Studies done by leading surgeons in the field of Bariarics show that regardless of the pouches ability to stretch, if care is taken during the first two years after surgery, during the crutial healing and stretching time for the pouch, the common factor in successful weight loss maintenance is the ability to control hunger. 

Studies were done by Dr. Flanagan, which proved that no matter what size the pouch was after the two year healing period, the common thread that connected the success of weight loss patients was the ability to use their pouch tool effectively making necessary life style changes, maintaining satiety.

Dr. Latham Flanagan, a leader in the field of Bariatrics, says, "The implication is clear that learning how to use the pouch/tool effectively is important and it is our responsibility as bariatric surgeons to see that effective teaching is made available to our patients over this two year period of changing intake and satiety control. In brief, the Cottage Cheese Test data tells us that within the context of a small meal volume, lifestyle change including exercise is the most important variable. The stepwise progressive growth in the functional pouch volume (meal size) probably defines the rate of weight loss for the patients taken as a whole, but the degree of weight loss and maintenance for the individual patient is more dependent upon that patient's ability to make the required lifestyle changes: proper use of the pouch/tool and adequate amounts of activity and exercise."

THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY

1. The pouch needs to be truly filled with adequate wall distention with each meal (i.e. no snacking).

2. Keep the pouch filled over time and slow down the emptying time (by eating solid foods and avoiding liquids for fifteen minutes before and one and one half to two hours after eating. We understand this to be the most important lifestyle change after the gastric bypass procedure.

In a standard gastric emptying test using radioactive sulfur with a scrambled egg, bread, and milk indicates the following results: milk: 90% of the meal volume has exited the stomach within forty-five minutes. However, without the milk, only 45% of the meal has exited the stomach by ninety minutes.

3. Finally, adequate protein with each meal. We emphasize three meals a day including breakfast (defined as the first meal of the day which is eaten within one to two hours after arising). We define the "enemy" as high calorie liquids. We point out that snacking and high calorie liquids cheat the patient because the calories are taken in without offering significant satiety.

Full meals, which means, enough food to fill the pouch and not snacks which do not fill the pouch fully can be the key to satiety.  In between meals, water is used to maintain satiety in a technique known as "water loading".  Keeping the pouch full as long as possible after eating a meal and knowing how to keep your pouch full between meals with water seems to be a great tool for successful weight loss, along with healthy life style changes.  

For more info see post entitled "wet your whistle".

Yes, we can, we have many more miles to go!