Pre-op and post-op diets for weight loss surgery

patients
• Thu 13th Aug 2015

Inspiring Daily Quotes to print out and post as reminders on meal tables

❖ Mindful eating means simply eating or drinking while being aware of each bite or
sip.
― Thich Nhat Hanh, Savor: Mindful Eating, Mindful Life

❖ At its most essential, the apple you hold is a manifestation of the wonderful
presence of life. It is interconnected with all that is. It contains the whole
universe; it is an ambassador of the cosmos coming to nourish our existence. It
feeds our body, and if we eat it mindfully, it also feeds our soul and recharges our
spirit.
― Thich Nhat Hanh, Savor: Mindful Eating, Mindful Life

❖ Soulful eating means we feel well nourished. Soulful eating is about pleasure,
slow, the nuances of the meal, a bit of sensuality, some smiles, some hearty
laughs, celebration, connection, and a sweet communal experience. Marc
David- Institute for the psychology of eating

❖ If you truly get in touch with a piece of carrot, you get in touch with the soil, the
rain, the sunshine. You get in touch with Mother Earth and eating in such a way,
you feel in touch with true life, your roots, and that is meditation. If we chew
every morsel of our food in that way we become grateful and when you are
grateful, you are happy. Thich Nhat Hanh

❖ We don’t need to make peace with our food. We need to make peace with
ourselves. Food is nourishment; it’s not the enemy. Kris Carr

❖ Just slow down. Slow down your speech, Slow down your breathing, slow down
your eating and let this slower, steadier pace, perfume your mind. Doko
❖ Slow Down and experience the bounty of your food. Take in every sense, every
color, and every nuance. Give your meal a hearty dose of time, and it will
gratefully nourish you in return.Emily Rosen

❖ The very ingredients of our bodies are made up from the food we consume which
comes from the earth. When we honor and respect our planet, we honor and
respect ourselves. Cherie roe Dirksen

❖ Good nutrition creates health in all areas of our existence. All parts are
interconnected. T Collin Campbell

❖ Be aware of the thoughts you think about your body and food. They create your
metabolic reality. Marc David

❖ Create healthy habits, not restrictions.

❖ How to be Healthier: be Honest, be Real.

❖ Chew your food 32 times. Life will castigate those who do not masticate.Horace
Fletcher

❖ When walking walk, When eating Eat. Zen proverb

❖ If you take the road of self-attack in order to change yourself, you will end up at
the end of the road all beat up. If you take a road of self-love to change yourself,
you will find yourself at a happier and healthier destination.

❖ Our eating challenges are often asking us to self-reflect and look at the place
where we need to grow- Marc David
What is the pre & post-operative diet for bariatric surgery
patients? What food can I eat? How many calories a day should I
have after WLS?

Protein is priority

Your pre-op and post-op bariatric diet will focus on protein, which is needed by your body to function
properly, improve wound healing, maintain muscle tissue and avoid unnecessary hair loss.

Protein, unlike fat and carbohydrates, is not stored by the body and must be consumed in sufficient
quantities every day. Protein will be the top diet priority during recovery and for the rest of your life
following weight loss surgery. In general, it's recommended that 10–35% of your daily calories come
from protein.

The Recommended Dietary Allowances (RDA) for women is 46 grams and for men 56 grams of
protein each day¹.

Your surgeon will have specific guidelines as to the amount of protein you should be eating daily.
Your sex, BMI, and age are all factors that determine your daily needs for protein. Protein
supplementation will be used as needed to reach your daily goal for protein.

Pre-op diets

Even before you undergo weight loss surgery, your bariatric surgeon may recommend a change in
your diet to prepare your body for surgery. This special pre-operative diet will help shrink your liver
and reduce fat in your abdomen so that your surgeon can operate more easily and safely and
increases the chances of your surgery being performed laparoscopically.

Losing weight before surgery will also help with your recovery, increase your rate of weight loss and
aid with the transition to your post-op diet.
The time frame for your pre-op diet will vary from patient to patient. Based on your situation and how
much weight you need to lose before surgery, your bariatric surgeon will advise you when to start
your pre-surgery diet.

For gastric band patients, the pre-op diet may start two to three weeks before surgery, while for the
more involved procedures such as gastric sleeve or gastric bypass your pre-op diet may start
sooner.

You can expect your pre-surgery weight loss diet to be high in protein, but low in calories, fats, and
carbohydrates, especially refined sugars and saturated fat.

The pre-surgery diet generally ranges from 800 to 1200 calories per day with about 70 to 120 grams
of protein each day. You will also be advised to start vitamin supplements to ensure your body has
the nutrients necessary for recovery and health.

A few of the benefits of the pre-op diet include:

• Shrinking your fatty liver
• Preparing your body for surgery
• Faster recovery following surgery
• Preparing you for your post-operative diet

The liver shrinking diet

The liver shrinking diet is an eating plan low in dietary carbohydrate and fat that will encourage your
body to use up glycogen (a form of sugar that is stored in the liver and muscles for energy) and fat
stores to help shrink the size of your liver.

With each ounce of glycogen your body stores three to four ounces of water². When you follow a
very strict diet that is low in starch and sugars your body loses its glycogen stores and some water
resulting in your liver shrinking.

This diet is only recommended before surgery and is not to be followed post–operatively.

It is quite possible that you will lose a lot of weight following the liver shrinkage diet but it will mainly
be water loss. This diet usually allows between 800 to 1000kcal a day.

By reducing the size of the liver, the operating time for laparoscopic surgery is shortened and the
procedure is safer.

In some instances, a bariatric surgeon may postpone surgery if the patient's liver is too large.

