Lapband Slippage: Causes & Prevention
A Clinical Study
A clinical study was done in Germany to review complications following lap band surgery. Thirty-five hospitals were involved in the study, with 4138 patients that underwent gastric banding over a five-year period. Lap Band long-term complications were described in 8.6% of all patients. The most common complications included: pouch dilation or enlargement (5.0%), lap band slippage (2.6%), and Lapband migration or erosion (1.0%). (Stroh,C Manger, T “Complications after adjustable gastric banding”, Chirurg, 2006, Vol 77,pag 244-250)
Normal Lap Band X-Ray Under Fluoroscopy
Enlarged Lap Band Pouch
What is Lap Band Slippage?
One of the long-term complications of lap band surgery is called “Lapband slippage” and can be defined as “when the Lapband and the stomach pouch are both prolapsed.” This means that the lap band has shifted position and the enlarged stomach pouch has also shifted or twisted so that food does not go through the lapband into the rest of the stomach. This may result in pain, discomfort, decreased appetite and inability to eat or drink, and vomiting. Lapband Slippage does not happen immediately but may take several months to develop.
Large Lap Band Pouch
Lap Band Slippage generally develops in a progressive manner. As food intake is increased, the stomach begins to stretch and grow and the patient may stop losing weight or start to regain weight. At this point, patients may only exhibit an enlarged stomach Lap band pouch. This can be medically treated by deflating the lap band to release pressure and slow the growth of the pouch (successful in 70% of cases, or surgical treatment can be considered). However, if the enlarged lapband pouch continues to grow, the lapband progressively rotates until both the lap band and the enlarged pouch become prolapsed, resulting in Lap band slippage. This is followed by functional stenosis (narrowing) of the stomach.
Lap Band Slippage
Lapband Slippage Symptoms typically include progressively worsening reflux, vomiting and epigastric complaints, which may increase to sudden near-total dysphagia (inability to swallow or eat anything, including saliva).
Risk factors or causes of lap band slippage include surgical technique, model of the lapband used, early consumption of solid foods, early inflation or filling of the band, consumption of carbonated or sparkling beverages, and frequent vomiting.
Treatment for lap band slippage requires surgical intervention. The lapband must be repositioned or removed, based on the operative findings and condition of the stomach pouch. If appropriate, the surgeon and patient may elect to choose another type of bariatric procedure such as a Gastric Sleeve.
How Do I Prevent Lap Band Slippage?
In order to decrease the risk of developing lap band slippage, it is important to follow the recommended diet following surgery and to avoid introducing solid foods too early. In addition, the fills should not be started before 6 weeks post-operatively and these Lap band fills should be very gradual. We also recommend that fills should be done under fluoroscopy, even if you are asymptomatic (no symptoms of lap band slippage), to be able to monitor the position of the lapband, and the size of the stomach pouch and condition of the esophagus. This will allow for early diagnosis of an enlarged stomach pouch or possible lap band slippage.
Originally posted 2009-02-17 13:25:15. Republished by Blog Post Promoter
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Dr. Rodriguez, I had my realize 9cc band placed 9/2008. 8/2010 my doctor said I had an anterior slip and removed fluid leaving me with 4.5 cc in the band. 12/2010 I went back for a follow up she added 0.5cc (5 cc total). In 2/2011 I was seen by a different doctor who insisted I did not have a slip. He removed all fluid and refilled it to 6.75cc. Once I progressed back to solid food I had problems keeping it down and started having awful heartburn. I went back a month later 3/2011 and he removed .25cc (leaving a total of 6.5cc) and started me on Prilosec. Since 6/2011, I have gained 10 pounds. Two weeks ago, I started having a dull ache in the right upper quadrant and bloating. A week ago, I started having mild discomfort when eating in the left upper quadrant and for several hours after. It’s not excruciating. Today I started having the same dull ache on the left side of my back at the same level of the left side upper quadrant pain. I don’t have any vomiting or dysphagia. However, when I eat it feels like the food is pocketing in my throat and takes several hours to go down. The only thing I’ve done different is I started taking 5hr energy shots daily for about 3-4 months. Could this be the cause of my symptoms? My apologies for the long history, but I’m very concerned and cannot get in to see the surgeon for a few weeks. Any advise you may have is greatly appreciate.
