Hello, I am new here and don't know where or how to post things to ask the Dietician - but here is my story and I need help please.

I had Laparoscopic Sleeve Gastrectomy August 6th, 2019. My surgeon and nutritionist said being almost 2 years out of surgery, my stomach should be able to hold 8 ounces in volume or 1 cup of food at a time (but obviously if I get full, don’t eat the whole thing) When I first started this journey, I had the Laparoscopic Sleeve Gastrectomy on August 6th, 2019, they said only eat 4 ounces of food for a meal three times a day. I did that and weighed my food at 4 ounces on my kitchen scale. Then a year and a half out they tell me no, I need to go by VOLUME and not by weight or else I will stretch my stomach! I feel like I am limited in what I can eat now because how do I make a sandwich fit in a measuring cup or a piece of pizza (which I no isn’t nutritious..) but just using those as an example for size. In addition to the whole volume thing, what about foods that expand like breads and crackers and pasta? How do I measure their volume? If I figure out the volume of something like that should I take away some of the food item that will expand, so I do not go over the volume? For example: If I make a sandwich that is a perfect half cup in volume, should I remove some of the bread because if it expands it will be more that that half of cup? I hope that makes sense. I have lost 230lbs since August 2019. Now I have to learn how to reeat again, because I don’t know how to measure volume without putting it into a measuring cup. I find conversion calculators online, but they give me different answers. I thought, well if my kitchen scale says 4oz in weight am I able to find the fl oz of that without smushing it? I don’t know what is accurate? Weighing was so much easier, but now I am told volume and that it has to fit into a measuring cup, but how do you put a meal in a measuring cup? Right now, I eat 3 meals a day at 1/3 cup volume measuring cup per meal and with 1 – 2 protein shakes for the day in between my meals. I eat a meal at around 6am, 12 – 1pm, and around 6 – 6:30pm. I get full on only a few bites of my 1/3 cup food or what I think fullness is so I don’t always finish even that.
My hunger signals and fullness signals are all screwed up. And I don't know if it is all in my head?

Thank you so much for your time. I truly appreciate it. I try asking my nutritionist and surgeon these things and they say they don’t know how to answer them – just make sure you don’t stretch your sleeve and go over the volume! I try to stay at 1/3cup volume per meal, because I am afraid of stretching my stomach out now. Maybe one day I can go up to 8 ounces in volume I hope because my meal choices have become really restricted because I can’t mush them into a measuring cup and what I can doesn’t seem worth it because If I wanted to enjoy a little something sweet, it barely fits in the 1/3cup – so why bother. Then that makes me sad. I originally weighed 352lbs and now I am 119lbs.

I also spoke to someone who said that after I lose all of my weight that it doesn’t matter if I overeat and stretch my stomach back out any more just as long as I stay within 1,200 calories, 120 carbs, and 90g of protein? Is that true? My hunger and fullness signals are really difficult for me to tell apart and I have a severe anxiety over stretching my stomach (that I am trying to seek help for). But if the whole “It doesn’t matter if your stomach stretches back to normal” is fine and I watch my nutrition, is that ok? I feel like that would be giving up and taking the easy way out because I “like food more than blah, blah, blah, and just want to eat..” I am afraid of going back to old habits because I love bread and sweets. It scares me to gain any of my weight back because I don’t want to be one of those where people say, look at her – you can’t even tell she had weight loss surgery because she gained it all back! I made this big decision, this massive life change and accomplished a great weight loss, but now am I giving it all up? All because I miss food and want to eat in between meals. Right now I am so hungry or head hungry, but not physically hungry, but head hungry enough I think I want to eat something.

I need help tp get on track and figure some things out please? I don’t know what else to do and I am so utterly lost. My surgeon tells me to ask my dietician these questions because he doesn’t know how to answer them – he just preforms the surgery. My dietician told me to go by weight, then volume and now she’s telling me not to weigh or measure at all just to go by how I am feeling? Well sometimes I feel I can eat a lot. I am not getting the support from them I need and I just need someone to have patience and understanding and who is kind to work with me please. I am sorry if this is a lot of information to take in. I don’t mean to go on a rant. I am just so confused. I am going to see a therapist, but the whole stretching my stomach thing is a real fear. I also had complications after surgery with bleeding that I am told may have given me PTDS..

IMHO ...

For someone who has been successful this seems like a lot of extra grief to switch over the way you measure your food.

If it were me, I would talk to my team again and tell them I need help with this specific issues because it’s confusing.

Good Luck ❤️

Thank you, they told me I was a patient for life when I started this journey. Now I am facing financial difficulties and they say I am beyond their help anymore if I cannot pay and because my fear of stomach stretching is repetitive. My nutritionist told me I could reach out to her whenever through mychart, but now this one nurse intercepts my messages and doesn't let me speak to her...

