery, or who already have a band.
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Websites
American Board of Plastic Surgery website
Offers information on choosing a surgeon and answers to frequently asked questions.
American Society of General Surgeons
Offers information on the PALSS certification of laparoscopic surgical skills.
American Society of Plastic Surgeons
Offers procedure information along with before and after photos.
Body Mass Index (BMI) Calculator
BMI Calculator provided at the National Heart, Lung and Blood Institute website and sponsored by the National Institutes of Health.
Diet Facts
DietFacts.com
Nutrition facts for foods, including fast food and popular restaurants.
Fit Day
FitDay.com
An online diet and fitness journal. Especially helpful in determining individual protein and calorie intake needs.
WLS Lifestyles Magazine Online
A magazine aimed at inspiring, educating, and supporting life after weight-loss surgery.
Glossary
Abdominoplasty Also known as the "tummy tuck," this plastic surgery procedure involves removal of excess skin and tightening of the abdominal area.
Adipose tissue The medical term for stored fat.
Adjustable Gastric Banding (AGB) This is the generic term for the banding process, including both the Lap Band® and Obtech banding systems.
Alimentary tract The main component of the digestive system, consisting of a long tube that begins at the mouth and ends at the anus.
American Board of Plastic Surgery (ABPS) The recognized national organization responsible for certifying plastic surgeons.
American Society of Bariatric Surgeons (ASBS) A national organization of surgeons who specialize in the surgical treatment of obesity.
American Society of General Surgeons (ASGS) A national organization composed of general surgeon specialists.
Amino acids The small molecules that are bound together to form more complex protein molecules.
Amnesia The inability to remember an event. Sometimes patients experience a degree of amnesia from just before surgery to well after the event as a result of anesthesia medications.
Amylase A digestive enzyme secreted by the pancreas and found to a lesser degree in saliva, which breaks down starches and other carbohydrates, converting them into simple sugars that can be absorbed into the bloodstream through the intestine.
Anemia A condition characterized by fewer than expected red blood cells in the blood. This may be due to blood loss (bleeding), abnormal destruction of red blood cells (hemolytic), or inadequate production of red blood cells as a result of a lack of iron or a deficiency of certain dietary elements such as Vitamin B-12. See Vitamin B-12.
Anesthesia The administration of specific drugs to block the painful effects of surgery. A medically induced sleeplike state that allows for the safe and controlled performance of surgery.
Anesthesiologist A physician who specializes in putting patients to sleep for surgery and monitors them during the procedure.
Anesthesiology The medical specialty of placing people into a sleeplike state or providing other means of pain relief during surgery.
Antibiotic Any of a variety of medications designed to kill bacteria and aid in the body's efforts to fight infection.
Anticoagulant A medication used to keep blood from clotting. Commonly referred to as a blood thinner.
Apron The excess skin of the lower abdomen, which can hang down over the pubic region following weight loss.
Arteriosclerosis The development of deposits within the walls of arteries resulting in thickening of the arterial walls and narrowing of the arterial channels. Frequently associated with hypertension.
Arthritis Any condition in which one or more joints become inflamed.
Aspiration The process of food or fluids passing from the normal swallowing channel into the trachea, or windpipe.
Atelectasis The collapse of small airways in the lower aspects of the lungs, trapping mucus and bacteria that can turn into pneumonia. Deep breathing and coughing post-op help prevent this condition.
Attention Deficit Hyperactivity Disorder (ADHD) A psychological disorder characterized by, among other things, an inability to control impulsive behavior.
Band The generic term for the silastic ring used in the AGB process, including both the Allergan (Inamed or Bioenterics) and Johnson and Johnson (Swedish or Obtech) bands.
Band migration (gastric erosion) A relatively rare, but serious complication of the adjustable gastric band whereby the band erodes through the wall of the stomach. The erosion may be attributed to the band placing excessive pressure on the stomach and cutting off circulation in the affected areas. It may also be due to ulcers within the stomach penetrating out to connect with the band. The usual remedy is removal of the band.
Band slippage A condition in which the band around the stomach moves up or more commonly down on the stomach, away from its initial intended position.
Bandster A person who has undergone the placement of an Adjustable Gastric Band as weight-loss surgery.
Bariatric surgery The treatment of excess body weight using one of several surgical procedures designed to alter the digestive system in an attempt to promote weight loss.
Bariatrics The medical specialty that involves the study and treatment of excess body weight.
