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Bariatric Surgery : Your Guidelines for Food Choices and Nutrition Aisling Mc Ginty MS, RD, Tricia Mah MS, RD.

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Presentation on theme: "Bariatric Surgery : Your Guidelines for Food Choices and Nutrition Aisling Mc Ginty MS, RD, Tricia Mah MS, RD."— Presentation transcript:

1 Bariatric Surgery : Your Guidelines for Food Choices and Nutrition Aisling Mc Ginty MS, RD, Tricia Mah MS, RD

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3 Lap- Band® Lap- Band®

4 Gastric Bypass

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6 Diet Progression: Gastric Bypass Stage 1: Clear liquids and protein supplement. Stage 1: Clear liquids and protein supplement. (1 week) (1 week) Stage 2:No concentrated sweets, low fat puree diet ( 3 weeks) Stage 2:No concentrated sweets, low fat puree diet ( 3 weeks) Stage 3: Regular texture weight reduction diet. Stage 3: Regular texture weight reduction diet.

7 Diet Progression: Lap - Band Stage 1: Clear liquids and protein supplement. Stage 1: Clear liquids and protein supplement. ( 2 weeks) ( 2 weeks) Stage 2: No concentrated sweets, low fat puree diet (2weeks) Stage 2: No concentrated sweets, low fat puree diet (2weeks) Stage 3: Regular texture weight reduction diet. Stage 3: Regular texture weight reduction diet.

8 Stage 1 Stage 1 Only clear liquids allowed Only clear liquids allowed Avoid sweetened beverages Avoid sweetened beverages Sip very slowly Sip very slowly No straws No straws Avoid caffeinated, carbonated and alcoholic beverages Avoid caffeinated, carbonated and alcoholic beverages STOP drinking if you feel fullness, pain or discomfort STOP drinking if you feel fullness, pain or discomfort

9 Stage 1 sample menu Water, diet jello, decaf tea, broth, Water, diet jello, decaf tea, broth, apple juice, cranberry juice apple juice, cranberry juice Juices must be diluted 1:1 with water Juices must be diluted 1:1 with water It will be up to you to regulate how much It will be up to you to regulate how much you consume. you consume.

10 4 x 4 Rule 4 x 4 Rule 1 oz of liquids every hour for 4 hours 1 oz of liquids every hour for 4 hours Increase in 1 oz increments every 4 hours Increase in 1 oz increments every 4 hours Goal: 4 oz of liquids every hour while awake Goal: 4 oz of liquids every hour while awake

11 When you go home Goal: To drink oz of liquids/day at rate of 4oz/hr Goal: To drink oz of liquids/day at rate of 4oz/hr This will take you 12 to 16 hours to consume This will take you 12 to 16 hours to consume Avoid juices, they have too many calories Avoid juices, they have too many calories 64oz of juice =960 calories 64oz of juice =960 calories

12 Stage 1 beverages Crystal light® Crystal light® Herbal tea( decaf) Herbal tea( decaf) Diet Gelatin Diet Gelatin Water Water Diet Twister ® Diet Twister ® Wylers diet lemonade ® Wylers diet lemonade ® Sugar free Kool-Aid ® Sugar free Kool-Aid ® Broth/Consommé Broth/Consommé Diet V8 Splash ® Fruit 2 0 ® Country Time Diet Lemonade ® Propel Water ® Sugar free ice pops Diet Snapple ® Smart Water ®

13 Protein supplements Begin the day after you go home from Hospital Begin the day after you go home from Hospital Minimum protein target 70gms/day Minimum protein target 70gms/day May use powder or pre-mixed liquid forms (Whey protein is preferred) May use powder or pre-mixed liquid forms (Whey protein is preferred) Protein pills may not be used Protein pills may not be used

14 Protein Supplements ( cont) May be mixed with Skim milk, Skim Plus milk, I% milk soy milk, water, crystal light… May be mixed with Skim milk, Skim Plus milk, I% milk soy milk, water, crystal light… Mixing with milk increases protein content Mixing with milk increases protein content

15 Protein Supplement ( cont) Unjury protein powder provides 20 gms of protein/scoop. Unjury protein powder provides 20 gms of protein/scoop. If mixed with 8 oz of water will still yield 20 gms protein If mixed with 8 oz of water will still yield 20 gms protein If mixed with 8oz skim milk will yield 28 gms protein If mixed with 8oz skim milk will yield 28 gms protein If mixed with 8oz Skim Plus milk will yield 31 grams protein. If mixed with 8oz Skim Plus milk will yield 31 grams protein.

16 Protein Supplements (cont) Try sample supplements Try sample supplements Available for purchase at Vitalady.com, Bariatriceating.com, Unjury.com, Health food stores, GNC, Vitamin Shoppe Available for purchase at Vitalady.com, Bariatriceating.com, Unjury.com, Health food stores, GNC, Vitamin Shoppe

17 Vitamin and Mineral Supplements Gastric bypass patients Gastric bypass patients In addition to eating much less food gastric bypass patients will also absorb vitamins and minerals differently after surgery. In addition to eating much less food gastric bypass patients will also absorb vitamins and minerals differently after surgery. You will require daily multivitamin, calcium and iron supplementation for the rest of your life You will require daily multivitamin, calcium and iron supplementation for the rest of your life

18 Vitamin and Mineral Supplements Lap-Band® patients Require a multivitamin with minerals daily Require a multivitamin with minerals daily It may be necessary to take additional vitamins and minerals e.g. calcium, iron, folate,B1, B12.These will be prescribed as needed. It may be necessary to take additional vitamins and minerals e.g. calcium, iron, folate,B1, B12.These will be prescribed as needed.