Weight loss recovery diet

After bariatric weight loss surgery, whether you have an adjustable gastric band put in place or
undergone a more complex operation such as the gastric sleeve or gastric bypass procedure, it will
take time for your body to heal. As your body recovers from surgery, it is essential for you to follow
the specific eating guidelines given to you by your bariatric surgeon or dietician/nutritionist. The
bariatric recovery diet is set to ensure that your body heals properly and obtains adequate nutrition.

Post-op diet progression

Immediately following weight loss surgery you will not be able to eat much of anything. The post-op
recovery diet will slowly progress from clear liquids to full liquids, pureed food, soft foods, and then
you will finally be able to start eating solid foods.

No matter the procedure, it is important to progress gradually through the post-op diet so your body
has time to heal from surgery and you can adjust to the changes.

If you don't follow the post-op diet progression plan, you can:
• disrupt the healing process
• increase the risk of surgical site complications
• experience more pain
• cause vomiting
• dislocate the band (for gastric band patients)

Take time to heal and don't try to rush recovery!

Diet Phases:Phase 1 – Liquids

• Clear liquid diet: At first, you will only drink clear liquids. Clear liquids are liquids that you can see
through, such as water, tea, diluted non-acidic fruit juices (apple, grape, cranberry), broth (beef,
chicken, vegetable), protein fruit drinks, sugar-free gelatins, and artificially sweetened non-
carbonated drinks.

• Full liquid diet: After the first phase you will progress to full liquids. These are fluids you cannot see
through, such as low-fat cream soups, protein shakes and skimmed milk.

Phase 2 - Soft foods

• Pureed food diet: Pureed foods do not contain any chunks and have been blended into the smooth
consistency of baby food. At this stage chunks of food can get stuck in the stomach opening and
cause pain and vomiting. To puree foods, combine high-protein foods with broth, skimmed milk or
low-calorie sauces in a blender and puree until smooth. Other options might include pureed soup or
cottage cheese.

• Soft food diet: You will gradually move on to soft foods, which are foods with texture but tender and
easy to chew. Soft foods might include ground or finely diced meats, fish, canned or soft fruit,
scrambled eggs and cooked vegetables.

Phase 3 - Solid foods

• Solid food diet: Once your body has healed, your bariatric surgeon/ dietician or nutritionist will put
you on a regular bariatric diet. Meals should always include high-protein food items such as lean
meat, yoghurt, eggs, whole grains, fruits and vegetables.

Top tips to following a post-operative bariatric diet:

• Aim for three small meals a day³.

• Limit snacking between meals to one to two times per day and only eat low calorie, healthy snacks
such as fruit, vegetables, low fat yoghurt.
• All meals should be eaten slowly and food should be thoroughly chewed. Aim for about 15 chews
per bite so that the food turns to mush and about 25 minutes for each meal.
• Eat the protein foods first as these are the most important.
• Eat solid food. While soft foods may be easier to digest, they usually contain more carbohydrates
and fat and make you feel less full than solid foods.
• When you feel full or tightness in your chest, stop eating, even if you haven't finished your meal.
• Don’t eat and drink at the same time. This can flush food out of your stomach pouch and make you
feel less full or it can overfill your pouch leading to vomiting and stretching.
• Since the amount of food eaten each day is very limited, every bite counts. It is important to eat
only healthy and nutritious food.

Calories

Most bariatric diets allow 1000 to 1200 calories per day with meals focused on lean sources of
protein, whole grains, fruits, and vegetables.

Proteins

Ideally you should aim to have three small portions each day. Eat the protein part of the meal first, in
case you feel full. Meals will primarily consist of protein-rich foods, including lean meats (chicken,
turkey, fish), low-fat dairy products (yogurt, cottage cheese), eggs, and soy products. Include a
variety of nutrient-rich fruits and vegetables

Protein is particularly important after a gastric bypass and sleeve gastrectomy as you have greater
wounds to heal than band patients.

Fluids

Aim for 1.5 litres of low calorie liquids per day⁴. Try to avoid drinking high-calorie drinks, such as
cola, alcohol, sweetened fruit juices and milkshakes. These types of drink will quickly pass out of
your stomach and into your small intestine, increasing your calorie intake.

Post-operatively, one of the main challenges for a gastric bypass patient over time is to maintain
hydration. You will only be able to drink one to two ounces of fluid at a time but your body still
requires the same amount of fluid as before the surgery.

The best way to achieve your fluid goals each day is to take small amounts of fluid on a near-
constant basis. Carry along a bottle of fluid with you at all times.

Diet after a gastric balloon

To get the best results from your gastric balloon procedure it is crucial that you understand and
follow a strict post-operative diet. A gastric balloon is a very effective weight loss solution, but you
must adhere to some important dietary choices in order for it to be as successful as possible.

Shortly after insertion of the balloon you will be asked to sip water. If that is tolerated then you can
progress onto clear liquids and then full fluids for three days. You should aim for at least eight cups
of fluids daily. Your liquid diet will help you adjust to the balloon, prevent dehydration and keep your
energy levels up. You should avoid solid foods at this stage as they may cause nausea and
vomiting.

On day 4 you can progress on to soft foods. Aim to have 4 small meals a day. If you are tolerating
soft foods and liquids well then you can progress on to a normal textured diet on day 10. Some
foods can stick to the balloon such as pasta. It is advisable to drink a few sips of water shortly after
your food to rinse off the balloon.

