Sally Johnston

Clients often tell me one of their biggest challenges after weight loss surgery is eating slowly. Clients often tell me one of their biggest challenges after weight loss surgery is eating slowly. Eating too quickly means that you are unlikely to chew foods properly. This can cause discomfort, pain and in some cases, regurgitation. To be able to eat a variety of foods comfortably after weight loss surgery, you really need to concentrate while you are eating. The following tips may help you do this: Set aside time for meals and avoid doing other things whilst you are eating. Sit up straight and avoid slouching. Sit at the table rather than the couch. Avoid eating whilst preparing food. Move away from the television or computer. You cannot focus on what you are eating if you are immersed in something else. Avoid playing with your mobile phone or other electronic devices. Avoid getting really hungry. The hungrier you are when you start a meal, the more likely you are to eat quickly, take big bites and not chew properly. Avoid eating with your hands as you will tend to take bigger bites. Use cutlery to cut food into small pieces. The more pieces you need to cut the longer it will take to eat. Avoid eating on the run, or in the car. Put your cutlery down between mouthfuls. Wait until you have swallowed your food before cutting the next piece. Avoid having that next mouthful loaded on your fork ready to go. If you really struggle to slow down, use your cutlery in the opposite hand until the pace of eating feels more natural. Choose a relaxing environment to eat. If the staff room at work is too distracting, head outside to a nearby park. Opt for a quiet café rather than a noisy food court, where you may be tempted to rush. Be especially careful when eating socially, as during conversation it is very easy to become distracted. Eat during a break in conversation. Avoid the tendency to want to keep pace when eating with others. Take notice when you do slow down your eating. Do you feel more satisfied? Do you enjoy your food more? Many people report they enjoy food more after surgery as they eat more slowly, allowing them to really taste the food and savour the flavours. Get in the habit of eating slowly. It could take up to 20 minutes to eat a small meal – between 10 and 20 minutes is a good goal. If there is food left on your plate after this time, discard it. There is a risk of eating too slowly which can turn a meal into grazing, which defeats the purpose of weight loss surgery. Time how long it takes you to eat your next meal. It may just surprise you!

Recently I have found myself spending a lot of time talking with my weight loss surgery clients about getting the most from what they are eating, in particular, feeling satisfied after eating. Whilst the purpose of weight loss surgery is to help you feel satisfied on a smaller amount of food, the type of foods you choose is important to help maximise this. Recently I have found myself spending a lot of time talking with my weight loss surgery clients about getting the most from what they are eating, in particular, feeling satisfied after eating. Whilst the purpose of weight loss surgery is to help you feel satisfied on a smaller amount of food, the type of foods you choose is important to help maximise this. There are two key ingredients in helping you to feel satisfied after eating: 1. High fibre, low glycemic index carbohydrate-containing foods
 2. Protein-containing foods.
 This post will demystify the glycemic index, or GI. Protein will be the focus of a later post.
 The GI is a measure of the effect that different carbohydrate-containing foods have on blood glucose (blood sugar) levels. It describes the way our body digests and absorbs these foods. Carbohydrate-containing foods include: breads, cereals, rice, pasta and noodles starchy vegetables including potato, sweet potato and corn legumes including baked beans, kidney beans, chickpeas and lentils fruits and fruit juices milks, yoghurts, custards and ice cream any food containing flour or sugar. Some carbohydrate-containing foods are broken down and absorbed quickly, so they raise our blood glucose level faster and higher. These are high GI foods. Other carbohydrate-containing foods are digested and absorbed more gradually, causing a slower, longer lasting rise in blood glucose levels. These are low GI foods. Low GI foods keep us feeling satisfied for longer after eating.

 Often people experience a 'honeymoon' period following weight loss surgery, where weight loss seems automatic. Unfortunately this may not last forever and weight regain can occur with all surgeries. Maximising the satisfaction you get from the food you eat is crucial to keep losing weight and maintain that lost weight. A lower GI eating pattern also helps us feel satisfied for longer after eating, which can help with losing weight. For example, if you eat high GI foods at your meals, you are likely to become hungry sooner after the meal than if you eat low GI foods. This can make you more likely to snack and if you have not planned for this, you may be forced to grab something from the biscuit barrel or vending machine. 
 
 Appetite control is not the only benefit of a lower GI diet. Research has shown that people eating a lower GI diet can reduce their average blood glucose levels, which is particularly important for people with diabetes. Lower GI foods are often also higher in fibre. A high fibre diet helps prevent constipation, decreases the risk of heart disease as soluble fibres can help remove cholesterol from the body and helps protect against bowel cancer, haemorrhoids, irritable bowel syndrome and diverticulitis.

 Foods are classified as low, moderate or high GI.

 To follow a low GI diet, try to choose one low GI food at each meal. Eat high GI foods in small amounts, or less often. 
 Head to my website to see a simple table of low, moderate and high GI foods. Go to www.glycemicindex.com for further information.