I think at this point, you need to develop a more common sense approach to this. It sounds like you know what you should not be eating and need to focus on what you can eat and track that as accurately as possible. I am attaching my Boot Camp document again...which in the final stage says to eat three 4 oz high protein meals, plus two servings of vegetables, two servings of fruit and three servings of complex carbs. Get a tracker like My Fitness Pal and track your intake. I do NOT think you need to "smoosh" things into a measuring cup, you should be able to "eyeball" a cup or quarter cup of food, or weigh it.

Good luck and I hope you can find something that works for you!

Post Op Diet Boot Camp.pdf

hmmmm....if it ain't broke, why fix it?

From what you've posted sounds like you are already doing/have done just fine for your own personal experience.

That feeling you get when you can't eat anymore is what will prevent your "stomach from stretching" (though I have some thoughts on the misconceptions of this in another vein...but I digress). Sounds like you are listening to your "signal" and are stopping before you get too full. Which is a behaviour that many struggle to learn and implement. You are doing great.

Here is a good reference that I like to use -

You don't need to follow his dietary guidelines, but I do find that his progression on meal volume over time is consistent with my experience. In short, some increase in volume capacity is to be expected and is normal. Call it stretching, adaptive growth (the body will adapt to the changes that surgery has imposed upon it, like it or not) or a more varied diet that includes more slippery foods that move through rather than stay in the stomach, or more likely, a combination of all three.

On the volume vs. weight issue - a basic physics lesson to start with. When measuring water, an ounce of volume weighs an ounce - that is a definition and is the basis of our measurement system (similarly, a ml or cc of water weighs a gram in the metric/SI system. Most of our food is mostly water (as indeed, we are,) so on average, an ounce of food by volume will weigh about an ounce, give or take maybe 20%, and over the different components of a meal meat, fruit, veg, starch, etc. - should about average out to about one for one.

Another consideration is that the important thing to your stomach is what the volume is when it hits your stomach, not when you put it into your mouth before you chew it and soak it in saliva. Once that is done, you have a blob (bolus) hitting your stomach that will be about, wait for it..... and ounce of volume that weighs about an ounce. This really saves you from agonizing over how to measure a cup of spinach - how big a leaf, chopped or whole leaf, how finely chopped, how densely packed into the cup...?

Dr Weiner in the video above notes that we ultimately, on average, will be able to consume in a meal about half of what we could before surgery which is consistent with my experience ten years out, and in looking at others whom we dine with in our support group (pre Covid) who are all in the 10-20 year out range, and most every one is taking something home or leaving it on their plate, so some increased volume is normal. The tricky part is keeping your caloric intake steady as this volume increases over time - you still need to keep it at 1200,1500, 2000 calories - whatever level keeps your weight stable.

27 minutes ago, ms.sss said:

hmmmm....if it ain't broke, why fix it?

This right here

1 hour ago, Jaelzion said:

This right here

I have lost all of my muscle and cannot lift a ream of paper into the copier at work and barely go up stairs no matter how much I exercise my strength is gone. I miss food from overly restricting, but my fear is so great. I faint, pass out and can count all of the bones in my body. My arms and legs get numb and tingly and my hands and feet turn red and purple and I freeze! I eat 1/3cup 3 times a day and don't eat anything in between. I know something is wrong I am just afraid to fix it.

4 hours ago, GreenTealael said:

IMHO ...

For someone who has been successful this seems like a lot of extra grief to switch over the way you measure your food.

If it were me, I would talk to my team again and tell them I need help with this specific issues because it’s confusing.

Good Luck ❤️

Thank you for your kind response. I am trying everything I can?

1 hour ago, RickM said:

Here is a good reference that I like to use -

You don't need to follow his dietary guidelines, but I do find that his progression on meal volume over time is consistent with my experience. In short, some increase in volume capacity is to be expected and is normal. Call it stretching, adaptive growth (the body will adapt to the changes that surgery has imposed upon it, like it or not) or a more varied diet that includes more slippery foods that move through rather than stay in the stomach, or more likely, a combination of all three.

On the volume vs. weight issue - a basic physics lesson to start with. When measuring Water, an ounce of volume weighs an ounce - that is a definition and is the basis of our measurement system (similarly, a ml or cc of water weighs a gram in the metric/SI system. Most of our food is mostly water (as indeed, we are,) so on average, an ounce of food by volume will weigh about an ounce, give or take maybe 20%, and over the different components of a meal meat, fruit, veg, starch, etc. - should about average out to about one for one.

