Post Surgery Portions

Internal Cues or External Rules? What is best for me?

One of the most important keys to long term success following weight loss surgery is eating when you are hungry and stopping when you are satisfied. Sounds simple in theory, however putting this into practice can be a whole different story.

This ‘rule’ works very well if your body is giving you lovely clear cues of hunger and satiety, or you pick up the subtle hints that it is time to stop eating. These hints can be a runny nose, a sneeze, a bubbling feeling, hiccups, a cough or simply understanding that one more bite would be too much.

But what if you are one of the many people that doesn’t sense the satisfied feeling or get these subtle body hints? Of what if you feel you need to eat significantly more than suggested to get a sense it is time to stop? Or what if you are never hungry? How do you know when you are satisfied if you were never hungry to start?

Let’s tackle each of these issues one at a time, using some ‘real life’ questions we have had from our patients/


1. What if I am never hungry?

A very low appetite is relatively common in the early post operative period. If you only ate when you were hungry, you would rarely eat, and it is likely you would under nourish your body. It would also be very hard to know when to stop eating if you relied on internal cues. In this situation we suggest you follow some external rules until those internal cues kick in, or you are able to tune into them.

Make sure you eat a minimum of three meals per day that are a maximum of half a cup of food. If your portions are less than half a cup you will need to eat more frequently, up to six times per day is fine.


2. What if I can ‘fit’ more than half a cup of food (or more than 1 cup once you are through the recovery phase)?

Your stomach post weight loss surgery doesn’t have a firm, set capacity it can hold. It is muscular, as it was before your surgery, and has plenty of stretch.

Prior to weight loss surgery the stomach can stretch to hold six to eight cups (or more) depending on the individual, but this doesn’t mean we need to, or should eat six to eight cups per meal.

This same principal applies after surgery. You don’t have to eat to eat to your maximum capacity, or test what that maximum capacity is. In fact if you eat to this point, you risk damaging your sleeve or stomach pouch. The key is to stop before you feel overfull or uncomfortable.

This amount is different for everyone, so don’t panic if it is over half a cup. Try to set a maximum of one cup per meal (once you are through the recovery phase) using external measures, so you can feel confident even if you finish the whole meal, it isn’t too much.


3. What if one cup doesn’t satisfy me?

If you find one cup of food (a side plate, filled to the edge 2cm high) doesn’t satisfy you, before increasing your portion, first consider the following tips to help improve satiety:

  • Make sure you are keeping your drinks well away from meal times, ideally ensuring 30 minutes before and after food without a drink. Fluid can increase the speed of gastric emptying, allowing more food to be eaten without getting a sense of feeling satisfied. Drinking too close to meals is strongly correlated with weight regain, so it is worth sticking to this rule!
  • Ensure your meals are 10 – 20 minutes in duration. Eating too quickly often results in over shooting the point of satiety before you even realise. Pause between each mouthful and tune into how you are feeling. Has your hunger gone? If you stopped at this point would you be satisfied?
  • Equally, allowing meals to drag out longer than 20 minutes can result in the need for larger portions. This is because food is emptying out of your pouch or sleeve, into your intestine, allowing room for more food.
  • Ensure your meal contains adequate protein, ideally 50% of your meal. Protein is the most satiating macronutrient, meaning it helps us feel satisfied and keeps us satisfied the longest. Balancing this protein with fibre and fluid rich foods such as vegetables, salads and wholegrains can maximise the satiety from a meal.
  • Avoid liquid meals and very soft sloppy meals. If your portions are increasing, focusing on dense, solid meals can help. You are far more likely to feel satisfied on a small plate of steak and salad as compared to a soup or smoothie, as these move through your sleeve or pouch faster.


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