As I mentioned in Satiated vs Stuffed, satiety isn't the same thing as being full. Full means your upper stomach has hit its max capacity — you've overeaten again, an old habit that got you big enough to qualify for weight loss surgery in the first place. Satiety is what you feel on your way to being full. With a properly adjusted band, you'll be comfortable if you stop when you're satiated. Eat until you're full? That's where the trouble starts.
This is the third article in the Satiety 101 series, and here's what we're doing: I'm going to walk you through the signals your body sends when you're satiated. But that's only half the battle. The other half is actually listening to those signals instead of ignoring them. That topic could fill a whole book — which I might write someday. For now, let's focus on recognizing your own personal Stop Eating Signals.
Because of where the band sits anatomically (right near your diaphragm, pressing on the vagus nerve at the top of your stomach), its presence can give you quick feedback about how you're eating. Not the band itself — remember, it's just an inert piece of plastic with zero magic inside — but its position. The feedback comes in a language your brain understands, with help from your endocrine and digestive systems. Even if you bombed high school French, you're going to need to learn how to get directions in this new language, so you don't end up on Weight Gain Road instead of Weight Loss Avenue. Those directions come as what I call Soft Stop and Hard Stop signals.
To pick up on those directions, you'll need to slow down and actually pay attention while you eat. It takes 15 to 20 minutes for satiety signals to travel to your brain and get broadcast back to the rest of you. If you usually eat with other people — family, friends, coworkers — try eating by yourself for a few meals so you're not distracted. Stop signals can be subtle, and they can show up from unexpected parts of your body. Trust me, it's better to heed a gentle reminder than wait for a hammer to the head.
SOFT STOPS are your early warning system — gentle reminders from your body that it's time to wrap it up. They don't hurt much, which makes them easy to ignore. They include:
· Mild queasiness (an icky feeling, but not about-to-vomit)
· Fullness or pressure in the back of the throat
· Pressure in the chest or just below the breastbone
· Throat clearing
· Some difficulty swallowing
· Burping (or the urge to burp)
· Taking a deep breath
· Mild coughing
· A sigh
· Hiccups
· Watering eyes
· Runny nose
· Left shoulder pain
· A sneeze
· More saliva in the mouth than usual
· A sudden distaste for the food you were enjoying a moment before
As soon as you notice any of these signs, stop eating! I don't care what your stubborn mind is telling you — that it's fine to keep going because you have room for one more bite, or the food tastes good, or you haven't cleaned your plate, or you deserve it, or whatever story it's spinning. If you keep eating past this point, you're not changing your behavior, and you're probably headed for trouble. Specifically, a hard stop.
HARD STOPS are like running into a brick wall. They can seem to come out of nowhere, but usually you've blown right past a soft stop before you hit the wall. Hard stops are painful — and sometimes embarrassing — reminders that you ate too much, too fast, in bites that were too big, without chewing enough. They include:
· Chest pain and painful pressure or tightness in the chest
· Feeling like you have a rock in the back of your throat
· A burning sensation in the throat
· A "stuck" feeling, like the food has nowhere to go
· Productive burps (PB's) — regurgitation, kind of like how a baby spits up milk
· Sliming (so much excess saliva and mucus you have to spit it out)
When you hit a hard stop, STOP EATING. Seriously. Do not keep eating, even if the discomfort fades and your plate still looks tempting. You might feel fine and you might even be able to eat more, but you should not. The hard stop has already irritated your upper GI system. Continuing to eat just makes the problem worse, and you'll end up in a nasty cycle: eat, hard stop, pain — eat, hard stop, pain. Cycles like that can lead to band slips, esophageal dilation, and stomach dilation. That's why I recommend a liquid diet for 24 hours after a hard stop episode, then ease back into pureed, soft, then solid food.
If you're anything like me, you didn't get weight loss surgery so you could live on liquids forever. That's another reason to learn how to prevent hard stops in the first place — so you can eat and enjoy real food at every meal.
