Bariatric Surgery : Bariatric Surgery : Your Guidelines for Your Guidelines for Food Choices and Food Choices and

NutritionNutritionAisling Mc Ginty MS, RD,

Tricia Mah MS, RD

Lap- Band®Lap- Band®

Gastric BypassGastric Bypass

Diet Progression: Gastric Diet Progression: Gastric BypassBypass

Stage 1: Clear liquids and protein Stage 1: Clear liquids and protein supplement.supplement.

(1 week)(1 week)

Stage 2:No concentrated sweets, low Stage 2:No concentrated sweets, low fat puree diet ( 3 weeks)fat puree diet ( 3 weeks)

Stage 3: Regular texture weight Stage 3: Regular texture weight reduction diet.reduction diet.

Diet Progression: Lap - Diet Progression: Lap - BandBand

Stage 1: Clear liquids and protein Stage 1: Clear liquids and protein supplement. supplement.

( 2 weeks)( 2 weeks)

Stage 2: No concentrated sweets, low Stage 2: No concentrated sweets, low fat puree diet (2weeks)fat puree diet (2weeks)

Stage 3: Regular texture weight Stage 3: Regular texture weight reduction diet.reduction diet.

Stage 1Stage 1

Only clear liquids allowed Only clear liquids allowed Avoid sweetened beveragesAvoid sweetened beverages Sip very slowlySip very slowly No strawsNo straws Avoid caffeinated, carbonated and Avoid caffeinated, carbonated and

alcoholic beveragesalcoholic beverages STOP drinking if you feel fullness, STOP drinking if you feel fullness,

pain or discomfortpain or discomfort

Stage 1 sample menuStage 1 sample menu

Water, diet jello, decaf tea, broth,Water, diet jello, decaf tea, broth,

apple juice , cranberry juiceapple juice , cranberry juice

Juices must be diluted 1:1 with waterJuices must be diluted 1:1 with water

It will be up to you to regulate how It will be up to you to regulate how much much

you consume.you consume.

4 x 4 Rule4 x 4 Rule

1 oz of liquids every hour for 4 hours1 oz of liquids every hour for 4 hours

Increase in 1 oz increments every 4 Increase in 1 oz increments every 4 hourshours

Goal: 4 oz of liquids every hour while Goal: 4 oz of liquids every hour while awakeawake

When you go homeWhen you go home

Goal: To drink 48-64 oz of liquids/day at Goal: To drink 48-64 oz of liquids/day at rate of 4oz/hrrate of 4oz/hr

This will take you 12 to 16 hours to This will take you 12 to 16 hours to consumeconsume

Avoid juices, they have Avoid juices, they have too many caloriestoo many calories 64oz of juice =960 calories64oz of juice =960 calories

Stage 1 beveragesStage 1 beverages Crystal lightCrystal light®® Herbal tea( decaf)Herbal tea( decaf) Diet GelatinDiet Gelatin WaterWater Diet Twister ®Diet Twister ® Wyler’s diet Wyler’s diet

lemonade ®lemonade ® Sugar free Kool-Sugar free Kool-

Aid ®Aid ® Broth/ConsomméBroth/Consommé

Diet V8 Splash Diet V8 Splash ®® FruitFruit220 ®0 ® Country Time Diet Country Time Diet

Lemonade ®Lemonade ® Propel Water ®Propel Water ® Sugar free ice Sugar free ice

popspops Diet Snapple ®Diet Snapple ® Smart Water ®Smart Water ®

Protein supplementsProtein supplements

Begin the day Begin the day after after you go home you go home from Hospitalfrom Hospital

Minimum protein target Minimum protein target 70gms/day70gms/day

May use powder or pre-mixed liquid May use powder or pre-mixed liquid forms (Whey protein is preferred)forms (Whey protein is preferred)

Protein pills Protein pills may notmay not be used be used

Protein Supplements Protein Supplements ( cont)( cont)

May be mixed with Skim milk, Skim May be mixed with Skim milk, Skim Plus milk, I% milk soy milk, water, Plus milk, I% milk soy milk, water, crystal light…crystal light…

Mixing with milk increases protein Mixing with milk increases protein contentcontent

Protein Supplement Protein Supplement ( cont)( cont)

Unjury protein powder provides 20 Unjury protein powder provides 20 gms of protein/scoop. gms of protein/scoop.

