Preparing for gastric bypass

Contents

Your Guide to the Gastric Bypass Diet

After surgery, the diet plan goes through several stages. How long each stage lasts and what you can eat and drink will be determined by your doctor or dietitian. All stages stress the importance of portion control. This habit will help you continue to lose weight and prepare you for how you will eat for the rest of your life.

Stage one: Liquid diet

During stage one, your nutritional intake is geared towards helping your body heal from surgery. Your diet can help you avoid postoperative complications. For the first few days, you are only allowed to drink a few ounces of clear liquids at a time. This helps your stomach heal without being stretched out by food. After clear liquids, you will graduate to additional types of liquid. These include:

  • decaffeinated coffee and tea
  • skim milk
  • thin soup and broth
  • unsweetened juice
  • sugar-free gelatin
  • sugar-free popsicles

Stage two: Pureed diet

Once your doctor decides you’re ready, you can move on to stage two. This stage consists of pureed foods that have a thick, pudding-like consistency. Many foods can be pureed at home with a food processor, blender, or other device.

Spicy seasonings may irritate the stomach, so avoid these completely or try them one at a time. Avoid fruits that have lots of seeds, such as strawberries or kiwi. You should also stay away from foods that are too fibrous to liquefy, such as broccoli and cauliflower.

Instead, choose foods that liquefy well, such as:

Fruits applesauce
bananas
canned fruits
peaches
apricots
pears
pineapples
melons
Vegetables tomato juice
spinach
carrots
summer squash
green beans
Protein yogurt
white fish (cod, tilapia, haddock)
cottage cheese
ricotta cheese
beef
chicken
turkey
scrambled eggs

V-8 juice and first-stage baby foods, which do not contain solids, are also convenient options.

As you start to include purees into your diet, it’s important not to drink fluids while you eat.

Stage three: Soft diet

You will probably eat nothing but pureed food for several weeks. Once your doctor decides you’re ready, you can start building soft, easy-to-chew foods into your diet. These may include:

  • soft-boiled eggs
  • ground meat
  • cooked white fish
  • canned fruits, such as peaches or pears

It is important to eat small bites. Use good portion control and eat a little at a time.

Stage four: Stabilization

Stage four of the gastric bypass diet includes the reintroduction of solid food. It typically begins about two months after surgery. You will still need to dice or chop your food into small bites because your stomach is much smaller. Large pieces of food may cause a blockage. A blockage can lead to pain, nausea, and vomiting.

Introduce foods slowly. That way, you can best determine which ones your stomach can tolerate and which ones to avoid. Eliminate any food that causes abdominal discomfort, vomiting, or nausea.

Foods to avoid in stage four

Certain foods should not be attempted yet, such as foods that are hard to digest. These include:

  • fibrous or stringy vegetables, such as pea pods
  • popcorn
  • corn on the cob
  • carbonated beverages, such as seltzer
  • tough meat
  • fried food
  • crunchy foods, such as pretzels, granola, seeds, and nuts
  • dried fruit
  • bread and bread products, such as muffins

About four months after surgery, you may be able to resume eating normally. However, portion control is still important. Make sure your diet consists mostly of fruits, vegetables, lean protein, and healthy carbohydrates. Avoid unhealthy foods that are high in fat, carbohydrates, and calories. Eating well means you can enjoy continued health without putting weight back on.

What to Expect Before and After Bariatric Surgery

Bariatric surgery isn’t a spur-of-the-moment operation. In fact, preparing for the procedure may begin a year or more before your surgery date, and lifestyle changes continue well after the surgery has been performed. Be prepared by knowing what will be asked of you every step of the process.

The Year Before Surgery

Leading up to the procedure, your surgical team will likely recommend becoming more informed about diet and exercise.The amount of time you spend in this stage depends on several factors, including your insurance and your team’s recommendations, says bariatric surgeon Ann Rogers, MD, director of the Penn State Hershey Surgical Weight Loss Program in Hershey, Pennsylvania.

“There’s always some component of nutritional education and some expectation that patients will lose some weight in that program,” explains Dr. Rogers. The dietitians and others who work with you during this stage will send reports on your progress to your surgical team before you schedule your surgery date.

In this phase, you may need to make additional lifestyle changes as well depending on the program. Rogers’ program, for instance, requires smoking cessation, though other weight-loss surgery clinics do not.

The Week Before Surgery

The final days before your surgery can be extremely emotional, filled with excitement, nervousness, and anxiety. Taking these steps as you prepare for your surgery will ease tension and ensure that everything goes smoothly the day of your procedure:

• Read the materials from your clinic.

• Eat and drink as directed. “We have a preoperative diet for eight days, which consists of bariatric-friendly protein shakes,” Rogers says. “They are high in protein, and they do not have sugar.” Most programs have a preoperative diet, although the duration varies, she says. Make sure you understand how long that diet lasts and exactly what you can eat.

• Adjust medications as needed. Discuss how to manage any other conditions you might have, such as diabetes, with your weight-loss surgery team and your primary care physician.

• Meet with the anesthesiologist. Once your surgery date is scheduled, you’ll also meet with the anesthesiologist, who will ask about your health history. Although patients will have lots of tests done and medical information detailed during the months before surgery, the anesthesiologist might ask for more tests, advises Rogers.

• Take a blood thinner. Clotting is a risk associated with surgery, says Rogers. Your doctor might recommend taking a blood-thinning medication before and after the surgery.

