Because the neurohormonal, set point lowering effects of the Sleeve are less powerful, I tend to see less of a change in my patients’ food preferences after surgery. While both Gastric Bypass and Sleeve Gastrectomy patients are only able to eat very small portions after surgery, the Gastric Bypass patients tend to favor more natural, unprocessed foods and are disgusted by processed foods. Sleeve Gastrectomy patients tend to tolerate and even enjoy processed foods after surgery. This is a general observation and I certainly have seen profound and powerful taste changes in Sleeve Gastrectomy patients, but it tends to happen less often and to a lesser degree.
I believe that patients with a healthier starting diet tend to be better candidates for the Sleeve Gastrectomy. Because the Sleeve is less likely to change the types of foods that you prefer, those patients who already enjoy the healthy, unprocessed foods that make up the Pound of Cure program will find this program easy to follow postoperatively. Those patients who struggle to eliminate processed, sweetened foods from their diet preoperatively need more help in order to be able to make the necessary lifestyle changes after surgery. If you are struggling in your efforts to adopt the Pound of Cure eating style before surgery, I believe that you may benefit more from a gastric bypass since it will offer you more assistance in changing your food preferences.
I’ve also found that many people misinterpret the Sleeve as a purely restrictive operation that only works by reducing the amount of food that you can eat. The more important component of the surgery is the neurohormonal effects that work to lower your set point. This misunderstanding often leads to a postoperative eating philosophy that I often refer to as the “portion control trap.” Patients who fall into the portion control trap will often report to me that a few months after surgery, they have resumed eating some heavily processed foods like pizza or french fries, but only in very small portions.
Just like the gastric bypass, patients who undergo a sleeve gastrectomy will immediately be able to eat only very small portions of food in one sitting. However, as time passes, your portion sizes will increase. Patients who are six months out from their surgery will typically be able to eat twice as much as someone who is only three months out. There is a progressive increase in your ability to consume food that steadily increases over the first three to five years after surgery. Sleeve patients who are five years out from surgery can often eat nearly two-thirds of the portion size that they could tolerate before surgery.
Those who have fallen into the portion control trap find that the few bites of pizza that they are consuming at 3 months becomes a small slice after a year, two slices after two years and ultimately they find themselves eating three or four slices of pizza five years out from surgery. Eating three to four slices of pizza on a regular basis sets a patient up for a steady weight regain of 5-10 pounds per year.
While the portion control trap can just as easily occur after gastric bypass surgery, the extra neurohormonal., set point lowering effects offers patients more assistance in not just eating less, but eating better after undergoing a gastric bypass surgery. An improvement in the quality of your diet is the most critical ingredient to finding lifelong success and self awareness of your own struggles to choose the right foods is critical to making the right procedure choice.