I sent an update to my clinic where I had my surgery and received this great reply from the nurse within a few hours. I mentioned I was doing well but was a bit discouraged that I wasn’t seeing a weight loss. I also asked when the first fill would be (it will be at 4 weeks) and since I have to pay each time, I did request that they consider an “aggressive” fill to avoid the cost of multiple little fills over a short period of time. I thought the advice from the nurse was so encouraging and don’t think they would mind if I shared some of her reply (in blue below).
"Thank you for your email and I'm glad you are doing well. Don't think of this phase as a weight loss phase. Most people do not lose very much weight in the first four to six weeks, in fact some people gain. This is the healing phase and although you are probably eating far less your body may decide to hold onto some of your weight until you've had a few fills.
We completely understand the desire for a "big fill" due to the cost and inconvenience. For most people two to three fills, done at least two weeks apart are needed to reach that 'sweet spot' where one cup of food keeps the hunger away for approx. four hours. After that you will need the occasional tweak as you lose weight. After the first year most people need very few adjustments. If we fill aggressively we run the very great risk of missing that sweet spot all together and making your band too tight. This results in lost time due to having to defill, then refill etc., not to mention discomfort and the adoption of maladaptive eating habits.
When the band is too loose, as you know, food passes across too quickly and you are hungry in a short amount of time and that is when we fill, to slow the passage of food and increase the amount of time that you are not hungry. If we tighten the band too much you get into problems such as heartburn, reflux of fluid at night and difficulty with solid foods. This is why we are careful with adjustments. Sometimes you may just experience difficulty with solid foods and find that you are consuming mainly mushy/soft/slider foods which leads to a plateau in your weight or a weight gain as these foods pass more quickly across the band and tend to be higher in calories. Nobody ever wants to have fluid removed from their band as they think that this will make them gain, however contrary to this we always find that when the band is too tight, by removing some fluid it allows the patient to get back to consuming healthy solid foods and they lose weight.
Sometimes people wait for the band to "tell" them to stop eating. The purpose of the band is only to control your hunger when you choose to eat less food. Some people do get a "full" feeling when they have consumed the proper amount of food and their band is well adjusted, but others don't. This is why it is very important to stick to one cup of solid food. By eating more than a cup there is a very real danger of stretching the upper pouch. This usually presents with persistent heartburn and/or no feeling of satiety, i.e. you feel like you can eat and eat. This is confirmed by a barium swallow and results in having the band defilled for 4-6 weeks to allow the pouch to return to normal size. As you can imagine this is very distressing for patients as their hunger comes back and their weight inevitably goes up. These are just some things to keep in mind as you are starting out."