19 Stage 2 diet Puree

20 Puree diet Regular scheduled meals Regular scheduled meals Avoid meal skipping Avoid meal skipping Plan meals in advance Plan meals in advance Eat Slowly Eat Slowly Eat protein foods first Eat protein foods first Moisten meats Moisten meats Use liquid protein as supplement not as meal replacement Use liquid protein as supplement not as meal replacement Measure 2 oz portions at each meal. eating when full Separate liquids and solids No bread, rice or pasta Avoid added sugars and high fat foods VARIETY!

21 Stage 3 diet No Concentrated Sweets, Low fat, Calorie controlled diet No Concentrated Sweets, Low fat, Calorie controlled diet

22 Stage 3 diet Stage 3 diet Continue to eat blended food, adding one new solid food at a time Continue to eat blended food, adding one new solid food at a time Dice meats Dice meats Chew slowly Chew slowly Food intolerances vary Food intolerances vary Prioritize protein rich foods Prioritize protein rich foods Daily MVI, calcium and iron Daily MVI, calcium and iron Gradually increase meal size to 4-5 oz Gradually increase meal size to 4-5 oz

23 Stage 3 continued Avoid meal skipping Avoid meal skipping Continue to separate liquids and solids Continue to separate liquids and solids Protein intake assessed and supplement will be adjusted/eliminated accordingly Protein intake assessed and supplement will be adjusted/eliminated accordingly

24 Common post-operative nutritional problems Nausea Nausea Vomiting Vomiting Dehydration Dehydration Frothing Frothing Diarrhea Diarrhea Dumping Syndrome Dumping Syndrome Dizziness Dizziness Bad Breath Bad Breath Loss of appetite Loss of appetite Food gettingstuck Food gettingstuck Hair Loss Lactose intolerance Vitamin/mineral deficiencies Protein malnutrition Food intolerances Food aversions/fears Depression: often caused by frustration around inability to eat for comfort/stress Hibernation Syndrome

25 Late post –operative complication Weight Gain Late post –operative complication Weight Gain Grazing Grazing Snacking on left –over meals Snacking on left –over meals Hidden calories Hidden calories Alcohol Alcohol Poor food choices Poor food choices Carbonated beverages Carbonated beverages Lack of exercise Lack of exercise Failure to check weight regularly Failure to check weight regularly Not attending follow up visits with Bariatric Surgeon Not attending follow up visits with Bariatric Surgeon

26 Long-term Success Habits of WLS patients Long-term Success Habits of WLS patients First post-op year critical time that must be dedicated to changing old behavior and forming new lifelong habits First post-op year critical time that must be dedicated to changing old behavior and forming new lifelong habits 3 meals, 2 snacks daily 3 meals, 2 snacks daily Water vs. sweetened/carbonated beverages Water vs. sweetened/carbonated beverages Regular exercise-4x 40mins/wk to maintain weight Regular exercise-4x 40mins/wk to maintain weight

27 WLS Patient Success Habits (cont) 7 hours sleep nightly 7 hours sleep nightly Daily MVI, Calcium and iron. Daily MVI, Calcium and iron. Accepting personal responsibility for staying in control Accepting personal responsibility for staying in control Cooke et al, Obesity Surgery September 1999 Cooke et al, Obesity Surgery September 1999

28 Preparing for Weight Loss Surgery Start to make diet and lifestyle change today! Start to make diet and lifestyle change today! Plan meals in advance Plan meals in advance Avoid meal skipping Avoid meal skipping Limit snacks to 2 /day Limit snacks to 2 /day Wean off sweets / added sugars Wean off sweets / added sugars Reduce dependency on fast foods Reduce dependency on fast foods Avoid fried foods Avoid fried foods Eliminate caffeinated, carbonated and sweetened beverages Eliminate caffeinated, carbonated and sweetened beverages

29 Preparing for Weight Loss Surgery Practice mindful eating techniques Practice mindful eating techniques Avoid eating in bed/while watching TV Avoid eating in bed/while watching TV Chew each bite times Chew each bite times Practice separating liquids and solids Practice separating liquids and solids Try stage 1 and 2 diet prior to scheduling surgery Try stage 1 and 2 diet prior to scheduling surgery Start exercise program e.g. walking, water aerobics, armchair exercises……. Start exercise program e.g. walking, water aerobics, armchair exercises……. Try protein supplements and purchase your favorite! Try protein supplements and purchase your favorite! Daily MVI and calcium Daily MVI and calcium Avoid weight gain Avoid weight gain Attend Support group………. Attend Support group……….

30 Support Group : Patient Feedback Support Group : Patient Feedback The ……most crucial factor for me has been the group………I do not think this surgery should be performed without a support component and…….participation should be mandatory The ……most crucial factor for me has been the group………I do not think this surgery should be performed without a support component and…….participation should be mandatory

31 Whats next? Whats next? First office visit- meet the surgeon and complete nutritional evaluation with the dietitian First office visit- meet the surgeon and complete nutritional evaluation with the dietitian Schedule tests and send results to office Schedule tests and send results to office Attend at least 2 support group meetings Attend at least 2 support group meetings Second visit Second visit Pre-op mandatory class, bariatric quiz and pre- surgical testing Pre-op mandatory class, bariatric quiz and pre- surgical testing Surgery Surgery


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