The Bariatric Guide to PORTION SIZE

How much do I put on my plate?
One of the most common discussions in our Online Support Group forum is about Portion Size. People have a lot of trouble judging how much food to dish.

The Pouch Rules
The answer will surprise you because it’s more about choosing the right food and how to eat, not necessarily how much is on your plate. Learn to rely on food choices and your pouch rather than your measuring cup. IF I went for it, I could easily overeat Macaroni & Cheese but Chicken notsomuch because it is self limiting. Use the pouch as a tool by filling it with protein and using that fullness as an ally.

By the way, for this to work, no bread, no potatoes, no tortillas, no rice, no rolls, no pasta, no high carb foods. Do not drink with your meals. If you have been drinking with meals. STOP IT.

Hunger Games
Consider the ten point scale below for judging from hunger through fullness. Imagine the way each level feels as you slowly read through its description and think about how you feel right now. You will recognize the progressions. As I ate supper this evening, it suddenly clicked that I was eating past Level 6 right into 7 and it helped me to stop so abruptly my husband asked me what was wrong. Right now, several hours later, I am watching tv at a level 4, it’s 10pm and I am fighting night eating.

There is a small sweet zone at Level 4 where your body goes to its stored fat for energy and that is where you want to be as much as possible! If you are always feeding, your body doesn’t burn what it has stored.

This list is to encourage thinking about how you feel while eating instead of mindlessly consuming an entire measured amount or focusing on cleaning your plate. Think about these levels as you eat and soon you will be able to stop right where you need to be. 

level 1 – weak, headache, confusion, slow movements, low blood sugar
level 2 – very uncomfortable, light headed, irritable, unable to concentrate
level 3 – uncomfortable hollow feeling, stomach rumbling
level 4 – slightly uncomfortable, just beginning to become aware of and feel hunger
level 5 – comfortable, you are satisfied but could eat a little more
level 6 – happily comfortable, satisfied. Many emit a signal, usually a hiccup, sniffle or sneeze at the back edge before moving to level 7
level 7 – full and feeling that you don’t really want another bite. This is just a little beyond where you want to be
level 8  – not wanting to swallow the chewed food in your mouth where you must spit it out, uncomfortable
level 9 – overfull, very uncomfortable, regret in having eaten too much, pouch pain, hoping to regurgitate for relief. Feeling this way normally initiated by foods that go down easily but swell such as rice, pasta, bread
level 10 – stomach pain, chills, regurgitating of food, followed by intense fatigue

Protein First Works
It doesn’t matter how much is on the plate if we use ‘Protein First’ and ‘Vegetables Second’ as our portion control and only eat until we are comfortable and satisfied, somewhere between Bariatric Level 5 and 6.

As a guide, fix your plate with 4 to 6 ounces solid protein with salsa or sauce and 1/2 cup lower carb vegetable or chopped salad. A good example would be 2 small chicken thighs braised in pasta sauce with broccoli, tomato cucumber salad, or sautéed spinach.

Eat 1/2 of your Protein First, 1/2 the Vegetable Second then go in for small alternating bites of protein and vegetable until you recognize you are at a soft fill level of 6. Then stop. Thinking about levels 5 through 9 while eating is very empowering.

Grazing: not just for cows anymore
Those who don’t achieve satiety are always hungry and often graze by eating small amounts throughout the day. This somewhat fills the pouch but never to satisfaction, which is the strongest feeling we can create for ourselves. I know post ops who only take three bites of food but repeat it over and over – they lose weight – but live in fear and have no comfort that they have a safety net.

The feeling of satiety, which by definition is the complete absence of hunger, lasts a very long time once it has been tripped.  Those who don’t use the pouch fill mechanism are often hungry as they never trigger their own response.

If you are a scared measurer who stops eating before fullness, or a plate loading overfiller, learn to rely on your food choices and listen to your pouch. Have confidence to use your surgical pouch as the power tool it was made to be and experience the lasting fullness that has escaped you. It has been there all along!



