How should a patient that has an adjustable gastric band eat to obtain their best result?

This is the advice I give to all of my adjustable gastric band patients at the time of the office visit about 5 weeks after their operation when I give them the first "fill" or adjustment:Adjustable Gastric Band Instructions:

You are embarking on the next phase of your Journey to significant weight loss and better health.
As you have changed your dietary habits you have:
• Learned healthy nutritional principles and demonstrated them with food
records that were requested by the dietitian.
• Stayed on a liquid diet before and after surgery to allow the band to
heal and transitioned through the phase of soft foods to regular food.
• From this point on protein and vitamin intake will no longer be your major concern.

Now with your first band adjustment your focus changes to how you should eat:

You should eat small volumes of solid food for your meals and snacks. This will allow the food to fill the pouch and pass through the restriction created by the band slowly over the next few hours thus suppressing your appetite. I refer to this phenomenon as “auto-snacking” that is not feeling hungry because some food is slowly being released despite you not eating more food by mouth for a few hours. Liquid foods such as milk, soda, ice cream, soup, milk shakes and fruit juice only serve to sabotage your progress and will blunt your weight loss since they will flow through the narrow outlet created by your band without being slowed by the restriction and you will be hungry soon after eating these liquids.
Wait 30 minutes after eating a solid meal before drinking non caloric liquids such as water or Crystal Light. Drinking prior to this time is likely to only build up in your esophagus and cause you discomfort.
Listen to the signals your body gives you. You should pay attention to how much food you can eat prior to feeling too full. Pressure in your chest is telling you that you just ate more than can be contained in your pouch and food and drink are backing up in your esophagus. You have just eaten too much or too fast or both. If you are experiencing this symptom repeatedly you may put too much force on your pouch and cause “band slippage”. This is likely to occur if you exceed about ½ to one cup of solid food at a time. Learn to eat only this amount. One more bite or drink and you are likely to exceed the amount you can eat comfortably.
Potential Problems:
1). Not keeping your scheduled visits. It is very clear that patients seen in the office each month for the first year do better than those that do not. This is understandable since the band is encircled around fatty tissue as well as around the upper stomach. As you lose weight you are likely to lose some of the fatty tissue within the band as well. This can allow you to eat more food since the opening allowing food out of your pouch becomes larger. In turn this will decrease or arrest your weight loss.
In fact, if this continues you will begin gaining weight again. Therefore, it is crucial that you keep your monthly appointment. In our practice the average weight loss at one year for those who see us in the office each month is 63% of their excess weight. After your fist year the frequency of your office visits will decrease depending on the amount of weight you have lost and your weight loss goals.
2). Don’t drink your calories. Liquids run out of your pouch very quickly, the calories will be absorbed and you will feel hungry soon after taking high caloric liquids for your meals. This is a common mistake and will thwart you weight loss goals. Between meals always select non-calorie containing liquids such as water or Crystal Light. Do not waist your calories on liquids. Skim milk should be used sparingly since it still contains a lot of sugar as lactose despite having the fat removed. Choose high quality protein containing solid foods instead of liquids for your meals and snacks.
3). Eating the wrong consistency and types of food. When the band is adjusted properly, the size of the outlet to the pouch is only about ¼ inch in diameter. Therefore foods such as chicken, steak and doughy breads are not your friends. These are likely to obstruct the outlet of your pouch and cause you pain that will not be relieved until you throw up the food causing the blockage or wait until the particle of food finally passes through.
• Chicken has long stringy fibers and will make a ball much like twine after it is swallowed. Cooking it a long time and /or slicing it thin against the “grain” into very small pieces is likely to help.
• A bite of steak is likely to be larger than the outlet of the pouch unless it is cut extremely small. Of course ground beef is not likely to be a problem since the particles are small. Cooking beef a long time may also help.
• Crackers and toast are likely to form small particles and pass through the outlet of the pouch just fine. However, doughy breads may ball up into a ball in the pouch and “plug up” the outlet.
• Swallowing liquids will only make the problem worse since you would only add to the material that is backing up in the esophagus making it more painful as the esophagus squeezes in an attempt to push the food bolus through the outlet.
• Not chewing enough or eating too fast can cause similar difficulty

Your band is adjusted properly when you are:
• Satisfied with small solid meals
• Not hungry for about 3 hours following a small solid meal
• Not experiencing heartburn or reflux at night
• Losing between 1 and 2 lbs. per week

Your band may be too tight when you:
• Feel you can only take liquids
• Experience heartburn or reflux at night even if you have not eaten for 3 hours prior to bedtime
• Experience frequent vomiting

Your band may be too loose when you:
• Can eat foods such as chicken, steak and /or sandwich breads
• Feel hungry between meals despite small solid meals
• Lose less than 1 Lbs. per week for a few weeks in a row

Exercise:
Exercise is likely to enhance your weight loss and improve your health. However, as you begin an exercise program you are likely to begin increasing your muscle mass and your weight may plateau for a couple of weeks. Do not be alarmed. If you are still experiencing loss of inches despite a plateau in your weight you are likely continuing to lose fat mass and gain muscle mass and your weight lose will soon resume.

Final thoughts for success:
Your band is a tool to use properly. Tools are of no help and can even be dangerous if not used properly. Do not ask too much from your band. Your band is there to remind you how much solid food you should eat at any one time and to help you to manage your hunger. Your band is a tool not a crutch. You should not rely on the band to be so tight that you cannot make wrong choices. You should use your band to remind you to make correct food choices. Your band can help you to control of you eating habits. The band is there to help but do not rely on the band to make you feel “Full”. Use your eyes and brain to tell you how much is the appropriate amount of solid food you should eat at any one time.
If you are experiencing pain that you think is related to your band or having other difficulty that may be related to your band it is best to contact your bariatric surgeon directly or go to the emergency Room of the hospital where you had the band placed. It may not be in your best interest to rely of your primary care physician or another emergency room in case of an emergency. Of course in case of emergency, if you are out of town and cannot reach your bariatric surgeon or visit the emergency room of the hospital where you had the band placed, proceed to an emergency room in that area, preferably to a facility where bariatric surgery is routinely performed.
Finally, if you are vomiting frequently do not assume you have “the flu”. Vomiting in a patient with a band is almost always the result of the band and you need to contact your bariatric surgeon for help.
If you follow these instructions you are likely to be very successful in losing considerable weight, become more active and healthier.

I wish you the very best as you continue on your journey toward better health.