Hello Sharon,
Quit taking the energy shots!!!!
It is very difficult to know if you have a slippage since 2 doctors have different opinionPrilosecs but for sure you have a swollen pouch.
Take prilosec and Maalox and go from liquid diet progressively to soft food and then let me know how you do.
So I saw the doctor, he says i have a little bit of dilation and a little bit of an anterior slip. He removed 0.5 cc of fluid (now I have approx. 6cc) He said to wait 6 weeks to see what happens. Is that standard protocol? He also suggested there may not be a “sweet spot”, and that there is a possibility that I will continue to have problems. He also mentioned that if problems persist, that I may consider converting to a gastric sleeve? Does removal of fluid tend to correct anterior slips? Should I seek a second opinion?
Hello Sharon,
Small slips tend to correct with no fluid in the Lapband for several weeks specially if you don’t have a pouch dilation as a baseball size.
I think you will do great without the energy shots and not forcing the lapband pouch with large meals or big bites.
Do not take vitamins or irritants that will make your pouch to grow.
Let me know.
Hi – I have a question. Ok I had my surgery in July of 2009. I lost right at 75 lbs and then I went back b/c I wasn’t losing & they did a deal for a fill and said I had a dilated pouch so they took some out. Of course I gained a little weight back and went back & they put a little more in. At the time they said I had a dialate pouch I was having indegestion & not keeping anything down. That has been almost a year ago. I have went to a different doctor who did my moms surgery & she put some more in & I started having indegestion so she took some out & then next visit put a little more in. I believe I am at 6.2 or 6.3 right now. I had gained back to where I was only down 62 lbs and that was about 2 months ago. I am down only 3 lbs from 2 months ago & I’m frustrated. Should I go for another fill or should I go & have them do the deal to see if I have a dialted pouch or what? Should I go on a all liquid diet for a week or exactly what should I do. I know one of my problems is I’m not eating enough so I’ll eat ice cream at night or something to try & get in calories. Please help me!! I’m so frustrated & don’t know what to do.
Hello Shannon,
You should be on a liquid diet for one week and to quit the ice cream at night.
You can have ice cream once a week and increase your daily activity to reach the point on what you feel comfortable with your weight loss.
The Lapband is build to help you to lowering the amount of food you usually eat but without irritants and liquid calories.
I have had a lapband for over 4 years. I am experiencing pain in my left side and some pain in my left back where my left kidney is. I have had a CT Scan and x-rays and my urologist told me that I have 2 very small kidney stones but nothing to cause me this pain in my side and left back. I thinks it may be my lapband. I have no vomiting and it is not hard for me to eat. I have a large band and I only have about 6 cc of fluid. I had my last fill in August, 2011. I have been taking a week of antibiotics and the pain seems less but it has not went away. This is the second time that I have been on antibiotics for the same pain, so went back to my urologist and he ran all of these tests. He told me that it might be my lapband.
Hello Sharon,
You need a barium swallow to rule out lapband problems but since your doctor has found kidney stones in the same side I think that that could be the probable cause of your pain.
The antibiotics you are taking would make worse any lapband complication but will improve urinary infections.
Let me know after you have the Barium what they find.
Can a prolapsed lapband cause pain in the left kidney area? I have had a CT scan of the abdoman and the only thing that they saw wasa an umbiblicla hernia. I do have a prolapsed lapband that is being follwed and am wondering if that could be causing my pain in the kidney area.
Hello Judy,
No, I haven’t have a patient with that kind of pain due to prolapsed Lapband.
The pain coming from the kidney is at the back and sometimes is a lateral pain.
The pain coming from a prolapsed pouch is in front either the abdomen or the chest.
Have you have an urine test done?
Hello, I had a bulge of stomach hanging over the back of the band. The band was emptied and checked a month or so later. The bulge is gone, but the band angle is not right. The band is in a fairly straight horizontal line and the pouch is resting on it. I am not having any symptoms like pain or reflux. At this point, the surgeon and myself have decided to wait and see what happens. I am wondering about the likelihood of this resolving itself and if I could do anything to help, like be on liquids. Thanks
Addendum: I have a realize band and it’s been in 2 years. Thanks
Hello Pam,
You have some kind of slippage and a big pouch.
I recommend you to be on liquids and soft food divided in 5 meals.
You should not get a fill in at least 2 months and then be check again.
