If you have had weight loss surgery, there are likely to be times you feel that your eating has gone a little off-track. This is completely normal as it is part of learning how to live in the longer-term with your surgery to manage your weight. You may have looked to support groups or social media for advice. I bet if you have, you will have seen mention of ‘’pouch reset’’ diets. These are often described as a way for people to ‘’shrink’’ or ‘’reset’’ their stomach pouch after weight regain.
What are ‘’pouch reset’’ diets?
They are based on the idea that if you follow a very strict liquid and soft food diet, similar to the one you followed immediately after your weight loss surgery, over a few days or weeks, your stomach will supposedly return to its immediate post-surgery size.
Pouch reset diets are not helpful or scientifically valid, and here’s why…
We can’t reset our stomach size
You will have experienced a heightened sense of restriction for a while after surgery, this will be because of the more intense gut hormonal changes after a gastric bypass or sleeve gastrectomy, and also part of the immediate physiological response to bariatric surgery.
The stomach pouch does not ‘’stretch’’ or ‘’shrink’’ drastically in a short period of time.
Over time after weight loss surgery the stomach may enlarge slightly as part of a natural healing process, but the idea that it can be reset through dietary restriction is not realistic.
Quick-fix Vs long-term change
The ‘’pouch reset’’ diets are usually very restrictive, consuming mostly liquids and soft food. This may lead to short-term, temporary weight loss due to fluid loss and caloric restriction; it is unlikely that it is something you can, or would want, to continue. Nor does it address the long-term habits that lead to weight regain.
The core elements to managing your weight in the longer term after bariatric surgery are:
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sustainable eating patterns that work with your surgery,
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conscious and mindful eating habits,
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sufficient fluid, and
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physical activity.
Our habitual eating patterns have a much greater impact on body weight and metabolic status.
Risk of Muscle Loss and Nutrient Deficiencies
When we severely restrict our diet for an extended period, we risk nutrient deficiencies and losing muscle mass.
You may remember the advice from your surgical team after surgery was to ensure you prioritise protein, fibre and you have a good range of food. You are at risk of nutrient deficiencies after a gastric bypass or sleeve gastrectomy, anyway, so severely limiting your food intake increases this risk, negatively impacting on your metabolic health.Muscle tissue is metabolically active which means it burns more calories at rest than fat tissue does. When we follow a very restrictive diet, the reduction in muscle mass which occurs can slow down our metabolism, making it easier to regain weight.
‘’Pouch reset’’ diets focus on quantity not quality
Rather than focusing on the quality and variety of food which is important for both long-term sustainability and health ‘’pouch reset’’ diets focus on reducing the quantity.
Our bodies are designed to have fluctuations in energy intake week-to-week or month-to-month. This is normal and believed to promote good metabolic health. Remaining overly restricted for long periods of time has shown to increase weight.
Metabolic adaptation
When we experience significant caloric restriction, our metabolism adapts to this by slowing down which makes weight loss harder.
This is why very restrictive or crash diets, such as a ‘’pouch reset’’ diet can actually make it harder physically to manage weight after an initial weight loss.
Emotional and psychological impact
For many people, ‘’pouch reset’’ diets repeat an old cycle of yo-yo dieting that may have been problematic before surgery. This pattern of restriction is typically followed by a period of overeating and is associated with disappointment, frustration, a sense of failure and shame. Often when this occurs after surgery it can feel even harder because people can feel that they failed at what they had considered was their last-ditch attempt to manage their weight.
Lack of evidence
Despite ‘’pouch reset’’ diets being popular with people who are searching for a way to manage weight after bariatric surgery, there is no substantial scientific evidence to support the idea that you can physically alter the stomach pouch through diet. The idea is largely based on anecdotal experience, not clinical research. Rather than it being helpful in the long run, it often causes more difficulties with eating patterns.
What you can do instead
Rather than following a ‘’pouch reset’’ diet, managing your weight after bariatric surgery benefits from focusing on the 4 pillars:
1. Food:
- Prioritise protein, vegetables and healthy fats as well as alternating the amount of carbohydrates you are having from day to day.
- Learn which foods are slider foods for you and which foods enhance your satiety.
2. Fluid:
- Make sure you are drinking enough and regularly enough. It is very easy to become dehydrated after weight loss surgery.
- Be careful with the amount of alcohol you are consuming; your tolerance and sensitivity will be different after weight loss surgery.
3. Attention:
- Keep focused on your food to ensure that you don’t slide into eating on autopilot as we can end up eating more and feeling less satisfied if we stop paying attention.
- Notice when you are eating from reasons other than gut hunger. For example when you’re bored, tired, stressed or as a way of managing other emotions. Consider other ways to meet these needs instead of food.
- Remind yourself to slow the pace of your eating: chew your food well, enjoy the taste and texture and pause between mouthfuls.
4. Activity:
- Incorporating physical activity into your everyday routine helps to support muscle mass and metabolic health.
- Consider the level of activity that is right for you, based on your physical health.
you’ll be very focused, and sometimes you will find yourself back in older eating patterns. This is absolutely normal. The problematic part to this is when you become critical of yourself and feel anxious that you have ‘’blown it’’.
And remember, you don’t have to do this alone. Research has found that working with your surgical team helps to improve your outcome.
Nutritional needs vary considerably. Occasionally it’s useful to re-assess your individual needs; focusing on food quantities, micronutrient composition and food timings. Our expert dietitians can work alongside you to plan a nutritional approach that is specific to your needs, not a ‘one-size-fits-all’. Working with a clinical psychologist will help you to explore the barriers that might be getting in your way.
As much as you might wish that a quick-fix approach like a ‘’pouch reset’’ diet will solve the issues that you are struggling with, you will be more likely to achieve lasting weight management and overall health improvements if you find habits that you can sustain.
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