What to Pack

Rogers suggests taking the following items with you to the hospital:

• Instructions. Bring the manual or other instructions you’ve been given, as well as any preoperative paperwork.

• Identification. You’ll need it to check in.

• CPAP (continuous positive airway pressure) machine. If you’ve been using one for sleep, take it with you.

• Laptop and cellphone.

• Pajamas and toiletries.

• Pillow and blanket.

The Day of the Surgery

What your weight-loss surgery will entail varies depending on the specific type of surgery you’ll be having.

• Roux-en-Y: This procedure is also known as “gastric bypass.” Your stomach will be divided into a small top pouch and a larger lower pouch. Your small intestine will also be divided and the lower part raised up to attach to your new, smaller stomach. This procedure reduces the quantity of food you can eat at any given time.

• Sleeve gastrectomy: In this procedure, the majority of your stomach will be removed, creating a banana-shaped stomach.

• Biliopancreatic diversion with duodenal switch: In this procedure, a portion of your stomach is removed. The remaining portion is then attached to a lower segment of your small intestine.

• Banding: In this procedure, an inflatable band is wrapped around the upper part of your stomach, creating a small stomach pouch. The band can be adjusted as needed.

9 Things You’ll Have to Do After Surgery

• Have a ride home in place. Expect to spend at least one night in the hospital, Rogers says. When you’re discharged, you’ll need to have someone drive you home.

• Prevent blood clots. You will need to adhere to strategies to prevent blood clots from developing. These include taking blood thinners and getting up and walking around while in the hospital and at home.

• Take pain medication. You’ll probably get a prescription for pain medication. Laparoscopic surgery reduces pain and hospital stays, but you still may need prescription pain medication for a day or two after discharge, Rogers says.

• Anticipate constipation, as it’s a byproduct of the pain medications and the surgery itself. Be sure to talk with your doctor or nurse about how to prevent constipation.

• Eat a restricted diet. Your diet will be restricted to liquid protein shakes for a week or so after the procedure, and then soft foods following that period. Most people can transition to eating food with texture after their one-month follow-up appointment. By three months you should be able to eat fruits and vegetables, Rogers says. The ASMBS recommends cutting down on carbohydrates and increasing protein.

• Drink lots of fluids. The ASMBS recommends at least 64 ounces, or 8 cups, of fluids daily.

• You may need to take supplements. Calcium, vitamin D, and B vitamins are among those your doctor might recommend.

• Exercise – but nothing too strenuous. Walking daily, starting the day you get home, is good for you, says Rogers. However, skip the gym until you have your doctor’s permission. You should be able to lift small weights, she says, but avoid heavy items.

• Plan on missing work for a while. People with desk jobs usually can go back to work in about three weeks, Rogers says. Those with physical jobs or jobs that require extended periods of sitting, such as driving trucks, will have to wait a longer period of time.

Sydney Weight Loss Surgery Preparation

Although it’s normal to be nervous, the day of your weight loss surgery is really an exciting day because it’s a major milestone on your road to a healthier, happier life. Here is a general overview of how to get ready for your Bariatric Surgery, and what to expect that day.

The Day Before Weight Loss Surgery

On the day before your procedure, you will need to follow specific instructions to ensure all goes well the next day. Your team will provide you with a complete list of instructions on how to prepare for the surgery.

Here are two general guidelines

  • Do not eat or drink anything after midnight. Your stomach must be empty for surgery to minimize risks during the operation
  • Ask a friend or a family member to be at the hospital with you for comfort and support

The Day Of Bariatric Surgery

You will be admitted to the hospital on the morning of your surgery. You may be in the operating room for two or three hours, but the actual procedure typically takes about 1-2 hours depending on the type of your operation. Then you will spend a few hours in the recovery room.

Once the anesthesia has worn off, you may feel some pain or discomfort, which can usually be treated with ordinary pain relieve medication. The hospital staff will help you get out of bed and start moving as soon as possible to help prevent blood clots and respiratory problems.

Weight Loss Surgery Aftercare & Recovery

During the first few weeks after surgery, we do not think about weight loss as you need to take the time to recover from the operation and to start adjusting to your new life after your weight loss surgery. A big part of your long term weight loss success will be your motivation and commitment to a new lifestyle that includes a new diet and exercise plan, routine check ups with your surgeon, ongoing LAP-BAND® System adjustments (if you choose to have gastric banding procedure) and more. However, be patient with yourself in the first weeks after surgery. You have already taken the biggest step – the first one. Your new life and lifestyle you will have to create over time, not overnight. The first month after surgery entails:

  • Recovery time from surgery
  • Following strict dietary guidelines: liquid diet / pureed food / soft foods
  • Your First Adjustment (only for gastric banding patients)

It’s extremely important to follow the eating and drinking instructions immediately after the surgery. This allows your new stomach pouch to heal completely.

