How big is my stomach pouch?

Just about every patient asks this question at some point or another. It is expected and appropriate that the stomach pouch will enlarge somewhat as the months pass after gastric bypass. Some of this enlargement is an actual increase in size, and some represents a softening (regaining of elasticity) of the pouch and its outlet.

The real answer is that the FUNCTIONAL size varies with many factors such as time of day, the amount of time taken to eat, mood of the patient, other medical issues, and (most importantly) the type of food eaten. It is expected and appropriate that the pouch will handle a much smaller amount of solid food (chicken) than mushy stuff like mashed potatoes or soup.

The cottage cheese test is a technique that was presented at the June 2000 meeting of the ASBS (and many times before that) by Latham Flanagan, MD (website is at The Oregon Center for Bariatric Surgery).  It is meant to be a standardized, reproducible measurement of the physical size of the stomach pouch in a person who has undergone a gastric bypass procedure.

It is suggested that the Cottage Cheese Test be performed at 3 months, 6 months, 1 year and yearly thereafter.

1. Purchase a container of small curd low-fat cottage cheese. Begin the test with a full container, and perform the test in the morning before eating anything else (this will be your breakfast on that day). 

2. Eat until comfortably satisfied, but complete meal within 5 minutes or less.  The idea is to fill the pouch before there is much time for food to flow out of it.  Note that the small soft curds do not require much chewing. 

3. Stop eating when comfortable, but not stuffed

4. After eating your "fill" of cottage cheese, you will be left with a partially eaten container that has empty space where cottage cheese used to be.  Starting with a measured amount of water (8 ounces, for example), pour water into the container of cottage cheese until the water is level with the original top level of the cottage cheese.  Measure accurately.

5. Voila! - the amount of water poured into the container is the functional size of the pouch.

If this is your first time doing the test - DON'T PANIC. You are likely to find that the "cottage cheese" size of your pouch is way bigger than your surgeon told you he/she made it at the time of surgery.  Dr. Flanagan's data indicates that the average size of the mature pouch by cottage cheese test is 5.5 ounces.  He has also found that sizes ranging from 3 to 9 ounces have NO IMPACT on the person's success in weight loss. 

Note:  Hate cottage cheese?  Use oatmeal instead.  Make sure the oatmeal is thick and not runny.

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