I was banded, by you, April 12,2008. Since then my life has been terrible. Days,weeks,months and years of vomiting and not being able to eat anything except oatmeal.during the past 3years post surgery,I’ve made you aware of my complications on numerous occasions via email. After reading your replies to others about their problems, it sounded like a repeat of all the correspondence from you to me.Same old
unhelpful advice.I paid & 7,500 cash for a botched surgery and all I ever asked from was to remove it, free of charge or pay another surgeon in the states to remove it for me. My problems have been ongoing since I got it, I want it removed. I tried to follow the diet but all I can ingest is water and oatmeal.My weight is still the same as pre-surgery..hmm ..Are you willing to help me or not cause I don’t have the money to get it removed. Why should I have to pay for something that wasn’t my fault.
Hello Sharon,
I have been answering all the emails that I get from you.
Have you seen any doctor is the past 3 and 1/2 years after the surgery?
Have you have your Lapband been check?
The patients that do not have any weight loss after any bariatric surgery should be check for counseling, dietary and nutritional guidance and orientation on what to expect with the procedure.
The patients that are in continuous vomiting as you are saying get inflammation of the stomach and specifically at the lapband level. All of them lose weight in this bad manner.
I recommend no to have any adjustments at all to all those patients until they change they way they are eating and behaving.
The Lapband is not made to be vomiting but educating the patient in new habits in how to eat, what to eat and what to drink.
Patients that are vomiting as you are sooner or later ulcerate the stomach or get lapband slippage.
You urgently need to be check under fluoroscopy or endoscopically to determine the grade in what the stomach is affected.
Removing the Lapband always have a cost so if you are in the position to save your lapband by changing what you are doing wrong will be great.
Hello Dr. Rodriguez, I have had my band for about 7 years. I started having problems with small slippages about 3 years ago. I would go in for a fill, the band would slip a little bit after that and then the doctor would take the fill back out to let the band go back to its regular position. After going through this three times I stopped getting fills. I haven’t had any fill restriction for over a year and I’m sure that my band has slipped again. It isn’t so bad that I can’t eat or drink I just have pain under my shoulder blade and in my rib where I think that my band probably is. I have been on liquids for 4 days now and it doesn’t seem to be getting any better. I feel at this point that the band needs to come out I’m just not sure what to do at this point. I don’t know if I should continue liquids for more days or if it just isn’t going to get any better. It hasn’t ever been a “bad enough” slip to do surgery. I haven’t been checked this time, I think I am just getting tired of the whole thing.
Hello Martina,
I need to know your Lapband model. The cc’s that can hold, the amount of cc’s you actually have, your actual weight and beginning weight, etc…
I thing you have slippage but don’t know how big it is and you will need a barium swallow to be sure about it.
Some of the patients improve after having totally unfill the lapband and been on liquids for several days.
They also get better with antacids and acid blockers.
I was banded in December of 2010. I have lost 67 lbs. All of a sudden the last 3 days my band has been really tight and its very hard to eat or drink and have vomitted a few times . Could i have something wrong with my band?
Hello Angie,
You need to have some saline removed from the Lapband and to take acid blockers.
You probably have developed some inflammation in the stomach at the level of the lapband neck so been only on liquids will help you also.
I have a question ….i was banded on march of 2010 , amd since last week cannot get any food down but it doesnt hurt really just discomfort and it wants to come back up..can drink alil some ti,es but started to feel light headed the last couple of days what should I do?
Hello Shell,
You need to pull out some saline from the Lapband.
I was banded in 2008 in California and subsequently moved to Texas. I have never really lost any weight, and at one point did not get any fills for over a year. I had a fill last August, and I am eating less, but still not getting the weight loss I had hoped for.
Two nights ago I ate a bite two big and started to throw up. Normally, if I do that everything is fine and I can go back to eating regularly. Since then, I have not been able to hold much down except liquids. I can drink about half of a Dr. Atkins shake or a half cup of soup. On the one hand, I am happy that I might finally lose weight, but on the other hand, I am worried that my band might have slipped when I threw up.
I will see my doctor next week, but he is not in the office on his regular day this week due to the holidays.
Hello Libby,
Quit the shakes you are drinking, have some Maalox e/4 hrs and get ranitidine or pepcid complete e/12 hrs.
