When you have weight loss surgery, there is sometimes this notion that you will no longer be hungry after bariatric surgery. It is normal not to have as large of an appetite after bariatric surgery. But experiencing constant hunger may signal something else is going on.
A significant portion of your stomach is removed when you have bariatric surgery, particularly the gastric sleeve, gastric bypass, or duodenal switch. When we remove a large part of your stomach, we also remove the cells that live in the stomach lining and control hunger (ghrelin and leptin). So, the conversation between your gut and your brain will change after surgery.
It is normal not to feel as hungry after bariatric surgery as your body adjusts to the new system and figures out how to send those hunger signals to the brain.
Feeling hungry after bariatric surgery is not a bad thing; that is only your body talking to you and letting you know it needs something. However, excessive hunger is different, and there are several ways to control your appetite post-operatively.
Reasons you are Hungry after Bariatric Surgery
1. You aren't eating enough.
One of the most obvious reasons you may be hungry after bariatric surgery is you are not eating enough calories and nutrients throughout the day. After surgery, many patients do not eat enough calories, partly because of their reduced pouch size.
Yet, some patients are trying to restrict too much, which can make them feel hungry after weight loss surgery. After surgery, bariatric dietitians and programs recommend eating about 1,200 calories a day. Of course, that is different per person based on your level of activity, your gender, and your body composition. However, if you are more than one-year post-op, your caloric needs may have shifted due to hormones, your activity levels, and your biological set-point.
Restricting your calories too much can actually be detrimental to your weight loss goals. Restricting your calories too much can trick your body into thinking it is in starvation mode, so when you do eat your body will hold on to those calories as fat.
If you believe your hunger is coming from not eating enough, we recommend you begin tracking your daily food intake. You may be shocked to find you are eating less than 1,000 calories a day. Tracking your food intake will also be of assistance when talking with your bariatric care team to get your hunger cues more regulated.
2. You aren't eating enough protein.
Once you get your caloric intake under control, it is important to look at what you are eating. When we dig into a patient's hunger, we find that sometimes they are eating 1,200 worth of grains and carbs, which are not keeping them satisfied.
If a patient eats 1,200 calories, heavily concentrated on protein and fiber, their hunger will likely subside. Higher protein intake helps with hunger because protein takes longer to break down, and it also fuels your body to give it better energy vs. quick energy.
Protein is a critical component of the post-bariatric patient's diet. It is recommended that patients eat 80 to 100 grams of protein a day to "plug the pouch." Many studies have found that high-protein foods keep patients full for extended periods. Additionally, since protein only has four calories per gram (compared to 9 calories per gram for fat), eating a protein-dense diet will aid in weight loss.
3. You aren't eating enough fiber.
Fiber is a type of carbohydrate that your body can not digest. It is another nutrient that keeps you full longer and keeps you feeling satisfied. Sources of fiber will come from whole grains, wheat bread, whole-wheat pasta, oatmeal, vegetables, and fruits.
The fiber and fibrous foods help to add bulk and volume to your diet. So if you are feeling extra hungry after bariatric surgery, fibrous foods can help to fill you up with the size of the vegetable and also slow digestion to keep you feeling more satisfied for longer.
4. You are thirsty.
Another thing to consider is hydration. Sometimes it is easy to confuse hunger with thirst. After bariatric surgery, we recommend all patients drink at least 64 ounces of sugar-free liquids a day. This will also help to subside the hunger between meals.
5. It’s head hunger.
The last piece to remember is that sometimes when you are hungry after bariatric surgery, it is, in fact, head hunger. We do surgery on your stomach, not on your brain. So your brain has to play this catch-up game.
Your brain is used to seeing larger portions on your plate, so when you see a smaller plate after bariatric surgery, it can seem like you are not eating enough. This can trigger a “hunger” that is not physical but mental.
It is critical to make sure you take the time to work with your bariatric psychologist to overcome some of the worries surrounding portion sizes and food insecurities.
What to Do Next
If you are still feeling hungry after bariatric surgery, despite meeting all your nutritional recommendations, we suggest you meet with your physician or healthcare providers. They may be able to help you figure out different options to help reduce your excessive appetite.
In some cases, your hormones may be off balance, which can cause you to be hungry after bariatric surgery.