The ESG operation is designed to help you lose weight by restricting your food intake and increasing your sense of satiety (fullness) so that you feel satisfied from eating less. It also acts by reducing the absorption of food from the upper part of the small bowel. The sleeve will be a tremendously powerful aid to weight loss but if you expect it to do all the work, you are going to be very disappointed.
This stage is really the start of learning how to work with your sleeve developing lifelong healthy eating habits to achieve your health and fitness goals. You must leave soft, sloppy food in the past and discover solid textured foods that remain longer in your stomach to stop you from feeling hungry.
Recognising the full feeling
You must learn to recognise new feelings of hunger and fullness from your new small stomach sleeve. This is completely different from your previous ‘rumbly tummy’ hunger or ‘whole tummy; uncomfortably stuffed’ feeling of fullness. Your new tummy can still make rumbly, gurgly noises but actually you may not be hungry! Physical hunger is also completely different from eating out of boredom or comfort because when you do this, you will NEVER feel full because your body does not need food at this time. Most people acknowledge some sort of ‘emotional eating’ or ‘head hunger’. Your sleeve cannot help you with this. You will need to identify times when this is likely to happen and develop behavioural strategies to tackle it before it sabotages your weight loss.
Your new smaller stomach is situated somewhere behind your breastbone and this is where your new feeling of fullness will be felt. People describe the full feeling in different ways; ‘indigestion’; ‘like I’ve had a huge meal’; ‘wind’, ‘if I had another mouthful I’d burst’, ‘discomfort’; ‘I don’t want to eat more’. If you have eaten too much you will feel pain or may even feel a choking sensation, ‘as if something is stuck’. This means your sleeve is TOO full.
There is considerable variation in how full people feel at any given time. Your stomach will feel smaller and more restricted on some days than others, so that whilst you may cope with a particular food on one day, you may not manage it quite so well on another. Accordingly, it is always important to eat slowly, chew slowly and sense when to stop eating so that you feel comfortably full and not in pain or that food is stuck. There may be times, perhaps due to illness where you need to revert to softer foods or even drinks for a few days but do not do this permanently.
What should I eat?
For your sleeve to work effectively, food now needs to be of a ‘drier’ consistency, eaten and chewed slowly in small mouthfuls so that you learn to sense fullness and stop eating when you think you've had enough. From now, you can eat all foods but if you are introducing a food for the first time, we recommend you try it at home and chew it well so that you are confident you can eat it without discomfort or regurgitation. Be particularly careful with any of the ‘difficult’ foods that you may have avoided last month i.e. red meat, shellfish, bread (especially really fresh), fibrous fruit and vegetables including skins, dried fruit, nuts and rice. If you experience discomfort or food ‘sticking’ the first time you eat it, try again a week or two later perhaps chewed slightly longer and eaten even more slowly so that you know how much you can manage.
- Choose healthy, wholesome foods and no junk food. Your new eating plan has no room for wasted calories from sugary, fatty foods and your emerging new body needs good nutrients to keep you healthy and full of energy. Most fast foods and snacks are high in fat, salt or sugar. These are not good for your health or energy levels
- Always choose foods low in fat and sugar. Yogurts and similar products like fromage frais should be ‘diet’ i.e. low in fat AND sugar. Meat and poultry should have fat and skin removed. Food should be baked, grilled, micro waved, steamed or stir fried, not deep fried. You then taste the food, not oil.
What shouldn't I eat?
Leave behind the milkshakes, smoothies, gravy and sauces that you had in the last few months. Soft and liquid foods are not recommended because you tend to eat large volumes of them quickly, they pass through your system and you will soon be hungry again. If you frequently consume soft foods and drinks that are high in fat and sugar e.g. ice cream, cake, chocolate, milk shakes etc OR high calorie ‘crunchy’ foods such as crisps, biscuits etc you will not feel full and you will be tempted to consume larger quantities. This will prevent further weight loss and may lead to weight gain.
How much should I eat?
An appropriate quantity of food should fit in the palm of your hand e.g. half an apple and this will keep you feeling full for longer. Use the timer provided to control the time you take between each mouthful.Your main meal should fit onto a 7 inch side plate or small bowl and be composed of foods in the following proportions:
- One quarter protein (eg meat, poultry, fish, pulses)
- One quarter starchy (eg potato, pasta, rice, bread, couscous)
- One-half vegetables or salad (without butter, mayonnaise or rich dressings)
Start to ‘think thin’!
People who weigh less tend not to think about food too often, they eat slowly and consciously, don’t eat large portions, stop eating when they think they are full and often leave food on their plate. It is useful to develop these skills for permanent weight control. Get used to looking at your new portion size, eat without any distractions e.g. away from the television and concentrate on your food. Relax when eating, eat slowly and savour the tastes in each mouthful. It is a good exercise to try putting down your knife and fork between mouthfuls. Try it! Sit on your hands between mouthfuls if you are still trying to rush your food. You will soon start to eat in a more relaxed way and recognise when to stop eating so that you are comfortably full but not in discomfort. If food is left on your plate, throw it away; don’t keep it for later or act as the rubbish bin.
