Most of the science shows, and most experts believe, the gastric sleeve (and the gastric bypass and duodenal switch) works by a hormonal mechanism that helps decrease hunger, increase satiety, and change food preferences. Feeling “restriction” is super variable, and some people feel a lot of it and some people none, based on a bunch of factors like their gastric motility. Even the LapBand, which we used to think worked by creating gastric restriction, is now believed not to work by creating “restriction” but by facilitating “satiety” – something a little more elusive. Regardless, our best advice remains to knuckle down and work on more daily exercise minutes and a long-term diet emphasizing protein and vegetables and minimizing carbs.
If a patient feels gypped by not having a lot of restriction, it is helpful to empathize first, and then gently encourage them that it is still okay, restriction is not a key piece of this puzzle and it varies from lots to zero. Stay focused on the main goals of exercise and healthier diet of protein and veggies. Whether people feel a lot of restriction or a little has minimal predictive value in their ultimate weight loss success.