NUTRITIONAL RECOMMENDATIONS FOR BARIATRIC SURGERY PATIENTS
You will be seen by a dietician before, during and after your operation. You will have a total of 8 consultations before during and after your surgery with the dietician.
The Diet Program is completed in 22 weeks, but can vary amongst individuals depending on each patient’s compliance, progression and availability of appointments. The 22 week program is divided into two major parts: 12 Weeks before the operation and 10 Weeks after the operation. The dietician will also visit you while you are in hospital after you operation. During each of these sessions you will be counselled in detail regarding your diet and the necessary behavioural changes that will be required, before, during and after the operation.
It is of utmost importance to come to each dietary session as outlined in your program as you will be taught and counselled by the dietician on what to expect after surgery, how to change your eating habits and lifestyle before and after surgery to maintain the recommended weight loss and prevent possible nutrient deficiencies. You will also receive important information to prevent dietary complications after surgery. Education sessions will further include individual goal settings to suit your needs as well as the possibility of exercise programs. All these consultations aim to ensure optimal nutritional status at all times before, during and after your surgery with the ultimate goal to change your lifestyle to a healthy way of living.
PRE-OPERATIVE NUTRITIONAL SESSIONS:
The first twelve weeks before surgery is divided into two phases:
Pre-operative Phase 1: Weight Loss Diet during Week 1 to Week 8
For the first 8 weeks you will follow a weight loss diet low in fat, low in refined carbohydrate and high in protein. This diet will be individualized to meet your specific needs.
During this period you will have four sessions with the dietician. You will be weighed during each of your visits.
Week 1: An hour session which includes the following:
- Full medical, weight and dietary history
- Weight, Height and BMI calculations
- Dietary assessment
- Assessment of individual objectives
- Full explanation of the specific bariatric surgery that you will undergo as well as a detailed explanation of all the dietary and nutritional implications to expect before and after the operation.
- Assessment of objectives and setting of individual goals.
- Behaviour changes with regard to your specific dietary intake and problem areas as assessed.
Week 2: An hour session which includes the following:
- Explanation of your individual diet. Emphasis will be given on healthy eating habits including the right amount of lean protein, whole grain products, fruits, vegetables, healthy fats. Foods to avoid for general health will be discussed.
- Teaching you to consume small meals, how to chew slowly, how to still your hunger pains.
- Portion control and ways to overcome binging of any type of food at any time.
- Composition of your meal plate
- Portion controlled meal replacements suitable to use, e.g. shakes or smoothies.
- Healthy eating patterns using the individual food groups
- Cooking methods, kitchen equipment.
- Addressing existing vitamin or any other deficiencies as had been identified during your previous session.
Week 4: Half an hour session which includes the following:
- Compliance with your diet. Necessary changes will be made.
- Dining out and portion control.
- Reaching the set objectives and goals.
Week 7: Half an hour session which includes the following:
(This session is optional for those who feel that they still need to come and see the dietician.)
- Revision of previous problems.
- Working with recipes and cookery books.
- Reaching the set objectives and goals.
Pre-operative Phase 2: Preparation Diet during Week 9 to Week 12
Week 9: Half an hour session which includes the following:
- Explanation of your preparation diet to be followed in two sessions.
- Week 9 and Week 10: You will be required to follow a soft-light diet, very low in fat that consists of food with a smooth, soft consistency without any lumps, skins, pips or seeds. You now need to prepare your intestines for the operation. Your stomach will be much smaller after the operation. You therefore need to start to prepare it for very small quantities of food. You also have to teach your liver to produce less bile and let the enzymes rest. Therefore the very low intake of fat at this stage is required.
- Week 11-Week 12: You will be required to follow a full liquid diet. This diet consists of liquids and easy digestible fluids. You must be able to drink all your fluids through a straw and liquids such as smoothies, soups and protein supplements will be taken. This diet is necessary to relax your digestive tract completely and to excrete all residue.
- You will receive the necessary information regarding types of food, preparation and products low in fat and sugar to consume.
POST-OPERATIVE NUTRITIONAL SESSIONS:
The second ten weeks after surgery is divided into five phases. During these phases your diet will progress as follows:
- Clear fluid: 2 days
- Full fluid: 14 days
- Puree: 14 days
- Soft: 28 days
- Solid: Onwards
HOSPITAL STAY: YOUR SURGERY
POST-OPERATIVE PHASES: AFTER YOUR SURGERY.
Post-operative Phase 1:
Your dietician will visit you in hospital, immediately after your surgery. This phase lasts for 2 days in hospital.
- You will be allowed to drink only clear, noncarbonated liquids containing no sugar, fat or caffeine.
- These liquids need to be sipped in very small amounts (100ml/hour) during the day. This will be explained by your dietician.
Post-operative Phase 2: Week 13, 14: FULL LIQUIDS
Your dietician will explain this phase while you are in hospital before being discharged.