Your calorie intake must remain at a maximum of 1000 to 1200 kcal per day.
Diet after a gastric band surgery

Typically following the insertion of your gastric band you will start with 2 weeks on a liquid-only-diet
initially being clear liquids then progressing to full liquids. During the next 2 weeks you will only be
able to drink liquids and eat small amounts of pureed food. Attempting to eat solid foods at this stage
could put pressure on the band and damage it.

In weeks 4 to 6, you can you have soft food. After 6 weeks you can gradually resume a healthy diet
based on eating small amounts of nutritional solid food that you will need to stick to for the rest of
your life.

Due to the position of the band, you will probably experience a feeling of fullness or tightness in your
chest rather than in your stomach. If you experience repeated episodes of vomiting after eating, it
may be a sign that you are eating too much or that your band needs to be adjusted. At 6 weeks your
band will be adjusted to ensure it is not too tight or too loose.

Your calorie intake will normally be between 1000 to 1200 kcal per day.

Diet after a gastric sleeve surgery

Following your sleeve gastrectomy you should take small sips of liquid throughout the day and pay
attention to the feeling of fullness. Once you tolerate liquids, you will be able to start on pureed
foods. It may only take a few days to advance from liquids to pureed foods, but this stage can last
weeks.

After pureed foods are well tolerated and healing has progressed, you will be able to start adding
soft foods to the diet. This is generally sometime around 4 weeks after surgery. New foods should be
added to the diet one at a time to observe your reaction to it.

After 6 weeks you should be able to resume a normal solid food diet. The gastric sleeve will allow
you to eat almost any type or texture of food.

Your calorie intake will be between 1000 and 1200 kcal per day.

Diet after a gastric bypass surgery

Immediately after your gastric bypass surgery your diet will be limited to liquids. Recovery will vary
from patient to patient but it can take up to 3 months for your body to heal.

In the first couple of weeks after surgery you will drink liquids starting with clear fluids and moving on
to full liquids as your body tolerates them. In week’s 2 to 4, you can eat pureed food and by week 6
you may be able to eat soft food. After 6 weeks, gradually resume eating a healthy diet.

After gastric bypass diet, eating is focused on providing the body with healthy proteins and nutrient
rich foods. You will need to avoid eating food that is high in sugar, such as chocolate, cakes, sweets
and biscuits as your bypass will affect how you digest sugar and if you eat these foods you may
suffer from dumping.

You will also need to take daily vitamin and mineral supplements, as your small intestine will no
longer be able to digest all the vitamins and minerals your body needs from your diet. This varies
from person to person but most people are required to take:
• a multivitamin supplement, which contains a combination of different vitamins
• a calcium supplement (the body requires calcium to maintain healthy bones)
• an iron supplement⁴

You will be advised to consume 800 to 1000 kcal for the first 1 to 2 years during weight loss and
then 1000 to 1200 kcal per day thereafter for weight maintenance.

Understand your eating triggers

It’s important to take time to consider and understand your current eating habits before you have
bariatric surgery. Appreciating the emotional triggers for your eating, also known as head hunger,
may help you establish and maintain new eating habits after surgery that listen to your physical body
hunger instead of head hunger.

Here are a few examples of head hunger and strategies to help you break the emotional
associations that lead you to overeat.

a) Grazing

It is common for people to eat snacks throughout the day in place of full meals. Your post-op
bariatric diet will need you to stick to 3 meals a day and up to 2 healthy snacks.If you are used to
snacking during the day you will need a strategy in place to distract you from grazing such as calling
a friend, exercising or reading a favourite magazine.

b) Seasonal and weather related cues

If it’s cold outside you may comfort eat. You may have social ties of special seasonal activities that
can lead to bigger portion sizes. Being aware of these will help you really listen to your body, follow
your eating plan and help you eat special foods mindfully.

c) Forbidden food syndrome

The thought of dieting can trigger feelings of deprivation and cravings and it has been shown to
increase food intake⁵. Try not to talk about food, weight and dieting too much and depend on your
physical hunger cues to let you know when it’s time to eat.

d) Emotional

Emotions are common triggers for eating. People sometimes eat to cope with stress, boredom,
anger, anxiety and loneliness. Overeating to deal with these feelings leads to weight gain whilst
denying you the opportunity to satisfy your true needs. Try to figure out what you need that drives
you to eat when you aren’t physically hungry. Once you’ve identified these emotions seek ways to
comfort, nurture, calm and distract yourself without turning to food.

Here you can find our guide prices for bariatric surgery.

Read more weight loss surgery blog posts to find answers to the most common questions including:
pros and cons of gastric balloon and gastric sleeve, how to choose a weight loss surgeon,exercise
after weight loss surgery, cosmetic surgery after weight loss surgery etc.

About Ramsay pre and post-operative bariatric diets

Ramsay Health Care is a leading provider of weight loss surgery in the UK. Ramsay offers weight
loss procedures performed by experienced bariatric surgeons who are highly qualified and have
undergone intensive specialist training.
At Ramsay Health Care your weight loss surgeon will work in a multidisciplinary team who liaise with
each other to provide the best plan of action for you. They include a dietitian who will meet with you
and produce a bespoke eating plan, and specialist trained nurses who will be by your side during
your journey to offer support and guidance to ensure that you achieve your goals.
New

