Lap Band 02

you,ve come so far

We understand. To transition successfully to your new life, you will need to make emotional adjustments along with the physical ones. You will need to draw on emotional resources as well as practical ones. And because we want to ensure your success, we want you to receive all the support you need.

First, don't overlook your healthcare professionals. They have developed insights from helping many LAP-BANDS Adjustable Gastric Banding System patients. And their collective experience may help you. Always feel free to discuss your feelings with them.

Second, if you haven't done so, sign up for My LAP-BAND1 Journey at lapband.com.

You will find plenty of tools, tips and information. And by tracking your progress there, you will be supporting yourself.

Finally, reach out to your community. And you are now a member of the LAP-BAND® System community — thousands of people who have gone through what you are going through. So many of them are eager to share their stories and offer their support. You can join them online and in person. Ask your surgeon if a group meets in your area.

And now the next phase of your journey is about to begin. It may be a highly personal one, but take comfort in the fact that you are not traveling alone.

After you've had your first adjustment and can eat solid foods, you may be wondering, "What's next?" This booklet contains several recommendations. Of course, what's most important is to always follow your surgeon's instructions. But first, congratulations — you've made it through an important transition period in your LAP-BAND' System journey and are closer to achieving your weight-loss goals. Now is the time to dedicate yourself to a healthy lifestyle. And that begins with healthy eating and the right level of activity.

Your new eating plan

Eating smart is the key to your success. Sometimes that can mean choosing different foods. It can also mean enjoying some old favorites — but in moderation. The LAP-BAND' System is designed to get you started living healthily ever after. Here's what you need to know.

Because liquids can pass through the reduced stomach pouch quickly, they will not make you feel full. So avoid high-calorie drinks from now on. Water, broth, tea and coffee (without sugar) are all good choices.

Eat only when you are hungry — about three small meals a day. Chew your food well and take small bites to avoid blocking the restricted area of your stomach. Remember, you'll need to get plenty of nutrients from a small quantity of food, so eat smart.

Have vegetables, fruit, meat and/or dairy products, and grains or cereals each day.

In this brochure, you'll discover how to create healthy, tasty meals that contain the nutrients you need without a lot of sugar and fat. If you have questions, don't hesitate to speak with your surgeon and/or dietitian about food choices.

10 rules easy but important at*

Here are ten rules for eating, drinking and exercising that will help you achieve your goals with the LAP-BANDS System. Remember, your success depends on how willing you are to work with your LAP-BANDS System — and embrace a new way of eating.

1. Eat about three small meals a day — avoid snacking and eat when you are hungry
2. Eat slowly and chew thoroughly (approximately 15 to 20 times a bite)
3. Stop eating as soon as you feel satisfied
4. Dr ccink while you are eating
5. Do not eat between meals
6. Eat only good-quality food
7. Avoid fibrous food
8. Drink enough fluids during the day
9. Drink only low-calorie liquids
10. Be active for 30 minutes each day

1. Eat only when you are hungry—about three small meals a day
The LAP-BANV System creates a small stomach pouch that can hold only about one-quarter cup (approximately 2 ounces) of food. If you try to eat more than this at one time, you may become nauseous or vomit. If you routinely eat too much, the small stomach pouch may stretch. That will cancel the effect of the operation. Frequent vomiting can also cause certain complications, such as stomach slippage. You need to learn how much your stomach pouch can hold comfortably and not exceed this amount.

2. Eat slowly and chew thoroughly
Food can pass through the new stoma (stomach opening) only if it has been chewed into very small pieces. Always remember to take more time for your meals and chew your food very well.

3. Stop eating as - soon as you feel full
Once your new stomach pouch is full, your body receives a signal that you have eaten enough.' It takes time, though, for you to become aware of this signal. If you rush through your meal, you may eat more than you need. This can lead to nausea and vomiting. Take time to eat and enjoy your meal. Try to recognize the feeling of fullness — then put your utensils down.

4. Do not drink while you are eating
The LAP-BANIr System can work only with solid food. If you drink at mealtimes, the food you have eaten becomes liquid, and the effectiveness of the LAP-BANDS System is greatly reduced. You should not drink anything for one to two hours after a meal. This allows you to keep the feeling of fullness as long as possible.

5. Do not eat between meals
After a meal, do not eat anything else until the next meal. Eating snacks between meals is one of the major reasons for weight-loss failure. It 1 is very important to break this habit. Patients with proper "fill" levels do not feel hungry in between meals. If you do, this may be a sign that the LAP-BAND" System is too loose, anc you should tell your clinician.