In talking with clients I am constantly reminded of the dietary myths that circulate to leave people confused about weight management. Here I bust some of my favourite weight management myths. Myth 1: Don’t eat after 7pm (or 7:30pm or 8pm, etc) Our body doesn’t switch off at night. Our metabolism continues ticking over as our heart pumps blood, our lungs breathe, our muscle tissue repairs, etc. This happens all day and all night. In fact, we burn calories when we are sleeping, just as we do when we are awake. Our metabolism does not shut down at 7pm, so there is no reason to stop eating at any one particular time. It is important however not to leave all of our eating until the evening. We should fuel our body regularly throughout the day so that it can perform at its best. This is even more important following weight loss surgery, as you can no longer eat the size of meals you once did. Therefore, you can’t skip your meals during the day and expect to meet your nutritional needs at night. Regular meals throughout the day are also important to control your hunger. Being ravenous at the end of the day is another trigger for overeating late at night. Some people find rules that they should not eat after a particular time at night appealing, as this is when they tend to overeat. Overeating at night can act as a ‘reward’ for getting through the day, or as a way to relax and wind down. It may be habit as we watch TV or a movie. This is when night eating is problematic, as it is not eating for hunger. Do you eat for reasons other than hunger at night? What else could you do to relax? Could you sort through those photo albums that are overflowing, have a bubble bath or phone a friend you haven’t spoken to for sometime. What about a jigsaw puzzle, a crossword, scrapbooking, sketching or even an evening walk? The options are endless. Myth 2: There are good foods and bad foods Food is neither good or bad, it is what we do with it that counts. Of course, some foods are high in energy (calories/kilojoules) and have little nutrition, so these should be eaten in small amounts. However, food itself is morally neutral. We assign it the ‘good’ or ‘bad’ label, or define it as ‘allowed’ or ‘not allowed’. By labeling food in this way, we are then ‘good’ or ‘bad’ if we eat it. A better view of food is one where all food is morally neutral. You have permission to eat any foods you choose, you can choose eat those that are more nourishing, most of the time. I often say to clients that there are 21 meals in a week, if one or two are not perfect nutritionally, it is not a problem. If the balance is reversed however and only one or two are nutritious, then this is not going to help you achieve good health. Some foods that provide little nutrition may provide much enjoyment, so may play a very valuable role in your diet in other ways. You can and should include foods that give you pleasure, it is managing the amounts of these foods that are important in achieving good health. Myth 3: Carbs are fattening Nothing is fattening in isolation. Anything can be fattening if you eat too much of it. Food is made up of combinations of carbohydrate, protein, fat, vitamins, minerals, fibre and water. Carbohydrate, protein and fat provide energy, the other nutrients do not. If we look at the nutrients that provide us with energy in their most simple form: • Carbohydrate contains 4 calories per gram • Protein contains 4 calories per gram • Fat contains 9 calories per gram. Whilst not a food, alcohol contains 7 calories per gram As you can see, carbohydrate itself is quite low in calories. So why does carbohydrate have such a bad reputation? The problem with carbohydrate containing foods is the way we have come to serve and eat them. We heap rice, pasta and noodles on our plates, leaving very little room for protein foods but more importantly, vegetables and salads. Low glycemic index, carbohydrate-containing foods can be quite nutritious and when eaten regularly, in appropriate amounts, help us manage our hunger through the day. We just need to look at how we serve them. For example, rather than serving spaghetti bolognaise as a plate or bowl of pasta topped with a little meat sauce, serve equal amounts of meat sauce and pasta on half the plate with a side salad on the other. Myth 4: You can do some extra exercise to compensate for eating ‘bad food’ The problem with this myth is that is feeds into the ‘good food’ and ‘bad food’ myth. If exercise is something we do when we eat ‘bad food’, exercise is seen as a punishment. Exercise can help you feel good, help you sleep better, give you more energy and help you become healthier. It should be enjoyed for these benefits. Myth 5: You need to eat every 3 hours to keep your metabolism up Every body is programmed differently and will have a slightly different metabolic rate. Some bodies will need to be fed more frequently than others. If we set a basic meal pattern, our body will let us know how much we need to eat. If we provide our body with appropriate fuel three times a day, it will then let us know if we need to eat more often, we just need to tune into the signals. If we start the day with breakfast, our body is given the signal we are starting the day and can help regulate how much we need to eat through the day. You may have heard a ‘rule’ after weight loss surgery to eat only three (or less) meals per day. I strongly believe that there is no one rule that fits every person. The only way you can tell if you need to eat between meals is to tune in to your hunger and satiety signals. If you are genuinely, physically hungry between meals it may be fine to have a small snack. If you are eating as you feel bored/tired/frustrated/lonely or simply watching the clock, then you need to work on another solution. Myth busting your way to success Whilst the internet has brought a whole world of information to our fingertips and can help share dietary fact, it has also perpetuated lots of dietary fiction. Think about some of the food facts you have come to believe over time. Write them all down and take them along to the dietitian in your weight loss surgery team. They will help you sort the fact from fallacy.

Clients often tell me one of their biggest challenges after weight loss surgery is eating slowly. Eating too quickly means that you are unlikely to chew foods properly. This can cause discomfort, pain and in some cases, regurgitation. To be able to eat a variety of foods comfortably after weight loss surgery, you really need to concentrate while you are eating. The following tips may help you do this: Set aside time for meals and avoid doing other things whilst you are eating. Sit up straight and avoid slouching. Sit at the table rather than the couch. Avoid eating whilst preparing food. Move away from the television or computer. You cannot focus on what you are eating if you are immersed in something else. Avoid playing with your mobile phone or other electronic devices. Avoid getting really hungry. The hungrier you are when you start a meal, the more likely you are to eat quickly, take big bites and not chew properly. Avoid eating with your hands as you will tend to take bigger bites. Use cutlery to cut food into small pieces. The more pieces you need to cut the longer it will take to eat. Avoid eating on the run, or in the car. Put your cutlery down between mouthfuls. Wait until you have swallowed your food before cutting the next piece. Avoid having that next mouthful loaded on your fork ready to go. If you really struggle to slow down, use your cutlery in the opposite hand until the pace of eating feels more natural. Choose a relaxing environment to eat. If the staff room at work is too distracting, head outside to a nearby park. Opt for a quiet café rather than a noisy food court, where you may be tempted to rush. Be especially careful when eating socially, as during conversation it is very easy to become distracted. Eat during a break in conversation. Avoid the tendency to want to keep pace when eating with others. Take notice when you do slow down your eating. Do you feel more satisfied? Do you enjoy your food more? Many people report they enjoy food more after surgery as they eat more slowly, allowing them to really taste the food and savour the flavours. Get in the habit of eating slowly. It could take up to 20 minutes to eat a small meal – between 10 and 20 minutes is a good goal. If there is food left on your plate after this time, discard it. There is a risk of eating too slowly which can turn a meal into grazing, which defeats the purpose of weight loss surgery. Time how long it takes you to eat your next meal. It may just surprise you!

@@Band2Sleever Thanks for your comment. I certainly see your point - some foods or drinks have no nutritional benefit or value, so it is hard to see them as a worthy inclusion in your diet. People may choose to include particular foods or drinks for very different reasons. I want to share an example of one client who grew up in the USA and now lives in Australia. She admits many times leaving her appointments at our clinic and driving home via McDonalds to get a Coke. A regular coke, from the machine, in the paper cup. This is not because she thinks it is good for her, but it reminds her of home and family that she misses dearly. It is the particular Coke at McDonalds, not that in bottles or cans, that she is genuinely excited to drink and feel a unique happiness when she does. Whilst she and I both know this is not helping her achieve her goals and offering her no nutritional benefit, that Coke serves an extremely valuable role in my client's diet. Rather than condemn her for choosing to include the Coke, I accepted it and focused on helping her with what she was able to change. At our last appointment she told me she had not had the Coke for months.

I could not agree more 2muchfun! Well said!

