3 meals a day or 6 meals a day after sleeve gastrectomy?

I often get asked about how to structure meals throughout the day. Often people say you should eat small but frequent meals, sometimes up to 6 meals per day, sometimes every few hours, and some people say you should stick to 3 meals a day with no snacks. But after a sleeve what is best? Should you still be eating every few hours even if you’re not hungry?

Let me start by saying that each surgeon and dietitian may have a slightly different take on this question and you should ultimately follow their recommendations, but this is what I see as working best with my clients.

The argument for 6 meals a day after a sleeve…

Before you’ve had surgery, eating smaller meals every 3-4 hours can help to control hunger and reduce feelings of deprivation or dieting. Some people also find eating more regularly helps to regulate blood sugar and/or energy levels, so eating this way definitely has its place. However, after surgery, this may not be your best bet.

The argument for 3 meals a day after a sleeve…

In the long term after a sleeve, I tend to recommend my clients try to stick to 3 meals a day with maybe a snack if they are hungry (physically hungry, not head hungry). Here’s why:

Eating too regularly can take the place of fluids

Drinking enough water throughout the day not only keeps you hydrated, but also reduces appetite. Often we eat when we’re actually thirsty either because we mistake thirst for hunger, or we are tired due to dehydration and reach to food (usually not great choices) for energy.

Also, logistically – if you can’t eat and drink at the same time after surgery, and you’re eating really regularly, you physically won’t be able to fit your fluids in!

Aim to drink 1.5-2L of fluids per day in between meals. Just remember to leave around 15-20 minutes after drinking before eating and 20-30 minutes after eating before drinking to minimise the chance of feeling uncomfortable.

Portion sizes

You’ve had a sleeve to help with portion restriction, and it does a really good job of this due to the physical size of your stomach and also the hormonal changes seen with sleeve gastrectomy.

So, if the argument for 6 small meals a day is to keep hunger at bay, you don’t necessarily need to keep that same pattern up after a sleeve when you have appetite control. Your sleeve should be a great form of appetite control, so make the most of it!

(I’ll caveat this by saying that some people do feel their hunger returns after surgery and if this is you, then the 3 smaller meals and 1-3 smaller snacks option could be a good one for you.)

The danger of grazing

It’s easy for “small, frequent meals” to turn into “grazing” after surgery. Eating to a set schedule or time between meals can form a habit of eating when you’re not actually hungry and push you further from the ultimate goal of listening to your body.

Although you do need to eat sometimes when you’re not hungry (your three meals) to get the nutrition you need, don’t feel you need to force feed yourself between meals. Instead, drink drink drink drink drink! (Water, that is!)

But what about nutrients? Am I getting enough?

One of the main reasons people eat regularly after surgery is to make sure they get enough protein in. I don’t get my clients to count protein or calories, instead, I think it’s more important to think about balance and quality (see this post if you want more info).

Also, sometimes I think people with a sleeve are setting the bar too high in terms of protein goals. For example, I’ve had people come to see me saying they are aiming for 100-200g protein per day. This is almost impossible due to the portion sizes you can eat! In fact, the American Society of Metabolic and Bariatric Surgery (ASMBS) who write the nutrition guidelines we use in practice, recommends post-op patients get at least 60g protein each day. A lot more achievable!

Instead of focusing on counting all the time, focus on choosing good quality foods and aiming to eat about half protein/half veg at each main meal with lots of fluids between.

The bottom line..

Ultimately I recommend long term for people with a sleeve to:

• Base your schedule around 3 meals a day (timing may vary depending on your schedule).
• Have a snack between meals only if you are physically hungry, but have a drink first, to help you determine if it’s thirst or hunger or another reason
• Try to get 1.5-2L fluids in between meals
• Don’t drink and eat at the same time – leave around 15-20 minutes before your meal and 20-30 minutes after your meal where you aren’t drinking.
• Make your meals good quality and aim for approximately half protein and half veggies
• Limit processed foods to an occasional treat.
• Establish a good supplement and exercise routine! If you’re not sure what supplements to take, read this post.

As always, if you have questions, see your team and if you want to chat with me, please feel free to contact me!