General advice for the solid food stage
- Aim to eat 3 small meals per day and no snacks between. This will help you to establish new and appropriate hunger and fullness responses and keep your metabolism going. You will learn to eat when you are truly hungry and not for other reasons
- Throw away the large plate and bowl and use a smaller diameter plate/bowl as research shows that when people eat from large plates and bowls, they tend to eat more. You might also want to try using a cake fork – very small bites indeed!
- Take small mouthfuls. Large mouthfuls will fill your stomach too quickly and you may suffer regurgitation. Also large mouthfuls are more likely to trap air in your stomach pouch, causing discomfort
- Eat and drink SLOWLY. Each time you swallow it takes 10-20 seconds for food to pass from your mouth into your stomach and then 20 minutes for nerve and chemical signals to reach your brain from your stomach to register a ‘feeling of fullness’. If you eat too quickly, you pass the point of fullness before you stop eating and will suffer pain, choking or regurgitation. Chew slowly, put your knife and fork down between mouthfuls. Use the timer provided to control the time you take between each mouthful
- Allow at least 20 minutes for each meal. You may need to plan extra time for meals so that you are able to eat slowly, not gulp large mouthfuls and recognise fullness. A rushed meal may be uncomfortable
- Stop when you're no longer hungry – NOT when you are full. You will need to learn the point at which you feel physically full but not in pain or discomfort. If you experience pain rather than ‘fullness’ you have had too much to eat or drink. Learn to become aware of the type and quantity of food that makes you feel full without discomfort. If you frequently go past being full you could risk stretching your stomach or oesophagus and lose the sensitivity to fullness
- If you choose to eat ‘soft’ foods, you MUST restrict your portion size to 1-2 tablespoons then fill the rest of your side plate with vegetables or salad. The stomach pouch will not tell you to stop eating these types of food. You may finish a ‘soft’ meal with ½ apple or other crunchy fruit to remain in your pouch.
- Drink low or zero calorie drinks water eg Bovril, low calorie squash, herbal teas, tea or coffee (restrict to 4 cups per day with a little low fat milk and no sugar to avoid excess caffeine)
- Keep alcohol to a minimum. Alcohol is full of calories that will stop you losing weight so it is best avoided. It may also make you forget your good eating plans!
- Drink frequently. Sometimes you may actually be thirsty rather than hungry. Always try a drink before reaching for something to eat. Have 1.5 litres of fluid every day, this will help to avoid constipation, headaches and dehydration
- Don’t drink with your meals. You will need to drink up to 15 minutes before your meal then leave 2 hours after your meal before drinking again; this will help you to feel full for longer by not washing your food out of your stomach pouch
The Balance of Good Health
This plate model shows the proportions of different food groups that make up a healthy eating plan. To stay healthy with your sleeve, follow the advice and guidelines given earlier and choose a variety of foods from the four main food groups below.
CARBOHYDRATE list (choose 3-4 items per day)
Have one or two portions at each meal time and try to choose wholegrain, wholemeal or high fibre varieties to help your digestive system. Examples include:
- 1 slice bread or toast / 1 crumpet / 1 scotch pancake
- 2 crisp breads / 3 small crackers / 2 small oat cakes
- ½ large pitta / 1 small pitta / 1 small chapatti
- 3 tablespoons dry porridge oats / breakfast cereal
- 2 egg-sized potatoes
- 2 heaped tablespoons boiled rice / pasta
- 2 rich tea / 1 digestive biscuit
- 1 small corn on the cob
FRUIT AND VEGETABLES list (choose 2-3 fruit items AND 3 vegetable items per day)
Include fruit as a snack if necessary, chopped on cereal or as a dessert after a meal. Make sure that for your main meals, at least half of your plate (side plate size) is full of a variety of vegetables/salad. You can use tinned, frozen or fresh fruit and vegetables. Examples include:
- 1 medium sized piece of fresh fruit eg apple, orange, pear, (½ banana)
- 2-3 small fruit eg plums, apricots
- 150g (5oz) strawberries, raspberries, blackberries
- 1 handful of grapes
- 1 tomato
- 7 cherry tomatoes
- 3 tablespoons stewed or tinned fruit (no added sugar)
- 100ml glass fruit / tomato / vegetable juice
- 1 heaped tablespoon dried fruit
- 3 heaped tablespoons cooked vegetables
