7Diet Progression: Lap - Band Stage 1: Clear liquids and protein supplement.( 2 weeks)Stage 2: No concentrated sweets, low fat puree diet (2weeks)Stage 3: Regular texture weight reduction diet.
8Stage 1 Only clear liquids allowed Avoid sweetened beverages Sip very slowlyNo strawsAvoid caffeinated, carbonated and alcoholic beveragesSTOP drinking if you feel fullness, pain or discomfort
9Stage 1 sample menu Water, diet jello, decaf tea, broth, apple juice , cranberry juiceJuices must be diluted 1:1 with waterIt will be up to you to regulate how muchyou consume.
104 x 4 Rule 1 oz of liquids every hour for 4 hours Increase in 1 oz increments every 4 hoursGoal: 4 oz of liquids every hour while awake
11When you go homeGoal: To drink oz of liquids/day at rate of 4oz/hrThis will take you 12 to 16 hours to consumeAvoid juices, they have too many calories64oz of juice =960 calories
12Stage 1 beverages Crystal light® Herbal tea( decaf) Diet Gelatin Water Diet Twister ®Wyler’s diet lemonade ®Sugar free Kool-Aid ®Broth/ConsomméDiet V8 Splash ®Fruit20 ®Country Time Diet Lemonade ®Propel Water ®Sugar free ice popsDiet Snapple ®Smart Water ®
13Protein supplements Begin the day after you go home from Hospital Minimum protein target 70gms/dayMay use powder or pre-mixed liquid forms (Whey protein is preferred)Protein pills may not be used
14Protein Supplements ( cont) May be mixed with Skim milk, Skim Plus milk, I% milk soy milk, water, crystal light…Mixing with milk increases protein content
15Protein Supplement ( cont) Unjury protein powder provides 20 gms of protein/scoop.If mixed with 8 oz of water will still yield 20 gms proteinIf mixed with 8oz skim milk will yield 28 gms proteinIf mixed with 8oz Skim Plus milk will yield 31 grams protein.
16Protein Supplements (cont) Try sample supplementsAvailable for purchase at Vitalady.com, Bariatriceating.com, Unjury.com, Health food stores, GNC, Vitamin Shoppe
17Vitamin and Mineral Supplements Gastric bypass patientsIn 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
18Vitamin and Mineral Supplements Lap-Band® patientsRequire a multivitamin with minerals dailyIt may be necessary to take additional vitamins and minerals e.g. calcium, iron, folate,B1, B12.These will be prescribed as needed.
20Puree diet Regular scheduled meals Avoid meal skipping Plan meals in advanceEat SlowlyEat protein foods firstMoisten meatsUse liquid protein as supplement not as meal replacementMeasure 2 oz portions at each meal.eating when fullSeparate liquids and solidsNo bread, rice or pastaAvoid added sugars and high fat foodsVARIETY!
22Stage 3 dietContinue to eat blended food, adding one new solid food at a timeDice meatsChew slowlyFood intolerances varyPrioritize protein rich foodsDaily MVI, calcium and ironGradually increase meal size to 4-5 oz
23Stage 3 continued Avoid meal skipping Continue to separate liquids and solidsProtein intake assessed and supplement will be adjusted/eliminated accordingly
24Common post-operative nutritional problems NauseaVomitingDehydrationFrothingDiarrheaDumping SyndromeDizzinessBad BreathLoss of appetiteFood getting”stuck”Hair LossLactose intoleranceVitamin/mineral deficienciesProtein malnutritionFood intolerancesFood aversions/fearsDepression: often caused by frustration around inability to eat for comfort/stress“Hibernation “ Syndrome
25Late post –operative complication Weight Gain GrazingSnacking on left –over mealsHidden caloriesAlcoholPoor food choicesCarbonated beveragesLack of exerciseFailure to check weight regularlyNot attending follow up visits with Bariatric Surgeon
26Long-term Success Habits of WLS patients First post-op year critical time that must be dedicated to changing old behavior and forming new lifelong habits3 meals, 2 snacks dailyWater vs. sweetened/carbonated beveragesRegular exercise-4x 40mins/wk to maintain weight
27WLS Patient Success Habits (cont) 7 hours sleep nightlyDaily MVI, Calcium and iron.Accepting personal responsibility for staying in controlCooke et al, Obesity Surgery September 1999
28Preparing for Weight Loss Surgery Start to make diet and lifestyle change today!Plan meals in advanceAvoid meal skippingLimit snacks to 2 /dayWean off sweets / added sugarsReduce dependency on fast foodsAvoid fried foodsEliminate caffeinated, carbonated and sweetened beverages
29Preparing for Weight Loss Surgery Practice mindful eating techniquesAvoid eating in bed/while watching TVChew each bite timesPractice separating liquids and solidsTry stage 1 and 2 diet prior to scheduling surgeryStart exercise program e.g. walking, water aerobics, armchair exercises…….Try protein supplements and purchase your favorite!Daily MVI and calciumAvoid weight gainAttend Support group……….
30Support 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”
31What’s next?First office visit- meet the surgeon and complete nutritional evaluation with the dietitianSchedule tests and send results to officeAttend at least 2 support group meetingsSecond visitPre-op mandatory class, bariatric quiz and pre-surgical testingSurgery