The Recommended Pre-Operative Diet For Bariatric

Weight Loss Surgery
It is essential for patients who are preparing to have bariatric surgery to eat the right foods
prior to their surgery. This will help to reduce the amount of fat that has been stored in
the liver and to get the body ready for surgery. The pre-op diet is just one of the many
changes that are required of all weight loss surgery patients: a number of life-altering
adjustments and new habits will need to be learned, for both the pre-surgery and post-
surgery periods. Your bariatric surgeon or a dietitian can give you the information you
need for making important dietary changes. Don’t lose sight of the fact that following
nutritional guidelines is a critical part of the weight loss process. Many patients’ eating
habits have grown slack over the years. But once the weight loss surgery date nears, all
former ideas about food will have to change; for example, the types of food you eat, the
size of portions and how you eat them will all be major considerations.Your diet will start
to change before you ever enter the hospital or clinic for your surgery. By then, you will
have reached a point where you need to prepare your body for the upcoming
procedure.The pre-surgery bariatric diet is vital for patients for a number of reasons:
• It will help to reduce abdominal fat and fat stored in the liver

• It will protect muscle tissue. On a reduced calorie diet, an increase in protein will stop the body from using
muscle tissue as a source of energy and will make it burn fat instead
• The body will be properly prepared for surgery and recovery
• It gets the patient prepared for the post-surgery diet. The two are actually similar – featuring a reduction in
calories and the addition of foods that are high protein, low-fat, and low in carbohydrates.

Download FREE Bariatric Surgery Planning Guide

How Long Should I be on the Pre-Operative Diet

The pre-operative diet is an essential phase for all weight loss surgical patients; however, the time
frame and food items that can be eaten are determined by the patient’s weight and the type of
surgery he or she is having.Lap-Band patients may begin their pre-op diet only a couple of weeks
prior to the procedure. The more complex surgeries, such as the duodenal switch or the gastric
bypass, may require a patient to begin a pre-op diet as long as three months before surgery.

What is the Benefit of a Pre-Operative Bariatric Diet?

Patients who can successfully lose some of their excess weight before their surgery often face fewer
complications due to surgery. The main reason to eliminate pounds before surgery is to get rid of as
much abdominal fat and fat stored in the liver as possible. When the liver is smaller, laparascopic
surgery can be done more quickly and safely. The amount of pre-surgery weight you need to lose
will be determined by your bariatric surgeon, based on your current weight and health, and the type
of procedure you are having. In addition to advising you on your pre-op diet, your bariatric
surgeonwill also make a few other essential recommendations, such as:
• Stop smoking
• Don’t drink alcohol
• Avoid binging between meals
• Don’t take certain over-the-counter medications and prescription medications without the approval of your
surgeon
Following your surgeon’s dietary restrictions and other guidelines before surgery is
crucial for a safe and effective surgery and aftermath. The pre-surgery diet may seem
drastic, but it does prepare your body for the monumental changes it is about to
undergo. And learning to re-think the way you eat – and why and how you eat –
beforehand is an excellent way to retrain yourself to follow good eating habits for the
rest of your life.

New

THE BIG GASTRIC SLEEVE DIET GUIDE

In Featured, Gastric Sleeve, Weight Loss Surgeries by OC StaffOctober 2, 2017

Gastric Sleeve (sleeve gastrectomy) surgery is quickly becoming the preferred surgery
for weight loss.

Gastric sleeve surgery is quick, the results are impressive and the complication risk is
low, less than 1% serious complication rate in the first 30 days after surgery (Safety and
Effectiveness of Newer Bariatric and Metabolic Surgery Procedure).

YOUR LIVER PRIOR TO SURGERY

Your stomach is located just to your left of your liver. To access your stomach for most
bariatric procedures, your surgeon will use a liver retractor. This is a device that lifts the
liver up and out of the way so your surgeon can safely operate on the stomach without
the liver getting in the way.

You have Non-Alcoholic Fatty Liver Disease

You probably don’t know it, but you have fatty liver disease. If you don’t and you’re
morbidly obese, you’re lucky. Fatty liver disease is when fat cells accumulate in and
around your liver cells. This causes the liver to function poorly.

HEALTHY LIVER VS FATTY LIVER

It also increases the size of your liver. A larger liver makes gastric sleeve surgery much
more difficult and increases the risk of complications.

I’ve witnessed a handful of cases where the surgeon decides that the liver is so large
that they cannot perform surgery safely. The surgery either then becomes an open
procedure (non-laparoscopic) or they close and cancel until the patient decides to follow
their 2 week pre-op diet.

2 WEEK PRE-OP DIET

Why do you need to be on such a strict diet before gastric sleeve surgery? Since you
are overweight, so is your liver. And, as mentioned above, a large liver increases your
surgical risk.

However, your liver can very quickly shrink in size if a strict diet is followed. This makes
your surgery safer, you healthier, and prepares you for your diet the first few weeks
after surgery.

Typical 2 Week Pre-Op Diet

You should always follow your surgeon’s recommended diet 2 weeks prior to surgery.
Most 2 week pre-op diets recommend:

• Increase your protein consumption

o Eat lean meats
• Lower your carbohydrate consumption
o Avoid breads, pasta, cereals, rice, etc.
• Eliminate Sugars
o Eliminate candy, desserts, juices, sodas

The list below is a typical diet two weeks before gastric sleeve surgery.

• Breakfast
o Protein Shake – get a high quality protein shake from GNC or other supplement
store in your area.
o Make sure there is no sugar in the protein shake.
• Lunch
o Vegetables and Lean Meat
• Dinner
o Vegetables and Lean Meat
• Snacks
o You can have a healthy, low carbohydrate snack in-between meals.
o Nuts, berries, vegetables, small salad with oil and vinegar, etc.
• Fluids
o Stay hydrated. This will help curb your hunger.
o You can typically drink anything sugar free and low in calories.
Remember, it’s very important to stick to your two week pre-op diet. This shrinks your
liver, decreases your risk of complications and makes the surgery quicker and easier for
your surgeon.

2 DAYS PRIOR TO SURGERY

Some surgeons will recommend you stop the following two days prior to surgery.