If mixed with 8 oz of water will still If mixed with 8 oz of water will still yield 20 gms proteinyield 20 gms protein

If mixed with 8oz skim milk will yield If mixed with 8oz skim milk will yield 28 gms protein28 gms protein

If mixed with 8oz Skim Plus milk will If mixed with 8oz Skim Plus milk will yield 31 grams protein. yield 31 grams protein.

Protein Supplements Protein Supplements (cont)(cont)

Try sample supplements Try sample supplements Available for purchase at Available for purchase at

Vitalady.com, Vitalady.com, Bariatriceating.com, Bariatriceating.com, Unjury.com, Health food stores, Unjury.com, Health food stores, GNC, Vitamin Shoppe.......GNC, Vitamin Shoppe.......

Vitamin and Mineral Vitamin and Mineral SupplementsSupplements

Gastric bypass patientsGastric bypass patients In addition to eating much less food In addition to eating much less food

gastric bypass patients will also gastric bypass patients will also absorb absorb vitamins and minerals vitamins and minerals differently after surgery.differently after surgery.

You will require You will require dailydaily multivitamin , multivitamin , calcium and iron supplementation calcium and iron supplementation for the rest of your lifefor the rest of your life

Vitamin and Mineral Vitamin and Mineral SupplementsSupplements

Lap-BandLap-Band® patients® patients

Require a multivitamin with Require a multivitamin with minerals dailyminerals daily

It may be necessary to take It may be necessary to take additional vitamins and minerals additional vitamins and minerals e.g. calcium, iron, folate,B1, e.g. calcium, iron, folate,B1, B12.These will be prescribed as B12.These will be prescribed as neededneeded..

Stage 2 dietStage 2 diet

PureePuree

Puree dietPuree diet Regular scheduled Regular scheduled

mealsmeals Avoid meal skippingAvoid meal skipping Plan meals in advancePlan meals in advance Eat SlowlyEat Slowly Eat protein foods firstEat protein foods first Moisten meatsMoisten meats Use liquid protein as Use liquid protein as

supplement supplement not not as as meal replacementmeal replacement

MeasureMeasure 2 oz 2 oz portions at each portions at each meal.meal.

eating when fulleating when full Separate liquids and Separate liquids and

solidssolids No bread, rice or No bread, rice or

pastapasta Avoid added sugars Avoid added sugars

and high fat foodsand high fat foods VARIETY!VARIETY!

Stage 3 dietStage 3 diet

No Concentrated Sweets, No Concentrated Sweets, Low fat, Calorie controlled Low fat, Calorie controlled

dietdiet

Stage 3 dietStage 3 diet

Continue to eat blended food, adding Continue to eat blended food, adding one new solid food at a timeone new solid food at a time

Dice meatsDice meats Chew slowlyChew slowly Food intolerances varyFood intolerances vary Prioritize protein rich foodsPrioritize protein rich foods Daily MVI, calcium and ironDaily MVI, calcium and iron Gradually increase meal size to 4-5 Gradually increase meal size to 4-5

ozoz

Stage 3 continuedStage 3 continued

Avoid meal skippingAvoid meal skipping

Continue to separate liquids and Continue to separate liquids and

solidssolids

Protein intake assessed and Protein intake assessed and

supplement will be supplement will be

adjusted/eliminated accordinglyadjusted/eliminated accordingly

Common post-operative Common post-operative nutritional problemsnutritional problems

NauseaNausea VomitingVomiting DehydrationDehydration FrothingFrothing DiarrheaDiarrhea Dumping SyndromeDumping Syndrome DizzinessDizziness Bad BreathBad Breath Loss of appetiteLoss of appetite Food getting”stuck”Food getting”stuck”