Keep on liquid diet without stomach irritants.
Hi Dr Rodriguez,
I am wishing to know your opinion of reducing fill during pregnancy. My surgeon advised me that it is up to the individual pregnant patient to decide if they feel uncomfortable and feel they cannot eat enough. I feel I’m eating enough, however my heartburn and portion sizes have changed dramatically in the third trimester. I have not changed my fill amount in 2 years and have lost 60kg/120lbs, so it has been a great success for me and I do not wish to meddle with my lapband if there’s no dire need to. Back in 2001, an Australian university recommended automatic lapband deflation before labour/delivery. My surgeon says this is not necessary. He has had one patient whose band slipped during crowning/labour, but he felt that was a special and rare case.
What do you believe? I have an Allergan 11ml band with 7.0mls filled.
Thank you.
Hi Catherine,
I promote reducing the lapband fill or deflating the lapband during pregnancy and delivery.
I’ve seen a few patients that had lapband slippage and erosion after delivery.
Iron and folic acid that you need will give you inflammation of the stomach lapband channel.
You won’t gain as much weight as if you wouldn’t have the lapband.
I do pull out 3 cc when the patients come to me saying they got pregnant and in the final month I might pull out a couple more.
Hi. I was banded Sep 2010 and everything was going great. I lost heaps after 3 fills (I think it was 6cc). All of a sudden I started to get very bad reflux. I told my doctor who suggested a prescription but I felt I was ok on heartburn chewable tablets. The heartburn became really bad, I felt sick all the time, felt like last nights dinner was still sitting there at lunchtime the next day. I felt horrible. I finally saw the doc who said I was too tight and took out 0.5cc. I felt like i could breathe again. A month and a half later the symptoms came back again, and worse. Could not handle any solids. Was on liquids for a week till I could see the doc. He took out 1cc. I told him I thought I might have a slipped band and he agreed it could be but he doesn’t seem to want to do any tests or take all the fluid out. I’ve just started getting symptoms again, two weeks after he took out the 1cc, and I have pain in my left side, near my ribs and in the back everytime i eat solids. I’m struggling to eat again. What should I do? Is the pain in the back and ribs from the band? How can I get the doc to really check me out??
Hello Dr Rodriquez,
i had the lap band surgery done 9 days ago. after I drink my protein shakes my stomach is really tight on both sides. my stomach is quite swollen and my insides fell really hot but i dont have a fever. at the moment the pain on my right side is over powering the pain on the left. I dont have a gall bladder. I had a check up and my incisions are healing but my stomach is still really swollen.
I had my surgery in 2008 Nov. And lost about 100lbs but stayed steady @ 90 lbs since then I have had two baby with no complication related to band. Although, I’ve had some dul pain to upper right abd. Saw a new MD the other day just to check and he says I have no pouch;the band is at the esosphagus and stomach junction but the band looks good. He added 0.5 cc which gives me a total of 6.5 but I am wondering since he says I have no pouch wil I be able to lose weight. This no pouch could this mean, I had a slippage?
Hello, I had the Lapband done back in July of 2010 and so far things have been good I have lost about 65 pounds. I got a fill back in June and within that same week I had to go back and get some taken out because it was too tight. After I got the fluid removed I didnt get another until the end of September 2011. I have been good for the most part unless I eat a little too fast then I have to get it out as it feels stuck. I have 2 questions for you. Is it normal for the band to periodically get tighter? I was sick with a cold and cough and during my sickness I could barely keep any foods down, liquids were fine then just this week I could get any food down including yogurt as it would just come right back up so I went on soft foods for 2 days and everything was fine untill now and again I am having difficulties. I have major anxiety from not being able to eat and having to drink very slow which in return causes me to panic because I start thinking something is wrong with my band. Could you please adivse?