One last thing before the bell rings and today's class wraps up. You might not experience all — or any — of these stop signals every time. You could get one signal at breakfast and a totally different one at lunch. At dinner, you might not notice any stop signal at all. And as time goes on, as you lose weight and the amount of saline in your band changes, your stop signals can change too.
I know that sounds frustrating. But here's the upside — it forces you to keep eating slowly and carefully for the rest of your life. And honestly, that's good practice for anyone, banded or not. That plate of food in front of you is a blessing that some people in this world can only dream of. Those small portions might look puny to you, but they'd be a feast to someone else. So treat your food, and your body, with the care they deserve.
Learning to recognize satiety is an ongoing process, because our bodies aren't marble statues. We're all wonderfully weird, one-of-a-kind, complicated creatures who change by the minute, every day of our lives. Click here to read about how those changes can affect soft and hard stop signals. http://www.bariatricpal.com/page/articles.html/_/support/post-op-support/restriction-riddles-r93
This is the third and final article in the Satiety 101 series of articles.
Related: SATIETY 101: Satiety & The Restriction Myth
I talk about satiety a lot. Why? Because recognizing satiety is absolutely critical to weight loss success and good health, no matter what bariatric surgery you've had. Satiety is the sensation of having eaten enough food. Understanding it is so important that I'm splitting what I have to say into three Satiety 101 articles. This is the first one.
Let me ask you something. Do you think your properly adjusted band will restrict how much you can eat, so you take in fewer calories and lose weight? I get it — somebody probably told you that. Maybe more than one somebody. Maybe even your own bariatric surgeon. The idea is that the adjustable gastric band works by creating a small stomach pouch that restricts how much you can eat. But here's the thing — it's way more complicated than that, and thinking of the band as a "restrictive" method does bariatric patients a real disservice.
The whole notion of restriction is a myth. It's a holdover from earlier days, before we fully understood how the band actually works. After nearly 30 years of clinical use and studies, band manufacturers and bariatric surgeons are starting to realize that the old "restrictive" idea isn't just wrong — it can cause a bunch of unpleasant and sometimes dangerous side effects and complications. We're talking band slips, esophageal dilation and achalasia, pouch dilation, disappointing weight loss. And some of those complications can cause permanent damage.
Here's what actually happens. If you swallow a few bites of barium-coated food (appetizing, right?), fluoroscopy shows that food passes through the upper stomach pouch, right past the band, and into the lower stomach pouch within minutes of each swallow. You can keep eating pretty much like you did before surgery — fast and furious. (When food doesn't make that trip quickly, it might mean the band is too tight and needs fluid removed.) That quick transit also means you can eat way more than you need, just like before. The bariatric medical community is finally catching on: the band isn't restrictive. It works by reducing physical hunger — the need to eat — and appetite — the desire to eat. It creates early and prolonged satiety, so that you, not the band, can reduce your food intake.
Let me say that again, this time from the perspective of someone who lived with a Lap-Band® for five wonderful years. It's up to you, not the band, to make it work. Your band is an inert, expensive piece of plastic. It doesn't limit how much you eat. It doesn't know your name or that you hate broccoli. It's not going to jump out of your mouth and knock the fork out of your hand when it's time to stop. No alarms, no flashing red lights. It's not going to yell, "Jean McMillan! Stop eating right this minute!" (OK, in that last one, the band sounded a lot like my mom.)
Seriously, though. One of your jobs as a successful bandster is learning when and how to stop eating — all by yourself. The "how" part is a huge topic, not just for WLS patients but for anyone trying to lose weight and stop wasting food. It's way too big for this article. So for now, let's focus on the "when." We'll tackle that in the second article in the Satiety 101 series: Satiated vs Stuffed. Stay tuned!
This is the first in the Satiety 101 series of articles.
Related: SATIETY 101: Satiated vs Stuffed
When I was a new bandster, it took me a long time to even pay attention to my eating, let alone figure out when to stop. And honestly, no wonder. For over 50 years, I ate mindlessly, greedily, endlessly. Every single day, every meal, every moment — I ate until I hit what I call Thanksgiving Dinner Full. I loved to cook (still do). I loved to eat (still do). My job had me traveling all over the world, and in every country I got to enjoy a huge variety of amazing food. Occasionally the food was pretty strange — I can't recommend the lightly grilled, still-wriggling sea slug I tried in Taiwan — but I was always game for a culinary adventure.
