Weight loss surgery will require you to make many life-changing adjustments both before and after surgery, especially in the areas of diet and nutrition. Bariatric patients will need to learn about the nutritional requirements and dietary changes that are necessary both before and after weight loss surgery. Talking to your bariatric surgeon or dietitian about dietary changes and nutritional guidelines is a very important part of the bariatric process.
Weight loss surgery will affect what foods you eat, the amount of food you eat, and how you will eat that food. Even before you undergo surgery, your diet will be changing in order to prepare your body for surgery, improve recovery, and increase the rate of weight loss. The time leading up to weight loss surgery is not the time to splurge on your diet and let your health worsen, but it’s the time to start making changes and preparing for the upcoming surgery.
Purpose of Pre-Surgery Bariatric Diet
- Reduce body fat: reducing body fat in the abdomen and liver increases patient safety
- Preserve and protect muscle tissue: increasing protein keeps the body from using muscle tissue as an energy source on a reduced calorie diet, and burn fat instead
- Prepare the body for surgery and recovery: eating healthy, increasing protein intake, and taking vitamin and mineral supplements will help the body heal and recover after surgery
- Prepare the patient for post-surgery diet: the pre-op diet is very similar to the post-surgery diet (reduced calorie, high-protein, low-fat, low-carbohydrate) and will prepare patients for the new way they will be eating after weight loss surgery
Starting a Bariatric Surgery Pre-Op Diet
Diet changes are necessary for all types of weight loss surgery, although the time frame for the pre-op diet will vary for each patient based on his or her weight and the type of procedure. For LAP BAND patients, the pre-op diet may start only two to three weeks before surgery, while for the more involved gastric bypass or duodenal switch surgery, the pre-op diet may start two to three months before surgery. Based on your situation and how much weight you need to lose before surgery, your bariatric surgeon will provide the time frame for your pre-surgery diet.
Pre-Surgery Weight Loss Increases Safety
Losing weight before surgery will lower the risk of complications and make weight loss surgery safer. For the super obese patients, losing sufficient weight before surgery will allow the surgery to be performed laparoscopically, rather than as open surgery. The main purpose of losing weight before weight loss surgery is to reduce body fat in the abdomen region, especially in and around the liver. By reducing the size of the liver, the operating time for laparoscopic surgery is shortened and the procedure is safer. In some instances, a bariatric surgeon may postpone surgery if the patient’s liver is too large.
Amount of Pre-Surgery Weight Loss
The amount of weight loss necessary before weight loss surgery can only be determined by your bariatric surgeon based on your health, weight, and bariatric procedure. Some patients are required to lose ten percent of their weight before weight loss surgery is performed. For other patients, losing just 15 to 20 pounds right before surgery is enough to reduce the risk of complications.
Pre-Surgery Nutrition – High Protein, Low Calorie
You can expect you pre-surgery weight loss diet to be high in protein, but low in calories, fats, and carbohydrates, especially refined sugars and saturated fat. The pre-surgery diet generally ranges from 800 to 1200 calories per day with about 70 to 120 grams of protein each day. Many surgeons require a full liquid protein diet for two weeks before surgery. You will also be asked to start vitamin supplements to ensure your body has the nutrients necessary for recovery and health.
Weight Loss Surgery Pre-Op Diet
Before undergoing weight loss surgery, your bariatric surgeon or dietician will explain your pre-surgery diet. Although specific diet suggestions can vary from patient to patient, procedure to procedure, and surgeon to surgeon, there are many dietary and nutritional guidelines common to most weight loss surgery patients. The following guidelines should not take the place of your surgeon’s directions, which are based on your health, weight, and type of weight loss surgery.
General pre-surgery dietary guidelines for weight loss surgery include:
- Begin protein supplements (protein powder)
- Decrease all fats (fatty meats, fried foods, whole milk products, and others)
- Decrease sugary foods (sweets and soda)
- Decrease high carbohydrate foods (bread and pasta)
- Stop smoking
- Avoid alcohol
- Avoid binge eating
- Don’t use certain over-the-counter medications and prescription medications (ask your doctor for specifics, but may include Aspirin, Motrin, Aleve, Excedrin)
It is important to follow your surgeon’s pre-surgery dietary and nutritional guidelines. Not only will your pre-surgery diet help prepare your body for surgery and improve the outcome, but it will help you adjust to the changes you will be expected to make about food following weight loss surgery and for the rest of your life.
After weight loss surgery it is important for the patient to follow the dietary and nutritional guidelines recommended by his or her doctor. Each patient will be expected to change the foods eaten, the amount of food eaten, and how that food is eaten, in order to provide the body with the nutrition it needs and to promote weight loss. Theses dietary changes and nutritional guidelines are meant to be followed for a lifetime.
The diet after weight loss surgery will gradually progress from liquids to purees to solid foods. The amount of time it takes before a patient can add solid foods to the diet will vary somewhat based on the patient and the procedure, but generally weight loss surgery patients are eating small amounts of solid food 4-6 weeks after surgery. Following your surgery, your doctor will monitor your recovery carefully to determine what foods are appropriate for you and provide you with specific dietary guidelines.
Although specific dietary guidelines will vary for each procedure and each patient, the guidelines below are some of the general dietary changes weight loss surgery patients can expect after weight loss surgery.
