Feeling Full Is the Key

Satiety means feeling full. Feeling full is a key to weight loss. This means not skipping meals. This means protein first—make 70 percent of your meal protein, followed by vegetables.

The first habit to develop: not skipping meals.

Do not skip meals: this never worked prior to bariatric surgery and it will not work now. Skipping meals means that you will feel hungry later, and you will be tempted to snack. The majority of obesity comes from snacks, not from meals.

During meals you need to feel full. The best way to feel full is to have protein first. Protein will keep you full and maintain your health. So eat some food that will stick with you—protein, beef, chicken, pork, or any other meat.

The second habit to develop: avoiding mushy foods.

You can fill any pouch or stomach with French fries, potatoes, candy, chips, bread, or pasta. These are “filler” foods that often require butter, salt, or sugar to taste better. Some of these foods can become stuck in the stoma, causing discomfort. Others go through all too easily. Your body will break down these mushy foods quickly and absorb the calories, and they will not keep you full for a long period of time.

In this section we will talk about protein and protein requirements, then we will talk about carbohydrates, then fat, and finally about alcohol.

Protein Requirements for weight loss surgery patients

Protein requirements of patients who are morbidly obese are calculated either upon lean body mass (what your weight is if your BMI was 20). The formula is 0.45 grams of protein required per pound for a BMI of 24.

BMI Calculator

This charts lists the protein needs based on ideal body weight for your height and BMI of 20. To determine the amount of protein required for sedentary activity see the surgery that you had (or your length of common channel). For example, if you are five-foot, eight-inches tall and had a proximal RNY bypass, you will require 71 grams of protein per day. If you are 6-feet tall and had a DS, you will require 100 grams of protein per day.

HeightNormal Lap Band/VBG400-500 cm
Proximal RNY
200-400 cm
Distal RNY
100 – 200 cm
DS
5 foot55 grams55 grams60 grams70 grams
5’2″58 grams58 grams65 grams70 grams
5’4″63 grams63 grams70 grams75 grams
5’6″66 grams66 grams72 grams78 grams
5’8″71 grams71 grams78 grams85 grams
5’10”75 grams75 grams82 grams89 grams
6 foot82.8 grams82.8 grams90 grams100 grams

The length of the common channel is the key to protein requirements. Once the common channel is over 200 cm in length, the small bowel becomes very efficient at absorbing protein. For patients who develop severe protein malnutrition, lengthening the common channel by as little as 25 cm (about a foot) makes a substantial difference in their ability to absorb protein. It also can decrease diarrhea, increase absorption of bile, and will increase absorption of fat. Prior to undergoing surgery to length -en the common channel, patients can be tried on pancreatic supplements. This allows more efficient digestion of protein, and can often spare an individual surgery.

Protein requirements increase with physical activity. The above numbers double for individuals who are in strength or endurance training. Following surgery the requirements increase by twenty percent or more and can double for patients who have major burns. Dietary intake is the key and modular protein supplementation may be required, especially in the early post-operative period when patients may have poor appetites or are intolerant of meats. Bio-availability of the protein is important, as some supplements contain essential amino acids which can be readily absorbed: whey and egg white proteins are better absorbed than soy based proteins. Gelatin based proteins are not sufficient to sustain human metabolism and do not contain enough essential amino acids.

96 Calories A Day and you can be eligible for weight loss surgery

The vast majority of patients seen for bariatric surgery gained their weight slowly, over an average of ten years. Most patients gain weight by ten pounds a year. Ten pounds isn’t that much and it can be lost, but often is regained plus more. Ten pounds a year for ten years is one hundred pounds, which means eligibility for bariatric surgery.

How easy is it to gain ten pounds a year? It amounts to 96 calories a day above the BMR. That is all! If your basal metabolic rate with your energy expenditure is 2000 calories, then to gain ten pounds in a year you simply need to add 96 calories to it. That amounts to one beer a day (100 calories), or one fourth of a Snicker’s bar. Going from medium fries to super size is about 170 calories. It is the handful of peanuts (160 calories) or finishing your kid’s plate.

The power of small numbers over the long term is huge. Ninety-six calories a day for a year is ten pounds of fat. Ten years and you have 100 pounds of extra fat.

Weight loss surgeons hear all the time how patients don’t feel they ate that much, compared with what others eat—and they probably didn’t. Ninety-six calories is not that many.