Back to School Week: The Four Rules

Weight loss surgery (WLS) is frequently perceived as an easy means to weight loss that requires little or no effort by the patient. However, patients who undergo bariatric surgery are prescribed Four Rules of dietary and lifestyle management that they will follow for the rest of their life if they wish to lose weight and maintain a healthy weight. All surgical weight loss procedures including gastric bypass, adjustable gastric banding (lap-band) and gastric sleeve, promote weight loss by decreasing energy (caloric) intake with a reduced or restricted stomach size. The small stomach pouch is only effective when a patient rigorously follows the Four Rules: eat a high protein diet; drink lots of water; avoid snacking on empty calorie snack foods; engage in daily exercise.

As part of their introduction to a bariatric program most patients are taught the Four Rules, which tend to be consistent from one bariatric program to the next. Many patients agree to follow the Four Rules which will work in concert with their surgically altered stomach and digestive system to bring about rapid massive weight loss. Some patients mistakenly believe they can return to the eating and lifestyle habits they practiced before surgery once they have lost the desired amount of weight. However, patients who return to their pre-surgery lifestyle and diet often fail to achieve full body fat loss and frequently regain much of the weight they initially lost.

For patients to lose all of their excess weight and maintain that weight loss they must follow the Four Rules for the rest of their life. Before undergoing any surgical procedure for weight management one must be fully aware of the Four Rules and willing to commit to them for life. Below is a quick look at each rule as it applies to WLS patients:

Get this infograph here: Four RULES

Protein First: At every meal the WLS patient will eat lean animal, dairy, or vegetable protein before any other food. Protein shakes or supplements may be included as part of the weight loss surgery diet. Patients are advised to consume 60-100 grams of protein a day. Eating lean protein will create a tight feeling in the surgical stomach pouch: this feeling is the signal to stop eating. Many patients report discomfort when eating lean protein, yet this discomfort is the very reason the stomach pouch is effective in lowering energy intake. Patients should not consume liquids while eating solid food because liquids will cause the stomach pouch to empty too quickly preventing nutrient absorption and satiation.

Lots of Water: Like most weight loss programs, bariatric surgery patients are instructed to drink lots of water throughout the day. Water hydrates the organs and cells and facilitates the metabolic processes of human life. Water flushes toxins and waste from the body. Patients are prohibited carbonated beverages and advised to drink caffeinated or alcoholic beverages sparingly.

No Snacking: Patients are discouraged from snacking which may prevent weight loss and lead to weight gain. Specifically, patients are forbidden to partake of traditional processed carbohydrate snacks, such as chips, crackers, baked goods, and sweets. Patients who return to snacking or grazing defeat the restrictive nature of the surgery and weight gain results.

Daily Exercise: Patients in recovery from morbid obesity must increase their daily activity and progress to formal fitness building activities that include aerobic conditioning and muscular strength and endurance. Walking, swimming, and biking are all encouraged following gastric surgery. Patients who continue to follow an exercise routine will sustain weight loss and live healthier lives. Patients who do not include exercise as part of their bariatric weight loss program will most likely regain weight and suffer from co-morbidities they hoped to relieve with surgical weight loss.

Nearly a half-million Americans this year will undergo some form of bariatric surgery for the treatment of their morbid obesity. Surgical intervention is proven to be the best treatment for many people in affecting long term weight loss and weight management. However, surgery does not work alone. Patients who are compliant with the Four Rules of dietary and lifestyle change are most likely to enjoy improved health and mobility following a bariatric intervention.


Learn more about the Four Rules and get back to the basics of WLS with the 5 Day Pouch Test plan. Check out the Owner's Manual available for instant download on Kindle:

5DPT Owner's Manual Kindle Edition