Thanks to you all for reading and more importantly, for sharing your experiences. I enjoy learning more and more from people living with weight loss surgery. Sally

Myth 1: Don’t eat after 7pm (or 7:30pm or 8pm, etc) Our body doesn’t switch off at night. Our metabolism continues ticking over as our heart pumps blood, our lungs breathe, our muscle tissue repairs, etc. This happens all day and all night. In fact, we burn calories when we are sleeping, just as we do when we are awake. Our metabolism does not shut down at 7pm, so there is no reason to stop eating at any one particular time. It is important however not to leave all of our eating until the evening. We should fuel our body regularly throughout the day so that it can perform at its best. This is even more important following weight loss surgery, as you can no longer eat the size of meals you once did. Therefore, you can’t skip your meals during the day and expect to meet your nutritional needs at night. Regular meals throughout the day are also important to control your hunger. Being ravenous at the end of the day is another trigger for overeating late at night. Some people find rules that they should not eat after a particular time at night appealing, as this is when they tend to overeat. Overeating at night can act as a ‘reward’ for getting through the day, or as a way to relax and wind down. It may be habit as we watch TV or a movie. This is when night eating is problematic, as it is not eating for hunger. Do you eat for reasons other than hunger at night? What else could you do to relax? Could you sort through those photo albums that are overflowing, have a bubble bath or phone a friend you haven’t spoken to for sometime. What about a jigsaw puzzle, a crossword, scrapbooking, sketching or even an evening walk? The options are endless. Myth 2: There are good foods and bad foods Food is neither good or bad, it is what we do with it that counts. Of course, some foods are high in energy (calories/kilojoules) and have little nutrition, so these should be eaten in small amounts. However, food itself is morally neutral. We assign it the ‘good’ or ‘bad’ label, or define it as ‘allowed’ or ‘not allowed’. By labeling food in this way, we are then ‘good’ or ‘bad’ if we eat it. A better view of food is one where all food is morally neutral. You have permission to eat any foods you choose, you can choose eat those that are more nourishing, most of the time. I often say to clients that there are 21 meals in a week, if one or two are not perfect nutritionally, it is not a problem. If the balance is reversed however and only one or two are nutritious, then this is not going to help you achieve good health. Some foods that provide little nutrition may provide much enjoyment, so may play a very valuable role in your diet in other ways. You can and should include foods that give you pleasure, it is managing the amounts of these foods that are important in achieving good health. Myth 3: Carbs are fattening Nothing is fattening in isolation. Anything can be fattening if you eat too much of it. Food is made up of combinations of carbohydrate, protein, fat, vitamins, minerals, fibre and water. Carbohydrate, protein and fat provide energy, the other nutrients do not. If we look at the nutrients that provide us with energy in their most simple form: • Carbohydrate contains 4 calories per gram • Protein contains 4 calories per gram • Fat contains 9 calories per gram. Whilst not a food, alcohol contains 7 calories per gram As you can see, carbohydrate itself is quite low in calories. So why does carbohydrate have such a bad reputation? The problem with carbohydrate containing foods is the way we have come to serve and eat them. We heap rice, pasta and noodles on our plates, leaving very little room for protein foods but more importantly, vegetables and salads. Low glycemic index, carbohydrate-containing foods can be quite nutritious and when eaten regularly, in appropriate amounts, help us manage our hunger through the day. We just need to look at how we serve them. For example, rather than serving spaghetti bolognaise as a plate or bowl of pasta topped with a little meat sauce, serve equal amounts of meat sauce and pasta on half the plate with a side salad on the other. Myth 4: You can do some extra exercise to compensate for eating ‘bad food’ The problem with this myth is that is feeds into the ‘good food’ and ‘bad food’ myth. If exercise is something we do when we eat ‘bad food’, exercise is seen as a punishment. Exercise can help you feel good, help you sleep better, give you more energy and help you become healthier. It should be enjoyed for these benefits. Myth 5: You need to eat every 3 hours to keep your metabolism up Every body is programmed differently and will have a slightly different metabolic rate. Some bodies will need to be fed more frequently than others. If we set a basic meal pattern, our body will let us know how much we need to eat. If we provide our body with appropriate fuel three times a day, it will then let us know if we need to eat more often, we just need to tune into the signals. If we start the day with breakfast, our body is given the signal we are starting the day and can help regulate how much we need to eat through the day. You may have heard a ‘rule’ after weight loss surgery to eat only three (or less) meals per day. I strongly believe that there is no one rule that fits every person. The only way you can tell if you need to eat between meals is to tune in to your hunger and satiety signals. If you are genuinely, physically hungry between meals it may be fine to have a small snack. If you are eating as you feel bored/tired/frustrated/lonely or simply watching the clock, then you need to work on another solution. Myth busting your way to success Whilst the internet has brought a whole world of information to our fingertips and can help share dietary fact, it has also perpetuated lots of dietary fiction. Think about some of the food facts you have come to believe over time. Write them all down and take them along to the dietitian in your weight loss surgery team. They will help you sort the fact from fallacy.

I have found that sadly there are a lot of misconceptions around gastric bands. In this article I want to explain how a gastric band really works, as shown by properly controlled research studies. I have found that sadly there are a lot of misconceptions around gastric bands. Firstly, there is a misconception that the gastric band creates a small stomach that must be ‘filled’ to feel full. There is also a misconception that a tighter band will result in more weight loss and that the vomitting or regurgitation caused by a tight gastric band is ‘normal’. Another misconception is that you shouldn’t be able to eat certain foods with a gastric band. Let’s get back to basics to understand how a gastric band should work. A gastric band is a silicone device placed around the upper part of the stomach. It was once believed that the gastric band created a new, smaller stomach above the band, where food would sit before passing into the lower, larger stomach. Recent studies at the Centre for Obesity Research and Education (CORE) in Melbourne have shown this to be incorrect. The gastric band actually creates a ‘funnel’ into the larger stomach and exerts pressure on the stomach. Adjusting the gastric band can vary this pressure. The band has an access point called a port, which is stitched to your abdominal muscle deep under the skin. You can usually tell where the port may be as it is likely to sit somewhere under your biggest scar. Your surgeon or weight loss GP uses the port to adjust your gastric band and vary the pressure it places on the stomach. They can inject or remove saline (a salty water) solution via the port to make your band tighter or looser. When food is eaten our oesophagus, or food pipe, squeezes bites of food down towards the band. Once food reaches the band, contractions of the oesophagus, called peristalsis, will squeeze well-chewed food past the band. In a person with a well-adjusted band, it can take between two to six squeezes of the oesophagus to get a bite of food across the band. One study suggests this process takes at least a minute. There are nerves in the stomach that detect when our stomach is stretching, and send a message to our brain that we have had enough to eat. One particular nerve involved in controlling our stomach is called the vagus nerve. With a gastric band sitting around the stomach this squeezes the vagus nerve all the time, and more so when you are eating. The squeezing process triggers a signal to the brain that you are satisfied, or no longer hungry. This means you feel satisfied on a smaller amount of food than you would have prior to surgery. The constant pressure of the band on the stomach also helps you to feel satisfied for a longer period of time, reducing hunger throughout the day. Feeling satisfied is different to feeling ‘full’. Feeling ‘full’ means you have eaten to excess. It may indicate food is sitting above the band, either due to eating too quickly, eating large pieces of food or not chewing food well enough. Try to stop eating when you feel satisfied or no longer hungry, rather than full. Each bite of food must be small and well chewed. An empty, or uninflated band has an opening the size of a twenty-cent piece. A fully inflated band has an opening the size of a five-cent piece. Most people will have their band adjusted somewhere between the two sizes. If you cut food into the size of a five-cent piece size and chew it well, it is more likely to pass comfortably through the band. Eating slowly also helps you to eat comfortably. In theory, you should aim to wait a minute between each mouthful of food, however it is not practical to time every mouthful. It is practical to put your cutlery down between mouthfuls and wait until you have swallowed before cutting the next piece of food ready to eat. People with a gastric band who eat quickly, describe a feeling of discomfort in their oesophagus, like a ‘traffic jam’. Eating slowly will help avoid this. I hope this clarifies how a gastric band works and what you should experience. If your band is not acting like it should, please follow up with your support team.