  • In the early weeks, it’s crucial not to stretch the small stomach pouch above the LAP-BAND® System if you choose to have this type of procedure done. Vomiting will do this, while also increasing the chance of stomach tissue slipping up through the band
  • Patients who underwent gastric sleeve procedure will follow dietitian advice. Vomiting with this procedure is extremely rare
  • Right after the surgery, you can take an occasional sip of water or suck on an ice cube. Don’t take any more liquid than this, though
  • The day after the operation, you can take a little more fluid but only a small amount at a time. Besides water, you should also choose clear liquids that have an adequate number of calories. To prevent nausea and vomiting, do not drink too much

Liquid Diet (1-2 weeks post-surgery)

Your goal during the first few weeks is to protect the small stomach pouch so that you can heal properly. It can only tolerate thin liquids at this time. It’s also important to stay hydrated by drinking lots of water (small amounts at a time). Other liquids recommended during this phase include:

  1. Clear broth or soup (with no vegetables or meat, and not creamy)
  2. Skim milk
  3. Fruit juice
  4. No-sugar-added popsicles

Pureed Foods (3-4 weeks post-surgery)

Now, you can start adding slightly textured foods. Think of the consistency of baby foods. This stage will help you transition to more solid foods later.

  1. Protein is very important for maintaining muscle while you lose weight. So, you should eat protein-rich foods first, and then move on to fruits and vegetables
  2. Foods in this stage may include
  3. Pureed skinless chicken or fish
  4. Mashed potatoes
  5. Peas
  6. Low-fat yogurt or pudding

Please note: In the first few weeks you may be able to eat foods that might not be allowed in your diet later, because they may contain too many calories. Remember, it’s more important in the first few weeks to let your stomach adjust to the LAP-BAND® System or gastric stapling than it is to lose weight. Also, your personal timing and progression into each dietary phase depends on your progress. In general, when it comes to your nutrition, you should follow the advice of your surgeon and/or dietitian.

Soft Foods (5 weeks post-surgery)

  1. Your meals can now include tender, cooked foods like fish and ground turkey
  2. Now that you can chew, make it a habit to chew foods well
  3. If you have dentures, be sure to cut your food into small pieces and chew your food thoroughly. By not chewing properly, you may experience vomiting, stomach irritation and swelling. You could also have stomach obstruction (obstruction of the stomach opening created by the LAP-BAND® System)
  4. Some products like bread, red meat, and rice may still cause you problems, so it is better to eat softer foods that are easier to digest. These might include foods such as moist white meat (chicken or pork) and fish
  5. If solid foods cause any nausea and vomiting, go back to the liquid diet you had earlier. Then you can slowly add soft foods and eventually transition to solid foods
  6. Always ask your doctor or dietitian for advice that is specific to you. Again, remember that vomiting may increase the incidence of band slippage, stomach slippage, or stretching of the small stomach pouch above the LAP-BAND®

Your First Gastric Band Adjustment

The first adjustment usually occurs four to six weeks after surgery, although the exact time varies from patient to patient. The LAP-BAND® System is designed to help you achieve steady and safe weight loss, so don’t be in a hurry. You and your surgeon will decide when the time is right for you to have your first adjustment.

At your first adjustment appointment, you should expect to discuss your eating habits, exercise, and rate of weight loss. This will help determine if it’s time for you to have a band adjustment. If it is, you can expect the following:

  1. An evaluation of your pouch size and stoma size before adjusting the band (this isn’t always done. Your surgeon may or may not evaluate your pouch size and stoma size before the adjustment.)
  2. Adjustment of your LAP-BAND® System
  3. Evaluation of your pouch size and stoma size after the procedure to confirm that the proper band adjustment has been made

Bariatric Surgery Patient Concerns

Wondering if bariatric surgery is right for you is a very common concern. As with any surgery, weight loss surgery may present risks. If traditional weight loss methods have not worked, bariatric surgery may be the right answer for you.

Coping with Fear and Physical Changes

Weight loss surgery changes the digestive process of your body for life. It is a major surgery, performed while the patients is under general anesthesia and for some people, the idea of surgery and anesthesia can provoke anxiety.

If the idea of surgery or anesthesia scares you, counter the fear by finding out more. Every surgery has risks, and you should discuss the benefits and risks of bariatric surgery withDr Kuzinkovas and anesthetist.

Finding Support

Many successful weight loss surgery patients say that their support network helped them immensely in maintaining their new healthy lifestyle changes. From family and friends to bariatric program support groups, there is a wealth of options available for people interested in gastric sleeve procedure, gastric banding and gastric bypass operations.

As an invaluable alternative you can Talk to Our Patients.

Your Diet Before Bariatric Surgery

Your surgeon may require that you start the following pre-surgery diet two weeks before surgery.

  • Begin protein supplements (protein powder or shakes)
  • Decrease all fats (fatty meats, fried foods, whole milk products, and others)
  • Decrease sugary foods and drinks (sweets and soda)
  • Decrease high-carbohydrate foods (white bread and white 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 this may include aspirin, ibuprofen (Advil/Motrin), naproxen (Aleve), acetaminophen (Tylenol/Excedrin).

Some surgeons also may advise patients to join a medical weight-loss program before having surgery.

This is the purpose for following a pre-surgery diet:

  • Reduce body fat: Reducing 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. The body will 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-surgery 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.

Pre-surgery weight loss increases safety

Losing weight before surgery will lower the risk of complications and make weight-loss surgery safer.

The main purpose of losing weight before weight-loss surgery is to reduce body fat in the abdominal region, especially in and around the liver. In some instances, a bariatric surgeon must postpone surgery if the patient’s liver is too large. Reducing the size of the liver can shorten the operating time for laparoscopic surgery, and this makes the procedure safer.

For super-obese patients (body mass index greater than 50), losing sufficient weight before surgery allows the procedure to be performed using a minimally invasive surgical approach performed through small incisions (laparoscopic), rather than as open surgery.