• Carbonated beverages
• Caffeine

Most surgeons will recommend you adhere to a strict clear liquid diet starting two days
prior to your surgery. Clear liquids will include broth, sugar free Jell-O, sugar free
popsicles, water and possibly one protein shake each day. Again, follow your surgeon’s
instructions.

AFTER GASTRIC SLEEVE SURGERY DIET

You’ve made it past surgery and you’re on your way to a healthier life. You may think
it’s clear sailing from here. Unfortunately, the hard part is just beginning.

Now is not the time to cheat. While the two week diet was important reduce your risk of
surgical (intraoperative) complication, the week 1 to 4 post-op diet will help prevent
post-op complications.

The first few weeks after surgery, you will experience frequent irritability and it’s not
uncommon to second guess your decision to have surgery.

The very extreme diet after your sleeve gastrectomy may seem like your surgeon is
being overly cautious. It is utterly important that you follow his or her instructions to the
‘T.’

Cheating on your post-op diet can cause diarrhea, dehydration, constipation, bowel
obstruction, or a very serious gastric leak. If you need more motivation to follow your
post-op diet, this article will help.

Below is a typical diet after gastric sleeve surgery for weeks 1 to 4.

WEEK 1 – CLEAR LIQUIDS ONLY

CLEAR LIQUIDS 1ST WEEK AFTER SURGERY

In week one you are limited to clear liquids only. This sounds tough. And it is tough.
However, most patients have very little desire to eat. The hunger hormone ghrelin is
almost non-existent after surgery.

The part of the stomach that produces the majority of ghrelin is removed during surgery.

Make sure all items listed below are sugar free.

• Water
• Broth
• Jell-O
• Decaf tea
• Decaf coffee
• Sugar free Popsicles
• Sugar free drinks that are not carbonated

You should avoid:

• Carbonated beverages
• Very sweet beverages
• Sugar
• Caffeine

WEEK 2 – FULL LIQUID DIET WITH PROTEIN

During week two you may start to feel some hunger pains. Continue to stick to your
surgeon’s recommended diet. Your diet may include all items from week 1 plus:
 • Protein powder mixed with a sugar free non-carbonated clear liquid.
• Sugar free pudding.
• Soup with soft noodles.
• Non fat yogurt.
• Carnation instant breakfast. Look for the sugar free option.
• Very thin creamed soups. No chunks.
• Sugar free sorbet.
• Very watery hot oatmeal. Check the sugar content.
• Diluted no-sugar added juice.
• Sugar free, nonfat ice cream
• Thinned applesauce. Check sugar content.

WEEK 3 – SOFT PUREED FOODS

Week three after gastric sleeve surgery is tough. But the good news is that you can start
adding some real food into your diet, albeit pureed.

You still need to be careful to limit sugars and fats. The goals for week 3 include:

• Get your 60 grams of protein per day

• Eat slowly
• Introduce new foods one by one.

Food may taste differently and will be tolerated differently than they were before
surgery. You may find that dairy is harder to digest. It’s recommended that you
introduce new foods slowly.

Give your body some time to react to each new food. By doing this you’ll be able to
identify foods that are causing gas, stomach upset, and/or diarrhea.

The foods listed below are typically acceptable for week three after surgery.

• 1 protein shake per day. You can now blend them with yogurt or non-fat milk.
• Almond milk or coconut milk makes a great protein shake.
• Hummus
• Cottage cheese (low fat)
• Soft cereals – Let your cereal sit in the non-fat milk until it’s soft.
• Soft vegetables – steam or boil them until they are soft.
• Soft cheeses – limit these, they are typically high in fat.
• Ground chicken or beef. Add some beef or chicken stock to keep the meat soft.
• Soups
• Scrambled eggs – these are a great source of protein.
• Soft (steamed) fish. Remember to chew well.
• Canned tuna and salmon (you can add low fat mayo). Great source of protein.
• Mashed fruit. Bananas, avocados, and canned fruit (watch sugar content).

You should avoid the following foods:

• While smoothies are ok, limit their sugar content.

 • Sugar
• Starchy foods like pasta, rice and bread.
• Fibrous vegetables like celery, broccoli, asparagus, raw leafy greens.

WEEK 4 – INTRODUCING FOODS!

You’ve followed your diet up to week four. Now it’s time to start introducing real foods.

Your sleeve and stomach are still sensitive, so go slow and remember to chew each
bite thoroughly. You’re done with pureed foods, but you should continue to look for
softer versions of food during this week.

• Continue your daily protein shakes

• Introduce chicken and beef very slowly. Ensure you chew thoroughly.
• Any type of fish.
• Fruits
• Vegetables (it’s still recommended that you cook these to soften them a bit).
• Sweet Potatoes
• Mashed and baked potatoes.
• Cereal
• Caffeine can be introduced. It’s recommended that you limit this.

You should avoid the following foods in week four:

• Sodas
• Fried foods
• Fibrous vegetables (i.e. celery and asparagus)
• Sugary drinks
• Candy
• Dessert
• Pastas and other high carbohydrate, low nutrient foods (pizza).
• Whole milk and other whole milk dairy foods.
• Nuts

WEEK 4 HEALTHY SNACKS

While it is recommended that you only eat 3 small meals each day and hydrate in-
between meals, you may need a small healthy snack. If your surgeon approves this, the
items below make healthy snacks.

