Patient Information 
    Bariatric Surgery
    Dietary information for patients  
    following sleeve gastrectomy or  
    gastric bypass surgery
                                                                                                                                     Bariatric Surgery Dietary information for patients following sleeve gastrectomy or gastric bypass surgery
          Contents
          Introduction 4                                                                                        Eating for good tolerance                                               14
              Supplements                                                               6                       Sample menu                                                             15
              Other medications                                                         6                       When can I move on to Stage Four?                                       16
              Why is this information important?                                        6                       Questions?                                                              16
          Stage One: Fluids – smooth liquids                                            7                  Stage Four: Solid foods and back to a normal healthy diet                    17
              How long do I need to be on Stage One of the diet?                        7                       When can I start Stage Four?                                            17
              Dietary aim                                                               7                       What is Stage Four?                                                     17
              Suitable fluids                                                           7                       Getting weight loss results that last                                   17
              How much and when?                                                        8                       Why is balanced eating so important?                                    18
              Avoid these liquids                                                       8                       So just what is a balanced diet?                                        18
              Sample menu                                                               9                       Being nutritious                                                        18
              When can I move on to Stage Two?                                          9                       The Eatwell Plate                                                       19
              Questions?                                                                9                       Protein foods                                                           20
          Stage Two: Pureed foods                                                      10                       Dairy foods                                                             20
              How long will I be on Stage Two of the diet?                             10                       Breads, cereals and starchy foods: carbohydrates                        20
              Foods to have                                                            10                       Fruit and vegetables                                                    21
              Foods to avoid                                                           10                       Fats and sugars                                                         21
              Food preparation tips                                                    11                       Fluids                                                                  22
              Tolerance                                                                11                       Alcohol                                                                 22
              Fluids for hydration to have between meals                               11                       Food servings                                                           22
              Sample Menu                                                              12                       Pregnancy                                                               24
              When can I move on to Stage Three?                                       12                       Long term Supplements                                                   24
              Questions?                                                               12                  Further information                                                          26
          Stage Three: Soft textured foods                                             13
              How long will I be on Stage Three of the diet?                           13
              What is soft food?                                                       13
              Diet aims                                                                13
              Suitable foods are                                                       13
              Foods to avoid                                                           14
              Fluids for hydration to have between meals                               14
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                                                                                                                                                                                                  Bariatric Surgery Dietary information for patients following sleeve gastrectomy or gastric bypass surgery
              Introduction
              This information is                                          After both types of surgery you will need to follow a                             Stage One                                                    Stage Four
                                                                           special diet for about six weeks before you return to                             Fluids only. Smooth liquids with no lumps.                   Solid foods, a normal textured, varied and 
              for patients who                                             a normal textured diet. The diet is set out over four                             Weeks one and two.                                           healthy diet. Week seven onward. 
                                                                           stages: 
              have had the sleeve                                          1. Fluids: smooth liquids with no lumps                                           This stage of the diet allows your stomach to rest           By now you should be able to tolerate a variety of 
                                                                           2.  Pureed food: smooth consistent texture, no                                    and recover from the surgery. Keep in mind that the          food textures. Do keep in mind that your stomach 
              gastrectomy or gastric                                           lumps                                                                         surgery has reduced your stomach size. It is now             may still be sensitive so continue carefully. At some 
                                                                           3.  Soft moist: soft foods, lumps allowed                                         much smaller than before surgery; it is roughly the          point you may experience setbacks. If you do suffer 
              bypass surgery.                                              4.  Normal textured varied healthy diet                                           size of an egg cup. Go slowly, don’t over do it. The         any trouble or difficulties then it is well advised 
                                                                                                                                                             smooth liquid stage of the diet helps preserve and           to return to the previous texture stage and to eat 
                                                                           Your first sips of water will be taken the morning                                protects the new stomach structure whilst it heals.          smaller portions until things improve. 
                                                                           after surgery, if you tolerate this well you will then                                                                                         Now is the time to establish and reset healthy eating 
                                                                           start stage one of the bariatric diet at lunchtime.                               Stage Two                                                    practices. Try to move away from the factors that led 
                                                                           The bariatric clinical nurse specialist, ward nurse or                            Pureed Food. Smooth consistent textures with                 to weight gain in the first place. Self monitoring is 
                                                                           dietitian will discuss the diet with you before you go                            no lumps. Weeks three and four.                              the key to long term weight loss. This takes planning 
                                                                           home.                                                                                                                                          and focus, but with practice will become second 
                                                                           Keep in mind that your surgery took place on day                                  Remember your stomach is still healing. This stage           nature. 
                                                                           one of week one. You should continue with each                                    continues the gentle process of reintroducing normal 
                                                                           food texture stage for two weeks unless advised                                   food textures. You can progress to the next stage at         Good nutrition is important after weight loss surgery. 