Hi B-52, I have not had weight loss surgery. I am a dietitian who has worked with hundreds of weight loss surgery patients. I synthesise the learnings from the most recent medical literature with my clients experience to provide advice, support and guidance. Thanks for reading, Sally

Thanks Carolinagirl, I love the quote on your footer! I shared it on my facebook page recently and it was very popular. You can see my page at www.facebook.com/NutritionforWLS Sally

Thanks you for your comments, I'm glad you enjoyed the article. It gives me motivation to keep posting articles when I hear people find them useful. Your in good health, Sally

Surgery itself is just one part of the picture of weight management. Surgery alone does not guarantee you will lose weight; it is a tool that can assist you to lose weight when teamed with lifestyle change. Both professionals in the field and those who have had or are considering having surgery themselves seem to be involved in an ongoing debate over what is the best type of weight loss surgery. The three most common forms of surgery in Australia at present, gastric band, gastric bypass and sleeve gastrectomy all have loyal fans and big opponents. In my Nutrition for Weight Loss Surgery Support Group the pros and cons of the different surgery types are regularly discussed by those who have been through the various procedures. Whilst technically different, what is common to all forms of weight loss surgery is that the surgery itself is just one part of the picture of weight management. Surgery alone does not guarantee you will lose weight; it is a tool that can assist you to lose weight when teamed with lifestyle change. Colleen Cook is a successful weight loss surgery patient from 1995 and is the author of the best selling weight loss surgery book, The Success Habits of Weight Loss Surgery Patients. It is based on her research of the most successful long-term patients and the habits they have in common as they maintain their weight over time. Colleen is also the President of Bariatric Support Centers International, a company that specialises in providing education and support services for those who have had weight loss surgery and the professionals who work with them. Following is a comment from Colleen that stood out to me when reading her work recently: “Successful patients took personal responsibility for staying in control. They were found to have a general feeling that maintaining their weight was indeed their own responsibility and that surgery was a tool that they used to reach and maintain a healthy weight.” Colleen’s words illustrate perfectly that weight loss surgery itself does not cause weight loss. Those undergoing weight loss surgery will need to take responsibility for their lifestyle choices. To achieve the best weight loss results and maintain that weight loss in the long term, you will need to choose healthy and nutritious foods, increase physical activity and maintain regular follow up with your support team. Are you maximizing the support available to you? Do you regularly follow up with your surgeon or bariatric GP to check your progress? For those with a gastric band, have you worked with them to find the green zone? Have you had the blood tests recommended to you to monitor any medical conditions or detect nutrient deficiencies? Have you seen an exercise physiologist or physiotherapist regarding an activity program tailored to you? Did you see your dietitian for the pre and post surgery info but never returned for ongoing support? Are you comfortable with the support team at your clinic? If not, you need to seek out a new support network. Ultimately it is up to you to utilise the support and resources available to you for a successful journey,

I recently came across an article online titled ‘5 Things We Can Learn About How to Eat by Watching Kids’. Interestingly, four of the five tips are topics I often discuss with my clients undergoing weight loss surgery. I recently came across an article online titled ‘5 Things We Can Learn About How to Eat by Watching Kids’. Interestingly, four of the five tips are topics I often discuss with my clients undergoing weight loss surgery. The five tips were as follows: 1. Be picky - only eat your favourites 2. Slow things down 3. Keep it simple 4. Eat with your hands 5. Eat when you’re hungry and stop when you’re full. Whilst eating with your hands is one I tend to skip, the other four tips are very relevant. 1. Be picky - only eat your favourites Have you found yourself scouring the supermarket for the perfect fat free, sugar free but still deliciously tasty chocolate? Dark chocolate of course, so it still provides all the antioxidants. How did that search go? I’m guessing you’re still searching. There is no substitute for the real thing and that is not only true of chocolate, but a whole range of foods. After weight loss surgery you have less space to fill with food, so it makes sense to fill it with food you enjoy. Sure, you need to make sure you are eating a balanced range of foods to get all the nutrients you need, but you should be doing this with food that is pleasurable. Tania, a gastric bypass client puts it very simply: “I do what the French do, I eat everything I want, but I eat in small portions." 2. Slow things down Eating too quickly and not chewing foods properly are both problematic after weight loss surgery. Many of you would have learnt very quickly what happens when you eat too quickly – discomfort, pain and possibly regurgitation. Have you ever told your child to hurry up when they are eating? Well perhaps they are the ones that have it right. I’m currently feeding a nine month old baby. I happened to watch the clock last night as she ate. Dinner took us about 20 minutes. Perhaps these children are on to something! It should take up to 20 minutes to eat a small meal. If there is food left on your plate after this time, discard it. Concentrate while you are eating. Sit up straight and avoid slouching. Set aside time for meals and avoid doing other things whilst you are eating. Put simply, slow down. 3. Keep it simple Many clients of mine will have heard me say that there is 21 meals in a week, so they don’t all have to be perfect. Do you need to serve meat and three different coloured vegetables every night? No. Do you need to cook a full roast meal every Sunday? No. Do you need to know exactly how many grams of carbohydrate you eat each day? No. Sure, you need to ensure you eat a balanced range of foods and your dietitian can guide you with that. But if you can’t be bothered cooking is there a problem with throwing a tin of tuna and some pre washed salad leaves in a wrap for dinner? No. Keep a supply of simple foods on hand that you enjoy for those times when you just need to throw something together. Here are a few of my favourite staples I keep on hand to throw together a whole array of meals: § Eggs § Tinned tuna or salmon § Lean sliced meat § Oven ready/microwave ready frozen fish § Baked beans § Pre-washed salad leaves § Avocado § Mixed frozen vegetables § Tinned corn § Tinned 3 bean mix § Tinned beetroot § Diced tinned tomatoes § Wholegrain/multigrain crackers § Wholegrain/multigrain wraps or mountain bread. 4. Eat when you’re hungry and stop when you’re full. Have you noticed that a child can eat almost all of a sandwich, pushing away the last two mouthfuls announcing that they are full? Our instinct is often to tell them to finish what is on the plate, remind them of the starving children in Africa, but is this doing more harm than good? Children have an innate ability to interpret their hunger and satiety signals, but we often encourage them to override this. What does this teach the child? To eat whether you are hungry or not. I have spoken to hundreds of people undergoing weight loss surgery and many were told to finish the plate, or were not allowed to leave the table until they were finished their meal. Many have also said that they have felt truly hungry for some time. To successfully manage our weight we must be able to interpret the hunger and satiety signals our body gives us. (Satiety is the feeling of satisfaction after eating.) No matter how healthy food is, too much of it is not good for us. Do you need to spend some time following surgery re‐learning how to listen to your body’s signals? Perhaps you need to watch a child eat and follow their lead.

