“My Band feels tighter in the morning, is this normal?”

Patients with Lap Band (or Realize band) sometimes feel that their band is tighter in the morning that in the evening.  At times, this difference can be quite substantial. In some cases, the band is so tight in the morning that patients can only drink liquids, while at night they can eat almost normally.  Patients are sometimes alarmed by this but in fact, this is a completely normal occurrence.

The band (whether it is a Lap Band or Realize band) works by having a tight “squeeze” around the top of the stomach, similarly to a well-fitted ring on your finger. Just like the ring, if it is too loose, it may fall off and if it is too tight it can be uncomfortable. The band is inflated with saline to change its diameter and to provide a proper “fit” on the stomach.

Properly adjusted band has the have a “snug” fit. The band, once adjusted, does not change its size. If that is the case, why does it feel differently throughout the day?

The explanation is in the following: stomach can change throughout the day. When a person lies down to sleep the fluid in their body shifts upwards and stomach tends to swell up. As it swells up, the band would feel tighter on the stomach because the stomach gets thicker due to swelling. That is why it may feel that it is more difficult to eat in the morning. Nothing happened to the band, it is all the stomach swelling underneath the band that is responsible for the tighter fit.

Once a person is up and about, the fluid shifts down from the stomach and the stomach becomes less swollen and thinner. Since the stomach is thinner, it will make the band fit more loosely.
The more fluid is there in the band, the more pronounced is the difference between how the band feels in the morning vs night.

Is it dangerous? No, unless you are vomiting in the morning and can’t keep anything down.  In that case, you need to have some fluid taken out from the band.

If you can tolerate the fluid in the morning, this is OK.

Patients can adapt to the change in how the band feels by having only liquids first thing in the morning. Two to three hours later they can have a light meal.

As far as band adjustments or “fills”, you are always better off having them in the morning when the band is its tightest, otherwise there is a risk in making it too tight. Keep that in mind when scheduling your next band fill!