55 thoughts on “The Bariatric Guide to PORTION SIZE

  1. Roxanne says:

    The 10 levels of your Hunger Games are quite descriptive. I have been eating without concentrating on dining, and I find myself suddenly at level 7, saying “Oh, crap!” I wish you would expand on the first three levels. I don’t want to think about eating all the time, and I don’t want my meals tied to the clock either. You say level 4 has that sweet spot; so, is it wise to always aim for 4? Level 4 four times daily? What advice can you give someone whose income steers them to feeding the family lots of rice, pasta, and potatoes?

    • Susan Maria Leach says:

      Thanks for asking. We are all works in progress! Right now you may need to think about eating until it comes naturally. I have zero hunger, so I have to be aware of the clock where I don’t suddenly end up in Level 2 with my blood sugar tanking. The idea is to time your eating so you stay in the middle levels and avoid big swings.

      As for the rice pasta and potatoes, you can’t eat those foods as they create large hunger swings and really hurt your efforts (short and long term). Plan for meal ideas in advance and watch for ‘buy one get one free’ deals at the grocery store for canned tomatoes, beans and eggs. We have a nearby farm stand where ‘ugly’ vegetables are packaged in one dollar bags. Chicken legs are on sale for .99 cent a pound at least once a month. Eggs and chicken are low cost high protein sources. Chicken cooks into soups and stews that can be stretched for the family with beans, and rice or noodles for their bowl but not yours. One egg omelets with a bit of cooked sweet pepper and onion are a mainstay of my diet. I use a big can of tomatoes to make a ten minute marinara and make my husband spaghetti, but poach an egg right in the sauce for me, or spoon sauce over ricotta cheese. Even the good Fage Greek yogurt is on sale for .50 if you watch for it. I get that it can be more difficult to break the high carb habits but eating healthy can be reasonable if you dig for low cost alternatives. Join our Online Support Group at as there are many discussions about Low Cost Bariatric Meals that I think you will find helpful! Ciao bella. Susan

  2. Venis Patterson says:

    Love your articles. I’m 5 months post op and is usually between level 5&6. Once in awhile I may get to Level 7 buts that’s when I don’t measure my food. I was 275 lbs heavy and now i’m 180 lbs and feel great.  Thanks for all your postings.

  3. Bonnie Schilling says:

    THANK YOU for being here for me. Your post help me immensely. I’m out two years but yet I struggle with my eating. This head hunger is killing me. I’ve begun to go back and read your post thru the day. This helps ; it makes me stop and think — am I hungry or do I just want to eat?  Thank you again!!!

  4. SANDRA says:

    This article couldn’t have come at a better time for me. I had gastric sleeve surgery 4 weeks ago and was already grazing very small amounts throughout the day. I have been too afraid of my pouch to eat more than 1 or 2 ounces at a time, and as a result have been constantly hungry. Your 10 point scale is a great tool and will help me adjust to a normal way of eating.

  5. Kim says:

    Thank you for this article.  I’m 8 years post-op and have gain back 30 of the 110 lbs I lost.  I ordered some of your protein powder and plan a two week liquid only diet to get me back on track.  Your article are wonderful for motivation and reminders!

    • Susan Maria Leach says:

      Thank you! So many of us gain back a decent hit of weight that I knew I had to figure it out for myself, much like fourteen years ago when I had my RNY. I know what it feels like and know what motivates me. Happy that it helps you and others as well. Ciao, Susan

  6. Joan Burnett says:

    Thank you for your articles. They are a great help. I am almost 6 year out from surgery. The last 2 years have been extremely stressful for me and I have gained back 20 pounds. I went from 320# to 165#. I still feel great but I am up to 180 to 185. Today I am starting back on 5 shakes a day and one meal. I know that I will feel better about myself again when the extra weight comes off.

    I read your articles every day and they are encouraging me to drop the weight again. Thank you so very much.

  7. Gwen B B says:

    I fell that you must be in my mind most of the time. When you write it seems that you are writing just for me. I’m five years out from my surgery yet I still have trouble with my eating. I can’t go a day without running to the toilet and emptying my stomach. I need help!!

