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If you’ve been struggling after bariatric surgery and looking for answers on the internet you’ve probably come across a bariatric pouch reset. These plans make the rounds on Google searches, Instagram accounts, and Facebook groups concentrated on the bariatric surgery crowd. Is a bariatric pouch reset necessary to get back on track after bariatric surgery?
What is a bariatric pouch reset?
A bariatric pouch reset is a protocol to go back to following the diet progression that is followed after bariatric surgery. This is done with the goal of ‘resetting hunger’ or ‘getting the pouch back to the normal size.’
Why would someone want to use a bariatric pouch reset?
People seek out a pouch reset for a variety of reasons. Common concerns include increased hunger, ability to eat larger amounts of food, weight regain, and inadequate weight loss. These are all valid concerns after bariatric surgery and oftentimes people are not provided with the right tools to cope with these problems.
Then, without the right tools to deal with these issues people naturally try to figure out what to do on their own. This sometimes leads to a pouch reset. Sounds good to start with: ‘shrink your stomach back to its ‘normal size,’ ‘reset the stomach’s full point.’
Bariatric Pouch Reset Evidence
Unfortunately though the evidence of the effectiveness of these programs is seriously lacking.
Some of the concerns that come up after bariatric surgery are related to a lack of realistic expectations. I am going to share some truths right now that may be difficult to hear or hard to believe if you have not been properly educated about bariatric surgery in the past.
Weight loss expectations after bariatric surgery
Weight loss after bariatric surgery is different for each person but there are some average expectations that can be used to estimate outcomes. Outcomes for weight loss after bariatric surgery are usually calculated as percent of excess body weight (EBW) lost. Calculate excess body weight by subtracting a person’s weight at the highest end of a normal BMI, which is 24.9, from their preoperative weight.
For a roux-en-y gastric bypass (RYGB) surgery the typical weight loss is 70% of the EBW. For sleeve gastrectomy (SG) the typical weight loss is 60% of the EBW.
You’ll notice that the weight loss outcome is not ‘everyone gets to a normal BMI’ after bariatric surgery. Sometimes people do, but that is not the expected outcome.
Another very important thing to understand is that obesity is a chronic disease and bariatric surgery is not a cure. I believe that more and more people are coming around to the idea that bariatric surgery is not an easy way out for weight loss but there still seems to be more work to do to help people understand that obesity is a chronic condition without a cure.
There are many treatments for obesity, but the treatment can be difficult and is lifelong. Bariatric surgery is the most durable, effective treatment we have for people with a BMI >35 that desire weight loss and/or have health problems that would improve with a larger percentage of weight loss than diet and lifestyle typically produce.
Many people dread the return of hunger after bariatric surgery and are hoping to avoid it at all costs. The thing is though, it is more common than not that hunger returns to some extent after bariatric surgery. After all, hunger is part of being alive and enjoying food is part of the human experience. I encourage people to embrace hunger, rather than to dread it.
To some extent weight regain is expected and normal after bariatric surgery. Even though the typical weight loss outcome after RYGB is 70% of EBW loss, by 10 years after surgery that outcome changes to 50% of EBW loss. Don’t get me wrong-that is still amazing weight loss that has huge outcomes on a person’s health and well being, but it should be noted that the initial weight loss is not the same as long term.
Habits to Avoid so You Never Have to Think About a Bariatric Pouch Reset
So, if you want to stay on track after bariatric surgery, what should you do? Remember the initial recommendations you were given by your bariatric surgery program and consider how you are doing with following them. Each program is a little different but the basics end up being pretty much the same.
Here are some habits to look at and do a check-in on your self-care after bariatric surgery:
Have you been engaging in mindless eating? Try to avoid doing other things while you are eating, such as watching television, reading, scrolling through Instagram, etc. This will help you to focus on your meal and help your body recognize when you’re full sooner.
Drinking Liquids with Meals
Have you been having beverages during and right after your meals? This can be problematic after bariatric surgery because it can push food through the smaller sized stomach pouch faster than usual. This can lead to food intolerances, increased hunger, and ability to eat larger portions of food.
