Many patients have bariatric surgery with the intent to lose weight and feel full faster. Due to the restrictive nature of the gastric bypass, gastric sleeve, and duodenal switch resulting from the surgeon making the stomach smaller, most patients will achieve weight loss by limiting their caloric intake. There is also a decrease in the hunger hormone ghrelin (produced in the stomach), resulting in patients feeling less hungry. 

However, some patients, especially those who are 1+ years out from weight loss surgery, may begin to experience increased hunger after bariatric surgery. This can become alarming for post-bariatric patients as they fear they may be at risk of regaining their weight if they eat more than the recommended amount. 

What is Hunger

Hunger is a critical biological signal that tells our brains when we should eat. Our brains pick up messages from our stomachs via our parasympathetic nervous system (PNS) about every 2 hours. So if you are eating multiple small meals a day, as recommended by your bariatric care team, you shouldn’t feel extreme hunger all the time. However, if you are constantly feeling hungry, it could be due to one of the following reasons.

1. You are not eating enough. 

One of the most obvious reasons you may experience hunger after bariatric surgery is you are not eating enough calories and nutrients throughout the day. After weight loss surgery, your bariatric care team will recommend you eat anywhere between 1,000 to 1,200 calories per day to achieve your goal weight. However, if you are more than one year post-op, your caloric needs may have shifted due to hormones, your activity levels, and in general, your biological set-point. 

If you believe your hunger is coming from not eating enough, we recommend you begin tracking your daily food intake. You may be shocked to find you are eating less than 1,000 calories a day. Tracking your food intake will also be of assistance when talking with your bariatric care team to get your hunger cues more regulated. 

2. You are not getting enough protein.

Protein is a critical component of the post-bariatric patient’s diet. It is recommended that patients eat 80 to 100 grams of protein a day to “plug the pouch.” Many studies have found that high-protein foods keep patients full for more extended periods. Additionally, since protein only has four calories per gram (compared to 9 calories per gram for fat), eating a protein-dense diet will aid in weight loss.

3. You increased your physical activity. 

Once you have gotten in the rhythm of life after bariatric surgery, you may have started to increase your physical activity, which is especially common in patients more than a year post-op trying to overcome that weight plateau. And the more you exercise, the more calories you burn. So if you haven’t increased your calorie and macronutrient budgets with the increase in exercise, this may be a reason you are experiencing constant hunger. If you exert yourself pretty intensely in physical activity multiple times a week, we recommend you adjust your calorie and macro budgets to fit your new lifestyle. 

4. You are eating too quickly.

Many studies have shown that people who eat fast have a larger appetite and are more likely to overeat. This results from not spending enough time chewing your food, which creates awareness around eating and alleviates feelings of hunger. Similarly, the longer we chew our food, the more time our brains have to release signals that convey fullness. This is one of the reasons your bariatric surgeon and dietitian will recommend you thoroughly chew your food. Other reasons are to avoid food getting stuck in your smaller pouch and to maximize food breakdown and nutrient absorption. 

5. You are not drinking enough liquids. 

After bariatric surgery, your surgeon and dietitian will recommend you drink at least 64 ounces of sugar-free liquids a day. Proper hydration not only will keep you feeling full but also has the potential benefit of reducing your appetite. It is not uncommon for patients to confuse thirst for hunger, so if you feel unusually hungry, we recommend drinking a glass of water before indulging in a snack or a meal. 

6. You are drinking your calories. 

If you are more than six months post-op, you should have begun incorporating solid foods into your post-bariatric diet. Eating solid foods promotes a different response in the body compared to drinking liquids and is more effective in suppressing hunger. It is common for bariatric patients to supplement their diets with protein shakes. Similarly, some patients may try the pouch reset diet (which consists of only drinking protein shakes) to get back on track after weight regain. So, if you are experiencing constant hunger after bariatric surgery, it may be beneficial to begin incorporating more high-protein, solid foods into your diet. 

7. You are not getting enough sleep. 

There are two types of hormones that affect our feelings of hunger and satiety; leptin and ghrelin. Sleep impacts these hormonal levels, therefore influencing our desire to eat and the ability to stop eating. Sleep-deprived individuals will have increased ghrelin levels, resulting in them feeling hungrier and decreased leptin levels, resulting in them feeling a lack of satiety. To best keep your hunger hormones in check, we recommend sleeping 7 to 8 hours a night.  

8. Your hormones are off-balance. 

Whether you are not getting enough sleep, are constantly stressed, have begun taking medications, or have some underlying medical condition, our hormones play a significant role in hunger and our desire to eat. Some medical conditions that impact hunger cues and the sense of satiety are diabetes, hyperthyroidism, hypoglycemia, premenstrual syndrome, depression, and anxiety disorder. If you believe you have any of these conditions, we recommend you schedule a consultation with your medical provider to receive a proper diagnosis and treatment options. 

Conclusion

Constant hunger is a method of your body telling you something is off. It is almost always a result of unbalanced hormones, whether from a poor diet, bad lifestyle habits, or underlying conditions.

If you are experiencing constant and extreme hunger after bariatric surgery, it may be beneficial to take the advice provided in this article. However, if you are still unable to curb the hunger, we recommend you reach out to your bariatric care team or primary care provider so they can provide the appropriate diagnosis and treatment options.