Appetite, and feeling full are complex interactions that occur somewhere in the brain, and are based on signals from the stomach. There is a disease, Prader-Willi syndrome, where the brain does not recognize satiety (the feeling of being full). These unfortunate individuals become morbidly obese as they have no internal mechanism to tell them when they should feel full, and they always feel hungry. In simple terms, your stomach gets to feeling full, it sends a signal to the brain which says—”Hey, I am full here so don’t throw anything more down or I will throw it back up.” That is the feeling I have after a Thanksgiving Dinner— usually after I have had seconds and have just finished off a nice pumpkin pie. But this feeling doesn’t happen the instant that the stomach is stretched. This sensation takes a while to reach the brain.

The signal may be from the hormone ghrelin. This hormone is found in low levels in weight loss surgery patients who have had the RNY gastric bypass and in people who are obese. Sounds strange? In obese people who begin to diet, the level goes up, stimulating the appetite. The levels are low because they are constantly eating and keeping the level low.

Many obese people have an aberration in their satiety mechanism. They don’t know when they are full. It is something they have not experienced. These early 12 weeks are a great time to get in touch with that feeling. Measure your food, eat your food, and know what satiety feels like. If you have had a RNY gastric bypass weight loss surgery and you are tolerating chicken, measure out an ounce of chicken (assuming you have a one ounce pouch) and SLOWLY eat it. Wait a bit and notice that feeling you have—your stomach’s upper pouch is full and your stomach is signaling your brain that you don’t need to eat any more. Again, some days you cannot eat one ounce, and only a tablespoon will do. That is okay.

Phantom hunger pains

Did you ever hear of a person who had an amputation and complained that his toes hurt? Phantom pain is a well-known phenomenon in medicine, and it applies more than just to feet. Some days you will feel hungry even though you are filled. There are a lot of complex theories as to why this occurs, but it is real. You will get hungry, but there are a few tricks we have to make it better.

One trick is water loading. Because of a limited capacity, you learn to eat and not to drink at the same time. This doesn’t change. Don’t start eating and drinking, but you can drink more between meals. Two hours after eating, begin drinking a lot of water. The water will fill you up, doesn’t have any calories, and while the feeling of being full won’t last long, it provides a few minutes of relief when you would otherwise reach for something that has a lot of calories. Water loading isn’t something you can hope to remember, it is something to plan for. If you are finding that you snack every day at a certain time try drinking water before that time and you will have a less intense hunger. It will relieve the phantom hunger pain, and allow you to continue to lose weight.

Protein drinks, shakes, bars and other “foods”

—sawdust in a bottle

Okay, I admit it, I don’t like the taste of most protein drinks, shakes or bars. I prefer that weight loss surgery patients meet their protein requirements with food—such as fish, poultry, tofu, cheese, egg whites. However, there are a number of weight loss surgery patients who have such a difficult time with food the first few weeks that these alternative sources of protein seem to work well. Whey based protein products or egg-white based products generally have more “bioavailability” than soy products. This means that more of the protein can be absorbed and used by the body. See Appendix One for protein requirements.

After weight loss surgery is a great time to try new sources of protein, especially fish (sushi) or tofu. Tofu is a “high quality” protein, a protein that is low in fat. There are several vegetarian restaurants in Phoenix Arizona that have excellent tofu meals, and these are quite easily tolerated in the early post operative period. I am not a vegetarian; in fact I believe taking baby carrots from their mothers is cruel and unusual. Tofu and soy based products, such as “Morning Star” brands, are available in supermarkets. No longer do you need to go to a health food store to purchase soy-based products.