1. Initial Weight Loss Surgery Nutrition Education

2. We recommend that you begin adapting
Bariatric surgery requires
a significant change in how and what you eat and drink.
We recommend that you begin adapting
now to prepare for these changes!

3. Band RNY Sleeve Duodenal Switch

4. How Your Diet Will Advance:
Weeks One & Two: Liquids Only Week Three: Liquids and Semi-Solids Week Four – Month 3: Liquids and Soft Foods

5. Weeks 1 & 2: Liquids Only
In hospital: Clear = ability to see light coming through
Upon return home: milky or creamy consistency

6. Liquids Only (Weeks 1 & 2) Hydrating Fluids Protein Fluids
Clear Liquid Protein (In hospital)
Full Liquid Protein (Upon return home)

7. Choosing a Protein Supplement
Choose a protein supplement with at least 15 grams of protein in an 8-12 oz. serving. Choose a liquid protein supplement with: 20g or less of total carbohydrates, 10g or less of sugar, and 10g or less of total fat.

8. Understanding the Nutrition Facts Label
Start here
< 10 g
total fat
< 20 g carbs
< 10 g sugar
≥ 15 g
protein

9. Drinking Schedule 1-2 oz. every 15 minutes
Protein drink
1-2 oz.
Fluid for hydration
1-2 oz.
Fluid for hydration
1-2 oz.
Fluid for hydration
Following this schedule, it will take most people about hours each day to reach their fluid and protein goals.
***Drinking too quickly or drinking too much at one time may cause pain or discomfort***

10. Nutrition Goals Fluid goal: at least 64 oz. hydrating fluid per day
Protein goal: g per day with band, sleeve, bypass g per day with duodenal switch
New “full” feeling:
Pressure
Tightness

11. Week 3: Semi-Solids and Liquids

12. Semi-Solids and Liquids (Week 3)
Allowed Semi-Solids
Semi-Solids to Avoid

13. Semi-Solid and Liquid Goals (Week 3)
Take minutes to finish each meal.
Begin separating fluid from foods.
Do not drink with meals!
Take very small bites. Chew thoroughly.
Eat a small meal every 3-4 hours.
Measure out no more than ⅓ cup of semi-solid food.

14. Soft Foods, Week 4 to 3 Months post-op
Group Soft Diet Class
Fork Tender Foods
Foods to avoid on the soft diet:
Sugar sweetened, caffeinated, carbonated beverages
Simple carbohydrates like chips, crackers, rice, pasta, and noodles
Crunchy, rough foods
Sticky or rubbery foods
Tough, dry meats
Skins and seeds of fruits and veggies
Fried or high fat foods
Whole milk products
Please DO NOT START the Soft Foods phase until you have received instruction on the soft foods diet from a BSNC dietitian!

15. Meal Planning Do not skip meals!
Breakfast
6:00 AM
2 egg whites
2 tbsp. salsa
1 oz. 2% cheese
A.M. Snack
9:00 AM
Two low fat string cheese sticks
Lunch
12:00 PM
Tossed salad with bib or butter leaf lettuce (1 cup of greens)
2 boiled eggs, chopped
2 tbsp. low-fat salad dressing
P.M. Snack
3:00 PM
1/3 cup tuna salad with ½ cup cucumber slices
Dinner
6:00 PM
1 black bean burger patty
1 slice bib lettuce
1 slice tomato
1-2 tbsp. light mayonnaise, mustard, ketchup
9:00 PM
½ cup Greek yogurt
Meal Planning
Plan to eat ⅓ cup protein every 3-4 hours
Breakfast within 1 hour of waking
Last snack or meal hours before bed
Do not skip meals!

16. Soft Foods Goals (Week 4 - 3 Months)
60-80 g protein per day ( g duodenal switch)
At least 64 ounces fluid per day
Start meals with ⅓ cup protein, supplement w/ veggies
Eat on a schedule - every 3-4 hours
Take thumbnail size bites
Chew foods to applesauce-like consistency
Take minutes to eat
No drinking with meals (“30 minute rule”)

17. ½ cup non-starchy vegetables
This volume usually reached by 6-8 months post op.
*Start Here*
⅓ cup or oz. protein This volume usually reached between weeks post-op.
¼ cup whole grain or starchy vegetables
This volume usually reached between 1 – 1 ½ years post-op.

18. Dumping Syndrome only a side effect of RNY Gastric Bypass
Early Dumping:
Abdominal cramping and diarrhea
Fatigue
Sweating
Rapid heart rate
Decreased blood pressure
Flushing
Dizziness
Shortness of breath
Late Dumping:
Shakiness
Cold sweats
Decreased blood pressure
Headache
Limit FAT and SUGAR
Avoid fried, greasy, and sugary foods
Follow the “single digit rule” <10 g of total fat and <10 g of sugar per serving

19. Alcohol All patients should avoid alcoholic beverages
for one year after surgery.

20. Vitamins and Minerals
You are on vitamin and mineral supplementation FOR LIFE!
Bariatric Formulated vitamins
All supplements and medications must be chewable or liquid for the first 30 days after surgery.
A chewable or liquid B-Complex is the only vitamin recommended for the first month after surgery.
On day 21 post-op: begin lifelong bariatric vitamin regimen
RD will discuss during soft diet class

21. Liver Reduction Diet, 2-4 Weeks Prior to Surgery
2-4 Weeks Before Surgery
Liquids only the week before surgery: 5 shakes per day

22. Things to Do Before Surgery
Begin or continue an exercise program.
Attend bariatric support groups, both before and after surgery.
Maintain weight or initiate weight loss (follow instructions from surgeon).
Discuss chewable or liquid medication options with PCP
Begin planning a small meal every 3-4 hours
Practice eating without drinking
Practice sipping on fluid between meals – 64oz daily.
Practice chewing foods to an applesauce consistency
Practice eating with smaller utensils
Practice mindful eating and try to eliminate distractions (ex. TV, phone, tablet) during meals

23. Purchase Prior to Surgery!
Post-Op Essentials
Purchase Prior to Surgery!
Chewable or liquid B-Complex vitamin
1 bottle clear liquid protein – bring to hospital
A variety of approved protein shakes
A variety of approved hydration fluids

24. Download our patient app “BSNC” in the app store or Google Play!
Begin self-education prior to surgery
SurgeryNC.com – password: protein60
Download our patient app “BSNC” in the app store or Google Play!

25. Nutrition Follow-Up Case Managers: Brenda Piper Michelle Harvey
Do I need to see the dietitian again before surgery? Contact your case manager!
Case Managers:
Brenda Piper
Michelle Harvey
Gabriela Cabeza
Danielle Lowry
Kristin Tosto