Preparing Yourself: Your Post-Op Relationship with Food

[Alex Brecher 10,512]

There’s no doubt weight loss surgery helps you eat less. Whichever type you get replaces your regular stomach with a smaller pouch (or stoma or sleeve). But your struggle with food isn’t automatically over the minute you get out of surgery. The sooner you accept and confront this, the more weight you can lose, and the easier your weight loss journey is likely to be.

Whether you get the adjustable gastric band, gastric sleeve, gastric bypass, or another type of Weight Loss Surgery, your Weight Loss Surgery is a restrictive procedure. It helps you fill up sooner, stay full longer, or be unable to tolerate certain foods. (And yes, some procedures such as the gastric bypass are malabsorptive – they reduce nutrient absorption – but all of them restrict food intake).

The Struggle Often Continues

For some patients, Weight Loss Surgery can lower your interest in food, so you are not constantly thinking about it. There’s no question Weight Loss Surgery can help you gain control of your eating, but it’s unlikely to eliminate your struggles with food disappear. A few lucky Weight Loss Surgery patients really do stop being tempted by food. The rest, who make up the vast majority of Weight Loss Surgery patients, continue to struggle.

You still may be hungry, enjoy salt, fat, starch, or sugar, or be tempted to use food as an emotional crutch. Your family members may continue to insist on keeping high-calorie foods in the house, or pressure you to eat things you shouldn’t. Your friends may still be going out to eat and inviting you to join them in ordering high-fat, high-sugar items.

“Why Me?” Isn’t Appropriate

It’s easy, even natural, to think of yourself as unlucky. Why should you have to struggle with food? Why should you have to monitor every bite you take, while some people don’t? The fact is, almost everyone does. Ask almost any skinny person how they stay skinny, and you’ll get some variation of the same answer: “I work hard for it.”

Just like you, they are aware of what goes into their bodies. They sometimes may be hungry; they sometimes may want to eat more than they should. But they, like you now, take responsibility for their decisions. They may:

• Skimp on portions if they over ate at the previous meal.
  
• Choose healthy foods first.
  
• Have a strategy for dealing with emotions and boredom that doesn’t involve eating.
  
• Have a support system that promotes healthy behaviors.
  
• Accept It and Manage It
  

If you find you still have a rocky relationship with food after weight loss surgery, don’t conclude that WLS didn’t work for you. Instead, accept that you will need to fight the cravings and urges for months, years, or life, and start making a plan. Don’t be afraid to ask for help in developing strategies – whether you ask other BariatricPal members or an always-thin person you admire!

Persist in Order to Get the Answers You Need

We all want to be able to trust our doctors. You want to believe your surgeon takes care of all aspects of your Weight Loss Surgery, including your post-op, long-term nutrition. But it doesn’t always happen like that. Nutritional counseling may not be part of your surgery package, or you may only get a limited amount of generic information.

Or, your surgeon may simply not know how to help you nutritionally. Remember that many doctors have no more than an hour of nutrition education in medical school. To become a weight loss surgeon, doctors need to learn surgery. There is no dietary education requirement.

If you need help finding strategies to satisfy hunger – physical or head hunger – and your surgeon and primary care doctor are not able to help, keep looking. A session with a nutritionist may be more affordable than you think, and worth every penny.

Your Emotional Support System and Your Relationship with Food

The support system you built so carefully can come in handy right about now. Take advantage of your ability to talk to a therapist or psychologist if you have one to bring up your concerns. Discussing your ongoing struggles with portion sizes, food choices, and over-frequent nibbling with a mental health professional can help you come up with some strategies that work for you.

Group sessions are also appropriate forums to talk about food struggles and strategies. Though it may feel embarrassing at first to admit you’re still thinking about food a lot, you will find nearly everyone in that room did or does have that same experience.

Most Weight Loss Surgery patients do not find their surgery instantly eliminates their food struggles. You can take months or years to come to terms with a food addiction, and it may be something you need to learn to live with for life, but in a healthier manner than before Weight Loss Surgery. Be honest with yourself and those around you, and be open to suggestions, and you can figure out strategies that work for you. Do not assume WLS did not work for you!

[ShrinkingPeach 1,291]

Excellent article. I see it on the forum all the time. food choices will always and forever be our challenge.

[MrsSugarbabe 727]

Great article! You always write such insightful pieces. There is always excellent information and advice included in your pieces. Keeping on writing!

