Using your Gastric Pouch as a Tool to Improve Weight Loss and Maintenance
By Dr. David Provost
A gastric bypass works by limiting dietary intake and minimizing the physical feelings of hunger. The creation of a separate, much smaller stomach pouch – initially less than an ounce in size – limits the amount of food you can physically consume. Eating or drinking distends the pouch and sends signals to your brain, which results in a “full” feeling and eliminates hunger.
Most patients experience very little hunger for the first three to six months after surgery. During this time, the frequent sips of liquid that you need to stay hydrated are enough to keep the pouch distended and minimize hunger pangs. But, all pouches increase in size over time, and feelings of hunger may return as your stomach improves the ability to empty liquids or soft foods.
Don’t worry – it is okay for the stomach pouch to stretch some after gastric bypass surgery. Studies have demonstrated that a reasonable pouch size of 2 ounces to 8 ounces does not correlate with weight loss. Weight loss is more dependent on how the pouch is utilized. That said, you should avoid continued forced overeating, which can stretch the pouch so your food intake increases to the point where you stop losing weight, or even regain weight that you previously lost.
Initial Weight Loss
Weight loss will be most rapid and easiest during the first six months following gastric bypass surgery, as your dietary intake is at its lowest. Take advantage of this fact and carefully watch your intake. Avoid eating a lot of softer foods, which may allow hunger to return sooner, and stay clear of high calorie liquids. Also, in the rare case that you experience frequent hunger shortly after gastric bypass, eliminating artificial sweeteners may reduce these feelings.
Exercise is important throughout the weight loss and maintenance phase, but it is most important during the first six months after surgery. During this period, the added weight loss achieved with an hour of exercise may require five hours of exercise a year or two later. (Remember this when you don’t feel like exercising some days!)
How the Pouch Works
When more frequent hunger returns after the first six months to a year, you can achieve further weight loss and successful maintenance with a few additional alterations to your eating habits. These alterations are based on the following facts and observations:
- After eating soft foods, soups, and high calorie liquids, the gastric pouch empties faster, and hunger quickly returns.
- Solid food stays in the pouch longer, resulting in a prolonged feeling of satiety (fullness).
- Extending meals past 30 minutes to an hour defeats the pouch by allowing greater food intake.
- Drinking with meals or within 30 minutes of a meal washes the food out of the pouch and causes hunger to return. Avoiding liquids during and after eating will keep the pouch distended for up to two hours so you continue to feel full.
Tips for Keeping the Weight Off
If you find that you are eating more, and your weight loss has slowed, alter your diet using the following seven guidelines.
- Eat more solid foods. Eat very small bites of low-fat meats, crisp or raw vegetables, or solid fruits, like apples or pears. Eat at least two ounces of meat with each meal.
- Try to finish your meal within 15 to 20 minutes. Make sure you still chew your food thoroughly, and don’t rush through the meal, but don’t linger at the table either.
- Avoid drinking with meals and for two hours afterwards.
- Start drinking when the feelings of hunger return, to avoid thirst and minimize hunger between meals. Start with smaller sips, but increase the volume until you feel full again. Drink 8 to 12 ounces of water rapidly over 20 seconds, then top off with sips until you feel comfortably full. Do this whenever you feel hungry. This will keep the pouch distended and minimize hunger.
- Drink a full glass of water 15 minutes prior to eating. By drinking a lot of water before the meal, you shouldn’t need to drink during or afterward.
- Avoid snacking, since snacks are usually insufficient to eliminate hunger and they provide empty calories.
- Minimize caloric liquids and softer foods. These foods are not banned, but when you make exceptions, you will likely experience hunger sooner and have to deal with the consequences.
If you follow these seven simple pouch rules, you can increase the amount of weight you lose with a gastric bypass, and make sure that you maintain a healthy weight for the rest of your life.