360° Weight
Management Center

Nutrition & Health

Keys to Success for Bariatric Surgery

Bariatric surgery can start your weight-loss journey, but surgery alone won’t ensure long-term success. Bariatric surgery is a tool that can aid in weight loss and improve comorbidities like diabetes, hypertension, and sleep apnea.  It is important to remember that bariatric surgery is not a cure for obesity and its related comorbidities; it requires lifelong commitment to a healthy diet, lifestyle, and behavior change in order to be a useful tool for weight loss and maintenance.  Most bariatric surgery patients lose almost half of their excess weight in the first year after surgery and continue to lose weight thereafter. Surgery doesn’t guarantee a specific amount of weight loss, however. Weight control is your personal responsibility, and it is maintained with commitment to healthy lifestyle changes.

Successful habits that promote and maintain weight loss include the following:

• Eat three small, well-balanced protein focused meals and one-two snacks a day each day.
• Avoid carbonated, caffeinated or sugary beverages and alcohol.
• Increase exercise to a goal of 60 minutes total through-out the day for 5-7 days per week.
• Follow up with bariatric clinic on a regular basis and attend support group.  

Patients who eat larger portions, graze throughout the day, consume high-fat and “junk” foods or drink high-calorie beverages tend to gain weight back. Patients who do not add in consistent exercise to their daily routine tend to have problems maintaining their weight loss.

A program of regular exercise is very important to losing weight and keeping the weight off. More than 50 percent of patients achieve good-to-excellent weight loss following bariatric surgery. The average expected weight loss is 55 to 75 percent of the excess weight. Patients who participate in support groups and follow up with their bariatric clinic regularly have been shown to lose more weight.

The first year after surgery is a critical time that must be dedicated to changing your old behaviors and forming new, lifelong habits. The medical community commonly defines the success of weight loss surgery by the total weight lost during the initial weight-loss phase. However, for the patients who have the surgery, the real questions are: “Will this be a long-term, permanent solution?” and “What can I do to ensure my lifelong success?” In other words, how can I maintain at least 75 percent of my initial excess weight loss after a successful bariatric surgery?

This is where you have control. Patients who understand that maintaining their weight is their ongoing responsibility and that surgery alone is not a permanent fix will maintain a healthy weight, succeed and do better in the long term. Lack of exercise, poorly balanced meals, constant grazing and snacking, and drinking calorie containing beverages are the basic causes of gaining weight back. You have control but you don’t have to do this alone. In fact, it’s better to do it together! Regularly attending support groups and workshops will help you maintain a healthy post-surgery lifestyle and greatly increase your odds of following the recommendations for optimal weight loss and maintenance.

Diet and Nutrition

Bariatric surgery changes the way you digest and absorb food. So, you must carefully follow the recommendations outlined in the bariatric surgery guide for the rest of your life to maximize weight loss and stay healthy. To ensure optimal nutrition, you’ll need to take multivitamins and mineral supplements for the rest of your life. You’ll also need to focus on healthy food choices to get the most nutrition from small amounts of food.

After surgery, you will follow a five-step diet to allow your body to heal and to gently introduce food to your digestive system:

• Step 1 – While you are admitted to the hospital you will start a clear-liquid diet. Clear liquids include chicken, beef and turkey broth, sugar free Jell-O, clear zero calorie beverages, decaf tea or decaf coffee and water.
• Step 2 - On discharge from the hospital you can advance to a full liquid diet as tolerated. A full liquid diet includes protein shakes, low fat milk, plain low fat yogurt, and low fat strained soups. These liquids need to be sugar-free and low fat. Patients will remain on the full liquid diet for 1 week.
• Step 3 - Advance to pureed foods, which have the consistency of applesauce or pudding. You can puree meat, vegetables and fruits in a blender or food processor. It’s very important to ensure that food is pureed well to prevent blockage in your digestive system. Patients will remain on pureed foods for about two weeks.
• Step 4 - Advance to a soft texture diet, in which you cook meat, vegetables and fruit to the point you can mash them with a fork. During this step, you may try new foods to see if you can tolerate them. If you have a bad reaction to a new food, don’t give up. Wait and try it again in a few weeks. Each person’s tolerance to different types of food varies. The only way to discover your tolerance is by trial and error. During this stage, taking small bites and chewing your food completely is important to aid digestion.
• Step 5 - Advance to a regular diet. Gradually increase your intake of textured foods until you can tolerate solid textures. For example, instead of mashing down steamed vegetables, simply chew them up very well. In this last step, focus on a well-balanced meal consisting of 2-3 oz lean protein, ½-1 cup vegetables and 2 tablespoons carbohydrate.
• As your body heals from the surgery, this five-step recovery diet will help you meet your protein and liquid requirements and later, your nutritional needs. It is critical that you follow the diet’s steps as outlined to enable healing and minimize the risk of surgical complications.