- 1 side salad (half a side plate size)
PROTEIN list (choose 2-3 items per day)
It is vital to include at least two portions daily from this group, because on your new eating plan it may be difficult to obtain enough protein in the small portions that you will be eating. If you struggle to eat protein or worry about not getting enough then Weight to Go shakes and porridge are high in protein but in an easily digestible form, making them a good choice for sleeve patients. Examples include:
- 100g (3 ½ oz) very lean cooked beef, pork, lamb, mince, chicken, turkey, liver, kidney, pilchards, salmon
- 150g (5oz) cooked white fish or tinned tuna (in brine or spring water), tofu or quorn
- 2 eggs (limit to 6 per week)
- 4 tablespoons cooked peas, lentils, beans (including baked beans), kidney beans etc
DAIRY list (choose 2-3 items per day)
This group is important for calcium to keep your bones and teeth strong. Choose low fat varieties eg skimmed or semi-skimmed milk. When buying yogurt or fromage frais, make sure that they are both low in fat AND low in sugar. Protein shakes and high protein porridge are also good sources of dairy. Examples include:
- 200ml (⅓ pt) semi-skimmed milk
- 1 small pot of diet yogurt / fromage frais
- 100g (4oz) cottage cheese
- 60g (2oz) low fat soft cheese
- 25g (1oz) low fat hard cheese e.g. cheddar / stilton
SUGARY and FATTY food list (Avoid as much as possible)
There is little room for sugary foods or drink in your eating plan as they contain very small amounts of nutrients but a lot of calories - Avoid them! Fats and oils contain twice the number of calories as any other food ingredient. Be careful with margarine, butter, cream, mayonnaise, nut butters and nuts. Whenever possible choose low fat versions and when cooking only use one teaspoon of oil per person or a low calorie oil spray. Examples of portion sizes when using fats:
- 1 teaspoon (5g) butter or margarine / oil / mayonnaise / nut butter
- 2 teaspoons low-fat spread / reduced fat mayonnaise / salad dressing / single cream
- 7g nuts (8 hazelnuts / almonds, 5 pecans, 4 walnuts / brazil nuts)
- 1 heaped teaspoon of seeds e.g. pumpkin, sesame, pine nuts
Sample menu 8.00am
1 shredded wheat with a little skimmed or semi-skimmed milk OR ½ slice toast with scraping of low fat margarine, Marmite and a fresh tomato AND 1 satsuma or pear
10.00am DRINKS (this is 2 hours after your food)
1.00pm ½ tin tuna in brine or spring water AND 1-2 crisp breads or crackers OR ½ slice toast AND mixed salad with lemon and herbs AND ½ apple OR 1 satsuma
3.00pm DRINKS (this is 2 hours after your food)
6.00pm 2 fish fingers AND 2 small new potatoes in skins AND crisply cooked vegetables OR a mixed salad AND 1 low calorie yogurt or fromage frais AND ½ banana OR handful of strawberries, raspberries etc.
8.00pm DRINKS (this is 2 hours after your food)
- 3 tablespoons Fruit and Fibre / Special K / no added sugar muesli with a little skimmed / semi-skimmed milk and no added sugar
- 3 tablespoons All Bran with a little skimmed / semi-skimmed milk, no added sugar AND 1 tablespoon raisins OR ½ banana / 8 - 10 nuts eg hazelnuts, brazil nuts, almonds / 1 flat tablespoon seeds e.g. pumpkin
- ½ slice toast AND 1 boiled egg AND 2 tablespoons boiled mushrooms OR 1 piece of very lean bacon grilled with 1 fresh tomato
Main meal ideas
• ½ piece of baked fish with 2 small new potatoes and 2 portions of lightly cooked vegetables.
• ½ tandoori chicken breast with 1 tablespoon basmati rice and mixed salad
• Small piece baked or grilled fresh tuna (size of ‘pack of cards’) with 1 tbsp pasta 'al dente’ with 1 tsp pesto to flavour and salad
• 2 slices roast meat with 2 small ‘dry roast’ potatoes and 2 portions of lightly cooked vegetables and 1 tsp sauce or gravy
• ¼ large pizza with mixed salad
• Stir fry with chicken / beef / tofu / pork, sugar snap peas, mini sweet corn, carrot, onion etc, and a little soy sauce. 3 tbsp serving
• 1 tbsp pasta, 'al dente’ mixed with 1 tsp pesto, 1 fresh chopped tomato and ½ boiled chicken breast. Serve with salad
• 1 small baked potato served with mixed salad and tuna in brine / spring water mixed with 2 tsp low fat mayonnaise and lemon juice / vinegar
• 2 pieces of liver*, lightly brushed with oil, baked or grilled with 2 small new potatoes and 2 portions of lightly cooked vegetables
• 2 small slices of bread (wholegrain or granary) with 2 slices of lean meat or chicken and salad
* Do not eat liver if you are pregnant
Dessert ideas (if required)
• 1 small low calorie yogurt with fruit
• 1 small low calorie fromage frais with fruit
• 1 plain low calorie yogurt with 1 small portion of fruit e.g. ½ banana, 1 satsuma