After sleeve and bypass, weight loss is due to a significant reduction in hunger and a major increase in satiety. In practice, patients eat little or very little SPONTANEOUSLY: in the first 18-24 months, satiety during meals occurs after eating 30-40 grams. Weight loss in the first year is substantial and fairly rapid.

After about 2-3 years, some hunger returns, and patients are able to eat a little more, but this modest increase in quantity does not have significant effects on weight.

However, it is important to make the most of the initial long period of little hunger and high satiety to implement lifestyle changes that will help maintain the lost weight in full health.

Bariatric surgery should be considered as a form of behavioral surgery: thanks to the reduced appetite, I need to learn a new lifestyle, and be prepared for when some hunger returns, with the right changes already in place.

The first and most important point is: I must learn to eat very slowly and drink away from meals.

Our 30-40 grams (of regular food, ideally transitioning to a healthy and varied free diet) must be eaten, meaning chewed, over at least 20 minutes. I should take very small bites (for example, if eating pasta, cut a penne into 2-3 parts), put a bite in my mouth, leave the utensils on the table, chew counting up to 20, or 30, swallow, wait a moment, and then take another bite.
No one eats that slowly naturally; it’s something that has to be learned.

I should also drink away from meals (at least 30 minutes apart), because if I drink while eating, it is like eating quickly even if I eat slowly. Many will think, “But I drink liters while eating,” and it’s true. But consider that during a normal (or even large) meal, a lot of salt is consumed: by eating very little, the amount of salt consumed is minimal, and the desire to drink decreases.

If I don’t learn to eat slowly, and if I don’t continue eating slowly over time, the consequences are as follows:

1. In the first months, eating quickly causes severe stomach pain, hiccups, vomiting, and strong acid reflux. It feels really bad.
2. Some common foods (pasta, bread, focaccia, pizza, red meat) are very challenging in the first months. However, if I learn to eat slowly as described above, I will be able to eat everything in just a few months (3-4 months). It’s not just a nutritional issue: overall, one can live healthily without eating pizza. But our social life is often based around food: how often do we go out for pizza with friends or are invited to dinner by friends or family? If I don’t learn to eat slowly, I risk experiencing these situations as a nightmare: if eating pizza, pasta, or meat becomes painful (causing discomfort or vomiting), eventually, I will give up on social life. Learning to eat slowly also means being able to enjoy social dining experiences and knowing I can eat anything.
3. After 2-3 years, when I can eat a little more, I will have also gotten to know myself better. If, at this point, I forget to eat slowly, I will never be able to eat as much as my stomach could contain because I will feel signals telling me to stop eating, resulting in pain and vomiting. But if I eat too little when I could eat a little more, I risk feeling hungry all day, snacking, and eventually gaining weight back.

Maintaining weight loss is based on 4 key pillars:

1. Chewing thoroughly and eating slowly, even years after the surgery. I will never be able to have large meals again, but if I snack frequently, I risk consuming too many calories in a 24-hour period.
2. Except in the first month post-surgery, avoid soft or liquid foods as much as possible. Soft or liquid foods allow me to eat quickly without feeling ill, allow me to eat more than I could with solid food, and give me short-term satiety, putting me in a situation where I may snack. As a result, high-calorie soft foods (spoon desserts, soft cheeses) should be avoided as much as possible, but even low-calorie foods like yogurt, vegetable purees, soups, and fruit juices should be eliminated.
3. Be mindful of calorie density, which is something everyone of normal weight does. High-calorie foods are not prohibited, but should be limited over time. Essentially, sweets, soft drinks, cheese, fried foods, and dried fruits should be eaten no more than 1-2 times a week, and seasonings should be used sparingly.
4. Engage in regular physical activity, which can help lose an additional 4-5 kilograms but is primarily a great aid in maintaining the weight loss. A healthy life is one where, if possible, I walk to work (and if not, park far from the workplace), avoid using elevators, and walk for at least 30-40 minutes almost every day of the week. If I can also incorporate 2-3 specific physical activities per week (home exercises, swimming, gym, dancing, tennis), that’s even better, but the first step is transforming a sedentary lifestyle into an active one.