In a previous article I introduced the concept of getting the most from what you are eating, in particular, feeling satisfied after eating. Whilst the purpose of weight loss surgery is to help you feel satisfied on a smaller amount of food, the type of foods you choose is important to help maximise this. There are two key ingredients in helping you to feel satisfied after eating: 1. High fibre, low glycemic index carbohydrate-containing foods 2. Protein-containing foods. The previous article explored the glycemic index, or GI. This article focuses on protein. Protein-containing foods help us feel satisfied for longer after eating, which is helpful in managing our weight. Protein is also involved in many bodily functions including: building and repairing body cells such as bone, hair, skin, nail and muscle producing hormones to help us burn stored energy, including body fat making enzymes to help digest food helping to protect our body against colds, hair loss, muscle weakness, and fatigue. Not eating enough protein can result in: a weaker immune system muscle loss hair loss inadequate weight loss. Why am I at risk of inadequate protein intake after weight loss surgery? As indicated in the protein counter (on my website), meat products contain the most protein per serve. An Australian study from The St George Upper GI Clinic in Sydney, Australia, found that those with a gastric band often find red and white meat difficult to tolerate whilst fish was tolerated more easily. Some people who have had sleeve gastrectomy and gastric bypass also reported difficulty eating these foods but it was far less common than it was among those with a gastric band. Red meat and chicken breast can be more difficult to eat if they are dry, overcooked, stringy, or if they have been reheated. Any meat can be difficult to tolerate if you are not using the correct eating technique. Some people will then avoid these foods, when working on improving eating technique may allow them to eat these foods comfortably. Food tolerance varies from person to person and is found by trial and error. Tolerance of all foods can be improved by following the correct eating technique as I have discussed previously. Following all surgeries, you will be eating smaller amounts of food. A reduced intake of food causes a decrease in protein intake. In the early stages following surgery, people who have had a sleeve gastrectomy or gastric bypass are likely to tolerate only very small quantities of food. When you eat your meals, eat the protein-containing food first to ensure you have room for this important nutrient. How much protein do I need? There is no one exact recommended protein intake following weight loss surgery. A range of 60-120g has been suggested, however your individual protein needs will vary depending on your age, gender and your particular stage of recovery. It is best to speak to your dietitian about your protein needs. You can then use the protein counter below to see how you can achieve this. It is easy to confuse the weight of food with the protein content. For example, some may assume 100g of meat provides 100g of protein. This is not the case. Head to my website for a simple table on the protein content of common foods. Lean protein foods are the best choices, as they are lower in fat, particularly saturated fat. Meat should be trimmed of fat and chicken should have skin removed. Low fat milk, yoghurt and reduced fat cheeses are recommended.

Recently I have found myself spending a lot of time talking with my weight loss surgery clients about getting the most from what they are eating, in particular, feeling satisfied after eating. Whilst the purpose of weight loss surgery is to help you feel satisfied on a smaller amount of food, the type of foods you choose is important to help maximise this. There are two key ingredients in helping you to feel satisfied after eating: 1. High fibre, low glycemic index carbohydrate-containing foods
 2. Protein-containing foods.
 This post will demystify the glycemic index, or GI. Protein will be the focus of a later post.
 The GI is a measure of the effect that different carbohydrate-containing foods have on blood glucose (blood sugar) levels. It describes the way our body digests and absorbs these foods. Carbohydrate-containing foods include: breads, cereals, rice, pasta and noodles starchy vegetables including potato, sweet potato and corn legumes including baked beans, kidney beans, chickpeas and lentils fruits and fruit juices milks, yoghurts, custards and ice cream any food containing flour or sugar. Some carbohydrate-containing foods are broken down and absorbed quickly, so they raise our blood glucose level faster and higher. These are high GI foods. Other carbohydrate-containing foods are digested and absorbed more gradually, causing a slower, longer lasting rise in blood glucose levels. These are low GI foods. Low GI foods keep us feeling satisfied for longer after eating.

 Often people experience a 'honeymoon' period following weight loss surgery, where weight loss seems automatic. Unfortunately this may not last forever and weight regain can occur with all surgeries. Maximising the satisfaction you get from the food you eat is crucial to keep losing weight and maintain that lost weight. A lower GI eating pattern also helps us feel satisfied for longer after eating, which can help with losing weight. For example, if you eat high GI foods at your meals, you are likely to become hungry sooner after the meal than if you eat low GI foods. This can make you more likely to snack and if you have not planned for this, you may be forced to grab something from the biscuit barrel or vending machine. 
 
 Appetite control is not the only benefit of a lower GI diet. Research has shown that people eating a lower GI diet can reduce their average blood glucose levels, which is particularly important for people with diabetes. Lower GI foods are often also higher in fibre. A high fibre diet helps prevent constipation, decreases the risk of heart disease as soluble fibres can help remove cholesterol from the body and helps protect against bowel cancer, haemorrhoids, irritable bowel syndrome and diverticulitis.

 Foods are classified as low, moderate or high GI.

 To follow a low GI diet, try to choose one low GI food at each meal. Eat high GI foods in small amounts, or less often. 
 Head to my website to see a simple table of low, moderate and high GI foods. Go to www.glycemicindex.com for further information.