Barium A chalky-tasting fluid that is used in a number of X-ray studies to outline the anatomy of parts of the intestinal tract.
Barium swallow An X-ray study in which barium is used to define the anatomy of the upper digestive tract. This test may be used to demonstrate swallowing abnormalities in the esophagus, band displacement on the upper stomach, reflux of stomach contents into the esophagus, or the presence of a hiatal hernia.
Basal layer A layer of cells within the skin that separates the top layer, or epidermis, from the bottom layer, or dermis.
Bat wings The excessive skin hanging from the under side of the upper arms, usually after weight loss.
Belt lipectomy Removal of excess skin in a circle from the stomach, flanks, and back, and lifting of the skin of the buttocks and the outer aspects of the thighs.
Bile The yellow to greenish liquid material secreted by the liver through the bile ducts into the small intestine, which is essential to the process of breaking down fatty foods into tiny particles that can be absorbed into the bloodstream during digestion.
Bile ducts A system of tubes that gather and transport bile from the liver to the intestines.
Biliopancreatic Diversion with Duodenal Switch (BPD-DS) A complex bariatric operation in which the size of the stomach is reduced via a sleeve gastrectomy; then the duodenum is divided, the outlet of the stomach is connected to the small intestine, and the remaining part of the small intestine is reconnected well downstream, near the end of the ileum. The procedure combines both the restriction of a small gastric pouch and the malabsorption effects of a short intestine.
Biliopancreatic fluid The combination of bile from the liver and enzymes from the pancreas that are essential for the digestion of fats and carbohydrates.
Bioenterics LAP-BAND®: The LAP-BAND® is an adjustable gastric band that is FDA approved in the United States as a restrictive surgical option for the treatment of serious obesity.
BiPAP A machine designed to be worn at night to provide airway support during sleep for people with sleep apnea.
Blood glucose The measurement of the amount of sugar in the blood.
Body contouring A term used to describe plastic surgical procedures following weight loss that emphasize removing skin or changing the body shape and appearance to more pleasing proportions and removing problem areas.
Body Mass Index (BMI) A commonly used measurement that combines a person's weight and height. BMI is generally accepted as the standard for determining overweight and obesity diagnoses. The formula for calculating BMI is (weight in kilograms) divided by (height in meters squared).
Canula A small tube that is placed into the abdominal cavity through the skin and muscular wall during laparoscopic surgery, which acts as a conduit or portal for the introduction of long slender instruments used during surgery.
Cardiac stress test A group of tests designed to determine how well the heart functions during periods of maximal stress or exertion. One or more of these tests may be performed prior to surgery in an attempt to identify problems that could arise during the stress of anesthesia and an operation.
Cardiology A branch of medical science having to do with the heart.
Catheter A tube inserted into the body to serve a medical purpose. One common type of catheter is a urinary catheter, which is placed into the bladder to drain urine.
Cells The smallest units of living tissue.
Cellulite Lumpy fat stores under the skin.
Cholecystokinin A chemical released by the stomach as it fills up with food that stimulates the gallbladder to contract, literally squeezing bile out of the gallbladder, through the main bile duct, and into the intestine, to assist in the digestion of recently ingested fat.
Circumferential body lift See Belt lipectomy
Cirrhosis A scarring of the liver that can interfere with the function of the liver as well as the flow of blood from the intestine through the liver.
Clinical research trials Research studies designed to evaluate the safety and effectiveness of medications or medical devices by monitoring their effects on large groups of people.
Cognitive dissonance A pattern of negative thinking generated by the brain that nearly always occurs whenever a person tries a new activity or behavior.
Colon That portion of the intestinal tract responsible for absorbing most of the water from the waste material left after the digestive process. The colon is also responsible for transporting the waste to the rectum for evacuation in the form of feces.
Comorbidity (Comorbidities) Serious medical condition(s), usually mentioned as a result of another chronic condition because they compound the problem. For example, high blood pressure is frequently a comorbidity to obesity.
CPAP (Continuous Positive Airway Pressure) A machine designed to be worn at night by people with sleep apnea to support the upper airways during sleep.
Crohn's disease A form of inflammatory bowel disease that has no known cause and can influence the risk of gastric surgery, including the placement of an adjustable gastric band.
Deep Vein Thrombosis (DVT) The clotting of pooled blood in the large veins of the legs and pelvis.
