According to the father of bariatric surgery, Dr. Edward Eaton Mason, a common misunderstanding about gastric bypass surgery is that “the gastric pouch” causes weight loss because it is so small. Because of this, many people come to the conclusion that the patient eats less. This principal holds true for the first six months following surgery, but it is not why the gastric pouch works for weight loss long term or how gastric bypass surgery works.
How the Gastric Bypass Pouch Works
“The gastric pouch” is made when part of the stomach is used to create a small pouch that is separated from the rest of the stomach and connected directly to the small intestine. Food enters the small gastric bypass pouch and exits directly into the intestines, bypassing the normal caloric absorption process. This is a simplified explanation of gastric bypass and suffices for the purpose of this article.
The gastric pouch is a tool that patients must learn to use to extend the feeling of being full until the next meal.
The gastric pouch is about the size of an egg. Dr. Mason found there is regular growth of the pouch for two-years after surgery on average. After the second year, pouches stop growing and end at 6-10 oz. capacity.
Dr. Mason compared the weight loss of people relative to their pouch size in order to determine if the size of the pouch made a difference in the amount of weight lost. His findings showed no difference in the percentage of weight lost and proved it is not the pouch size — but rather how it is used — that makes weight-loss maintenance possible. The truth is that the gastric pouch is a tool that patients must learn to use to extend the feeling of being full until the next meal.
The following are clinical observations how the gastric bypass pouch works:
1. Success requires that a small pouch is created with a small outlet. Using the thick, hard to stretch part of the stomach in making the gastric pouch is important.
2. Almost all patients always feel full 24/7 for the first months, then that feeling disappears.
3. Getting a sense of “fullness” with each meal is essential to success. Avoid grazing.
4. Regular meals larger than 1 ½ cups (12 oz) will result in eventual weight gain.
5. Lightly stretching the pouch with each meal sends a signal to the brain that the body doesn’t need any more food.
6. Maintaining a sense of fullness requires keeping the gastric pouch stretched for a while.
7. Incredible hunger will develop if there is no food or drink for eight hours (fasting).
8. ‘Soft foods’ empty from the gastric pouch quickly. ‘Heavy’ foods empty more slowly and thus make the feeling of fullness last longer. By eating “soft foods” patients will get hungry too soon and be hungry before their next meal. This can cause snacking that leads to poor weight loss or to weight regain.
9. Meat and slightly cooked or raw vegetables are good for you and empty very slowly from the gastric pouch.
10. Drinking water as much as possible and as fast as possible before a meal (“water loading“), will give the patient a feeling of fullness that lasts 15-25 minutes.
11. Patients who exercise regularly lose more weight and maintain weight loss longer.
12. Patients that participate in follow-up care and support groups have the best and most durable results.
13. The patients that follow “the pouch rules” lose their extra weight and keep it off.
14. The patients that lose too much weight can maintain their weight by doing the reverse of the “the pouch rules.”
Dr. Mason found that hunger returns in patients as early as three months after gastric bypass surgery, and in most patients it takes 6-months to 1-year. He stresses the importance of learning the “the pouch rules” after healing has caused hunger to return in order to prevent weight regain.
Living larger than ever,
My Bariatric Life
Photo: University of Rochester Medical Center