Amount of pre-surgery weight loss

The amount of weight loss necessary before surgery can only be determined by your bariatric surgeon based on your health, weight, and bariatric procedure. Some patients are required to lose 10 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.

It’s important to follow your surgeon’s pre-surgery diet and nutrition guidelines. A pre-surgery diet helps prepare your body for surgery and improve the outcome. It also helps you adjust to the food and eating changes you need to make following weight-loss surgery—and for the rest of your life.

Updated April 4, 2018

Preparing for Bariatric Surgery

Preoperative Appointment: Preparing for Gastric Bypass or Lap Band Surgery

Soon after engaging in your bariatric presurgical lifestyle program, you will meet with your bariatric surgeon to:

  • Review your weight loss procedure
  • Discuss expectations about surgery
  • Learn about preparing for bariatric surgery – gastric bypass or lap band surgery
  • Learn about postoperative follow-up care

Talk to your doctor about how to prepare for your bariatric weight loss surgery. You may have restrictions on eating, drinking, and taking medications before your procedure.

What if I can’t attend monthly lifestyle classes?

As part of preparing for bariatric surgery, insurance companies require patients to participate in a comprehensive, six-month bariatric presurgical lifestyle program.

If you can’t attend our program, you can make special arrangements with your primary care physician (PCP) to fulfill the insurance requirements. We will provide materials to help your PCP guide you and document your progress through the six-month program.

Contact us about for help preparing for bariatric surgery and assistance making these special arrangements.

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You may need to tackle a few issues to make sure you’re mentally prepared for surgery, Ms. Schulz says. Here are five tips that Ms. Schulz has to help get you started on the path to achieving a healthier weight.

1. Start with realistic expectations

You won’t wake up thin after bariatric surgery. In fact, you may leave the hospital weighing more because of accumulated fluid. Keep in mind that your surgery is not the immediate answer to weight loss, rather, it’s an internal tool — in the form of a smaller stomach — that will help you on your weight-loss journey.

You can expect to take at least six months to lose half of your excess weight. Then you may hit a plateau. It will likely take another year for you to achieve your weight loss goal.

Know that your weight loss will be a journey that will take some time and effort. Having a clear idea of the process ahead can help you stay on track and not give up.

RELATED: Surgery Helps Control Type 2 Diabetes for Years

2. Don’t try to go it alone

If you are thinking about surgery, it’s important to have support.

Seek out your primary care provider, and also possibly a family member or a friend to help you set long-term goals. Recruit someone to help track your weight-loss milestones and help you stay motivated.

The idea of bariatric surgery is a daunting prospect for many people, so it may help for you to start with baby steps. Rather than trying to learn and do everything at once, look at your options and pick one or two resources. Some possible first steps include:

  • Watch online seminars on the topic.
  • Investigate and consider joining a support group.
  • Work with your doctor to start a medical weight-loss program.

RELATED: Alcohol Abuse May Increase After Bariatric Surgery

3. Recognize and confront a food addiction

If you have a food addiction, you’ll need to address that before surgery. Having a smaller stomach through bariatric surgery is not going to fill the emotional needs that eating meets.

Many people use food to deal with daily stress. However, this is a short-term way to manage your problems — and creates further issues down the road. Knowing this and broadening your perspective may help you to realize the value of limiting your consumption and making healthier food choices, Ms. Schulz says.

“You have to be at the point where you want to change, feel better and have other activities take the place of eating,” she says. For many it takes a desire to focus on the longer term goals for their lives rather than the food they are eating at the next meal. Others are motivated by the daily pain and illness that often accompanies excess weight.

Learning to manage food is imperative after surgery to maintain weight loss because:

  • Your food intake will be sharply restricted, particularly for the first few months.
  • You have to eat slowly — a small meal should take at least 20 minutes to consume.
  • A healthy diet is imperative — grazing on junk food will sabotage your ability to lose pounds.

RELATED: Best Advice for Before and After Your Bariatric Surgery

4. Depression may be an issue for you

Bariatric surgery is about 80 percent effective, but it takes time and focus to keep weight off. It is important that your emotional energy is working to support your efforts, Ms. Schulz says.

After surgery, your body is recovering and eating is physically restricted. If you suffer from depression, it’s even harder to stay on track, particularly if you struggle with food addiction.

Work with your doctor or a counselor to develop and maintain a positive attitude about the process.

RELATED: 7 Bariatric Surgery Benefits Besides Helping You Lose Weight

5. Understand the risks of other addictions

Alcohol and tobacco addictions also can undermine your efforts to lose weight — with or without surgery.

Alcohol is high in calories and reduces your inhibitions, which makes you more susceptible to overeating. You also will feel its intoxicating effects more quickly after surgery — one drink can put you over the legal blood alcohol limit to drive, Ms. Schulz says.

Tobacco use increases the risk of surgical complications, respiratory problems and ulcers — patients who return to smoking after surgery can develop a post-surgical stomach irritation or ulcer.

Life-changing

Bariatric surgery can change your life for the better and is a powerful tool that can provide sustained relief for overweight people.