[Dawn306 50]

Thanks for this article. One thing puzzles me though. What about the claim that the stomach produces the hunger hormone called Ghrelin, and that if you have 3/4 of your stomach removed (gastric sleeve), then your hunger is automatically reduced because there is less stomach tissue and therefore, less ghrelin?

Edited August 9, 2015 by Dawn306

[Alex Brecher 10,512]

Thanks for the compliments on the articles! I am so glad they are useful.

Yep - WLS (especially gastric sleeve and bypass) can definitely affect (reduce) ghrelin levels and therefore reduce hunger. That's right - so that's a way WLS helps you eat less and lose weight, because you're less hungry. In this article, I was thinking about the factors that contributed to weight gain that WEREN"T strictly about hunger - because I think all of us (me, anyway) used to be guilty of eating when we weren't truly biologically hungry, but eating for other reasons, like we wanted food or for emotional reasons.

Great point, though, and definitely a consideration when choosing which type of WLS, since lap-band doesn't affect ghrelin in the same way sleeve does.

[Staggerlee33 6]

According to my surgeon and the research I've done on the gastric sleeve procedure, ghrelin levels are only reduced temporarily. The body is always striving for what it considers homeostasis and eventually begins to compensate for ghrelin reduction. It may take a good while for this to occur but it appears to be the rule for most, rather than the exception.

[KristenVSG2014 1,872]

I definitely recommend reading the book "It Starts With Food". It explains the science behind how our brain is addicted to certain foods and how to heal your body physically and mentally. I didn't realize how much I was addicted to sugar and sugar substitutes until I cut them out. I had binging dreams (mostly cake and doughnuts) for a week straight.

[Alex Brecher 10,512]

Staggerlee33,

Yes, I have seen this, too. I think there is probably some truth to this, but I also think any research on the sleeve is either sparse or too short-term to know, since the sleeve is still so new. At the least, hopefully the decrease in ghrelin lasts long enough for the patient to lose a good amount of weight and develop healthy eating habits.

[joatsaint 2,814]

I'm only a 31 months post-op Sleever, and I realize that's not really long enough for a scientific study. But, my epsiodes of head hunger have almost disappeared and the intensity of the head hunger is nothing compared to the constant "little nagging voice to eat" I dealt with daily pre-op.

I still get the occasional head hunger, but it's because of a trigger food. Pre-op, head hunger used to happen every 2 hours. And I knew that no matter how much I ate, in 2 hours, I'd be hungry again. I've had to learn what are my trigger foods and how much I can eat before the cravings kick in.

Staggerlee33,

Yes, I have seen this, too. I think there is probably some truth to this, but I also think any research on the sleeve is either sparse or too short-term to know, since the sleeve is still so new. At the least, hopefully the decrease in ghrelin lasts long enough for the patient to lose a good amount of weight and develop healthy eating habits.

[katybelle7 65]

My doctor explained to me that ghrelin usually kicks back in after about a year...hopefully long enough to see a substantial weight loss and to have gained new eating habits.

[VSGAnn2014 12,992]

I have seen zero studies that measured and reported changes (down, up or both) in VSG patients' levels of ghrelin.

I see ghrelin changes discussed a lot, but no specific references to research.

Has anyone seen this kind of research?

[esskay77 785]

Great article. However, I have found nutritionists to be absolutely useless. I am about 1 1/2 years post surgery and I am still battling head hunger. I also attend a support group at the hospital where I had my surgery and while I get that I'm a food addict, when I've said that I need a strategy for the times that I want something bad, they tell me there are no strategies, that I'm an addict and I just have to call someone. So not helpful! This forum has been much more helpful than the nutritionist and support group combined. Thanks.

[Dream4tc 192]

I spoke with my surgeon yesterday and I had asked specifically about Ghrelin, PYY, GLP-1 and Leptin. I asked if the hormone levels return over time or stay reduced. He replied with a combination of a yes and no. The body is an amazing system. It will always try and compensate to homeostasis. Below is a great article with research regarding the hormones for sleeve and bypass.

http://www.medscape.com/viewarticle/578906

[Dream4tc 192]

There’s no doubt weight loss surgery helps you eat less. Whichever type you get replaces your regular stomach with a smaller pouch (or stoma or sleeve). But your struggle with food isn’t automatically over the minute you get out of surgery. The sooner you accept and confront this, the more weight you can lose, and the easier your weight loss journey is likely to be.