• Hummus with rice crackers or softened (boiled and cooled) baby carrots.
• Hard boiled egg.
• Quarter cup of oatmeal.
• Quarter of a baked sweet potato (or microwaved)
• Banana
• Strawberries or fresh fruit.
WEEK 5 AND BEYOND

NUTRIENT DENSE FOODS AFTER SURGERY

Continue to introduce foods one by one to see how well they are tolerated. Watch out
for constipation, diarrhea, and upset stomach.

• Eat three small meals every day.

• Hydrate throughout the day.
• Stop drinking fluids 30 minutes before each meal.
• Avoid snacking. If you do, choose a nutrient-dense food (fruit, vegetable, nuts).
• Take your recommended daily vitamins.
• Ensure you get 60 grams of protein.
• Supplement daily with a protein shake.
• Incorporate exercise into your daily routine. Make it a habit.
• Avoid sodas.
• Prepare for bad days. How will you cope when you are in a difficult situation?
• Find an accountability partner. Go to a support group and make friends that you can call.

6 TIPS – HEALTHY EATING AFTER GASTRIC

SLEEVE SURGERY
1. Choose foods that are nutrient dense. Bread is not nutrient dense. An apple, banana,
fish, etc. are nutrient dense foods.
2. Do not drink your calories. It won’t fill you up and most caloric drinks are filled with sugar.
3. Expect an emotional roller-coaster. Don’t let food be your comfort. Create a plan.
4. Chew your food thoroughly and take your time eating.
5. Plan what you will eat if you’re going out. Ask for half the portion size at restaurants. You
may get a discount and you won’t be tempted to overeat.
6. Make water your new best friend. Drink it regularly throughout the day. Buy a reusable
64 oz bottle that you can carry to work with you. Make sure you finish the entire bottle
 each day. But remember not to drink with meals (this helps prevent stretching your
pouch).

New

The Importance of Meeting your

Nutritionist before Surgery

When you start to think about weight loss

surgery, so many people immediately jump to thinking about what happens after the
operation. This is the exciting period of the weight loss program. This is when the
weight is coming off fast and you can anticipate the countless changes in your body,
health, and lifestyle.
But those changes don’t happen magically. Weight loss surgery works because of the
gradual process of change that you agree to put your mind and body through. This
process begins long before the first pounds come off, and certainly before the day of
the operation.
While it is exciting to think about the progress you’ll make after having weight loss
surgery, when you make the decision to embark on a weight loss program like this you
have to keep yourself grounded in the here and now. This is why seeing a nutritionist
early on is a good idea. In fact, many weight loss surgeons go so far as to require that
you visit with a nutritionist before you ever get weight loss surgery.
WHY A NUTRITIONIST?
A nutritionist is an expert in health and nutrition. The job of a nutritionist is to know
what makes up a healthy diet, of course, but beyond that, the nutritionist is skilled in
 developing diet plans and identifying potential shortcomings, deficiencies and
sensitivities. Meeting with a nutritionist gives you the chance to develop a customized
dietary plan that meets your lifestyle and personal nutrition needs.
A nutritionist will talk to you about issues like:
• Weight gain and obesity

• Nutrient and vitamin intake

• Nutritional deficiencies and potential side effects
• Dietary changes associated with weight loss surgery

By the time you get your bariatric procedure, this is information that you already need
to know. Meeting with a nutritionist early on gives you a chance to focus on adjusting to
healthy habits before your body goes through any intense physical changes, which
makes the transition to a healthier lifestyle much easier to adjust to. Research shows
that those who make dietary changes prior to having weight loss surgery and who are
able to start losing weight prior to their bariatric procedure are more likely to lose more
weight and maintain their weight loss longer than those who didn’t.
When you are thinking about weight loss surgery, the dietary choices you make become
incredibly important. Don’t make any changes to your diet without consulting with a
professional. Taking advantage of the resources around you, like meeting with a
nutritionist, will help you with your long-term weight loss goals.
Contact us today to schedule a consultation.
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exercise into your schedule can mean extra stress as you […]
BE A SMART SNACKER AFTER WEIGHT LOSS SURGERY
• Sticking to a healthy diet isn’t always the easiest thing to do, but when it comes to
improving your health and wellbeing there is no better strategy. Luckily, as anyone who
has adjusted their lifestyle can tell you, the more you focus on eating healthy the easier
it becomes. Over time, the decision to opt […]
BARIATRICS AND BUFFETS
• There are a few challenges in life that seem to never get easier, no matter how much
time goes by or how many times you try. Managing your healthy eating plans while at a
buffet is one of those challenges. Buffets are difficult for everyone. They are designed
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New
January 2012 Issue

Counseling the Outpatient Bariatric Client

By Megan Tempest, RD
Today’s Dietitian
Vol. 14 No. 1 P. 38

Pre- and postoperative nutrition counseling is imperative. Here’s how to do both successfully to ensure optimal
postsurgical outcomes.

It’s common knowledge that obesity is a public health crisis. Statistics from the Centers for Disease Control and
Prevention (CDC) estimate that one-third of US adults are obese, as are 17% of children and adolescents. Morbid
obesity (defined by a BMI of 40 or higher or 100 lbs over ideal body weight) is also a serious problem. Its incidence
has risen to more than 5% of US adults, who’ve found it difficult, if not impossible, to lose weight through diet and
exercise—which is the main reason bariatric surgery has become widely accepted as a viable, albeit invasive, means
to weight loss.

