Measure everything you eat. If it is more than your stomach size, DO NOT CHANCE IT. Better to eat less and not vomit than to eat more and purge yourself. Vomiting is not a fun way to lose weight. You will lose some pounds if you eat too much and vomit, but it is uncomfortable, and at the most it can cause severe problems including electrolyte imbalance, tearing your stomach or esophagus, or ripping staple lines. You can prevent most vomiting by watching and measuring what you eat. In time you will be able to “eyeball” the amount of food you eat and determine how much you should eat.

Measuring your food seems silly, but it is not. One of the great items to have on hand is a shot glass: it can be your best friend in times of trouble. Okay—so you want to hear a story about a shot glass. This is also a story about measuring. John is a great friend of mine, a bright fellow with two master’s degrees who started out life as a plumber. John’s favorite job was owner of a bar; in fact John is looking to purchase a bar again (Seattle bar owners, feel free to apply). John told me that there are “professional” drinkers—some of these would come to his bar and ask for a shot of their favorite beverage (whisky for my dad, vodka for my friend Chuck, and for me—tequila. They would throw the shot into their mouth, and they would measure the shot with their mouth. If it was five-eighths of an ounce they got up and left the bar. If it was a full ounce or more, he had a new, steady customer. The point is (yes, you were probably wondering) that you can learn to measure your food—but unlike our barflies, we want you to swallow it slowly. If you eat slowly you will not experience discomfort and you will know what it is like to be full.

A weighty issue—well measured

Boerhaave Syndrome is a rupture of the esophagus after forceful vomiting. This syndrome is named after the surgeon who described a Dutch Admiral who overate, vomited, ruptured his esophagus, and the contents of his stomach were found in his chest (at autopsy). This can easily happen to post operative weight loss surgery patients who overfill their small stomach (or pouch). It is fatal if not treated early. Two weeks after her duodenal switch, a patient of mine overate, vomited, and ruptured her esophagus. After chest surgery, a few days in the ICU, and a month in the hospital, she finally went home. Measure twice, eat once, and vomit never! This is also a reason you should NEVER induce vomiting.

The question is, how much does your stomach hold?

1 ounce30 cc1/8 cup2 tablespoons
4 ounces120 cc1/2 cup8 tablespoons
8 ounces240 cc1 cup16 tablespoons
40 ounces1.2 liters5 cups80 tablespoons
50 ounces1.5 liters6.25 cups100 tablespoons

It is astounding to think that the average stomach holds between 40 and 50 ounces before weight loss surgery. When you compare the before and after size of the stomach, it is clear why weight loss surgery patients are amazed how they are full on so much less.

I hate to bring up vomiting again (yes, by now you must be use to my puns). When you have a regular stomach and you vomit, you might put a bit of beverage in it to help calm it down. When you have a one-ounce pouch or a 4-ounce stomach, putting a bit in is a lot! Would you eat a 10-ounce steak to calm down your stomach? Of course not! But having a “sip” of soda, or drinking some water can fill that one-ounce stomach up, stretching it and cause you to regurgitate its contents. This is why the first rule of an upset stomach is to STOP, relax, and once your stomach settles down, go back to the clear liquids as prescribed.

How much can you lose with weight loss surgery?

During my Friday afternoon chats one of the common questions is, “How will my body know when to stop losing weight?” The implication is that the post op weight loss surgery patient will lose so many pounds they will dry up and blow away. This doesn’t happen. The stomach remnant will expand a bit over time, and you will be able to hold more food. Every now and then, we hear of someone who loses too many pounds after weight loss surgery, and these unfortunate individuals may have other issues and problems. In fact, the problem most weight loss surgery patients face is not losing too much, but getting rid of the last 30-50 pounds.

Honest, two tablespoons are enough

Well-meaning friends and family will be concerned that you are not getting enough to eat—you are. These same individuals may think you are losing too many pounds too fast, and sometimes even a physician will tell weight loss surgery patients that they shouldn’t be losing so much weight.

With some very notable exceptions (as in, you are rapidly approaching a BMI of 18 and not reaching a plateau) weight loss is expected to be very rapid, especially early on. Do not force yourself to eat more; if you force yourself to eat what others think you should, you may stretch your stomach. If you are one-hundred-pounds overweight you contain enough calories to sustain yourself for six months with just fluids and some supplements.

Discipline is something people use in a negative sense—and every person who has a few pounds to lose has heard that term used this way, as in—”If only you had some discipline you would have never gotten this way,” In case you didn’t know, “this way” is their politically correct euphemism for “fat.” However, your body enforces a discipline that is beyond the “will.” Your body’s “discipline” is a complex mechanism of appetite and feeling full. In this case, because of your new anatomy, your “discipline” has changed substantially from what it was before weight loss surgery. So learn it, test it, feel it, but, most important, measure it.