Here's the irony. During those overseas trips, I saw true hunger, deprivation, and near-starvation up close. What I ate in one day back then could probably feed a whole family for a week. In Southeast Asia, I once met a new business associate for the first time. We talked shop for a while, and then he said something that caught me totally off guard: "Your family must be very wealthy."
I said, "Uh, not especially."
He smiled at my modesty, gestured at my size 24 body and said, "But it is true, because I can see that you eat very well."
That moment was mortifying on so many levels, as you can probably imagine. When I eventually left that career and started dealing with my weight and eating issues, I felt a lot of shame about how I ate — all the food I'd gobbled up in my never-ending quest for TDF. But how was I supposed to end that quest? How could I ever learn to stop eating before I hit the TDF level?
I was incredibly lucky to start my weight loss surgery journey soon after. Even luckier that my Lap-Band® became such an effective tool for eating less and losing weight. I thought I'd done a ton of research as a pre-op, but I have to laugh every time I think of a bandster friend who told me, "I had no idea how much work this was going to be." I had no idea either. Every bite of food, every sensation before, during, and after eating — it all became a big project.
If you're a new post-op, or even further out, are you discovering how much work this takes too? Maybe wondering, "What did I get myself into?" If so, that's totally normal. You're not alone, and you can succeed — even if it feels like it's taking forever.
OK, Jean. Enough already. Tell us: how do you know when to stop eating? Do you eat until you're full? What's "full" supposed to feel like now?
My answer to the first question is no. As a WLS patient, you don't eat until you're full. You should never eat that way again — not just because that's how you got big enough to qualify for surgery, but because eating that way will slow your weight loss and can cause nasty side effects and complications. So you need to find a new stopping point. That point is the satiety point.
Satiety isn't the same as being full. For a bandster, full means you've overeaten again. You'll be so uncomfortable you have to take a few breaths before finishing that plate like a good kid. (Which, by the way, is another habit you'll have to break.) Full means your upper stomach has reached max capacity and any second now, that food is going to back up into your throat and make an ungraceful exit — all over you, the table, and your dining companions. Full means you sped right past your satiety point. Full means it's time to pay much closer attention to how you feel while you eat.
Satiety happens on your way to being full. With a properly adjusted band, you'll be comfortable if you stop when you're satiated. Eat to full, and you'll be sorry. If you eat to the TDF point, you won't get that old familiar full-belly sensation that made you loosen your belt while waiting for Mom to bring you a slice of pumpkin pie.
Instead, you'll probably feel pressure — even pain — in your upper abdomen and chest. You'll produce enough excess saliva to make you drool. You'll think you're about to power barf. You'll be really sorry you overate. You'll promise God and your bariatric surgeon (who are not the same person, by the way) that if you can just get some relief, you'll never overeat again. And you'll need to learn some strategies to prevent another episode. In article #3 of the Satiety 101 series, "Recognizing Satiety," we look at some common signals your body gives you when you're closing in on the satiety point.
Related: Natural Fullness vs. Learned Fullness
Think about how full you feel after a meal. If you often feel too full or stuffed, you've learned to overeat. After surgery, you don't have room to overeat even a teaspoon too much. Finding your natural fullness means taking the time to slow down and chew well.
Natural fullness is when you feel comfortably full and satisfied with what you ate — and you know that a couple more bites would leave you a little overfull. It takes about 20 minutes of eating for your brain to recognize your stomach is full. When you slow down and chew to applesauce consistency, you'll feel full on less food.
Weight loss and better digestive health are benefits of practicing the skills that help you recognize natural fullness. We cover this with our patients during their first appointment with the dietitian. Learning to slow down and chew well will cost you some time and frustration, but the payoff — staying safe with your eating after surgery — is worth it.