Drinking Carbonated Beverages
Carbonated beverages can potentially cause problems with stretching out the opening of the stomach pouch to intestines in the RYGB surgery. They are also not tolerated very well after bariatric surgery. This can lead to being able to eat larger portions and food moving through the stomach faster than it should.
Consuming an Excess of Non-nutritive Calories
Making a habit of consuming non-nutritive calories can lead to weight regain or inadequate weight loss. These include alcoholic beverages and ultra-processed foods.
Activity is of great importance for weight loss maintenance. Increasing muscle mass helps to increase metabolism slightly. Research shows that people that engage in regular exercise have an easier time maintaining weight loss. Exercise is also a great way to relieve stress, improve mood, and ensure healthy sleep habits.
Alternate Options to a Bariatric Pouch Reset
If you’ve been struggling and spiraling trying to figure out what your next steps should be, read on for some alternate options to try instead of a pouch reset. If you’re feeling overwhelmed go with one thing at a time. When you get the hang of that, move on to the next thing.
You’ve got this and you don’t need any bariatric pouch reset!
Get Yourself Back to Your Follow-up Appointments
It is imperative that you continue to follow up with your bariatric program. If you’ve moved, find a new local program that will take you on or complete virtual follow-up if possible with your original program. Falling into old habits or regaining weight are not reasons to avoid your follow-up appointments. I promise you that a good bariatric program will not judge you-we are here to help!
Start Tracking Your Food
Tracking your food is not meant to make you feel bad about yourself or to be a habit forever. Think about it as a teaching tool. You should track honestly and start with what you normally eat. This will give you an honest picture of what you are actually eating. Then you can see where to start making changes.
Pay Attention to Your Meals
Eat meals and snacks at the dinner table and without distractions. No television, no mobile phones, no books, and no crossword puzzles. This also includes no eating in the car!
Include Protein at Every Meal (and Snack)
After bariatric surgery it is important to include a source of protein at each meal. This is to make sure that you are meeting your basic protein requirements but also to make sure that you feel adequately full after meals, which is important for weight management.
Choosing protein foods that are of plant origin instead of animal origin is also helpful as they are often higher in fiber and lower in fat than their animal origin counterparts. The added fiber helps you stay full for longer. The lower fat content often means that these foods are lower in calories.
Now, when I say plant foods I don’t mean the plant meat analogues; at least most of the time. These foods are okay occasionally but most of the time you should choose legumes, tempeh, tofu, seitan, nuts, and seeds to meet your protein needs.
Eat Vegetables and Fruits Daily
Not only are fruits and vegetables a great source of vitamins, minerals, and fiber, but they are very low in calories. This is of great importance for weight loss to help manage hunger. If you’re not eating vegetables and fruits daily, start now-I mean it!
Include Whole Grains and Starchy Vegetables
To say this is a controversial topic in the bariatric community is an understatement! So often bariatric surgery patients are told to ‘avoid carbs’ and ‘carbs make you fat’ and ‘if you eat carbs your appetite will be out of control.’ First of all: ‘carbs’ are not foods. Carbohydrates are a nutrient that is present in a variety of foods. Many of these foods are healthy choices after bariatric surgery.
Include whole grains and starchy vegetables in meals to increase fiber, increase satiety, and decrease risk of chronic disease.
Take the Time to Plan Your Meals
Plan out your meals ahead of time – this could be for a week, or two, or more. Planning your meals ahead of time reduces the risk of eating whatever, whenever (also known as grazing). Making a habit of grazing increases your weight of inadequate weight loss or weight regain.
Weight Loss Medications
Another option to consider instead of a bariatric pouch reset would be medications for weight loss. Weight loss medications can be used after bariatric surgery and are an effective option to consider. Your doctor can prescribe the one that is right for you. Just like any other medication they will be monitored for effectiveness and if it is effective would be prescribed long term.
In conclusion, as a registered dietitian that specializes in bariatric surgery I would recommend avoiding bariatric pouch reset programs. There is no evidence to back them up and they are more of a fad diet for bariatric surgery patients than anything. Instead, look to the tips in this article for a more useful ‘bariatric reset.’
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Ashley Krautkramer, RD, CSOWM, CD, CDCES is a vegan and bariatric nutrition expert with more than six years of experience. She is a board certified specialist in obesity and weight management.