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

3. Lap- Band®

4. Gastric Bypass

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

7. Diet 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.

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

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

10. 4 x 4 Rule 1 oz of liquids every hour for 4 hours
Increase in 1 oz increments every 4 hours
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
This will take you 12 to 16 hours to consume
Avoid juices, they have too many calories
64oz of juice =960 calories

12. Stage 1 beverages Crystal light® Herbal tea( decaf) Diet Gelatin Water
Diet Twister ®
Wyler’s diet lemonade ®
Sugar free Kool-Aid ®
Broth/Consommé
Diet V8 Splash ®
Fruit20 ®
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
Minimum protein target 70gms/day
May use powder or pre-mixed liquid forms (Whey protein is preferred)
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…
Mixing with milk increases protein content

15. Protein Supplement ( cont)
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 8oz skim milk will yield 28 gms protein
If mixed with 8oz Skim Plus milk will yield 31 grams protein.

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

17. Vitamin and Mineral Supplements
Gastric bypass patients
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

18. Vitamin and Mineral Supplements
Lap-Band® patients
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.

19. Stage 2 diet
Puree

20. Puree diet Regular scheduled meals Avoid meal skipping
Plan meals in advance
Eat Slowly
Eat protein foods first
Moisten meats
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. No Concentrated Sweets, Low fat, Calorie controlled diet
Stage 3 diet
No Concentrated Sweets, Low fat, Calorie controlled diet

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

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

24. Common post-operative nutritional problems
Nausea
Vomiting
Dehydration
Frothing
Diarrhea
Dumping Syndrome
Dizziness
Bad Breath
Loss of appetite
Food getting”stuck”
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
Grazing
Snacking on left –over meals
Hidden calories
Alcohol
Poor food choices
Carbonated beverages
Lack of exercise
Failure to check weight regularly
Not attending follow up visits with Bariatric Surgeon

26. 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
3 meals, 2 snacks daily
Water vs. sweetened/carbonated beverages
Regular exercise-4x 40mins/wk to maintain weight

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

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

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

30. 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”

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