Dehydration A condition in which the body doesn't have enough water to function normally.
Dermis The deep layer of the skin, which contains the blood vessels, nerves, and glands of the skin.
Diabetes A shortened term for diabetes mellitus. See Diabetes mellitus.
Diabetes insipidus A pathologic condition in which the body loses much of its ability to retain water normally.
Diabetes mellitus A chronic medical condition affecting the uptake and utilization of glucose by the cells of the body, which requires the presence of insulin produced within the pancreas. The condition may be the result of inadequate insulin production or the development of resistance of cells to available insulin.
Diaphragm The broad, flat muscle that separates the chest cavity from the abdominal cavity. The diaphragm contracts and relaxes as part of the process of breathing.
Diastolic pressure The second number in the blood pressure, which is the minimum pressure remaining within the arteries during the period between heartbeats.
Diet Food and liquids that are taken into the body and subsequently digested within the intestinal tract.
Dietitian A expert who is trained in the dietary needs and nutrition of the human body and the effects of nutrition on health and disease.
Digestion The process of breaking food down into its essential components to fuel and provide the basic building blocks for the body. Includes both mechanical and chemical breakdown of food.
Diverticulitis A condition caused by chronically higher than normal pressure within the colon in an attempt to move very small, very firm stools through for elimination. Often caused by not enough roughage in the diet.
Dumping syndrome The term used to describe the rapid addition of large volumes of water from the bloodstream into the intestine in direct response to eating a large amount of sugar or carbohydrate. This is common in gastric bypass patients because the stomach normally serves as a buffer, allowing only small amounts of highly concentrated sugar or carbohydrates to reach the intestine at any one time. Symptoms can include sudden crampy abdominal pain, nausea, bloating, diarrhea, lightheadedness, sweating, rapid heart rate, dizziness, and fatigue.
Duodenal Switch (DS) See Biliopancreatic Diversion with Duodenal Switch (BPD-DS).
Duodenum The first part of the small intestine, approximately 1 foot long, which begins at the bottom of the stomach and ends at the second part of the small intestine, the jejunum. The duodenum is the point where chemical digestion begins, since this is where bile and pancreas enzymes are added to food.
Early obstruction A condition in post-op AGB patients whereby the band can be so tight that not even fluids can pass through.
Edema Swelling caused by an accumulation of water in dependent tissues with poor circulation.
Electrocardiogram A common test used to determine the electrical activity within the heart, which can suggest possible problems. This test is commonly obtained prior to surgery in patients at risk for cardiac problems.
Electrocautery A technique that employs electrical current to control bleeding during a surgical procedure.
Emulsification The process of breaking fatty foods into tiny particles or globules in the stomach during digestion, which requires bile from the liver.
Endoscopic examination The procedure to examine the inside of the esophagus, stomach, and duodenum. See endoscopy.
Endoscopy A diagnostic test in which a flexible lighted tube is passed through the mouth, down the esophagus, and into the stomach and duodenum, providing a visual examination for possible problems inside these parts of the digestive tract.
Endotracheal tube A tube placed through the vocal cords, into the windpipe, or trachea, to maintain breathing during surgery
Epidermis The superficial layer of skin composed mostly of dead cells, which are constantly being replaced.
Esophageal hiatus The natural opening in the diaphragm through which the esophagus passes just prior to emptying into the stomach.
Esophageal varicies Dilated veins in the lower esophagus that are usually the result of restricted blood flow through the liver; commonly associated with cirrhosis.
Esophagus The muscular tube that transports food from the back of the throat to the stomach.
Excess Weight Loss (EWL) The measure of how much weight has been lost in relation to an individual's ideal body weight. This is usually stated as a percentage. For example, a person with an ideal body weight of 150 pounds, who has lost from their actual starting weight of 300 pounds down to 225 pounds, would have a 50 percent EWL (75 lbs. lost / 300 lbs. - 150 lbs.).
Fatty liver A liver in which too much glycogen is stored, which can potentially interfere with normal liver function.
Fecal material Roughage that is left over after the digestive process, which is transported through the colon and eliminated from the body as a bowel movement.
Fenfluramine® The brand name of a drug used to achieve weight loss through appetite suppression. This was a component of Fen-phen®, a compound drug that is no longer available in the United States.
Fen-phen® A brand-name drug combination of Fenfluramine® and Phentermine® created in the 1990s to promote weight loss. It was later taken off the market because it became linked to the development of a type of valvular heart disease thought to be life threatening.