6. Eat only good-quality food
Your meals should be high in protein and vitamins. Don't fill your small stomach pouch with "junk" food that lacks vitamins and other important nutrients. Avoid foods high in fat and sugar. Instead, choose fresh vegetables, fruit (but not fruit juice), meat, and whole grain cereals. Ask your doctor or dietitian before you take any vitamin supplements. And for more information on maintaining a healthy diet, see the section "Good food choices."

7. Avoid fibrous food
Fibrous food can cause problems for some people. Foods that contain many fibers, such as asparagus, can block the stoma. That's because you can't chew it well enough to break it up into small pieces and your saliva can't break it down. If you would like to eat asparagus or other fibrous foods once in a while, be sure to cook them well, cut them into very small pieces and then chew them thoroughly.

8. glasses of water a day.
That's because as you lose weight, and your fat content drops, your body will need to eliminate waste products. You will need to drink large amounts of liquid every day in order to urinate enough to excrete these waste products from your body. Remember to drink only water, tea, skim milk or coffee (without milk, cream or sugar). But don't drink during or immediately after meals.

Meat, fish, poultry, eggs
2 to 4 oz. of meat, fish or poultry, or one egg, for additional protein. Remove all visible fat from the meat. Remove the skin from poultry. Prepare the meat in ways that require very little fat. Grilling, steaming, microwaving and boiling are all good ways to do that.

Dairy products
Milk and yogurt are calories in liquid form. In theory, then, they should be low-fat. But these types of food have calcium and protein. That makes them an important part of a healthy daily diet. Choose a maximum of 2 cups of low-fat milk or low-fat yogurt or 1 oz. of low-fat cheese a day.

Fats
Restrict the use of fat to 3 to 4 teaspoons of margarine, butter or oil per day. You can have low-fat salad dressings and mayonnaise in moderation.

Food not so good

Proceed with caution. Some foods have difficulty passing through the opening of the stoma and may cause blockage.

Dry meat
Pasta or rice
Coconut
Seeds and skins
Peanut butter
Fibrous vegetables
Popcorn of fruits and
Shrimp like corn, celery
Membrane of vegetables
Untoasted or and asparagus citrus fruits
Greasy or fried doughy bread
Dried fruit
Nuts food

Certain foods may cause problems for some people. Introduce these foods to your diet slowly and individually to see if they are tolerated. Always be careful, chew well, `and follow your surgeon's or dietitian's advice.

choices

physical Actinity tips

Along with the LAP-BAND" System, physical activity should be an important part of your weight-loss journey. Staying active can not only contribute to weight loss, it can help increase your cardiorespiratory fitness and help you maintain your eventual weight.

Perhaps before your surgery, it was hard to be as active as you should be. But now's the time to get started — slow and easy at first.

For example, stand rather than sit, walk rather than drive, take the stairs rather than the elevator. The more weight you lose, the easier this should get. Then, gradually increase your exercise level. Swim, bicycle, play ball.

Additional LAP-BAND System adjustments

To achieve your goals, you may need additional adjustments over time. During each, a very small amount of saline is added or removed from the LAP-BAND& System. The exact amount required to make the stoma the right size differs from person to person. An ideal saline 'fill" should result in the LAP-BAND" System being just tight enough to let you eat the right amount to get the nutrients you need, while still reducing the overall amount of food you need to feel satisfied. The chart opposite can help you recognize when you're in the Green Zone for gradual, healthy, long-term weight loss. If you're in the red or yellow zones, it's time for an adjustment.

The LAP-BAND& System is an effective way to obtain steady and safe weight loss. And adjustments are an important part of this process. But there's no hurry to have an adjustment before you're ready.

Stay in the green zone

Remember, slow and steady does it.
Gradual, steady weight loss with the LAP-BAND System can be healthy for you. Losing weight too quickly creates a health risk and can lead to a number of problems. The main goal is to have weight loss that prevents, improves or resolves health problems connected with severe obesity.

Signs and symptoms of potential complications.
The LAP-BAND' System has been proven safe.' However, as with all surgeries, there are some potential risks of complications. If you experience any of the following, speak with your surgeon:

Sleep disturbances
Respiratory symptoms
Chronic cough
Recent onset of asthma
Recurrent or prolonged bronchitis
Pneumonia
Persistent or painful vomiting

How much weight can I expect to lose?
In the first year of the operation, weight loss of 1 pound a week is likely, but for some, 2 to 3 pounds per week is possible. Twelve to 18 months after the operation, weekly weight loss is usually less.

Can the LAP-BANUE'System be removed?

Although the LAP-BAND' System is not meant to be removed, it can be. In some cases, this can be done laparoscopically. Surgeons report that the stomach generally returns to its original shape once it is removed. After the removal, though, you may soon return to your original weight, or even gain more.

What about pregnancy?

Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. If you need to eat more while you are pregnant, it can be loosened. After the pregnancy, it may be made tighter again, allowing you to continue on your weight-loss journey.

What if I go out to eat?
Order only a small amount of food, such as a healthy appetizer or child's serving. If you order an entree, ask the waiter to serve you half and wrap the rest so you can take it home for another meal. You may want to let your host or hostess know in advance that you prefer smaller portions.

What about alcohol?
Alcohol has a high number of calories. It also breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight-loss.

Am I allowed to have the LAP-BANCO System opened for a special occasion?
No. It should never be opened to eat a big meal at a special occasion. However, it can be opened for medical reasons, such as pregnancy.

Will I need plastic surgery for the surplus skin once I have lost a lot of weight?
Not necessarily. As a rule, don't consider plastic surgery for at least a year or two after the operation. Your skin may mold itself around the new body tissue and you may not need it. Allergan is a world leader in aesthetic surgery. For more information, visit allergan.com.

How many adjustments will I need?
Most patients need adjustments every 4 to 6. weeks during the first year. After that, adjustments can usually be less frequent.

How will I know when I need additional LAP-BANDS System adjustments?
The most common reasons for adjustments are:

You are not able to eat much of anything without experiencing discomfort, reflux (heartburn) or vomiting. The band may be too tight

You are able to eat without restriction. It may be too loose.
You are not losing weight. The band is possibly too loose. It could also be too tight, causing you to choose a liquid diet.

What can I eat after an adjustment?
If your surgeon adds fluid to your LAP BAND' System during your adjustment, go back to liquids like clear soup for the first day or so. Then, much like your first few days after surgery, you can work your way back to well-chewed solids over the next couple of days.

One important point.

Always follow your surgeon's advice. It is important that you ask her or him all the questions you may have about obesity surgery and the LAP-BANIr Adjustable Gastric Banding System.

A Brief Description of Relevant Indications for Use, Contraindications, Warnings and Adverse Events for the LAP-BANIr System.
Indications: The LAP-BANV System is indicated for use in weight reduction for severely obese patients with a Body Mass Index (BMI) of at least 40 or a BMI of at least 35 with one or more severe comorbid conditions, or those who are 100 lbs. or more over their estimated ideal weight. The LAP-BAND' System is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise, and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives.

Contraindications:The LAP-BAND" System is not recommended for non-adult patients, patients with conditions that may make them poor surgical candidates or increase the risk of poor results (e.g., inflammatory or cardiopulmonary diseases, GI conditions, symptoms or family history of autoimmune disease, cirrhosis), who are unwilling or unable to comply with the required dietary restrictions, who have alcohol or drug addictions, or who currently are or may be pregnant.

Warnings: The LAP-BAND= System is a long-term implant. Explant and replacement surgery may be required at some time. Patients who become pregnant or severely ill, or who require more extensive nutrition, may require deflation of their bands. Patients should not expect to lose weight as fast as gastric bypass patients, and band inflation should proceed in small increments. Anti-inflammatory agents, such as aspirin, should be used with caution and may contribute to an increased risk of band erosion.

Adverse Events:
Placement of the LAP-BAND" System is major surgery and, as with any surgery, death can occur. Possible complications include the risks associated with the medications and methods used during surgery, the risks associated with any surgical procedure, and the patient's inability to tolerate a foreign object implanted in the body. Band slippage, erosion and deflation, reflux, obstruction of the stomach, dilation of the esophagus, infection, or nausea and vomiting may occur. Reoperation may be required. Rapid weight-loss may result in malnutrition, anemia, or other complications that may require additional surgery. Deflation of the band may alleviate excessively rapid weight loss or esophageal dilation.

Important: For full safety information please visit www.lapband.com or call 1-800-624-4261. CAUTION: This device is restricted to sale by or on the order of a physician.

References: 1 Choban P et al. Bariatric surgery for morbid obesity: why, who, when, how, where, and then what? Cleveland Clinic Journal of Medicine. 2002. 69(11):897-903. 2 Weight-control Information Nehvork (VIN), an information service of the National Institute of Diabetes and Digestive and Gdney Diseases (NIDDG. Active at My Size. October 2006.

Available at:
http://win.niddk.nih.govipublicationstactNe.htm. Accessed October 7, 2008. 3 O'Brien PE, et al. tap-Band: Outcomes and Results. 1 Laparoendosc Adv Surg Tech A. 2003;13(4): 265.270.

Lap Band 02

you,ve come so far

Your new eating plan

10 rules easy but important at*

Food not so good

choices

physical Actinity tips

Additional LAP-BAND System adjustments

Stay in the green zone

Adult BMI Calculator

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