Healthy Food Choices
The diet after weight loss surgery will primarily consist of low-fat proteins (lean meats such as chicken, turkey, and fish) and fruits and vegetables. Your doctor will provide you with a list of foods that can be eaten after surgery, including healthy protein choices, healthy carbohydrates, and heart-healthy fats. It is important to consume a sufficient amount of protein to help maintain muscle and burn fat, and to choose lean protein foods because they are lower in calories. Since you are only eating a small amount of food, it is important to choose foods that are healthy.
Eating Habits & Behaviors
After surgery, how you eat will change just as much as what you eat. Your stomach will only be able to hold a small amount of food at any one time and your digestion process has been changed.
- Meal portions must be small, you must eat slowly, and food must be chewed thoroughly. If you eat too much, eat too fast, or don’t completely chew your food (your body is not able to break down foods that have not been chewed to a liquid consistency), it may cause nausea or vomiting.
- Avoid drinking liquids with meals. Liquids do not relieve hunger and may force food thru your stomach pouch too quickly. This may cause you to become hungry during the day. It may also cause dumping syndrome in gastric bypass patients. Do not drink 30 minutes before or 30 minutes after a meal.
- Set a time for three meals a day, and eat only at those scheduled meal times. Do not skip meals. Do not snack between meals.
- When you feel full, stop eating. If you overeat, not only can it cause nausea and vomiting, but it can stretch out the size of your stomach pouch. When you first start on your solid diet, you may only be able to eat 4 to 6 bites of food before you feel full. With time, you may be able to eat a half cup up to one cup of food.
Nutritional Supplements
You will need to supplement your diet with vitamins and minerals for the rest of your life. Lap band patients will need to take a daily multi-vitamin supplement, whereas gastric bypass patients will need to take daily supplements including a multi-vitamin, calcium, vitamin B12, and iron for menstruating women. Protein supplements are also recommended. Protein supplements include whey protein powder, whey isolate (for lactose-intolerant), lactaid milk, soy milk and other soy products.
Drinking Water and Other Liquids
It is important to stay hydrated and drink 6-8 cups of water daily. Water must be consumed slowly, about 1-2 mouthfuls at a time. Other approved liquids include tea, sugar-free flavored drinks, and sugar-free sport drinks. Drink plenty of fluids between meals, but avoid liquids with meals. Carbonated beverages should be avoided as they may cause gas, bloating, pain, and may contribute to enlargement of the small stomach pouch. Alcohol should be avoided because of the excess calories as well as the possibility of dumping syndrome and addiction.
Dumping Syndrome
Dumping syndrome occurs when foods enter the small intestine too quickly and causes nausea, weakness, abdominal cramping, headache, sweating, faintness, and eventually diarrhea. It may be caused by eating sweets, fried foods, fatty foods, greasy foods, eating too much at one meal, or drinking fluids with meals. Depending on how you view this effect, dumping syndrome can be considered both an advantage or disadvantage of gastric bypass surgery. Lap band patients do not experience dumping syndrome.
Foods to Avoid
It is important to avoid sugary foods (candy, ice-cream, cookies, cakes, syrups),high-fat foods (chips, fried foods, sausage, cream soups, sauces, gravies, margarine, mayonnaise, junk food), fibrous foods (asparagus, pineapple, rhubarb, oranges, dried fruit), and other problematic foods (tough or overcooked meats, doughy breads, pasta, rice, skins and seeds of fruits and vegetables, nuts and popcorn).
Follow Up Tests
There are long term nutritional effects with weight loss surgery and you will need to have your blood checked several times in the first year and once a year for the rest of your life to make sure you are adequately absorbing your vitamins and minerals. Nutritional deficiencies may occur over time and periodic life-long checks are necessary. Follow-up tests will check for many things including anemia, coagulation function, electrolytes, liver function, thyroid function, cholesterol, levels of vitamin, minerals, micronutrients, and iron in the blood.
Bariatric Counseling and Support Groups
Weight loss surgery patients are usually advised by their bariatric surgeons to participate in both nutritional and psychological counseling as part of their weight loss treatment. Nutritional counseling helps a patient learn healthier eating behaviors and make healthy food choices. Psychological counseling helps a patient deal with the emotional issues that contributed to obesity. Nutritional and emotional support after weight loss surgery is very important to a patient’s success. Another helpful source of support is to stay in contact with other weight loss surgery patients at support groups or on-line forums.
Low Calorie Diets and Exercise
Exercise has many health and weight loss benefits. Following weight loss surgery, you will be eating less food than your body needs to operate. The body will then use fat reserves or unused tissues to get the energy it needs to function. If you do not exercise the body will consume unused muscle tissue before it burns fat reserves. You must exercise daily or you will lose muscle mass and strength. Muscle tissue is important to keep because it provides strength and also increases your body’s metabolism to help burn calories.
Weight loss surgery patients are usually advised to exercise aerobically (brisk walking, bike riding, stair climbing) 30 minutes a day and include weight/resistance training 3-4 days per week. Your bariatric surgeon will provide you with exercise guidelines, but most weight loss surgery patients are asked to start walking as soon as possible after surgery and slowly progress to a full work-out schedule as they recover.