The benefits of sustained weight loss through bariatric surgery can include:

  • Long-term remission for type 2 diabetes
  • Improved cardiovascular health
  • Relief from depression
  • Elimination of obstructive sleep apnea
  • Relief from joint pain
  • Improved fertility
  • Alleviation of other medical conditions, such as metabolic syndrome, pregnancy complications, gallbladder disease and more

But bariatric surgery is the beginning — rather than the end — of your weight-loss journey, so you’ll still have plenty of work ahead of you.

“You need to have constant awareness of the behaviors and choices we teach patients that work with their new stomach,” Ms. Schulz says. “It’s like going to church every Sunday — you have to keep it at the top of your mind for the rest of your life.”

RELATED: Is Weight Loss Surgery Right For You?

Checklist: 3 to 6 Months Out from Your Surgery

SECTION SUMMARY:

  • Medical care checklist
  • Investigate Your payment and savings options
  • Fine-tune Your logistics & scheduling
  • Begin your lifestyle changes (see below)

There are two separate “to do” lists for the 3 to 6 months prior to surgery. Click the sections below to learn more.

1. Medical Care, Payment & Logistics Bariatric Surgery Checklist

  • Start working with your surgeon’s team – From insurance and financing considerations to required pre-op testing to pre-op instructions specific to your situation, there are a variety of issues your surgeon will help you address while preparing for weight loss surgery. Attend your surgeon’s next seminar to learn more about your options, to get a better handle on what to expect and to learn how to best work with their team
  • Understand payment options and savings opportunities
    • If you have insurance, confirm your insurance benefits and find out what your insurance company requires.
    • If you don’t have insurance and can’t pay the full cost up front, arrange financing.
    • Costs and savings strategies:
  • Schedule pre-surgery tests and consultations/physicals to confirm that you are a good candidate for surgery
  • Arrange and begin your physician-supervised diet program (if required by your insurance company or surgeon)
  • Schedule your initial consultation with your surgeon and find out what paperwork and medical history you’ll need to move forward (e.g. Letter of Medical Necessity and Letter of Medical Clearance, medical records, psychological evaluation, etc.)
  • After evaluating all tests and completing all paperwork and requirements, the surgeon’s office will confirm that you are clear to proceed with surgery and will obtain pre-authorization from your insurance company (if applicable)
  • Your surgeon’s office may require you to participate in other preparatory steps or educational meetings and will guide you following pre-approval

2. Lifestyle Changes Bariatric Surgery Checklist

For long-term weight loss and health improvement following surgery, you must start living as if you’ve had the surgery at least 3 months in advance:

  • Begin eating for health and not just flavor and pleasure – Your smaller stomach after surgery will prevent your body from processing as much food as you’re used to. This is great for weight loss but bad for getting the nutrition your body needs to function properly. If you fill up with junk food and don’t get the nutrients you need following surgery, you’ll risk suffering from one of the many horrible effects of malnutrition – not to mention uncomfortable side effects like dumping syndrome.
    • This will be difficult to do while preparing for weight loss surgery but should get easier post-op. Your taste buds can be retrained and you will be able to eat things you never thought possible. Also, your taste buds will go through some changes after surgery and things you enjoyed before will no longer be appealing to you.
    • See our Top 5 Long-Term Bariatric Diet Success Factors for more information.
  • Eat protein, protein and more protein – Protein is essential for weight loss as it helps you to feel full sooner and for a longer period of time. It will also help you preserve muscle during your rapid weight loss following surgery.
  • Eat slow, chew each bite and watch the portion sizes – The feeling of satiety(fullness) takes 20 to 30 minutes to reach your brain. Eating slowly and chewing thoroughly helps you to stay in touch with with your body so you don’t overeat and stretch your new stomach/pouch. Practicing this while preparing for weight loss surgery will help you lose weight.
  • Start taking a multivitamin – Since bariatric patients don’t absorb nutrients as well due to changes in the digestive system and from consuming less food, you’ll need to take supplements after surgery. Start building that into your routine now… talk with your doctor about which multivitamins they recommend.
  • Don’t drink anything with your meals – Following surgery, you’ll need to wait at least an hour after meals before you drink anything. Liquids can flush food through your smaller post-op stomach causing you to feel hungry sooner and leading to weight regain.
    • In addition, after surgery you will not have as much space in your stomach for food and fluids (your stomach will be smaller) and you can end up dehydrated or malnourished if you don’t eat and drink separately. This step is very important, especially early after recovery when you are still healing.
  • Ditch the sugared beverages and drink more water – Provided you don’t have any fluid restrictions, start drinking 64 oz of water or more per day. Drinking plenty of water over the months spent preparing for weight loss surgery helps patients in a few important ways such as giving you an early feeling of fullness (thus promoting pre-op weight loss), keeping you well-hydrated and flushing out your kidneys in order to reduce the chances of kidney stones that can develop with rapid weight loss following surgery.
  • Careful with the coffee – Coffee in small amounts is fine but eliminate the unhealthy calories that come from sugar and cream. To ease the transition, high-caffeine tea with a small amount of honey may be a good alternative.
  • Stop drinking alcohol – Due to the changes to your digestive system after surgery, alcohol will have a much different effect on your body. It will be much easier for you to become intoxicated meaning you’ll be more likely to give into food cravings. Alcohol after surgery can also cause your blood sugar to go haywire resulting in weight regain and will put you at a higher risk of several health problems, some of which are severe.
  • Exercise just a little bit more – Start slow, do something you enjoy, just start moving. Ideally you can tolerate moving for up to 20 to 30 minutes each day. This will reduce the risk of complications during surgery, assist with weight loss before surgery and get you into a habit that will lead to long-term weight loss.
  • Stop smoking – Smoking increases the risk of blood clots during surgery up to 6 weeks following your last cigarette. Additionally, studies suggest that tobacco smokers failed to complete preoperative weight loss programs at twice the rate of non-smokers (3). If you currently use tobacco, consider entering a tobacco cessation program or starting a nicotine replacement regimen that may include patches or gum.
  • Start attending in-person support group meetings – The importance of hearing other patients’ real-world experiences can not be understated. Other patients will give you first-hand insights that your surgical team may not be able to provide directly and will let you build relationships that will continue to help you succeed following surgery. Your surgeon can provide details about how to find a local bariatric surgery support group.

