WLS Rules of the Pouch


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The Most Important Weight Maintenance Tools

I’m always astounded when a WLS patient tells me they’ve never heard of the Rules of the Pouch. These rules are a basic and extremely important set of tools that weight loss surgery gives you.

This surgery is like a supercharged vehicle that will help you win the race to the goal line of weight loss. And it gets you there fast with very few pit stops along the way. But the rules of the pouch are your maintenance guide. This hybrid supercharged vehicle  has very specific guidelines on how you can drive and maintain your vehicle to get the best performance. If you ignore these guidelines your vehicle will falter, break down, and fail you.

You can find the Rules of the Pouch in many places including at the back of my book and at various places on the web. But I’d like to go over those rules with you here. There are numerous versions but the one I use is courtesy of UW Health Bariatric Surgery Program, ©University of Wisconsin Hospitals and Clinics Authority. My alma mater!

  1. Meals must be timed about five hours apart or you will become too hungry.
  2. You should eat your entire meal in 10-15 minutes. This is contrary to what we told you immediately after your operation. While your pouch was healing, we emphasized tiny bites, thorough chewing, and long mealtimes (30-45 min.). Now that your pouch is mature and your appetite has returned, eating quickly will help you restrict your intake effectively. Eating too slowly means your pouch is already emptying before you finish eating and you can eat much more at one sitting.
  3. No liquids with food or for one and a half to two hours after eating. Fluids wash your meal out of your pouch. Delaying fluid consumption for this amount of time after filling your pouch allows your pouch to remain full for a longer period of time.
  4. After two hours, begin slowly sipping fluids and gradually increase the amount until shortly before your next meal. You still need a minimum of 64 oz (8 cups) of fluid a day or more depending on your level of exercise or activity and temperature.
  5. Water loading can help you buy time and ward off your appetite between meals. Drinking as much water as fast as possible will produce a strong sense of fullness. This should last for about 20 minutes.

When someone comes to me who is struggling with weight gain, I ask them how they apply the rules of the pouch. It’s not the whole answer to weight maintenance but it is an excellent place to start and sometimes the key to getting back on track.
Momentary lapses happen to all of us. Don’t beat yourself up. Just get back to your good habits and follow the rules! They work!

What part do the Rules of the Pouch play in your weight maintenance lifestyle?

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