"Cottage Cheese Test

How big is my stomach pouch?

Just about every patient asks this question. It is expected and appropriate that the stomach pouch will enlarge somewhat as the months pass after gastric bypass. Some of this enlargement is an actual increase in size, and some represents a softening or regaining of elasticity of the pouch and its outlet.

The real answer is that the functional size varies with many factors such as time of day, the amount of time taken to eat, mood of the patient, other medical issues, and most importantly, the type of food eaten. It is expected and appropriate that the pouch will handle a much smaller amount of solid food like chicken than softer foods like mashed potatoes or soup.

The cottage cheese test is a technique that was presented at the June 2000 meeting of the ASBS (and many times before that) by Latham Flanagan, MD. Dr. Flanagan is one of the founding pillars of bariatric surgery. He practiced in Oregon, and retired in early 2005. Dr. Flanagan designed this test as a standardized, reproducible measurement of the physical size of the stomach pouch in a person who has undergone a gastric bypass procedure. This test works less well for Adjustable Gastric Band patients, because the tested size of the pouch depends on how tight the Band is.

The Test

• Utilize a container of small curd low-fat cottage cheese. Begin the test with a full container, and perform the test in the morning before eating anything else (this will be your breakfast on that day). Eat fairly quickly until you feel full, ideally in less than five minutes. Note that the small soft curds do not require much chewing. The idea with the rapid eating is to fill the pouch before there is much time for food to flow out of it.
• After eating your fill of cottage cheese, you will be left with a partially eaten container that has empty space where cottage cheese used to be.
• Start with a measured amount of water (16 ounces, for example), and pour water into the container of cottage cheese until the water is level with the original top level of the cottage cheese.
• The amount of water poured into the container is the functional size of the pouch.
• If this is your first time doing the test – don’t panic. You are likely to find that the "cottage cheese" size of your pouch is much bigger than your surgeon told you he or she made it at the time of surgery. What is going on is that even if you eat quickly, some of the cottage cheese is flowing out of your pouch at the same time you are eating. Dr. Flanagan’s data indicates that the average size of the mature pouch by cottage cheese test is 5.5 ounces, as measured by this test. He has also found that sizes ranging from three to nine ounces have no impact on the person’s success in weight loss."