Thank you
Hello Dr. Rodriquez
My name is Melissa and I had the lapband done in 2007- I lost 120lbs in the first 16 months. Went from 320 down to 200lbs and leveled off – I am unable to go to the doctor regularly for fills and visits since I was a self pay patient (insurance would not cover it) and have since moved out of state from my gastirc surgeon. I recently had a baby in August (number one reason I had lapband done- infertility and health) and developed severe heartburn throughout my pregnancy (baby was born with enormous amount of hair) i did not have my band decreased during pregnancy and had no troubles with the band itself or food intake during pregnancy. I gained around 13 pounds during pregnancy and since being home with my child and having to quit breastfeeding due to lack of production I have gained another 7 for a total of 20lbs. I have continued to have severe heartburn and can not tell if the heartburn is just a side effect from pregnacy or a slippage…no pain, no trouble eating or drinking, just severe heartburn that is worse when I have not eaten or when I am in a horizontal position. Any suggestions on how to tell if a slippage is the problem or just post pregnancy heartburn. I can not afford to go in for a fill since I am now an at home mother and we are living on one income. Your advice would be greatly appreciated!
Hello Anita,
You don’t need to worry about lapband slippage because is exactly the opposite, that means large pouches give slippages.
Doctors that are not familiar with the lapband tend to say that the lapband is at the esophagus so I wouldn’t worry too much also.
That pain you say is not related to the lapband.
You should have an upper abdominal sonogram.
Take care
Hello Erin,
Yes, I totally agreed with you, you should have all the lapband fluid removed from the balloon + medication.
You also need to check what you are drinking or new meds you are taking because that id frequent to be the cause of your symptoms.
A barium swallow will let your doctor know your lapband status. I recommended to have it done.
Your pain is related to swelling because of the tightness you have.
Hello Julie,
You shouldn’t have any protein shakes at all neither vitamins.
You should have Maalox E/4 hrs and Pepcid complete E/12 hrs
Hello M,
It is common to feel that the lapband is tighter when you are sick. Many times is due to the meds you are taking.
Vomiting will aggravate your lapband tightness so is better to have some fluid pull out avoiding to get the food stuck at the esophagus and have some antacids taken until you go back to new good eating habits.
Hello Melissa,
The ideal treatment would be to have 1 cc pull out of your Lapband but since you can’t you need to take Maalox 2 t/l spoons E/4 hrs and an acid blocker as Pepcid E/12 hrs.
If you are taking vitamins will make worse your heartburn.
Take care
Dear Dr. Arturo,
I had my lap band installed in Jan. 2009 and things were going great up until a week ago. I started to have reflux and noticed I could eat less than before, Things became progressively worse to the point that I could not keep any food down. My Dr. tried to give me an unfill and only 1 ML of fluid could be removed. He decided to take me in for emergency surgery and completely removed the band and my port. I’m left wondering did the band fail? I mean why wouldn’t the band open? My Dr. says my Realize band is an older style that they rarely see. Please help! My insurance says they will not cover the surgery.
Hello Paul,
I am sorry your doctor couldn’t save your gastric band.
I don’t know the amount of cc you had on the gastric band and why your doctor was just able to be pull out 1 cc but usually there is an improvement after that.
I also don’t know if you have a barium swallow and your doctor diagnose band slippage and that was the cause of you been de banded.
The gastric band model just change the way they are locked but the rest has not changed.
Question, I am loving the lap band. But right now, I am finding that I am able to eat… sometimes, like I was eating before my surgery.
I had my surgery 6/27/11 and so far I am down 72 pounds, I am happy with my weight loss, and I am working out with a personal trainer 3 times a week. But it scares me that I can eat so much, and I am going thru a depression, and it makes it worse because I am eating, and I develop eating disorders easily, whether I eat junk, eat a lot or don’t eat at all. But I am filled to 3cc’s now, I have been at a 4 but wasn’t even able to swallow a banana, so I had an unfill, and I can eat fine now, sometimes. Sometimes I PB, but that is just going to happen with certain foods. I really need a healthy diet to go on, but due to the depression, I don’t have that motivation, I rather not eat at all then diet right now. So, I was thinking about having 1cc put back in to help me with my eating of the bad stuff that I can get away with. I know I should diet and drink plenty of water, but I’m having a hard time with that. When I started I was in the right mind frame. But I have lost all that and now I am acting the same as if I were not banded at all. How do I get back to that banded mentality?
Hello Britanytx,
One way to get back on track is to buy foods that are good for you as banded patient and throw away all the junk food that are in your house.
I don’t know what kind of a lapband you have but 3 cc of a fill is very little with the new lapband models.
In case you have an old lapband model I would go for just 1/2 of cc but the best way to know how much should be is with a barium swallow at the time of the fill.