Another consideration is that the important thing to your stomach is what the volume is when it hits your stomach, not when you put it into your mouth before you chew it and soak it in saliva. Once that is done, you have a blob (bolus) hitting your stomach that will be about, wait for it..... and ounce of volume that weighs about an ounce. This really saves you from agonizing over how to measure a cup of spinach - how big a leaf, chopped or whole leaf, how finely chopped, how densely packed into the cup...?

Dr Weiner in the video above notes that we ultimately, on average, will be able to consume in a meal about half of what we could before surgery which is consistent with my experience ten years out, and in looking at others whom we dine with in our support group (pre Covid) who are all in the 10-20 year out range, and most every one is taking something home or leaving it on their plate, so some increased volume is normal. The tricky part is keeping your caloric intake steady as this volume increases over time - you still need to keep it at 1200,1500, 2000 calories - whatever level keeps your weight stable.

Thank you for all of this information. I can't wait to go home tonight and watch this. My head hunger is bad and I miss eating a snack every now and then. I was perfect my first year and a half until they said, no we mean volume, not weight. Now I have a horrible fear of stretching my stomach that I am making myself sick and I miss eating and don't know how to stop this.

4 minutes ago, Mckennajaims said:

I have lost all of my muscle and cannot lift a ream of paper into the copier at work and barely go up stairs no matter how much I exercise my strength is gone. I miss food from overly restricting, but my fear is so great. I faint, pass out and can count all of the bones in my body. My arms and legs get numb and tingly and my hands and feet turn red and purple and I freeze! I eat 1/3cup 3 times a day and don't eat anything in between. I know something is wrong I am just afraid to fix it.

Ok, i take it back. I incorrectly assumed you were living a way of life that was satisfying and “working”. Aside from continuing to ask for guidance from your team (who I realize is not being very helpful for you!). Can you align yourself with an alternate Bariatric team? Also, I’d like to suggest some therapy if you are willing and able...

8 minutes ago, Mckennajaims said:

I have lost all of my muscle and cannot lift a ream of paper into the copier at work and barely go up stairs no matter how much I exercise my strength is gone. I miss food from overly restricting, but my fear is so great. I faint, pass out and can count all of the bones in my body. My arms and legs get numb and tingly and my hands and feet turn red and purple and I freeze! I eat 1/3cup 3 times a day and don't eat anything in between. I know something is wrong I am just afraid to fix it.

I'm a newbie so not a ton of experience to share, and I'm not trying to sound preachy.... but maybe you need to seek out a therapist as it seems like your fear might be turning into an eating problem. From this response, it seems like you aren't eating nearly enough. I'm well over that amount and I'm only a month from surgery.

Yes, it sounds like you have psyched yourself out of eating...bordering on an eating disorder. Forget about volume and eat a healthy diet that includes protein, some veggies, some complex carbs. If you can find a therapist or bariatric team to give you guidance, please do. Are you at goal, close to goal? If so, it is even more important to focus on being healthy and rebuilding your energy and zest for life.

PLEASE take care of yourself!!

On 4/6/2021 at 12:35 PM, Mckennajaims said:

I have lost all of my muscle and cannot lift a ream of paper into the copier at work and barely go up stairs no matter how much I exercise my strength is gone. I miss food from overly restricting, but my fear is so great. I faint, pass out and can count all of the bones in my body. My arms and legs get numb and tingly and my hands and feet turn red and purple and I freeze! I eat 1/3cup 3 times a day and don't eat anything in between. I know something is wrong I am just afraid to fix it.

Oh I see! With that additional information, things are very much broken. My best advice would be to seek a therapist, preferably one that has experience treating bariatric patients or people with eating disorders. This state of affairs is unsustainable and won't end well.

Thank you all for the advice. I greatly appreciate your input on what to do. My bariatric support team is broken and I am stressing my family out so much. My providers said if i went back to weighing on a scale and not by volume that I would stretch my sleeve. I feel like my body is accustomed to this 1/3c now because now I can barely swallow only a few bites of solid food without it hurting my chest and I am losing more weight. I always wanted to be "pretty and skinny" ?‍♀️?‍♀️ and now I can count all of my bones and look like a Halloween skeleton. I poked myself the other day and was like ow what'd I hit?! ...JUST A SHOULDER BONE!???
I missed bread so I found these mini Bob Evans bread and sausages, they're tiny about the size of my 1/3c. Mentally I thought I'd start slow because I don't remember the last time I ate bread and that went down just fine but made my abdomen feel full of air and the sausage was good. I couldn't finish it though even though I was still hungry because the way my stomach felt. I was excited to eat more and I couldn't even finish it. I couldnt even finish cottage cheese because I felt full and the dairy didn't set well