    • Susan Maria Leach says:

      IF you are not overfilling your pouch, it is possible that you have a stricture, which is the narrowing of the surgically created opening. This causes the regurgitation issue where people cannot keep down foods that should work. I strongly suggest you join our Online Support Group as you will be able to let us know what you are eating and what foods are causing the trouble. We can help you bella! – SML

  8. Lynn Hoerres says:

    Great tips for identifying levels of fullness…but am I the only one who doesn’t get hunger pains anymore? I had gastric bypass in 1997 and have never had a hunger pain since…although I have gained some of my 140 lbs. weight loss back!! My stomach never growls…I just feel weak.

    • Susan Maria Leach says:

      You and I are in the MINORITY… I have almost no hunger since my 2001 RNY. Its a bad thing as I have no reminder, I just crash. Must be VERY careful on business trips as when I am with other people and they are skipping meals or bagels are brought into a morning meeting when I have not prepared and I am off plan, I get headache and super weak and confused as my blood sugar tanks.

      HOWEVER, I can create hunger if I chow down on some pretzels or crunch carbs, which is why I don’t dabble in them anymore!

  9. Kathy says:

    i wish I could tolerate the shakes, I never drank the regular full fat shakes from restaurants, much less protien shakes I’m  3 years post op, and have gained by 17 lbs, very depressing

    • Susan Maria Leach says:

      We tolerate what we want to tolerate, it depends on how bad we want it 😉 Open your mind to protein drinks… ours are not shakes, they are thin small drinks that are like a lightly sweeteneed glass of chocolate or vanilla milk. They keep you full and fuel fat burning! Our products are game changers because I know what it’s like to live with this surgery.

    • Susan says:

      I cannot tolerate the whey protein shakes. I am trying the plant based protein shake here and have sent for two Organic flavors that I found on Amazon. You are the only other person that I have communicated with who has this problem!! Nice to meet you!!?

      • Roxanne Ryan says:

        I seem to graze all day. Sometimes, maybe most times I do not eat enough but think it’s mostly mental. I pack lunch and a snack but am always looking for food. I have lost altogether about 75 lbs, I feel great and am extremely scared that I will regain. I am struggling to lose 20 lbs. I am also not sure what my good weight will be because I have never been at a good weight. I am not depressed, which I know can happen. I just think about food too much!!!

        • Tracy says:

          I am 14 month post op an am struggling exactly like you are. I do use protein bars instead of shakes and that is my main food source. I also eat nuts, cheese and lean sausage when I can find it. I had a very hard time eating food other than my bars for the first 9 months and lost 118 pounds and now struggle with the last 20. I do t get hungry ever but will get dizzy and feel wiped out if I forget to eat. But when I am home I find myself grazing. I recently started eating more Salads as a way to eat fewer calories and I really miss them in my diet. I have a hard time judging how much lettuce and veggies and usually make it to big. Currently I am searching for weight amounts to help make a proper salad for myself.

          • Suzanne Shaw says:

            My suggestion would be to take a serious look at the sausage, nuts and cheese you are eating. While they taste awesome and are low in carbs, they deliver a LOT of calories per oz so they are not a wise use. You can lower calories by snacking on veggies like carrot sticks or cucumber slices with almost NO impact to your calorie budget. Meals of a cup or two of lettuce plus 3-4oz of lean protein like chicken, beef or fish will help you keep calories low while helping to stop grazing. Try it!

  10. Rick H. says:

    I also have no hunger since my RNY 3.5 yrs ago.  I’ve used the clock and a meal routine to maintain my energy level and prevent the crash.  When I do crash I have found a protein bar restores me In approx. 10 minutes so I try to keep one readily available at all times.  I also travel and have to plan.  Packing sufficient protein bars for the duration of the trip helps me have options with the unpredictable meal and snack choices and non routine schedules.  The other thing that helps is maintaining hydration.  I always have a water bottle and keep track of fluid intake throughout the day.

