This article is part of a series on Living Well after Gastric Bypass that covers diet, nutrition, and weight control. Read the first article in the series here.
Wink My experience with my bariatric surgeon’s support group is that it was useful in preparing me pre-surgery and for a short-term post-op in managing my new anatomy. However, it did little to educate me on how to maintain lifetime obesity disease management. My surgeon told me, “I do the surgery. The rest is up to you.” So, in this series of posts, I will discuss the tools that I use to sustain long-term weight loss following bariatric surgery.
The tools I use: Pouch Rules for Dummies
The pouch rules are often overlooked once a patient is further out from his/her weight loss surgery. Yet the rules are one of the most important tools to use for maintaining long-term weight loss after obesity surgery. If you haven’t been using this tool, now is the time to take it off the shelf and use it to perform its intended task.
Let’s be clear on what “the pouch” is: As part of the gastric bypass weight loss surgery part of the stomach is used to form a small pouch, which is separated from the rest of the stomach and connected directly to the small intestine. Food enters the small stomach pouch then exits directly into the intestines, bypassing the normal caloric absorption process. This is a simplified explanation of gastric bypass and suffices for the purpose of this sharepost.
Thinking back to my own bariatric surgery, I don’t believe that my surgeon really discussed the pouch rules or stressed their importance with me. So, I am really glad that I came across the “Pouch Rules for Dummies” published on the Internet.
The document is 10-pages and reading it is well-worth your time. Following these rules should be a lifestyle - it will help you achieve lifetime obesity management! I’ll share some of my favorite nuggets of information in this Sharepost. First and foremost:
A common problem is obesity surgery patients who, after a year or two out from their surgery, plateau at a level above their goal weight or regain some of their initial weight lost. These patients return to the pouch rules: Fill themselves quickly with hard to digest foods, water load between meals, and increase exercise. The weight should come off more easily than if they followed conventional diets designed for the average overweight individual that has not have obesity surgery.
Patients should be careful not to follow the advice given to the average overweight individual, which is to eat several small meals and/or substitute a liquid protein meal for a solid food meal. This is not the way to go for obesity surgery patients!
My personal experience confirms this to be true. I recently tried two highly regarded diets, neither of which resulted in weight loss after several months. I returned to the pouch rules and lost 10lbs in one month.
OPTIMUM MATURE POUCH
The pouch works best when the outlet is not too small or too large, and the pouch itself holds about 1 ½ cups at a time.
By following the “rules of the pouch,” it doesn’t matter what size the pouch ends up. The feeling of fullness with 1 ½ cups of food can be achieved.
Hint: Regardless of the outlet size, liquidity foods empty faster than solid foods. High calorie liquids will create weight gain.
IDEAL MEAL PROCESS FOR THE MATURE POUCH
1. The ideal meal consists of the following:
½ of the meal is low fat protein, Read Gastric Bypass Diet: The Importance of Protein First
¼ is raw or lightly cooked low starch vegetables, and
¼ is raw fruit Read: Bariatric Diet: Community-Suported Agriculture is a Tool for Eating Healthy
- This type of meal will stay in the pouch a long time and maintain satiety.
2. Eat meals five hours apart.
3. Fill the pouch full quickly at each meal:
- Eat the entire meal in 5-15 minutes.
- A 30-45 minute meal will cause failure.
4. Stay full by slowing the emptying of the pouch:
- Eat solid foods only.
- No liquids 15 minutes before meals, and no liquids until 1 ½ to 2 hours after the meal.
- A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without milk, just egg and toast, more than ½ of the meal still remained in the pouch after 1 ½ hours.
- 15 minutes before a meal, drink as much as possible as fast as possible (“water loading”). This will keep you from getting thirsty during and after the meal.
- Hint: You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness for 15-25 minutes.
THREE PRINCIPALS FOR LONG-TERM SUCCESS
1. Weight loss surgery patients need to understand how the new pouch physically works. Read How the Gastric Bypass Pouch Works
2. Weight loss surgery patients need to be able to evaluate their use of the tool, compare it to the ideal, anddetermine where they need to make changes.
3. Weight loss surgery patients need to understand not only how but also why they need to learn to use their pouch. The goal is for the patient to become an expert on using the pouch. Read Pouch Rules and the Gastric Bypass Patient
What to read next: Obesity Epidemic in America, How Did It Begin?
You can read about other tools I use, such as Overeaters Anonymous and FitDay.com, so as to maintain a lifetime of obesity disease management following my weight-loss surgery in 2003. My wish is to help you on your own journey of lifetime obesity disease management with shareposts along the way to help you navigate that journey successfully.