We know these changes won’t be easy, which is why you’re starting early. Be patient with yourself… practice self management and forgiveness. As you slowly start changing your routine throughout the weeks and months spent preparing for weight loss surery, the adjustments will become easier and easier.

The Checklist – Top 10 Ways to Prepare for Bariatric Surgery

The Checklist – Top 10 Ways to Prepare for Bariatric Surgery

From the perspective of a dietitian and her patients

by Melissa Majumdar, MS, RD, LDN, CPT

Bariatric surgery is a great tool to help you manage your weight. But it’s just that – a tool – and takes a lot of hard work and preparation for it to work. The more thought and lifestyle changes you make before surgery, the easier the transition and the better you can hit the ground running with your weight-loss.

1. Start to think about why you eat. Bariatric surgery is not brain surgery, so if you eat for other reasons besides hunger, say stress, boredom, habit, emotion, you’ll still struggle with managing the head hunger. Surgery will change how much you can eat at one time, but it doesn’t force changes with what you eat or why you eat. Start building a safe food environment to help weed out mindless eating. Keep food off the counters, eat without distractions and eat off a plate instead of the package.

2. Keep a list of non-food ways to cope with stress. Losing the ability to eat to cover up an emotion, or even boredom, can feel like the loss of a friend. Start practicing using these methods before surgery so you’ll know which methods work for you. Keep your hands busy, such as with coloring, crocheting, building a mode or get out of the house. Try going for a walk or running an errand. Have a list of support people you can call or meet – family, friend or a fellow bariatric surgery patient. Ask your bariatric surgery team if they have a mentor you can work with.

3. Don’t compare yourself to others. Everyone has their own story and struggles and everyone will overcome it in different ways. Keep in mind that everyone will lose weight at different rates and in different ways. Someone who starts off heavier has more weight to lose. Keep the focus on what you have control of and do the best you can with what you have both before and after surgery.

4. Follow up, follow up, follow up. Losing weight and changing your lifestyle the first year is the “easy” part, keeping the weight off is more challenging. Follow up helps build a strong relationship with your bariatric team and allows you to share challenges. Follow up also provides the opportunity to makes sure you are on track and check blood work for vitamin deficiencies. Bariatric surgery is unique in that you are a patient for LIFE, so go into the process knowing that your team is along for the rollercoaster.

5. Prepare to feel a little left out at dining and social gatherings. You may be surprised to find out how much food plays a role in your social life or in your own personal identity. Start to identify changes that will occur and communicate with key stakeholders – friends, family, significant others. Read more about how to handle social changes with “Refocusing Social Events.”

6. Practice eating on a schedule. After surgery, you’ll need to eat a protein based meal every three to four hours. If you’re not eating this way now, the transition to multiple mini-meals a day is hard to fit in. Map out a schedule of when and what to eat. Food prep is the key for many to stay on track. Bring snacks, balanced meals, fluid and a backup protein shake with you wherever you go.

7. Eat like you’ve already had surgery. In other words, slow down and chew, chew, chew. Digestion is quite different after surgery. Your stomach isn’t mixing and churning the food as much and you have less gastric acid and digestive enzymes mixing with the food. Rely on your teeth to grind the food before you swallow or you’ll regret that bite.

8. Treat your water bottle like it’s you third arm. Dehydration is one of the biggest post-op complications. You won’t be able to drink large amounts of fluid at one time. Instead, you’re sipping ALL day. If you don’t drink for even one hour, it will be difficult to make up for that time. Also, the stomach is prime real estate after surgery so at meal times, protein takes priority. Practice not drinking while you’re eating to get used to your new norm.

9. Keep yourself accountable. Most successful weight losers are tracking something – protein or calories, fluid intake, weight, steps, and/or exercise. Other people weigh or measure all their food or eat off the same plate or container. This helps you both stay honest with yourself and track your progress.

10. Take pictures! The before and after pictures can be very motivating. You don’t always feel or see progress every day, so looking back on where you’ve come from, both physically and mentally, is rewarding. The pics can also keep you focused on not going back to old ways!

At the end of the day, you will get out of bariatric surgery what you put into it. Everything you do to prepare yourself for surgery will give payback after and everything else will give you the opportunity to learn from your mistakes. Enjoy the ride!

About the Author:
Melissa Majumdar, MS, RD, LDN, CPT, has helped patients navigate lifestyle change and achieve their weight loss goals for almost 10 years. She currently works with patients pursuing bariatric surgery at the Center for Metabolic and Bariatric Surgery at Brigham Health in Boston. She is an Academy of Nutrition and Dietetics Media Spokesperson and spends her free time running and cooking with her husband and two children. Follow Melissa on Instagram @melissard_eatfitlive.