Fill The process of using a syringe to inject saline or a similar substance into the subcutaneous port of the AGB to increase the tightness of the band around the stomach. This is the process that allows patients to adjust the pressure of the band, thereby affecting how much food they are able to eat and how quickly the food drops into the lower portion of the stomach.
Fluoroscopy A video X-ray procedure that makes it possible to see internal organs in motion. This may involve swallowing a barium liquid to observe its progress through the area of band restriction.
Follicle A specialized structure in the skin that produces a single hair.
Gallbladder A small pouch off the bile duct located under the liver, which functions as a temporary storage area for bile before it passes into the intestinal tract.
Gallbladder disease The presence of inflammation of the gallbladder, stones within the gallbladder, or malfunction of the gallbladder, usually associated with abdominal pain or nausea.
Gallbladder sonogram A diagnostic test to look at the gallbladder using ultra-high frequency sound waves that bounce back off the tissues and are converted into a visual image.
Gallstones Rocklike formations that can form within the gallbladder as a result of crystallized bile that may require surgical removal of the gallbladder.
Gastric bypass See Roux-en-Y Gastric Bypass.
Gastric herniation A condition in which a portion of the stomach from below the band pushes its way up through the band opening.
Gastric reflux The presence of stomach contents, usually acid, in the lower esophagus, typically the cause of heartburn.
Gastric sleeve See Sleeve gastrectomy.
Gastric stapling A bariatric operation that partitions the stomach with staples into a small upper stomach pouch and a larger lower stomach with a narrow opening for food to pass through between the upper and lower areas.
Gastroenterologist A medical specialist in the field of gastrointestinal diseases as well as liver disorders.
Gastroesophageal Reflux Disease (GERD) The condition characterized by the abnormal movement of stomach contents, usually acid, up into the esophagus causing heartburn, chest pain, regurgitation of food, and other related symptoms.
Gastroplasty Any surgical alteration of the stomach, typically to decrease the size of the stomach. These procedures include various operations including the vertical banded gastroplasty (VGB).
GERD See gastroesophageal reflux disease.
Glucose A simple sugar molecule that is a basic component of all starches and complex sugars.
Glycogen A complex sugar that is produced by the liver from excess glucose and that is stored in the liver for later use when glucose levels in the blood go down and the cells need energy.
Hardening of the arteries See Arteriosclerosis.
Heat stroke A condition that occurs when body temperature rises uncontrollably, frequently associated with dehydration.
Heparin A common anticoagulant or blood thinner, generally given prior to surgery and usually for 12 to 24 hours afterward to prevent deep vein thrombosis and pulmonary embolus.
Hepatic cirrhosis See Cirrhosis.
Hepatologist A medical doctor who specializes in the diagnosis and treatment of liver diseases.
Hiatal hernia A condition in which the natural opening in the diaphragm, called the esophageal hiatus, becomes stretched, allowing the pressure in the abdomen to push the stomach and other abdominal organs up through this opening into the chest.
HIDA scan A test used to assess the functional capability of the gallbladder. Typically used to determine whether the gallbladder is emptying bile as it should.
High blood pressure A medical condition characterized by consistently elevated pressure within the arteries of the body.
Hydrochloric acid The type of acid produced by the stomach for digestion.
Hypertension See high blood pressure.
Ileum The second half of the small intestine, extending from the midway point to the end of the small intestine, where it empties into the colon.
Incisional hernia A complication of any abdominal operation, more common following open incisions, whereby the muscular layer of the abdominal wall fails to heal completely, allowing the edges of the muscle to separate, creating a defect in the abdominal wall.
Intertriginous moniliasis An infection of the skin caused by the growth of fungus attracted to a warm, moist, and dark place such as under deep folds of skin.
Intestinal bypass See Jejuno-ileal bypass.
Intravenous The injection of medications or fluids directly into the bloodstream through a small catheter placed into a vein.
Intubations A part of the induction of anesthesia that involves placing a tube into the trachea for breathing during surgery.
Jejuno-ileal bypass An older bariatric operation that has not been performed for many years because of the high risk of medical problems associated with the procedure. Also known as JI bypass or intestinal bypass, this surgical procedure shortens the small intestine from its usual length of about 18 feet to only about 4 feet in order to minimize the absorption of food.