Hello My Name is Veronica,
I’ve had the band for 3yrs now. I recently started having pain on my left side, it hurts when i breath or lay on my left side. I am feeling VERY uncomfortable. My band is empty now but i really want to get it removed. I can’t eat or drink much all i do it vomit but i am still putting weight on
I relly want this year to be good for me, I hope you can help.
Hello Veronica,
Are you taking Maalox and acid blockers?
It is important that you check what you are eating or drinking that could possibly be causing you to be swelling at the neck of the lapband.
Having pain on the left side plus difficulty in swallowing are not good signs.
I do perform lapband removals as well as revision surgeries.
Hi Dr. ARTURO…I had lap band surgery almost 3 years ago in March. I probably eat more than I should and my band feels tight sometimes and I can feel it on my upper abdomen when I do overeat. I went in for a fill approximately before Nov and my very accomplished bariatric Dr who always does a barium swallow told me that its full enough and to stick with this b/c I would be uncomfortable to add anymore. Being that I just had a barium swallow recently could I assume my band is not compromised & that I can stop the swollen band feeling I get at times by really committing to a better diet. I have been reading these forums and feel so ridiculous for my poor eating habits that may jeopardize my. surgery. About 2 days ago I feel a change of heart and these forums make me realize how poorly my habits are. At times I do vomit and have heartburn. Its not everyday though. Thank you
Hi Julie,
I thank you very much for sharing your feelings and for your honesty.
The first step to do it the right way with the lapband is to know what you are doing wrong.
I believe that increasing your daily activity can help you to reach your goals.
Have a great 2012!
Thank you Dr. Arturo for the quick response. I will be joining a gym on Monday simply to start walking on a treadmill for an hour each day. Perhaps I will move to some streghtening exercises after a month . My son , who is a little overweight , has swim practice everday for 2 1/2 hours so I will go to the gym then. He is also shaping up well and turning his extra weight into lean muscle. I’m so proud of him. Now back to my swolen band. When I did the barium swallow in Nov, my band looked like the first picture at the top of this page. I also know a Doctor who is 5 years out from his lap band surgery and you can feel his band in his abdomen. Is this normal as you begin to lose weight? I am down 70 lbs. since my surgery and recently have lost another 10-15lb ( it fluctuates) that I thought I would never get past and now my band is easily felt. It is pretty hard and somewhat tender. Could my band be turned around due to vomiting or overeating? Also will strength training exercises help my extra skin to shrink some? I don’t have alot of it , ( I’m 5’10″) but I would like my arms to shrink back and not have excess skin? Any suggestions? Thank you
This is such a wonderful forum. Your patients are lucky to have such I caring Doctor. I also have a wonderful, accomplished Doctor in Texas.
Hi Julie,
The lapband port can be felt after losing weight and in some patients can be seen as a bulk.
When the lapband port is tender is wise to be checked by your doctor to rule out any inflammation around it.
Hot and cold placed at that area will help.
The gym can help your skin a little but some times the plastic surgeon has to do the rest of the job done for excess skin and fat tissue.
Hi,
I have a 4cc lapband that was placed in May of 2009, I currently have 2.4cc in my band and have not had a fill in over a year. I am eating and drinking fine BUT I have a feeling like a tickle behind my breast bone. I really don’t know how to describle it a little pressure maybe. I don’t know if it could be related to my lapband or if I am just having anxiety worrying about it. Thanks for your help.
Bi Jen,
Why you have a very old lapband model if you had your surgery just 3 years ago?
Any way, what you are feeling could be related to esophageal inflammation so taking acid blockers and Maalox plus having some king of diet without stomach irritants will help you.
Thank you very much for your quick response. I don’t know why she choose the older type for me. I will try your suggestions and maybe get a bit of an unfill.
Dr. Rodriquez, I had my lapband surgery in December 2010 and lost 78 lbs. I have a Lapband-AP Standard. My last fill was Oct 2011 which gave me a total of .7 cc. However, when I went to the doctor last week the PA informed me the band had slipped a little. There was an extra pouch, but one the fluid was removed the pouch disappeared. I’m on liquids for a week, but that could expand to 2 weeks. In addition to protein shakes, broths, puree soups, water, and jello can I have anything else to drink. With no fluid in my band I am hungry about every 4 hours. I don’t want to over eat even on liquids, but I need to satisfy the hunger pains.