Sleeve gastrectomy surgery reduces the size of the stomach by stapling along its length to form a long tube that looks similar to a banana. The majority of the stomach is then removed and discarded. The new banana shaped stomach is long and thin hence is often referred to as a ‘sleeve’. About 80-90% of the stomach is removed making it much smaller, hence it holds much less food than it did previously. This smaller stomach helps you feel satisfied after eating a small amount of food. In addition, the part of the stomach that is removed is the part that secretes much of the hormone called ghrelin, which is involved in stimulating appetite. It is thought that producing less ghrelin further helps to reduce hunger after surgery. Although ghrelin levels start to rise again after surgery, they don’t seem to return to their previous levels and so hunger is more easily satisfied. Unlike the adjustable gastric band the sleeve gastrectomy is not reversible. The stomach may stretch, or adapt to fit a little more food, but it cannot grow back. A sleeve gastrectomy therefore is a commitment for life. As you will be eating less after sleeve gastrectomy, making the most of your food choices is important to help you obtain all the nutrients required for good health. Following a sleeve gastrectomy most people will lose most of their excess weight in the first year. After this time weight loss often stabilises, so make the most of this period by making good food choices and regular physical activity a habit for life. After the first year, your ongoing success will depend on your efforts to change your lifestyle and maintain these habits in the long term. Whilst the size of the stomach changes after surgery, the type of foods that can be eaten does not. Choosing high-energy (calorie or kilojoule) foods regularly will hinder your progress. As with other types of weight loss surgery, snacking or grazing, lack of physical activity and poor food choices can lead to weight regain. Positive, lifelong changes to eating and physical activity will ensure your long-term success. Poor food choices can also cause dumping syndrome. Dumping syndrome had been thought to occur only following gastric bypass surgery, however it has been seen following sleeve gastrectomy surgery. Avoiding fatty or sugary foods will help prevent dumping syndrome. We will discuss dumping syndrome in a coming edition of the newsletter, but for now you can see a simple explanation here. Avoiding fatty or sugary foods will help prevent dumping syndrome. A 2011 study found that those who had regular follow up after sleeve gastrectomy achieved better weight loss, health improvement, quality of life and food tolerance, than those who did not. Your support team is there to guide you to acheive the best results following surgery, so make the most of the team and keep in touch! They have all sorts of hints and tips to help you achieve success on your weight loss journey.

During Roux-en-Y gastric bypass surgery (gastric bypass) the top of the stomach is stapled to form a small pouch. The small pouch becomes a new, smaller stomach and is totally separate to the rest of the stomach. This small pouch is then ‘re-plumbed’ to the jejunum, the middle part of the small intestine, bypassing the first part of the intestine called the duodenum. The new, smaller stomach pouch allows you to eat only a small amount of food before feeling satisfied. There are also some hormonal changes that occur help to decrease your appetite. It is important to note that bypassing the first part of the intestine means less vitamins and minerals are absorbed. This is why it is essential that you follow the advice of your team regarding vitamin and mineral supplementation. Maintenance Unlike the gastric band, the gastric bypass does not require any ongoing adjustments. However, follow up is necessary to ensure your weight loss is appropriate, you are receiving adequate nutrition and that the surgery is not having any negative effects on your health. One study has found the most intense weight loss occurs in the first six months following gastric bypass surgery and will slow in the second six months, stabilising in the second year. It is likely, however, that everyone will have a different experience. As with all forms of weight loss surgery, success is not guaranteed. Lifestyle changes including healthy eating and regular physical activity are key ingredients in your long term success following surgery. Whilst the size of the new stomach helps prevent overeating, the food choices you make are important. People who maintain their weight losses long term generally avoid high fat, high-energy foods. As well as improving weight loss and maintenance, it is important to avoid high sugar and/or high fat foods as following gastric bypass surgery they can lead to a side effect called dumping syndrome. See a simple explanation of dumping syndrome here. A 2012 study showed that following gastric bypass surgery, those who kept in closest contact with their support team achieved better results. Your team is there to guide you to get the best results following surgery, so make the most of them and keep in touch! They have all sorts of hints and tips to help you on a successful journey.

Last year I asked my Facebook followers the foods that were always on their shopping list since having weight loss surgery. Following were the most common responses: yoghurt mince avocado eggs porridge cottage cheese low fat ice cream. What do you notice about this list? What do all these foods have in common? They are all ‘easy to eat’ foods. This theme resurfaced in a similar conversation I observed recently about crackers. Following weight loss surgery, some people prefer to choose crackers over bread. It seems that easy to eat crackers, the ‘puffed’ varieties that dissolve in the mouth like Cruskits™, are a popular choice. You can eat them more easily, allowing you to also eat more of them, than a more challenging and nutritious cracker, like a grainy Vita-weat® or Ryvita®. So why are you choosing easy to eat foods? The purpose of weight loss surgery is to feel satisfied on a smaller amount of food, preferably nutritious food. So I ask, what would make you feel more satisfied? Taking time to chew, chew, chew through the higher fibre, more nutritious, grainy Ryvita® or Vita-weat® crackers? Or taking half the time and effort for the Cruskits™ to dissolve in your mouth after a quick, half-hearted chew? It is an experiment worth doing. Perhaps also note how many of each of the crackers you need to eat to feel satisfied, as well as how long you remain satisfied after eating them. In the hundreds of weight loss surgery clients I have seen I have noticed that after recovering from weight loss surgery some people never really progress past the ‘soft food’ stage of mornays, stews, casseroles and mince dishes. Or, they progress onto more solids foods but gradually slip back in to these softer, easier to eat foods, particularly those with a gastric band, as their band is adjusted and becomes tighter. I recall conversations with clients telling me they prefer the soft foods as they are “easy” and they “can eat more”. However, when we discuss this further, their true hunger is satisfied just as much on a smaller serve of a food, which is more challenging to eat. Eating larger amounts of soft, sloppy food or easy to eat, ‘dissolvable’ food is eating to satisfy our eyes, rather than our true hunger. I am fully aware that some people with a gastric band have difficulty eating particular foods. I also believe however that there are thousands of people with poorly managed gastric bands that are not able to eat healthy, solid food. Unfortunately there is a misconception with gastric bands that tighter equals better, and that regurgitation is normal. Whilst I have no scientific studies to back this up, in my work the people I see who successfully lose and maintain their lost weight with a gastric band are those who can eat a good variety of solid, healthy foods, not those who must survive on protein shakes, soups and juices as their band is too tight to eat anything else. If you can’t eat a range of healthy foods please speak to your team, or get a second opinion. It may be that you need to work on your eating technique, or you may need some medical intervention. Unfortunately the perception that easy to eat foods are necessary has become quite widespread and is not only confined to the gastric band community and with many online weight loss surgery communities these beliefs spread. Are you choosing easy to eat foods out of habit? Could you eat more challenging foods that will satisfy you more? Consider this ‘food for thought’ as you move forward on your journey.