Whether you get the adjustable gastric band, gastric sleeve, gastric bypass, or another type of Weight Loss Surgery, your Weight Loss Surgery is a restrictive procedure. It helps you fill up sooner, stay full longer, or be unable to tolerate certain foods. (And yes, some procedures such as the gastric bypass are malabsorptive – they reduce nutrient absorption – but all of them restrict food intake).

The Struggle Often Continues

For some patients, Weight Loss Surgery can lower your interest in food, so you are not constantly thinking about it. There’s no question Weight Loss Surgery can help you gain control of your eating, but it’s unlikely to eliminate your struggles with food disappear. A few lucky Weight Loss Surgery patients really do stop being tempted by food. The rest, who make up the vast majority of Weight Loss Surgery patients, continue to struggle.

You still may be hungry, enjoy salt, fat, starch, or sugar, or be tempted to use food as an emotional crutch. Your family members may continue to insist on keeping high-calorie foods in the house, or pressure you to eat things you shouldn’t. Your friends may still be going out to eat and inviting you to join them in ordering high-fat, high-sugar items.

“Why Me?” Isn’t Appropriate

It’s easy, even natural, to think of yourself as unlucky. Why should you have to struggle with food? Why should you have to monitor every bite you take, while some people don’t? The fact is, almost everyone does. Ask almost any skinny person how they stay skinny, and you’ll get some variation of the same answer: “I work hard for it.”

Just like you, they are aware of what goes into their bodies. They sometimes may be hungry; they sometimes may want to eat more than they should. But they, like you now, take responsibility for their decisions. They may:

• Skimp on portions if they over ate at the previous meal.
• Choose healthy foods first.
• Have a strategy for dealing with emotions and boredom that doesn’t involve eating.
• Have a support system that promotes healthy behaviors.
• Accept It and Manage It

If you find you still have a rocky relationship with food after weight loss surgery, don’t conclude that WLS didn’t work for you. Instead, accept that you will need to fight the cravings and urges for months, years, or life, and start making a plan. Don’t be afraid to ask for help in developing strategies – whether you ask other BariatricPal members or an always-thin person you admire!

Persist in Order to Get the Answers You Need

We all want to be able to trust our doctors. You want to believe your surgeon takes care of all aspects of your Weight Loss Surgery, including your post-op, long-term nutrition. But it doesn’t always happen like that. Nutritional counseling may not be part of your surgery package, or you may only get a limited amount of generic information.

Or, your surgeon may simply not know how to help you nutritionally. Remember that many doctors have no more than an hour of nutrition education in medical school. To become a weight loss surgeon, doctors need to learn surgery. There is no dietary education requirement.

If you need help finding strategies to satisfy hunger – physical or head hunger – and your surgeon and primary care doctor are not able to help, keep looking. A session with a nutritionist may be more affordable than you think, and worth every penny.

Your Emotional Support System and Your Relationship with Food

The support system you built so carefully can come in handy right about now. Take advantage of your ability to talk to a therapist or psychologist if you have one to bring up your concerns. Discussing your ongoing struggles with portion sizes, food choices, and over-frequent nibbling with a mental health professional can help you come up with some strategies that work for you.

Group sessions are also appropriate forums to talk about food struggles and strategies. Though it may feel embarrassing at first to admit you’re still thinking about food a lot, you will find nearly everyone in that room did or does have that same experience.

Most Weight Loss Surgery patients do not find their surgery instantly eliminates their food struggles. You can take months or years to come to terms with a food addiction, and it may be something you need to learn to live with for life, but in a healthier manner than before Weight Loss Surgery. Be honest with yourself and those around you, and be open to suggestions, and you can figure out strategies that work for you. Do not assume WLS did not work for you!

Click here to view the article

I have seen zero studies that measured and reported changes (down, up or both) in VSG patients' levels of ghrelin.

I see ghrelin changes discussed a lot, but no specific references to research.

Has anyone seen this kind of research?

I spoke with my surgeon yesterday and I had asked specifically about Ghrelin, PYY, GLP-1 and Leptin. I asked if the hormone levels return back to normal over time or stay reduced/increased. He replied with a combination of a yes and no. The body is an amazing system. It will always try and compensate to homeostasis. Below is a great article with research regarding the hormones for sleeve and bypass.

http://www.medscape.com/viewarticle/578906

Here is another with more research statistics http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356398/#!po=16.4474

Edited August 29, 2015 by Dream4tc