After surgery, the size of your stomach pouch will be about 1 ounce or 1-2 tablespoons. As you adjust to this very small capacity, you may find that just 2-3 teaspoons of food will fill you up. This is expected. You may also find that you are able to eat more of some types of foods than others. That is OK, too. Over time, your stomach pouch will stretch. By six months after surgery, it may hold 8 ounces or 1 cup. In the long term, the size of your pouch is likely to be 8-12 ounces, or 1 to 1 1/2 cups. This will limit the amount of food you can eat at one time for the rest of your life.

One of the biggest changes that patients often talk about is re-sizing “wasting food.” After surgery, your eyes and head still work the same way as they did before. However, because of your new, smaller stomach pouch, you will be satisfied with eating much less. It is critical to listen to your body’s signals of fullness and not to your eyes, which see the food left on your plate.

Patients also talk about being surprised by how surgery changes their wants and desires for certain foods. Foods you may have previously loved may no longer be interesting to you. Other foods may become more attractive and tasty.

A remarkable effect of bariatric surgery is the progressive change in attitude about food and eating. Patients begin to eat to live – they no longer live to eat. And this new life is what it’s all about.

“Proper nutrition plays a key factor into the success of our patients. Choosing the right foods, at the correct amounts, can make all the difference.” - Lianne Metcalf, MS, RD, LD, Bariatric Clinical Dietitian

Nutrition

After surgery, you’ll need to think about nutrition differently to make sure your body gets what it needs to stay healthy now that it digests and absorbs food differently.

After surgery, you will focus on consuming a well-balanced diet following the bariatric plate method.  Half your plate should contain a lean protein, and the other half of your plate should contain 1+ cups vegetables and a small serving of a whole grain starch or other complex carbohydrate. Your primary goal is to consume 60-80 grams of protein per day. The plate you will need to use will be a small 6 inch diameter “salad” plate.

Some patients experience dumping syndrome after surgery. Which occurs from eating or drinking sugary, high carbohydrate foods or high fat foods.  Dumping syndrome can last 30-60 minutes after eating these foods. Symptoms vary among patients and can be diarrhea, nausea, abdominal pain and heart palpitations. In-order to avoid having these symptoms it is highly advised to not experiment with unhealthy foods containing sugar, high amounts of carbohydrate or foods high in fat.  To maintain a healthy weight and to prevent weight gain, you must develop and keep healthy eating habits. You will need to be aware of the volume of food that you can tolerate at one time and make healthy food choices to ensure maximum nutrition in minimum volume.

General Recommendations

• Remember to take sips of water every 10 minutes and avoid drinking anything 30 minutes prior to a meal, during a meal and 30 minutes after a meal.
• Eat three, protein-focused meals a day at regular times, while sitting at a table.
• Eat slowly taking 30 minutes for each meal and savor your food. Don’t eat when you feel rushed or stressed -- this may cause gastric upset.
• Stop eating when you feel full or if you feel any discomfort.
• Always cut food into small pieces and chew food 25-30 times to prevent blockage.
• Focus on protein-rich foods such as fish and seafood, low fat cheese, eggs, poultry, lean beef and tofu.
• At mealtime, eat proteins first before any other food.
• Avoid sweet food, candy, chocolate and high-sugar beverages to avoid the unpleasant effects of dumping syndrome.
• Sip water and other liquids slowly, drinking at least 1/2 cup every hour between meals to total 8 eight-ounce cups per day to avoid dehydration.
• Avoid or minimize alcohol intake as it is high in calories, and the effects may be felt much more quickly.
• Take a multivitamin/mineral supplement, and a calcium supplement every day for the rest of your life.