During Roux-en-Y gastric bypass surgery (gastric bypass) the top of the stomach is stapled to form a small pouch. The small pouch becomes a new, smaller stomach and is totally separate to the rest of the stomach. This small pouch is then ‘re-plumbed’ to the jejunum, the middle part of the small intestine, bypassing the first part of the intestine called the duodenum. During Roux-en-Y gastric bypass surgery (gastric bypass) the top of the stomach is stapled to form a small pouch. The small pouch becomes a new, smaller stomach and is totally separate to the rest of the stomach. This small pouch is then ‘re-plumbed’ to the jejunum, the middle part of the small intestine, bypassing the first part of the intestine called the duodenum. The new, smaller stomach pouch allows you to eat only a small amount of food before feeling satisfied. There are also some hormonal changes that occur help to decrease your appetite. It is important to note that bypassing the first part of the intestine means less vitamins and minerals are absorbed. This is why it is essential that you follow the advice of your team regarding vitamin and mineral supplementation. Maintenance Unlike the gastric band, the gastric bypass does not require any ongoing adjustments. However, follow up is necessary to ensure your weight loss is appropriate, you are receiving adequate nutrition and that the surgery is not having any negative effects on your health. One study has found the most intense weight loss occurs in the first six months following gastric bypass surgery and will slow in the second six months, stabilising in the second year. It is likely, however, that everyone will have a different experience. As with all forms of weight loss surgery, success is not guaranteed. Lifestyle changes including healthy eating and regular physical activity are key ingredients in your long term success following surgery. Whilst the size of the new stomach helps prevent overeating, the food choices you make are important. People who maintain their weight losses long term generally avoid high fat, high-energy foods. As well as improving weight loss and maintenance, it is important to avoid high sugar and/or high fat foods as following gastric bypass surgery they can lead to a side effect called dumping syndrome. See a simple explanation of dumping syndrome here. A 2012 study showed that following gastric bypass surgery, those who kept in closest contact with their support team achieved better results. Your team is there to guide you to get the best results following surgery, so make the most of them and keep in touch! They have all sorts of hints and tips to help you on a successful journey.

I have found that sadly there are a lot of misconceptions around gastric bands. Firstly, there is a misconception that the gastric band creates a small stomach that must be ‘filled’ to feel full. There is also a misconception that a tighter band will result in more weight loss and that the vomitting or regurgitation caused by a tight gastric band is ‘normal’. Another misconception is that you shouldn’t be able to eat certain foods with a gastric band. Let’s get back to basics to understand how a gastric band should work. A gastric band is a silicone device placed around the upper part of the stomach. It was once believed that the gastric band created a new, smaller stomach above the band, where food would sit before passing into the lower, larger stomach. Recent studies at the Centre for Obesity Research and Education (CORE) in Melbourne have shown this to be incorrect. The gastric band actually creates a ‘funnel’ into the larger stomach and exerts pressure on the stomach. Adjusting the gastric band can vary this pressure. The band has an access point called a port, which is stitched to your abdominal muscle deep under the skin. You can usually tell where the port may be as it is likely to sit somewhere under your biggest scar. Your surgeon or weight loss GP uses the port to adjust your gastric band and vary the pressure it places on the stomach. They can inject or remove saline (a salty water) solution via the port to make your band tighter or looser. When food is eaten our oesophagus, or food pipe, squeezes bites of food down towards the band. Once food reaches the band, contractions of the oesophagus, called peristalsis, will squeeze well-chewed food past the band. In a person with a well-adjusted band, it can take between two to six squeezes of the oesophagus to get a bite of food across the band. One study suggests this process takes at least a minute. There are nerves in the stomach that detect when our stomach is stretching, and send a message to our brain that we have had enough to eat. One particular nerve involved in controlling our stomach is called the vagus nerve. With a gastric band sitting around the stomach this squeezes the vagus nerve all the time, and more so when you are eating. The squeezing process triggers a signal to the brain that you are satisfied, or no longer hungry. This means you feel satisfied on a smaller amount of food than you would have prior to surgery. The constant pressure of the band on the stomach also helps you to feel satisfied for a longer period of time, reducing hunger throughout the day. Feeling satisfied is different to feeling ‘full’. Feeling ‘full’ means you have eaten to excess. It may indicate food is sitting above the band, either due to eating too quickly, eating large pieces of food or not chewing food well enough. Try to stop eating when you feel satisfied or no longer hungry, rather than full. Each bite of food must be small and well chewed. An empty, or uninflated band has an opening the size of a twenty-cent piece. A fully inflated band has an opening the size of a five-cent piece. Most people will have their band adjusted somewhere between the two sizes. If you cut food into the size of a five-cent piece size and chew it well, it is more likely to pass comfortably through the band. Eating slowly also helps you to eat comfortably. In theory, you should aim to wait a minute between each mouthful of food, however it is not practical to time every mouthful. It is practical to put your cutlery down between mouthfuls and wait until you have swallowed before cutting the next piece of food ready to eat. People with a gastric band who eat quickly, describe a feeling of discomfort in their oesophagus, like a ‘traffic jam’. Eating slowly will help avoid this. I hope this clarifies how a gastric band works and what you should experience. If your band is not acting like it should, please follow up with your support team.

Both professionals in the field and those who have had or are considering having surgery themselves seem to be involved in an ongoing debate over what is the best type of weight loss surgery. The three most common forms of surgery in Australia at present, gastric band, gastric bypass and sleeve gastrectomy all have loyal fans and big opponents. In my Nutrition for Weight Loss Surgery Support Group the pros and cons of the different surgery types are regularly discussed by those who have been through the various procedures. Whilst technically different, what is common to all forms of weight loss surgery is that the surgery itself is just one part of the picture of weight management. Surgery alone does not guarantee you will lose weight; it is a tool that can assist you to lose weight when teamed with lifestyle change. Colleen Cook is a successful weight loss surgery patient from 1995 and is the author of the best selling weight loss surgery book, The Success Habits of Weight Loss Surgery Patients. It is based on her research of the most successful long-term patients and the habits they have in common as they maintain their weight over time. Colleen is also the President of Bariatric Support Centers International, a company that specialises in providing education and support services for those who have had weight loss surgery and the professionals who work with them. Following is a comment from Colleen that stood out to me when reading her work recently: “Successful patients took personal responsibility for staying in control. They were found to have a general feeling that maintaining their weight was indeed their own responsibility and that surgery was a tool that they used to reach and maintain a healthy weight.” Colleen’s words illustrate perfectly that weight loss surgery itself does not cause weight loss. Those undergoing weight loss surgery will need to take responsibility for their lifestyle choices. To achieve the best weight loss results and maintain that weight loss in the long term, you will need to choose healthy and nutritious foods, increase physical activity and maintain regular follow up with your support team. Are you maximizing the support available to you? Do you regularly follow up with your surgeon or bariatric GP to check your progress? For those with a gastric band, have you worked with them to find the green zone? Have you had the blood tests recommended to you to monitor any medical conditions or detect nutrient deficiencies? Have you seen an exercise physiologist or physiotherapist regarding an activity program tailored to you? Did you see your dietitian for the pre and post surgery info but never returned for ongoing support? Are you comfortable with the support team at your clinic? If not, you need to seek out a new support network. Ultimately it is up to you to utilise the support and resources available to you for a successful journey,

Thanks carolinagirl, Glad you liked the article and thanks for sharing your experience. You may also enjoy some of the tips in my free ebook, Top Ten Tips for Success with Weight Loss Surgery. It includes lots of tips from people who have had surgery, just like you! You can download for free at my website. Thanks for reading, Sally

