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Inter human variation always intrigues me. How come the same surgery works well for most while not for few? They believe increased hunger & ability to eat frequent meals is the culprit.

This explanation is based on poor understanding of post bariatric dietary education. Hunger is a physiological process & there is nothing wrong if the person is hungry before a meal. Hunger indeed reduces after surgery for few months due to decrease in hunger hormones. But body compensates by producing hormones from other organs & hunger is back.

The key message is that surgery is done to enhance satiety or feeling of fullness after a meal & not to curb hunger. Surgery is also expected to increase interval between meals. This is possible to achieve & maintain lifelong if the principles of surgical follow ups are adhered to, which include –

Consumption of liquids with meal – Post surgery stomach capacity is usually 30-50 ccs, which can increase to ~200 ccs after 1-2 years. Even this capacity is 1/3rd of normal stomach size so meal portion remains small permanently. Few patients realise that by gulping liquids with a meal, they are able to flush the food down from their stomach & consume larger meal. This also results in feeling of emptiness within 1-2 hours of surgery. This is completely avoidable by learning to eat without liquids for at least 1/2 -1 hour after a meal. 

Protein intake – Many patients believe that they they eat more sweets & fried items, when stressed. The fact is that once high GI(glycemic index) food like sweets, refined flour etc are consumed, the blood sugar precipitously rise & fall. This makes person hungry again & craving of food manifests within 1-2 hours.On the contrary, high protein meal results in slow & sustained provision of nutrients to body. Thus a protein meal is known to result in satiety which keeps hunger away for hours. Thus food choices play an important role in altering hunger mechanism.

Food choices & technique of eating plays an important role in feeling full & keeping hunger at bay. Hunger is normal & should not be considered as personal failing.

Surgery has worked well for millions across the world & do not let few episodes of indiscretion envelope you in feeling of guilt, personal failing or hopelessness. Important thing is to always remember years of lost hope & control over your body. The secret of success lies within you through education, compliance and positive approach. Yes… can.

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