Jejunum The second part of the small intestine, starting at the end of the duodenum and ending at the ileum, comprising approximately half of the overall length of the small intestine.
JI bypass See Jejuno-ileal bypass.
Lap Abbreviation for laparoscopic.
Laparoscope A long, thin telescope attached to a high-intensity light source and a miniature video camera that is inserted into the body during laparoscopic surgery to view the working area.
Laparoscopic surgery A minimally invasive surgical technique that involves using cameras and instruments inserted into the body through a number of small incisions rather than the large, open incision common to traditional surgery. Advantages include less pain, faster recovery, and less noticeable scars.
Laparoscopy See Laparoscopic surgery.
Laparotomy An abdominal operation performed through a large incision, allowing the surgeon open access to the abdominal cavity.
LAP-BAND® The trade name for the adjustable gastric band manufactured by Allergan, Inc., formerly Inamed, Inc., and BioEnterics.
Large intestine See Colon.
Leaking band The loss of fluid from the band system, which can either be small and slow or rapid and dramatic. A leak can occur from the injection port, the tubing, or the band itself. Treatments can range from more frequent fills to removal and replacement of the entire band.
Lipase A digestive enzyme produced by the pancreas that works on ingested fatty substances, breaking them down to fatty acids, cholesterol, and other absorbable fat molecules.
Lipids Fatty substances contained in various foods.
Liquid diet A diet that consists of liquids only. No solid foods are permitted. This is often prescribed from one to four weeks following gastric surgery.
Liver The largest solid organ in the abdomen, which is responsible for many vital functions, including making and secreting bile into the alimentary tract, detoxifying blood from the intestine before absorbed nutrients are sent into the bloodstream, and storage of glucose as glycogen for immediate use by the body.
Malabsorptive bariatric procedures Operations designed to remove or change the digestive system in order to interfere with the absorption of nutrients by the intestine.
Malignant An aggressive behavior commonly used to describe cancerous growths.
Melanin The pigment found in the basal layer of the skin, which is responsible for the color of the skin.
Melanocytes The cells present in the basal layer of the skin which produce melanin.
Melanoma An aggressive form of skin cancer arising from melanocytes.
Meridia® A brand name drug with appetite suppressant and metabolic stimulant properties used to promote weight loss.
Morbidity A diseased condition or state, the incidence of a disease, or of all diseases in a population. For our purposes, the term can be used either in regard to complications arising from the AGB process or obesity itself.
Morbidly obese Individuals whose BMI is 40 kg/m2or higher.
Mortality rate The likelihood of death as a consequence of a particular procedure or treatment. The ratio of the total number of deaths to the total number of procedures or treatments performed. May also be used to describe the likelihood of death because of a particular illness.
Motility The ability of a part of the intestinal tract to push food from one area to the next using spontaneous motion, a process called peristalsis.
National Institutes of Health (NIH) A part of the U.S. Department of Health and Human Services and the primary federal agency responsible for conducting and supporting medical research.
Nephrologist A medical specialist in diseases and disorders of the kidney
Non-scale Victories (NSVs) Important milestones during the weight-loss process that represent positive life changes yet don't have to do specifically with weight as measured by the scale.
Non-Steroid Anti-Inflammatory Drugs (NSAIDs) A large group of drugs that have anti-inflammatory characteristics and that work by inhibiting the production of prostaglandins. Common examples include ibuprofen, ketoprofen, piroxicam, naproxen, aspirin, fenoprofen, indomethacin, and tolmetin. There are many others in this group, and most surgeons recommend they be avoided following AGB or other bariatric procedures, as they may irritate the stomach lining causing ulcerations and even bleeding.
Obese Those patients with a body mass index over 30 kg/m2 but less than 40 kg/m2.
Obesity The medical condition characterized by excess body fat.
Obtech Swedish Adjustable Gastric Band The adjustable gastric band manufactured by a division of Johnson and Johnson (formerly by Obtech). This is considered a low-pressure band that typically requires more fluid to exert pressure on the stomach.
Operative laparoscopy See Laparoscopic surgery.
PACU The postanesthesia care unit, also known as the recovery room.
Pancreas An organ located behind the stomach that produces the digestive enzymes amylase and lipase, and also contains specialized groups of cells (Islets of Langerhan) that produce insulin.
Panniculectomy The removal of the pannus, or the "apron," which is the large, hanging skin area at the bottom of the abdomen.
