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Eating More? Bariatric Edition

What happens when hunger returns?


Allow me to set the scene. 

Betty had surgery 6 months ago.  In the beginning, she was very worried because she could only eat a few bites.  I can remember our first post-op calls.  She was so concerned that she had so much restriction.  I calmly explained that this is how the sleeve is supposed to feel immediately and for the first few months post-op.  This is also when the greatest weight loss occurs.  I also let her know that the day would come when she would reach out to me again because she was suddenly eating more.  I don’t know if she believed me at that time.


Fast forward to 6 months post-op. 


Betty reaches out to me and is very concerned because her weight loss has stalled, and she is very hungry again.  Her scale has not budged in about 6 weeks.  She is ravenous.  She wants some assistance.


How do I help Betty out?  I know that many of you know exactly “what Sheri would say/do”. 


The dialogue goes like this …


  • Sheri: Betty, I really need a food log from you.  I need to know exactly what you are eating, drinking each day.  How is your activity level?  Stress levels?  Sleeping patterns?


  • Betty: Sheri, I am hardly eating anything. I have some coffee for breakfast.  Maybe one protein shake.  I have chicken and lettuce for lunch and dinner. I am in a panic because the scale has STOPPED….


  • Sheri: Okay Betty. Let’s review.  What did you eat for breakfast yesterday?


  • Betty: Breakfast yesterday was a coffee with cream and sugar-free vanilla flavoring with a protein shake added.  I then had some eggs with cheese and sausage.


  • Sheri: Okay.  What about snacking between breakfast and lunch yesterday?


  • Betty: Yesterday wasn’t a normal day. I had a protein cookie that a co-worker insisted that I try and some almonds that I brought with me.


  • Sheri: Okay. What about lunch?


  • Betty: I packed some cheese, crackers, pepperoni, olives, grapes.  I ate them throughout lunch and then for my snack in the afternoon.


  • Sheri: Okay. What was for dinner?


  • Betty: Normally I make dinner but last night I went through the drive-thru.  I normally NEVER do that.  I got myself a chicken burger, but I threw away the bun.  It was the fried kind but that’s ketogenic so that’s okay in my books.


  • Sheri: Did you snack after dinner?


  • Betty: Normally I never snack after dinner but last night my neighbor brought over a piece of cake because it was her daughter’s birthday.  It was a low-carb cake as she replaced the flour with almond flour, so I was fine to eat it.




Let’s review now. We can safely say that Betty was NOT eating just chicken and lettuce and stalling out the scale.  I have these conversations every single day.  I think we need to get honest with ourselves.


When I eat like crap, I call myself out.  I don’t pretend that I am eating perfectly.  If I want to stall my scale and even have a regain, I will eat like Betty is eating. I will drink processed protein shakes. I will snack between meals.  I will take excessive amounts of time to finish up my food, never really feeling satisfied. I will eat foods that are fried/ processed/ low quality.  I will eat foods that are supposedly “ketogenic”.


When we veer away from whole, live, fresh, natural, good quality food – we venture out of the “safe zone”.  This is fine if you are looking for maintenance.  This is not fine if you are looking for weight loss.


This is how I will respond to Betty.


Sheri:  Betty, I think you need to start logging your food again.  I think it is time to remove the protein shake.  There is no reason to keep it in your diet while you can EAT your protein. Those shakes are processed and can be in part while the scale has stalled.  Betty, I want you to follow this diet for the next 3 days just to see how your scale responds.


  • Breakfast: coffee, water,  and one to two eggs any style.  
  • Lunch: ½ a chicken breast or 4 ounces of tuna/ salmon with cucumber slices
  • Dinner: 4 ounces of lean beef or fish with a few bites of low-carb veggies.
  • No snacking.  No grazing.  No “ketogenic treats”.  No cheese.  No processed meats.  No nuts/ seeds.
  • Fill your pouch at your mealtime.  Make sure you are satisfied before finishing up.
  • Take a 30-minute walk after lunch or dinner.
  • Drink plain water.
  • Report back to me in 4 days.




Betty called me back.  She lost 3 pounds and is feeling less hungry, has better energy, and is happier and sleeping soundly.  The problem has been solved.  Now it is up to Betty to continue down this road. 


Bottom line:  Sometimes we allow poor food choices to creep back into our new lifestyle. This is fine while you are in maintenance and not actively trying to lose weight.  If your blood sugars are fine and you are feeling great, then you do you Boo!!  If the scale creeps up, it’s time to pull up our boots and get back to work.


I hope this helps.  Betty is not alone.  Sometimes I am Betty too!


Healthy Hugs,





About the Author: Sheri Burke is a Registered Holistic Nutritionist and Bariatric Surgery Coordinator at International Patient Facilitators in Tijuana and Cancun, Mexico. She has worked with bariatric surgery clients for over 10 years and especially enjoys providing nutritional guidance to pre and post bariatric clients.  In her free time, she enjoys spending time with her husband and two teens and cooking up a nutritional storm in the kitchen.

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