1. Bariatric Diet Guidelines: Pre-testing Tricia Mah MS,RD and Aisling Mc Ginty MS, RD. Dietitian/Nutritionist The Center for Bariatric Surgery and Metabolic Disease

2. Topic: Summary  Stage 1 Diet: Clear Liquid Diet  4 x 4 Rule  Protein Supplement  Daily Vitamin & Mineral Supplements  Physical Activity

3. Stage 1 Diet: Clear Liquids  Gastric Bypass: 1 week of clear liquids  Lap Band: 2 weeks of clear liquids

4. Stage 1 Beverages: Clear Liquids  Crystal light ®  Herbal tea( decaf)  Diet Gelatin  DIET Twister  DIET Snapple ®  DIET Ocean Spray Cranberry  Sugar free Kool-Aid  Broth/Consomm é  Diet V8 Splash ®  Country Time Diet Lemonade ®  Wyler ’ s diet lemonade  Sugar free ice pops

5. Flavored Water Options  Water  Dasani Flavored Water  Hint Flavored Water  Fruit 2 0  Aquafina Flavor Splash  Propel Water  Smart Water READ the nutrition label!!! *NO calories (<5-10kcal) *NO sugar *NO carbonation

6. What to Find on the Hospital Tray Clear Liquid Diet: Tray Contents Water Diet Jell-o Tea (non-caffeinated) Soup/Broth Juice  Must dilute 1:1 with water  Recommend: Avoid juices once discharged from hospital

7. 4x4 Rule

8.  Drink 1 oz per hour for the first 4 hours. Remember to sip slowly! = 1 oz  Drink 2 oz per hour for the next 4 hrs. =2 oz

9. 4 x 4 Rule  Drink 3 oz per hour for the next 4 hrs. = 3 oz  Drink 4 oz per hour for the next 4 hrs. = 4 oz

10. 4 x 4 Rule  Start with 1 oz/ hr- sipped slowly.  Increase in 1 oz increments every 4 hours Goal rate: 4 oz per hour

11. Fluids  Drink 48 to 64 oz each day  Avoid sweetened, caffeinated, carbonated beverages  Do NOT use a straw  STOP drinking if you feel fullness, pain or discomfort

12. Fluid Journal  Record ALL liquids consumed  4 oz EVERY hour for 12-16 hours per day.  Record total ounces per day

13. Protein Shake  Begin the day after you go home from Hospital  Minimum protein goal 70grams per day  May be mixed with Skim milk, Skim milk plus, 1% milk, Soy milk, Water, Crystal Light.....

14. Nutrition Facts Serving Size: 1 level scoop (~24g) Amount per Serving Calories 90Calories from Fat 15 % Daily Value * Total Fat 1.5g2% Saturated Fat 1g5% Cholesterol 30mg10% Sodium 80mg3% Potassium 160mg5% Total Carbohydrate 2g1% Dietary Fiber 0g0% Sugars 0g Protein 18.0g37%

15. Protein Supplement Worksheet Protein Powder Name: Nutrition Label: Serving Size: 1 scoop Protein Grams Designer Whey Protein _____18____

16. Protein Content: Beverages Beverage Type:Protein Content in 4oz: Skim Milk Plus5.5 grams Skim Milk4.0 grams Soy Milk3.0 grams Lactaid Milk4.0 grams Water0.0 grams Crystal Light0.0 grams X

17. Protein Supplement Worksheet _______Grams of Protein in Beverage _______Grams of Protein in 1 Scoop _______Grams of Protein in ONE SHAKE!!!! 5.5 18 23.5 +

18. Protein Supplement Worksheet Circle One: 1 2 3 4 5 Shakes Needed Per Day to get at least 70 grams of Protein!!

19. Daily Multivitamin and Mineral Schedule

20. Daily Vitamin and Mineral Schedule My scheduleTimeSample Schedule Time: Multivitamin7:00am Calcium: 500mg 12:00pm Calcium: 500mg 5:30pm Iron9pm

21. Daily Vitamin and Mineral Schedule  Multivitamin  Chewable or Liquid form  Calcium Citrate with vitamin D  Do NOT take calcium with iron Take 2-4 hours apart! Take 2-4 hours apart!  500mg of calcium at one time.

22. Multivitamin and Protein  Begin your daily vitamin/minerals and protein shake the day AFTER you get home!  You will need to take multivitamins for the rest of your LIFE!

23. MOVE!  Immediately following surgery get up and move! Helps get rid of excess gas Decrease potential health risks- pulmonary embolus, blood clots

24. MOVE!  At home: walk inside and outside. This is your responsibility! Record exercise in journal and bring to visits.  As tolerated slowly incorporate treadmill, stationary bike, elliptical, chair exercises. Swimming: incorporate once wounds heal.

25. Summary  Only clear liquids are allowed  Juices in hospital must be diluted 1:1 with water  Do NOT use a straw  Avoid caffeinated and carbonated beverages  Start off with 1 oz of liquids sipped slowly over 1 hr. Use the 1 oz cups provided.  As tolerated, fluids will be gradually increased in 1 oz increments every 4 hrs to a goal rate of 4 oz/hr while awake (4x 4 rule).

26. Important! Bring to Hospital:  Booklet “ Your Guidelines for Food Choices and Nutrition ”  Pen or Pencil  4x4 Worksheet (today ’ s handout).  Watch or clock Bring to EVERY office visit:  Booklet “ Your Guidelines for Food Choices and Nutrition ”  Food and Exercise Journal