Pannus The large abdominal "apron" made by the skin that often results when obese patients lose weight.
Peripheral vascular disease See Arteriosclerosis.
Peristalsis The process by which the intestinal tract "milks" food and fluid along from one area to the next.
Phenteramine® A drug used to promote weight loss by acting as an appetite suppressant.
Pickwickian syndrome A condition named for a character in the Charles Dickens novel Pickwick Papers who was extremely obese and would frequently stop breathing as a result of his weight.
Pilo-erector muscle A tiny muscle attached to the hair follicle that contracts to make the hair stand up.
Plastic surgery Surgery for the restoration, repair, or reconstruction of body structures.
Plateau A period of time of two to four weeks, during which an individual who is attempting to lose weight seems to stop losing and remains stable despite continued efforts.
Port The part of the band system that is accessible with a needle through the skin, used to perform adjustments to the AGB.
Pouch The small "upper stomach" created by the band as it draws the stomach into an hour-glass shape. This is where your food will go after swallowing, where it will slowly pass through into the lower stomach and on through the digestive tract.
Pre-op diet A two- to three-week preoperative low-fat, low-carbohydrate diet some surgeons have their patients on prior to surgery in an effort to shrink the size of the liver, making band surgery easier and safer.
Preoperative testing The battery of tests that help to determine the patient's physical health and fitness to undergo surgery. In addition to a detailed diet and health history and examination, as well as a psychological examination, this may include a full blood workup and electrocardiogram, depending on the patient's age, sex, and relative health status.
Productive Burp (PB) A common description of the regurgitation of food that has recently been swallowed by a band patient, but remains in the esophagus because the upper stomach pouch is full.
Proficiency Assessment of Laparoscopic Surgical Skills (PALSS) A laparoscopic skills certification process offered by the American Society of General Surgeons (ASGS).
Protease A group of digestive enzymes that break down complex protein molecules into their building blocks known as amino acids. These digestive enzymes are produced by the cells that line the inside of the small intestine and are necessary to convert protein into amino acids for absorption into the bloodstream.
Pulmonary embolus A potentially life-threatening condition in which clotted blood breaks away from the wall of a large vein in the pelvis or legs and travels quickly back to the heart and is then pumped up into the lungs, blocking blood flow through the lung tissue.
Pulmonologist A medical specialist in the field of lung function and lung diseases.
Pulse oximeter A monitoring device placed on a patient's finger or ear lobe, both during and after surgery, to continuously measure the amount of oxygen in the blood.
Pylorus The muscular valve at the bottom of the stomach that prevents food from passing out of the stomach until it has been mixed with stomach acid and becomes the consistency of oatmeal.
Redux® The generic name for a weight-loss drug developed in the 1990s and later taken off the market because it became linked to the development of a type of valvular heart disease thought to be life threatening.
Restriction A term used by AGB patients to describe the feeling that limits the amount of food they can eat.
Restrictive bariatric surgical procedures Weight-loss operations that limit the amount of food that can be eaten but do not otherwise alter the digestive process.
Roughage Foods that contain substantial amounts of material that is not digestible and therefore passes through the intestine as waste without being absorbed.
Roux-en-Y (RNY) gastric bypass The creation of a "Y-shaped street." This is the most common form of gastric bypass surgery. The gastrointestinal tract is rearranged by creating a small upper stomach pouch, and the small intestine is divided with the lower portion connected directly to this pouch, effectively bypassing a good portion of the stomach and duodenum. The "Y" is created by reattaching the upper end of the divided small intestine back into the food stream farther down.
Saliva The fluid produced by the salivary glands in the mouth, which acts as a lubricant that makes the food easier to swallow. Saliva also contains a small amount of amylase, an enzyme that helps digest carbohydrates.
Salivary glands Glands in the mouth that produce saliva.
Sebaceous gland A gland associated with hair follicles that produces an oily substance to lubricate both the hair and the surrounding skin.
Sequential Compression Devices (SCDs) Inflatable leggings that periodically massage the legs to promote normal circulation during periods of inactivity and are used to help prevent venous thrombosis as well as possible pulmonary embolus.
Short-gut syndrome A potentially fatal medical condition resulting from inadequate length of small intestine to allow for adequate nutrient absorption. This is a common problem following jejuno-ileal bypass and other "bowel-shortening" procedures. Typical symptoms include uncontrollable diarrhea, dehydration, kidney stones, anemia, malnutrition, various vitamin deficiencies, and even liver failure.