Eating and recovery after bariatric surgery

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Ann Hoyle’s life-changing decision to undergo bariatric surgery at St John of God Geelong Hospital to lose weight was the “best decision of her life”. Ann explains how the preparation for surgery and recovery in the days and months after has set her up to keep the weight off.

Ann’s mission to lose weight, and keep it off through diet and exercise alone wasn’t working.

Weighing 112kg and with high blood pressure, Ann started to panic and feel a failure for not being able to lose weight.

“So I did some research on bariatric surgery – gastric sleeve, gastric band and gastric bypass – to see what it involved and made an appointment with my bariatric surgeon,” she says.

Preparing for bariatric surgery

Ann now weighing 118kg had her surgery scheduled at St John of God Geelong Hospital and started a very low calorie diet to get her back down to 112kg before her surgery.

“Prior to going to hospital, I had prepared some meals as suggested by the dietitian focused on high protein, low carb to help with weightloss,” Ann says.

“This proved really important as it meant I had everything on hand and ready for meal time. Funnily enough, after the surgery I actually realised that I had made my portion sizes too big. What I thought I would eat for one meal actually lasted me two.”

Bariatric surgery at St John of God Geelong Hospital

Ann’s gastric sleeve surgery went well and she woke up the next day able to get out of bed and walk a few laps of the ward.

“I was on a liquid diet and quiet enjoyed my ‘hospital cocktails’ over ice,” Ann says

“The next day I started to feel nausea but after taking my medication, this feeling subsided and I was back at home three days after surgery.”

Recovery and diet after bariatric surgery

Small meals and portions were the order of the day after surgery, with Ann able to consume about three to five tablespoons of food for the first week.

“During this time started to feel light headed and I thought it was because of a lack of food but it was actually due to my blood pressure,” Ann says.

“I went to my GP and they halved my blood pressure medication – everything was heading in the right direction.”

Week two after surgery, Ann started walking around the block to incorporate some light exercise and from week three to eight, she increased her food consumption.

“I was actually enjoying food again as I took more time to chew and enjoy the flavours. This was partially because I didn’t want to make myself eat,” she says.

Now, a year after bariatric surgery

Ann says since her bariatric surgery she has a lot more control over her diet, eating up to one cup of food.

“My body tells me when it is full,” Ann says.

“I still cannot believe that I have an off switch. I know when I am full and I stop eating because I know that if I push it, my stomach will stretch and I won’t feel well.”

Ann says following steps outlined by her dietitian such as eating three meals a day and not drinking immediately before or after eating, she feels well.

“I stick to the rules because I feel I have been given a second chance at life and I am not going to wreck this.”

Weightloss after bariatric surgery

Ann has lost about 52kg from her heaviest weight and since her surgery she has lost almost 40kg.

Her weight now hovers between 78 and 80kg and she wears a size 14.

“It is the little things that I can reflect upon now and see how they change your life – walking, wearing clothes that fit, shopping and feeling normal.

“I want everyone to know that bariatric surgery changes lives and the care I received at St John of God Geelong Hospital was second to none.”

Preparing for Your Surgery

SMOKING

You must stop smoking and/or using tobacco products of any kind for at least four weeks prior to your surgery. It is best to stop smoking at your initial consultation and never resume smoking and/or using tobacco products of any kind. Your surgery will be cancelled if you have smoked and/or used tobacco products of any kind during the four week period prior to your surgery date. Smoking may adversely affect your healing process and the successful outcome of your surgery. It may also increase your pulmonary complications. Once you have stopped smoking and/or using tobacco products it is recommended that you do not start using them again.

MEDICATIONS:

Do not use aspirin, blood thinners or NSAIDS (Ibuprofen, Aleve, Motrin\xE2\x80\xA6) for 1 week prior to surgery. If there is a special need for the use of these medications please discuss them with your prescribing physician and Dr. Felts. If you are on blood thinners please discuss this with Dr. Felts and your prescribing physician.

PMC (PERIOPERATIVE MEDICAL CLINIC)

Once you have completed all your insurance and clinical requirements your case will be submitted to your insurance company for coverage approval of your surgery.

When your Insurance Company has given us an approval for your surgery our office will call you to schedule your surgery date, your education and your PMC (Perioperative Medical Clinic) appointment. The PMC may do a pre-operative assessment of you by phone or they may require you to schedule an appointment with them to come to the hospital for a pre-operative assessment. They will ask about prior surgeries, medications, allergies, use of herb and food supplements, any over-the-counter medications and any current medical conditions you may have. Please make sure you have a current list of your past surgeries, allergies, herbs, over the counter and medications or bring your medication bottles for accurate information. The PMC team will give you your arrival time for surgery.

EMMI

To better prepare you for your surgery, we have partnered with EMMI Solutions, an interactive tutorial. Dr. Felts requires that you walk through the procedure with EMMI as it takes you step-by-step from pre-surgery to post surgery, including risks and benefits. You will be given a web site and an access code to go on line and take the EMMI education for your procedure. The video is short but very educational. This is required in order to have your surgery. Please make sure you have completed the online video prior to your education class. If you do not have a computer at home or if you need help with this process please contact the office and we will assist you through the process.