I recently came across an article online titled ‘5 Things We Can Learn About How to Eat by Watching Kids’. Interestingly, four of the five tips are topics I often discuss with my clients undergoing weight loss surgery. The five tips were as follows: 1. Be picky - only eat your favourites 2. Slow things down 3. Keep it simple 4. Eat with your hands 5. Eat when you’re hungry and stop when you’re full. Whilst eating with your hands is one I tend to skip, the other four tips are very relevant. 1. Be picky - only eat your favourites Have you found yourself scouring the supermarket for the perfect fat free, sugar free but still deliciously tasty chocolate? Dark chocolate of course, so it still provides all the antioxidants. How did that search go? I’m guessing you’re still searching. There is no substitute for the real thing and that is not only true of chocolate, but a whole range of foods. After weight loss surgery you have less space to fill with food, so it makes sense to fill it with food you enjoy. Sure, you need to make sure you are eating a balanced range of foods to get all the nutrients you need, but you should be doing this with food that is pleasurable. Tania, a gastric bypass client puts it very simply: “I do what the French do, I eat everything I want, but I eat in small portions." 2. Slow things down Eating too quickly and not chewing foods properly are both problematic after weight loss surgery. Many of you would have learnt very quickly what happens when you eat too quickly – discomfort, pain and possibly regurgitation. Have you ever told your child to hurry up when they are eating? Well perhaps they are the ones that have it right. I’m currently feeding a nine month old baby. I happened to watch the clock last night as she ate. Dinner took us about 20 minutes. Perhaps these children are on to something! It should take up to 20 minutes to eat a small meal. If there is food left on your plate after this time, discard it. Concentrate while you are eating. Sit up straight and avoid slouching. Set aside time for meals and avoid doing other things whilst you are eating. Put simply, slow down. 3. Keep it simple Many clients of mine will have heard me say that there is 21 meals in a week, so they don’t all have to be perfect. Do you need to serve meat and three different coloured vegetables every night? No. Do you need to cook a full roast meal every Sunday? No. Do you need to know exactly how many grams of carbohydrate you eat each day? No. Sure, you need to ensure you eat a balanced range of foods and your dietitian can guide you with that. But if you can’t be bothered cooking is there a problem with throwing a tin of tuna and some pre washed salad leaves in a wrap for dinner? No. Keep a supply of simple foods on hand that you enjoy for those times when you just need to throw something together. Here are a few of my favourite staples I keep on hand to throw together a whole array of meals: § Eggs § Tinned tuna or salmon § Lean sliced meat § Oven ready/microwave ready frozen fish § Baked beans § Pre-washed salad leaves § Avocado § Mixed frozen vegetables § Tinned corn § Tinned 3 bean mix § Tinned beetroot § Diced tinned tomatoes § Wholegrain/multigrain crackers § Wholegrain/multigrain wraps or mountain bread. 4. Eat when you’re hungry and stop when you’re full. Have you noticed that a child can eat almost all of a sandwich, pushing away the last two mouthfuls announcing that they are full? Our instinct is often to tell them to finish what is on the plate, remind them of the starving children in Africa, but is this doing more harm than good? Children have an innate ability to interpret their hunger and satiety signals, but we often encourage them to override this. What does this teach the child? To eat whether you are hungry or not. I have spoken to hundreds of people undergoing weight loss surgery and many were told to finish the plate, or were not allowed to leave the table until they were finished their meal. Many have also said that they have felt truly hungry for some time. To successfully manage our weight we must be able to interpret the hunger and satiety signals our body gives us. (Satiety is the feeling of satisfaction after eating.) No matter how healthy food is, too much of it is not good for us. Do you need to spend some time following surgery re‐learning how to listen to your body’s signals? Perhaps you need to watch a child eat and follow their lead.

Those who have had weight loss surgery often ask how much they should be eating. Whilst is seems a simple question, there is no simple answer. How much you should be eating is a hot topic on many online forums or support pages. If you have read the discussions it becomes clear that weight loss surgery clinics and support teams widely differ in how much they are recommending their patients eat. This is also clear when I chat with other health professionals at our obesity surgery conferences. If the professionals working in the area can’t get their story straight, how are people to know what to do? Some surgeons recommend you limit meals to half a cup, some may say one cup, and others will say a bread and butter plate of food. Interestingly, one cup of food nicely fits on a bread and butter plate and this is the guide we use in our clinic. Accredited Practising Dietitians (in Australia, Registered Dietitians in the USA) are university‐qualified experts on food and nutrition. Whilst even their recommendations on what you should eat following surgery will vary, what they will generally agree on is that it is difficult to meet your nutritional requirements eating half a cup of food, three times a day. To date, there are no scientific studies on the exact amount of food people should include after gastric band and gastric bypass surgeries. Hopefully in time this will evolve. Research from Mercy Bariatrics in Perth, Western Australia, provides some excellent data to help guide serving sizes for those who have had a sleeve gastrectomy. Whilst initially very small amounts are tolerated, at six months after surgery most people will manage about half a cup of food at a time. By 12 to 18 months most people will manage about one cup of solid food. This is a guide only and will vary between people as there are different size sleeves. A point relevant to all surgeries is that the people studied found they could indeed ‘fit’ more food in than what they felt satisfied with. After all forms of weight loss surgery, eating to the maximum amount you can tolerate is not recommended. I have a favourite quote from Dr. Teresa Girolamo, one of the GPs in our clinic: “It’s not a matter of seeing how much you can eat and get away with, but how little you can eat and be satisfied.” Testing the limits of how much you can eat increases your intake, particularly if it occurs repeatedly, and can compromise your results. Tune in to your feeling of satisfaction after eating and let that guide the amount of food you need to eat. Always stop eating before you feel any discomfort. Create an environment that makes it easy for you to eat small portions. Ensure family and friends know you use a smaller plate/bowl/cutlery. Take these items with you if you travel. When eating out, order entrée size meals or if there are none available, separate your meal into an appropriate portion before you start eating. Tapas style menus, Asian or Indian eateries are often tailored to meals being shared, allowing you to dish up a small serve to suit your needs. It is fine to leave food on your plate when you have had enough, even if it is a smaller serve. Avoid the temptation to ‘clean the plate’. If ‘wasting’ food concerns you, carry a container with you when you eat out and take a serve home to have for another meal. After gastric band surgery some people may find it takes some time before they feel satisfied on small amounts of food. Many people need their gastric band adjusted several times to help them feel satisfied on small serves. If small meals of solid food do not satisfy you, keep in regular contact with your support team until they do. Some people will find this will occur early in their journey, for others it may take longer. Be patient. Whilst it is not necessary for you to measure or weigh everything you eat, it may be helpful to measure the amount you are usually serving. When you eat a meal, take note how much food it takes for you to feel satisfied and how much it takes to feel full. The aim is to feel satisfied after eating, so if you know roughly how much food this is you can avoid dishing up too much in future. The recipes in my book and on my blog have been designed to provide approximately four, one cup serves. This does not mean a one cup serve is right for everyone, but does allows you to easily adapt the recipes to your requirements.