    • Susan Maria Leach says:

      That is amazing Rick! I had to do a double take to see if I wrote your email. There was a period of a couple of years where this low blood sugar situation was very bad for me, but it seems to have lessened these days. Thank you for sharing how you handle absence of hunger and low blood sugar as it will help readers! – Susan

  11. Stephanie Grout says:

    I am really happy to have found this article. I am at three weeks post op, and consistently find myself at #7. I have never thrown up, but the pressure/pain is what stops me from eating. I now know after reading this article to listen more closely to my body to try to stay at #5.

    • Susan Maria Leach says:

      At three weeks post op you won’t full FEEL what you eat as your nerve endings are still disconnected from all the cutting in your GI system, so be careful about eating until FULL. Your feelings are not turned back on yet. Think about the levels and begin to know what to look for. We are happy you have joined us. – Susan

      • Paige Roddy says:

        Wow! Thank you for that, I will be 3 weeks out Wednesday and was wondering why I can’t feel. Now I know!

      • Polly says:

        I thought I was well informed. This is new to me.thank you so much for this information. I had revision from band to bypass and was worrying be a cause I wasn’t feeling full.

  12. Pam says:

    I’m 10 weeks post op and was doing well feeling full only a few times have I had pain from eating too much.  the past couple of days I’ve eaten more at a meal than I have been.  I’m going to try to see what # I’m at but it’s made me nervous.  I haven’t lost I  2 weeks and am petrified of gaining.  Advice, thoughgs? I’m so stressed.

    • Susan Maria Leach says:

      At ten weeks post op, you should be feeling more comfortable and less stressed but I get it. Take a deep breath and read about portions, food choices, start working out with some of our short but intense plans, come up with your personal plan. Its a cliche to say, if you don’t have a destination any road will get you there… but its true. Focus on your goals and figure out the best way to get there… that is your path. Download our food journal and start keeping track of your dailies plus water and vitamin… keep on the path you have created for yourself. We are here for you! click through to our Online Support Group. Lots of help there too! Ciao Susan

  13. Wendy L says:

    I am 5.5 years RNY post-op and have gained and lost around 8-9 lbs. on and off.  I went from 240 to 130 and that’s where I want to stay.  I am happy I found your web site because sometimes if I overeat, I am nervous that I will (or have) stretched my pouch out beyond repair.  I have heard the statistics about weight gain after surgery; but your levels of eating are amazing! How large can the pouch get?  Have I sabotaged my hard work?  My husband is having the procedure this Tuesday the 24th.  I am very excited about it and want to help him as much as I can.  He has so many co-morbidities his weight would kill him without change. He didn’t want the RNY but the sleeve (insurance will not pay for the sleeve) and our portion of the procedure is out of reach financially.  So of course he is very wary even with my success!  I support him 100% and will do whatever I can to help him as he has never had any type of surgical procedure except “scopework”.  Although this is a laporscopic procedure for him he is worried – he’s 67 and I applaud him for the decision he has made….even if it was “kicking and screaming.”  I will be preparing the protein for him as I am the cook and it will get me back on track also.  I have found myself wandering back to carbs! and I have a seemingly insatiable desire for sweet things!  My blood sugar is normal – is this craving due to the carbs I am consuming? Any advice will help me!  Thank you!

  14. Deborah Hutchins says:

    I don’t know if this the right place to ask this, but I need some exercise examples to do in a chair. I have severe arthritis in both knees and I need knee replacement in both. I can not do anything that requires standing very long or putting a lot of pressure on my knees. I need to lose down to 40% body mass to have knee replacement. I need and want to exercise,but this knee things make it almost impossible. Is there any help out there. Thanks!

    • Julie says:

      There is chair yoga. Check to see if your community offers this. Otherwise check with yoga studios in your area. I had to start by doing a few movements lying down. I eventually was able to sit in a chair and do yoga poses; then stand. Other good option is warm water pool exercises. They have equipment to lift you in the pool if steps are too difficult. Good luck!

  15. Jennifer Geiger says:

    Is this article for those with a RNY? I assume since it specifically refers to a pouch. It would be really helpful to know as advice (such as no drinking while eating) is different for different weight loss surgeries.