Hair LossHair Loss Lactose intoleranceLactose intolerance Vitamin/mineral Vitamin/mineral

deficienciesdeficiencies Protein malnutritionProtein malnutrition Food intolerancesFood intolerances Food aversions/fearsFood aversions/fears Depression: often caused Depression: often caused

by frustration around by frustration around inability to eat for inability to eat for comfort/stresscomfort/stress

““Hibernation “ SyndromeHibernation “ Syndrome

Late post –operative Late post –operative complicationcomplicationWeight GainWeight Gain

GrazingGrazing Snacking on left –over mealsSnacking on left –over meals Hidden caloriesHidden calories AlcoholAlcohol Poor food choicesPoor food choices Carbonated beveragesCarbonated beverages Lack of exerciseLack of exercise Failure to check weight regularlyFailure to check weight regularly Not attending follow up visits with Not attending follow up visits with

Bariatric SurgeonBariatric Surgeon

Long-term Success Habits Long-term Success Habits of WLS patientsof WLS patients

First post-op year critical time that must First post-op year critical time that must be dedicated to changing old behavior be dedicated to changing old behavior and forming new lifelong habitsand forming new lifelong habits

3 meals, 2 snacks daily3 meals, 2 snacks daily Water vs. sweetened/carbonated Water vs. sweetened/carbonated

beveragesbeverages Regular exercise-4x 40mins/wk to Regular exercise-4x 40mins/wk to

maintainmaintain weight weight

WLS Patient Success Habits WLS Patient Success Habits (cont)(cont)

7 hours sleep nightly7 hours sleep nightly

Daily MVI, Calcium and iron.Daily MVI, Calcium and iron.

Accepting personal responsibility for Accepting personal responsibility for staying in controlstaying in control

Cooke et al, Obesity Cooke et al, Obesity Surgery September 1999Surgery September 1999

Preparing for Weight Loss Preparing for Weight Loss SurgerySurgery

Start to make diet and lifestyle change Start to make diet and lifestyle change today!today!

Plan meals in advancePlan meals in advance Avoid meal skippingAvoid meal skipping Limit snacks to 2 /dayLimit snacks to 2 /day Wean off sweets / added sugarsWean off sweets / added sugars Reduce dependency on fast foodsReduce dependency on fast foods Avoid fried foodsAvoid fried foods Eliminate caffeinated, carbonated and Eliminate caffeinated, carbonated and

sweetened beveragessweetened beverages

Preparing for Weight Loss Preparing for Weight Loss SurgerySurgery

Practice mindful eating techniquesPractice mindful eating techniques Avoid eating in bed/while watching TVAvoid eating in bed/while watching TV Chew each bite 20-25 timesChew each bite 20-25 times Practice separating liquids and solidsPractice separating liquids and solids Try stage 1 and 2 diet prior to scheduling surgeryTry stage 1 and 2 diet prior to scheduling surgery Start exercise program e.g. walking, water Start exercise program e.g. walking, water

aerobics, armchair exercises…….aerobics, armchair exercises……. Try protein supplements and purchase your Try protein supplements and purchase your

favorite!favorite! Daily MVI and calciumDaily MVI and calcium Avoid weight gainAvoid weight gain Attend Support group……….Attend Support group……….

Support Group : Patient Support Group : Patient FeedbackFeedback

““The ……most crucial factor The ……most crucial factor for me has been the for me has been the group………I do not think this group………I do not think this surgery should be performed surgery should be performed without a support component without a support component and…….participation should and…….participation should be mandatory”be mandatory”

What’s next?What’s next?

First office visit- meet the surgeon and First office visit- meet the surgeon and complete nutritional evaluation with the complete nutritional evaluation with the dietitiandietitian

Schedule tests and send results to officeSchedule tests and send results to office Attend at least 2 support group meetingsAttend at least 2 support group meetings Second visitSecond visit Pre-op mandatory class, bariatric quiz Pre-op mandatory class, bariatric quiz

and pre-surgical testingand pre-surgical testing SurgerySurgery