A 2011 report that assessed trends concerning the incidence of weight loss surgery between 2003 and 2008 showed
that bariatric surgical procedures peaked in 2004 and remained steady thereafter.1 The American Society for
Metabolic and Bariatric Surgery (ASMBS) reported that the number of weight loss surgical procedures increased from
103,000 in 2003 to an estimated 220,000 in 2008.2

According to the ASMBS, recent research suggests that the higher mortality risk of the morbidly obese reverts to
normal following weight loss surgery. The procedure, which often gives morbidly obese patients their only hope for
losing weight and leading a normal life, has been an effective treatment for metabolic disease and conditions such as
type 2 diabetes, hypertension, high cholesterol, nonalcoholic fatty liver disease, and obstructive sleep apnea.3

The benefits of weight loss surgery also extend to close family members. A 2011 study, “The Halo Effect of Bariatric
Surgery,” by Woodard and colleagues, published in the Archives of Surgery, showed that 12 months after the
procedure, adult family members of gastric bypass patients demonstrated improved eating habits, reduced alcohol
consumption, and significant weight loss. Family members also engaged in increased daily activity and less
emotional eating. Obese children of gastric bypass patients tended to have a lower BMI than expected for their
growth curve.

Given that weight loss and improved health aren’t always synonymous, a functional knowledge of good nutrition and
the implementation of healthful eating habits are essential to positive outcomes after bariatric surgery. RDs are
integral members of the interdisciplinary care provided in the bariatric setting. This article will discuss several aspects
involved in nutritional counseling before and after weight loss surgery and provide insight from dietetics experts who
specialize in this field of practice.

Preoperative Phase
In the pursuit of weight loss surgery, individuals often approach the dietitian’s office with trepidation. Preoperative
counseling sessions for bariatric surgery candidates are commonly thought to serve as a screening process. While
there’s some truth to that, early counseling with a dietitian fulfills other valuable purposes. Generally speaking, it’s a
window of opportunity for the dietitian to prepare prospective surgery candidates for the long-term diet and lifestyle
changes they must implement and set them up for success after surgery.

Renee Cooper, RD, LD, a bariatric dietitian at University Hospitals Case Medical Center in Cleveland Heights, Ohio,
reinforces the primary goal of preoperative nutrition counseling: “As a clinician, you must ask yourself if the patient is
going to be successful after surgery. If not, what can you do to help them be successful?”

Evaluate Individual Needs

Weight loss surgery requires dramatic lifestyle changes from patients. Assessing an individual’s unique needs and
readiness for change are requisite components of preoperative nutrition counseling. Kristen Smith, MS, RD, CDN, a
dietitian with the bariatric surgery program at Montefiore Medical Center in New York City, considers this essential to
her preoperative conversations. “Some patients may not have even considered making changes to their food habits;
some may have just started to think about it, while others have already started making significant changes,” Smith
explains.
Bariatric surgery patients stand to benefit greatly from adopting basic changes toward healthful eating before surgery.
For Smith, rather than counsel her preoperative patients on relatively complex concepts like calorie counting, she
focuses on fundamental nutrition concepts such as what types of foods should go on their plates and how to create
nutritious meals. She elaborates, “I focus on basic healthful eating and encourage patients to start making gradual
changes, such as eating more fruits and vegetables, drinking less sugary drinks, or eating less fried food.”

Jody Halouska, RD, also finds that a wide range of nutrition knowledge exists among surgery candidates she
counsels as the bariatric surgery coordinator at the Colorado Bariatric Surgery Institute of Presbyterian/St. Luke’s
Medical Center in Denver. “Some of the clients we see have been dieting their whole life and understand what they
should be eating but haven’t been able to translate that knowledge into their lifestyle. Others may have no clue about
basic nutrition, how to cook, or how to make good choices with regard to eating.”

Accentuate Personal Responsibility

Bariatric surgery is anything but a quick fix for morbid obesity. In fact, surgery is little more than a tool that works best
in conjunction with specific diet and lifestyle changes to facilitate weight loss and improved health. From drastically
reduced portion sizes, unpredictable food intolerances, or the necessity of regular exercise, dietitians can use
preoperative counseling to give their clients a realistic outlook of the postoperative experience.

Following the guidelines established by the ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss
Patient, Halouska provides surgery candidates with verbal and written information detailing the specific postoperative
diet and lifestyle changes, such as daily protein requirements, fluid needs, and recommended vitamin and mineral
supplementation.4 “We provide a two-hour preoperative class in which patients receive in-depth instruction of all the
postoperative nutrition recommendations and a binder to reference when they go home,” Halouska explains. “If they
follow the instructions and guidelines presented in the class and binder and come back in for follow-up counseling
and support from our staff, they will very likely be successful with surgery. If they don’t, they probably won’t be
successful.”

For surgery candidates who require further nutrition education before surgery, whether to meet insurance
requirements or address a knowledge deficit, Halouska conducts additional preoperative nutrition classes that cover a
wide variety of topics such as making healthful choices when grocery shopping or dining out, exercise and physical
activity requirements, and healthful eating behaviors.

Barriers to Postoperative Success

Addressing needs for nutrition education is key in the bariatric surgery setting. However, to make optimal use of
preoperative counseling, dietitians should ask questions that help identify other, perhaps less obvious, barriers to
success following surgery. Cooper cites financial constraints as one barrier. “Having to wait for a paycheck in order to
buy groceries or having difficulty purchasing healthful foods is always a concern for bariatric surgery patients.”

Cooper also has heightened concern for individuals who lack a stable support system in their personal lives, noting
that some of her patients don’t even have support from their own spouses. This makes Cooper skeptical as to how
successful the person will be after surgery. “If the individual having surgery doesn’t have adequate support, their
likelihood of being successful is much lower.”

Halouska keeps an eye out for eating behaviors that could be problematic after surgery, such as binge eating,
emotional eating, and boredom eating, and consistently collaborates with a social worker on such issues. “If a person
shows evidence of a current or past eating disorder, for example, a psychological assessment will address that. We
want to make sure the person is cognizant that surgery won’t change those behaviors; rather it’s up to the individual
to address those behaviors before surgery occurs.”