    • Suzanne Shaw says:

      This article is for anyone who had weight loss surgery. Pouches, Sleeves and Banded stomachs are the same size and portions are typically in line to follow each other.

    • Suzanne Shaw says:

      Drinking with eating will wash the food out of your sleeve/pouch. That means you’ll be able to eat quite a bit more food than you should be eating.

  16. Mary says:

    I have never been able to get a direct answer to this question, I apologize in advance if it has been addressed previously. I did read through some of the remarks.
    Based on my knowledge I was told to eat only when hungry. That’s great, however I might not get hungry for hours after waking. When I do eat it is balanced and clean eating. Should I eat when hungry, eat 3 meals a day, or “graze” with small meals (snacks) through out the whole day and only eat when hungry? I have tried all of these, my weight has not changed either way but I do feel like I am forcing myself to eat said 3 meals, or 6 small meals. Some days I eat 2 meals and graze between (usually the weekends). I am not sure if it matters that I am approx. 24 years post. I range within 15 pounds, give or take or time of the year.

  17. JOYCE says:

    I have a question, I am 2 1/2 post op gastric sleeve and I am always cold, this drives my husband nuts, is this normal?

    • Alison Garcia says:

      Hi Joyce, the simple answer is this: when you shed weight after surgery(and possibly without), you tend to lose your “insulating fat”, which can cause you to feel chilly most of the time. My suggestion: dress in layers, get some wooly socks, maybe a shawl to keep at your desk and on the sofa, and hopefully it passes. Be sure to keep up on your labs as well, iron issues can sometimes be the cause if they are off. Take care- Alison

  18. Jennifer says:

    I feel like a fool. After the surgery I was able to follow the phases until I got to the end. Now I am almost at 4 months post op and still have not consulted a nutritionist, measured ANYTHING and I drink a bit while I eat, eat carbs in moderation and even eat sweets from time to time. I am losing though. I have gone from 214 to 172 in just under 4 months. I feel hunger a lot, though I just deal with it. I keep my portions small and have only reached an 8 or 9 a couple of times and hated how that felt. I avoid that like the plague! I seriously need to have a real honest to goodness plan. But, frankly, I have no idea where to start this far in. I still need to lose at least 35/40 pounds. That part I can do but I am seriously worried about long term maintenance. I can see how easily it would be to pack the pounds back on. Oh, and hunger sucks!

    • Roxanne Ryan says:

      Jennifer I have the same issues. I go to my doctor and see the nutritionist once a month. She gets me back on track. Eating bad will eventually make you gain weight. I find that even though I am eating small portions if I do not eat right I put on lbs. don’t go backwards, as I write this I realize how hard it has been for me but I try everyday. Good luck!!

  19. Trixie Banks says:

    I had sleeve surgery Jan 2018 and I m having a problem when I eat food get stuck in my throat as of today I have lost 50 lbs have anybody had this problem other then that I’m ok

  20. Tina says:

    I am 11 years postop. It seems over the years my body has changed, I can’t stand to eat until I am full. It is an insanely uncomfortable position to put myself into. So I eat on a very small plate and I put my fork down after each bite. The problem I’m having now is that when I eat something that is OK for me to eat it doesn’t take long before my heart is racing and I feel sick. I did not over eat, I don’t eat to get full just satisfied. But I don’t understand as to why when I eat I feel like I’m having an anxiety attack. I can’t eat sugar at all because it makes me very very sick and is much as I like a bite of cake or a piece of licorice it’s not worth it. Does anyone else go through this. I think maybe I need to find a new bariatric doctor since I haven’t seen one since 2010.

  21. Virgie Macias says:

    Hi I have a question today I was able to finish my healthy chicken noodle soup (small can) without a problem, this is the first time I was able to do this, I’m 30 days post op sleeve, is this ok?

  22. BillieJo says:

    Trixie, it could be that you are not chewing the food to applesauce consistancy. You can try that and if you are eating meats and gravy to moisten it

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