Occasionally,  I see a gastric bypass and gastric sleeve patient who, after some time post-surgery, has started to regain weight.  Understandably she’s concerned, and often her  concern is that she can eat more than she did immediately after surgery.  This frequently leads to questions about the “pouch reset” diet.

Even with gastric bypass or gastric sleeve surgery, the volume of food a patient can consume after surgery will increase over time.  What you tolerate at one week will not be the same as it is at one month or at one year after surgery.  It does not, however, keep increasing until you can eat the same as before surgery.  The stomach is naturally a stretchy organ.  Surgery drastically reduces its ability to stretch but it does not eliminate it altogether.  Post-operatively, recommendations are generally to eat a high protein diet of foods that require chewing because this is what has been demonstrated to provide the most satisfaction for the longest amount of time.

The concept behind the pouch reset diet is a return to the strict liquids of the immediate post-operative period and then advancing to regular food over a shorter period of time (usually 5 days).  Advocates of the pouch reset suggest that this will shrink the stomach back to its original smaller size.  Not only is there no scientific evidence to support this theory, it doesn’t work.  Liquids do not provide the same satisfaction that a solid meal does.  You can expect to be hungrier during this diet, without achieving any weight loss benefit for the long-term.  If the pouch reset was a truly effective technique, it would be well-described in the medical literature, discussed at bariatric conferences, and widely used with bariatric patients, which it is not.   The solution to post-operative weight gain is to get back to basics with the food habits taught from the very beginning.  Think of it more as a mind reset.

Weight loss is hard, and often times when patients feel that they increased their food volume, when you dig a little bit deeper, it can be the re-introduction of foods that don’t follow the bariatric diet.   Many patients do not realize how important follow-up with their weight loss team is to their success, even a year or more out from surgery.  It is not uncommon for a patient to say that they “got too busy” or were “embarrassed” to come back to the office because they were gaining weight.  Never feel embarrassed, weight loss is hard work, and we’re always here to help.   Come in and meet with your surgeon, make an appointment to see your dietitian and visit our “Fall Back into Good Habits” blog post for some quick tips to get back on track.