Postoperative Counseling
Those who’ve experienced the rewards of weight loss surgery no doubt can attest to the challenges they encountered
along the way. Consistent follow-up care with a dietitian—along with an interdisciplinary healthcare team—is a vital
component of successful surgery outcomes. Postoperative nutrition counseling may address issues such as food
intolerances, challenges in implementing healthful eating habits, adequacy of the diet in meeting basic nutritional
needs, and adherence to vitamin and mineral supplementation, all while providing a platform for the patient’s unique
questions and concerns.

Cooper describes the rewards of counseling her patients in the postoperative period: “I enjoy that postoperative
counseling really keeps you on your toes. You get to put your thinking cap on and do a lot of problem solving. … Why
is this person frequently nauseous? Why are they able to tolerate a certain food one day and not the next? Are they
meeting all their nutritional needs?”

Cooper firmly believes in the dietitian’s role in helping bariatric surgery patients achieve their health and weight-loss
goals after surgery. “I look forward to the moment when the light bulb goes off and my patients say ‘I get it now.’
These patients are making huge lifestyle changes, and many go all the way with it. Dietitians are so valuable because
nutrition is critical to their success.”

Value of Small Changes

Working with bariatric surgery patients to implement small, achievable changes can foster confidence and momentum
during the somewhat emotionally treacherous postsurgical phase. For instance, setting a goal to reduce intake of
high-calorie desserts rather than eliminate them or choosing whole grain foods over their white counterparts may help
circumvent feelings of failure or disappointment from falling short of loftier goals.

Halouska routinely adopts this realistic approach when counseling patients following surgery. “We can’t expect a
patient to come in to our office three months after surgery having changed all of their habits,” she contends.

Halouska utilizes postoperative counseling to review all previously delineated diet and lifestyle changes to determine
how well the patient is complying with them. “I make sure to give them time to ask questions,” she says. “At the end
of our talk, I provide them with a written handout summarizing their specific recommendations and highlight what
they’re already doing well. To address areas that need improvement, I work with the client to set specific goals to
work on until the next visit.”

Tackling Personal Conflicts

Despite thorough preoperative counseling, even the most determined surgery candidates may need to confront
unexpected challenges after surgery. Halouska finds that a common barrier to success is thinking that surgery works
like magic, when nothing could be further from the truth. “Postoperatively, patients often realize surgery doesn’t do all
the work. They must understand that healthful diet and lifestyle changes must be adhered to despite all of life’s ups
and downs that may make doing so more difficult.”

Halouska asserts that all bariatric surgery patients must make their health a priority in the face of personal struggles
and challenges. “Patients have to maintain those critical lifestyle changes rather than revert back to bad habits that
prevent weight loss.”

Cooper has witnessed some of her patients fall victim to such pitfalls to success. “The individuals that fall back into
their old ways and regain weight are often those who experience something tragic or perhaps become a caregiver to
an ailing family member.”

The dietitian can help support postoperative patients in maintaining healthful eating habits in the face of personal
stress that may provoke unhealthful behaviors, such as emotional eating. “The behavioral aspect may be just as
important as the nutritional changes,” Cooper suggests. “That’s a whole other component to their success after
surgery.”

Create a Supportive Environment

Smith uses a technique referred to as motivational interviewing, which she describes as a nonjudgmental, client-
centered approach to counseling. “It attempts to increase the patient’s understanding of a problem and relay the risks
if the problem isn’t improved or resolved. This helps patients establish their own goals and build a better rapport
between the dietitian and the patient.”

Smith feels bariatric patients benefit from believing the dietitian understands the challenges they face and that
dietitians aren’t without flaws when it comes to diet and nutrition. “Sometimes I share my personal story that I didn’t
grow up eating healthfully,” she says. “This approach helps patients understand we’re human, and everyone
struggles with making changes to their diet. I think patients come in the office feeling judged and like they can’t be
truthful about their eating. We must break that barrier and create an environment in which they feel comfortable and
supported.”

Cooper advocates for offering consistent support and availability to her patients. “I think one of the most important
things a dietitian can do is be as available as possible and always remain in communication with his or her clients,
whether via one-on-one counseling, e-mail, telephone, or at support group meetings. The more you stay in touch with
bariatric surgery patients, the more likely they are to stay on track with their weight loss goals.”

Organized support groups are very common in the bariatric surgery setting, providing yet another avenue to
successful health and weight loss outcomes from surgery. Halouska’s team at the Colorado Bariatric Surgery Institute
conducts regular support groups that provide patients an opportunity for ongoing, long-term education on topics such
as nutrition, exercise, and healthful behavior changes. Support groups also give patients a chance to communicate
with other people experiencing similar challenges and struggles. As Halouska says, support groups provide the
fundamental benefit of helping patients feel less alone in the process of adapting to a new way of life following
surgery.

— Megan Tempest, RD, is a freelance writer based in Colorado.

Components of Pre-Op Nutritional Assessment

• Anthropometrics

• Weight history

• Available laboratory values

• Psychological history

• Dietary intake

• Physical activity level

• Psychosocial assessment

• Details of postoperative intake

— Source: Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS Allied Health Nutritional Guidelines for
the Surgical Weight Loss Patient. Surg Obes Relat Dis. 2008;4:S73-S108.

Components of Post-Op Nutritional Follow-Up

• Anthropometrics

• Biochemical/laboratory values

• Medication review

• Vitamin/mineral supplementation

• Dietary intake