- You will follow a full liquid diet, high in protein, low in fat and in sugar.
- The liquids will still be sipped in small quantities during, trying to consume a 100m1/hour daily up to a total of 1000m1 nutrient dense fluids plus your other 1500m1 clear fluids.
- Your dietician will provide you with all the necessary information regarding the type, amount and possible recipes during this stage.
Post-operative Phase 3: Week 15, 16 : PUREE DIET
Dietician visit: 2 weeks post-operatively. Half an hour session.
- Your full liquids will be replaced by solid soft, moist and runny, pureed, ground, low fat, high protein foods.
- You will consume six small meals per day, each meal 60-90m1 or 4-6tbsp, of pureed food.
- You will be taught how to construct your plate and to consume your protein first.
Post-operative Phase 4: Week 17, 18 19, 20: SOFT DIET
Dietician visit: 4 weeks post-operatively (one month) Half an hour session.
- During this stage you will advance your diet to soft well cooked food, high in protein, low in fat and sugar.
- You must be able to mash your food with a fork.
- Food should be without any hard parts such as skins, pips and seeds.
- Your food needs to be consumed in small amounts of I/2 cup -3/4 cup, between four to six meals daily.
- During this stage you will be taught to consume protein first, how to construct your plate, not to drink fluids with solid foods and to chew your food very well.
- You are now gradually reintroducing your system to solid foods.
Post-operative Phase 5: Week 21 —Week 22 and onwards: SOLID FOODS:
Dietician visit: 8 weeks post-operatively (two months). Half an hour session.
- You will now be able to include all foods, based on a balanced diet with lean protein, fruits, vegetables and whole grains with a firmer texture.
- You may still eat some soft foods and avoid foods with too much fibre or causing you any discomfort.
- Consume 3-4 meals and 1-2 snacks daily.
- Never eat more than 1-11/2 cups of food at any time.
- Still chew foods well and do not consume fluid and solid food together.
- You now need to slowly introduce foods with normal consistency. This will vary depending on your individual tolerance of the different foods.
Post-operative Three months after your surgery: HEALTHY DIET
Dietician visit: 3 month post-operative visit: Half an hour session.
- Assessment of your weight loss.
- Nutritional status will be assessed.
- Your dietary intake will be assessed to determine if all your macro-nutrient requirements are met.
- Your goal setting achievement, eating behaviour, habits and lifestyle will be assessed.
TAKE HOME NUTRITIONAL RECOMMENDATIONS AFTER YOUR BARIATRIC SURGERY:
It is recommended that you always follow the healthy dietary guidelines given to you during your sessions with the dietician. You will never be able to fall back into your old unhealthy eating habits. Some points to especially remember:
- ALWAYS consume foods low in fat and sugar to avoid Dumping.
- ALWAYS remember the importance of PROTEIN! Lean protein should be part of each meal that you consume.
- NEVER consume liquids and solid foods together in one meal or snack. Drink liquids 20min before and after your meals.
- ALWAYS chew your foods very well and try to eat and drink slowly.
- ALWAYS consume small portions of food during any meal.
- NEVER binge on food or drinks.
- ALWAYS stay dehydrated, especially in the early weeks after your operation.
- ALWAYS take your recommended vitamin and mineral supplementations as prescribed by your doctor.
- AVOID the following before and three months after your operation: ALCOHOL, COFFEE, CARBONATED COLD DRINKS. Try to consume less of these on a regular basis after your surgery.
- NEVER follow any other dietary recommendations from any other person or authority than those given to you by your dietician.
FOLLOW-UP VISITS WITH YOUR DIETICIAN:
It is of utmost importance to continuously consult with your dietician on regular quarterly or annual intervals as indicated . The recommended visits should be 6 and 9 months after your operation and there after once a year. The following needs to be monitored on a continuous basis to ensure that you are in a healthy state at all times:
- Nutritional status, macro and micro-nutrient intake.
- Dietary compliance with all aspects of your new healthy eating plan.
- Healthy weight loss progression.
- General lifestyle changes as well as behavioural changes.
- Continuing physical activity.
DIETARY CONSULTATIONS: BARIATRIC SURGERY March 2016
- First consultation: 1h – week 1 – R800-00
- Second consultation: 1h – week 2 – R400-00
- Third consultation: 1/2 h – week4 – R400-00
- Fourth consultation: 1/2 h – week 7 – R400-00 optional
- Fifth consultation: 1/2 h – week9/10 – R400-00
- Hospital consultation: week 12 – Medical Aid feed: Hospital code
- Sixth consultation: 1/2 h – week 15 – R400-00
- Seventh consultation: Y2 h – week 17 – R400-00
- Eighth consultation: 1/2 h – week 21 – R400-00
TOTAL over 22 weeks: R3200.00-R3600.00
Follow up consultations:
- 1/2h – three months after operation – R400-00
- 1/2h – 6/9/12months after operation – R400-00
(will vary according to the patient)