EDUCATION CLASS

About 2 weeks prior to your procedure you will need to attend an education class. The classes are on Monday afternoon and Wednesday morning. The class takes about 1 to 1 遜 hours. You have been given a personalized process and education booklet. During your class we discuss your procedure, your activities, your diet, medications, regurgitation, support groups and the signs and symptoms to call Dr. Felts. You must attend this class prior to having your procedure. Adult family members are welcome but please make arrangements for small children.

YOUR SURGICAL CLEARANCE

You will need to see your Primary Care Physician for a surgical clearance prior to surgery. This should be done 3-4 weeks prior to your surgery date. Your surgical clearance is valid for a 30 day period. The office will provide you with a letter to give your physician if you need it or they may just write us a letter stating you are medically cleared for your surgery. If you have a history of heart, lung or other conditions you may be required to see your cardiologist/pulmonologist/ hematologist for surgical clearance as well.

PRE-OPERATIVE DIET

You will be placed on a high protein, very low calorie pre-op diet 2-3 weeks prior to your surgery. The diet reduces the fat in and around your liver improving the ease and safety of your surgery.

PRE OP DIET INSRUCTIONS

SURGERY DATE: _______________________________________

PRE-OP APPOINTMENT WITH DR. FELTS: ____________________

START YOUR PRE-OP DIET TODAY__________________________________

During the pre-operative diet, you will need to limit your daily calorie intake to 800 calories/day.

ELIMINATE FROM YOUR DIET:

  • All fats, butter, fatty meats, fried foods, whole milk products
  • High sugar foods
  • Carbonated drinks
  • Bananas \xE2\x80\x93 they are high in sugar

PROTEIN SHAKE:

  • Mix as per directions on package
  • Powder can be mixed with water or skim milk
  • You may use 村 cup of the following: fresh berries, frozen berries, fat free/sugar free Jell-O or pudding to add flavor. You may also try extracts and spices
  • You may have coffee, tea, or Crystal Lite and may use any of the artificial sweeteners, though we recommend stevia.

MEALS:

  • You may have 1 healthy meal, to include 4-5 oz. of lean meat (chicken, turkey, fish and beef).
  • Green vegetables ONLY.
  • You may also have 1 cup of fruit after your meal if you have not added this fruit to your protein drink.

REMEMBER TO BRING IN A \xE2\x80\x9CBEFORE PHOTO” FOR OUR SUCCESS ALBUM

THE DAY BEFORE YOUR SURGERY

The Day

The day before surgery you will begin a clear liquid diet.

When you get up the day before your surgery you will begin your clear liquid diet. This will help make your intestines and stomach easier to handle during your operation.

INSTRUCTIONS:

Liquids that you can see through at room temperature are considered clear liquids. This includes clear juices, broths, ices and gelatins. The list below will help you with your choices. (Choose sugar free or light drinks)

  • Broth
  • Consomm辿
  • Coffee
  • Tea
  • Sugar Free Kool- Aid
  • Crystal Light, Mio, Vitamin Zero
  • Sugar Free Gelatin
  • Sugar Free Popsicles (made from clear juices)

AT NOON THAT SAME DAY you will need to drink a 10 Ounce Bottle of Magnesium Citrate followed with 8 ounces of water. This is a strong laxative needed to clean out your intestines before your surgery. If you drink this by noon know that it will begin to work in 4-6 hours. MAGNESIUM CITRATE is available in all drug stores and most grocery stores over the counter. If you do not find it ask someone at the pharmacy or store where to find it.

Take a shower with Hibiclens (get at your drug store) the night before surgery and Nothing to eat or drink after midnight. See Hibiclens instruction sheet:

Preoperative Hibiclens Bathing Instructions

Before surgery, you can play an important role in your own health. Because skin is not sterile, we need to be sure that your skin is as free of germs as possible before surgery. You can reduce the number of germs on your skin by carefully washing before surgery. Following these instructions will help you be sure that your skin is clean before surgery.

IMPORTANT: You will need to shower with a special soap called chlorhexidine gluconate (CHG)*. A common brand name for this soap is Hibiclens, but any brand is acceptable to use. The soap may come in a liquid form or in a scrub brush applicator. Either form is acceptable to use.

  • Not to be used by people allergic to chlorhexidine.
    1. Shower or bathe with CHG the night before your surgery and the morning of your surgery. Do not shave the area of your body where your surgery will be performed.
    2. With each shower or bath, wash your hair as usual with your normal shampoo.
    3. Rinse your hair and body thoroughly after you shampoo your hair to remove the shampoo residue.
    4. Then apply the CHG soap to your entire body ONLY FROM THE NECK DOWN. Do not use CHG near your eyes or ears to avoid permanent injury to those areas. Wash thoroughly, paying special attention to the area where your surgery will be performed.
    5. Turn water off to prevent rinsing the soap off too soon. Wash your body gently for five (5) minutes. Do not scrub your skin too hard. Do not wash with your regular soap after CHG is used.
    6. Turn the water back on and rinse your body thoroughly.
    7. Pat yourself dry with a clean, soft towel.

PHARMACIES STOCKING CHG (HIBICLENS) ANTIBACTERIAL SOAP

CHG soap can be purchased at most large pharmacies, including CVS, Rite Aid, Stop & Shop, and Arrow. Please call your pharmacy to be sure that they have CHG soap in stock.

CONSENT FORMS

You were given a consent form for your procedure in your Education booklet. Please take the time to read over it prior to surgery so we may address any and all question.

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