Sleep apnea The result of airway blockage, which occurs during sleep if the tissues of the upper air passages relax, allowing the air passage to collapse. The normal automatic breathing process is interrupted temporarily until the person awakens sufficiently to initiate voluntary breathing. Sleep apnea can severely limit restful sleep.
Sleeve gastrectomy A restrictive bariatric operation that converts the stomach into a long tube with removal of the remaining portion of the stomach pouch.
Sliming The result of blockage at the site of the band, causing the production of a large amount of foamy mucus that quickly builds up in the esophagus, which, along with an increase in salivation, is the body's attempt to provide lubrication to remove the obstacle.
Slippage See Band slippage.
Small bowel limb The segment of intestine that extends from the stomach down to where the small intestine is reconnected.
Small intestine That portion of the digestive system that is approximately 18 feet long, where virtually all absorption of nutrients takes place. Tiny molecules of simple sugars, fatty acids, amino acids, vitamins, and minerals are all absorbed into the bloodstream through the lining of the small intestine.
Stoma An opening from one area of the intestinal tract to another, or to the outside.
Stomach The large pouch portion of the digestive tract located just below the diaphragm. Normally the stomach can hold a liter or more of food and fluid. It produces a highly concentrated solution of hydrochloric acid, capable of breaking down the structure of even the toughest foods we ingest. And it acts like a big mixer, literally grinding food and mechanically transforming it into a thick paste.
Stomach stapling See Gastric stapling.
Stool Waste material from digestion, stored in the colon until eliminated.
Stretch marks Unsightly, permanent, linear scars in the skin that are the result of the skin's stretching rapidly or beyond its ability to grow.
Subcutaneous adipose tissue The layer of tissue between the skin and the muscle layers where significant body fat is stored.
Subtotal gastrectomy A surgical procedure in which most of the stomach is removed.
Sugar diabetes See Diabetes mellitus.
Super obese A term used to describe individuals whose BMI is over 80 kg/m2.
Sweat gland A gland within the skin that excretes water to help cool the body through the process of evaporation.
Systolic pressure The first number in a blood pressure reading, which represents the peak pressure that exists when the heart is actively contracting to push blood through the arteries.
Terminal ileum The very last part of the small intestine, where key vitamins and bile salts are absorbed.
Trachea The anatomic term for the windpipe, meaning the airway from the back of the throat to the lungs.
Trocar A surgical instrument with either a sharp triangular point or a tapered point, used to insert a canula through the abdominal wall during laparoscopic surgery.
Tubing The part of the AGB that connects the port where saline is injected to the band around the stomach.
Tummy tuck A plastic surgical procedure designed to remove excess skin from the lower part of the abdomen. See Abdominoplasty.
Type 2 diabetes A medical condition commonly associated with obesity, in which the body's ability to utilize glucose is impaired. This may be due to reduced insulin production but is more often related to the development of resistance to the effects of insulin, necessary for the cellular absorption of glucose from the bloodstream.
Upper GI X-ray A diagnostic test in which the patient is asked to swallow a liquid solution containing barium that shows up on an X-ray, outlining the esophagus, stomach, duodenum, and a portion of the small intestines.
VBG Abbreviation for Vertical Banded Gastroplasty.
Venous stasis ulcers Skin ulcers, most commonly found in the ankle region, caused by chronic edema and poor circulation.
Venous thrombosis A condition in which blood clots within the veins, usually caused by stagnant flow.
Vertical Banded Gastroplasty (VBG) A restrictive bariatric procedure that combines an element of gastric stapling and a fixed, nonadjustable gastric band placed between the small upper pouch and the larger lower stomach.
Villae Tiny fingerlike projections that blanket the inside of the small intestine and that contain a network of capillaries capable of absorbing molecular nutrients directly into the bloodstream.
Villus A single fingerlike structure. See Villae.
Visceral fat deposits Deposits of fat around organs that can interfere with the organ's function, such as fat deposits around the heart.
Vitamin B-12 A vitamin that plays an important role in the process of making red blood cells, which carry oxygen to the body. Vitamin B-12 is also important to normal nerve function.
Windpipe See Trachea.
WLS Abbreviation for weight-loss surgery.
Xenical® A weight-loss drug that binds up ingested fat inside the intestine to prevent it from being absorbed by the digestive system.