                                                                           otherwise by your doctor or dietitian. At the end of                              the start of week five.                                      Aim to ensure your diet contains sufficient protein, 
                                                                           each two week period you can progress to the next                                                                                              energy, vitamins and minerals for optimum health. 
                                                                           stage if all is well and you are having no difficulties.                          Stage Three                                                  A healthy balanced diet includes a variety of foods 
                                                                           It is important to follow the food restaging protocol                             Soft, Moist Foods. Lumps now allowed. Weeks                  from the five food groups. After weight loss surgery 
                                                                           as described.                                                                     five and six.                                                you will find your appetite may be considerably 
                                                                                                                                                                                                                          reduced, however you should aim to eat a breakfast, 
                                                                           Most tolerance problems typically arise from:                                     At this stage you can introduce soft moist textures to       lunch and dinner daily. See stage four of this 
                                                                           •	 Eating	too	quickly	                                                            your diet. With trial and error you will find some foods     resource for more information on healthy eating. 
                                                                           •	 Simply	eating	too	much:	or	too	large	a	mouthful	                               are more difficult than others. It is very important at 
                                                                               in one go                                                                     this stage to get in the habit of chewing well to avoid 
                                                                           •	 Drinking	too	much	fluid	                                                       discomfort. You should eat slowly and stop eating as 
                                                                           •	 Eating	and	drinking	at	the	same	time	                                          soon as you feel full. The healing process continues. 
                                                                           •	 Introducing	solid	foods	too	early	                                             Simply eating too much or too quickly may cause 
                                                                           •	 Hot	and	cold	foods	may	also	be	an	issue	                                       pain and vomiting. This can aggravate your surgical 
                                                                                                                                                             wound. Aim to eat without distractions and learn to 
                                                                                                                                                             recognise when you’ve had enough. In reality this may 
                                                                                                                                                             be much less than you would expect. 
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                                                                                                                                                                                            Bariatric Surgery Dietary information for patients following sleeve gastrectomy or gastric bypass surgery
                                                                                                                                                        Stage One: Fluids – smooth liquids 
              More information                                           you have diabetes your medications will need review,                           This information is for patients who have had                 them in the chilled part of the supermarket. 
                                                                         please ensure that you speak to a member of the                                the sleeve gastrectomy or gastric bypass surgery.             Choose high protein soups that contain meats, 
              Each stage of the diet is covered in greater detail on     medical team about this before going home. You will                                                                                          beans or other pulses. Blitz them in your 
              the following pages.                                       also need to make an appointment within six weeks                              How long do I need to be on                                   blender; you may need to add water or milk 
                                                                         to speak to your GP or practice nurse who deals with                           Stage One of the diet?                                        until smooth. 
              Supplements                                                your diabetes medications.                                                                                                                •	 Creamed	soups	–	cream	of	tomato,	potato	and	
                                                                                                                                                                                                                      leek or any soup with no bits. Adding a little milk 
                                                                         Why is this information                                                        With each stage of the diet you should follow the             will improve the protein content. If in doubt of 
              Weight loss surgery may make it necessary to take                                                                                         guideline for two weeks.                                      the texture use a blender or sieve. 
              a range of vitamin and mineral supplements. Which          important?                                                                                                                                •	 Build Up high protein powdered soups from 
              ones will depend on the type of surgery you have                                                                                          Dietary aim                                                   Nestle. These can be found in most supermarkets. 
              had. Typically you can start the supplements in            The texture progression from liquid to solids is                                                                                          •	 Complan soup or drink products. 
              tablet form after week six of your operation. If you       important to reduce discomfort or unpleasant                                   The aim of each stage is to eat well whilst minimising     •	 Ovaltine or Horlicks made	with	semi-skimmed	
              wish you can start earlier with a liquid or chewable       side effects such as vomiting or regurgitation.                                the possibility of discomfort and side effects. The key       milk – be careful how much you use, three 
              supplement for example:                                    Without adequate attention to eating well the                                  thing with this stage is to stick to fluids and ensure a      teaspoons per mug is a good measure. 
                                                                         weight loss surgery may make it a challenge to get                             good protein intake.                                       •	 Slimfast ready made drinks in the bottle, 330ml. 
              •  Centrum chewable                                        enough vitamins and minerals from your diet. The                                                                                          •	 Low	fat	or	fat	free	natural	or	fruit	yoghurts	are	
              •  Bassett’s chewable                                      consequences of a poor diet can vary. In the short                                                                                           best. Do avoid the ones with added crunchy 
              •  Boots own brand chewable                                term this may lead to dry or cracked skin, nails or                            Suitable fluids                                               toppings. 
              •  Forceval soluble                                        hair loss. In the long term poor nutrition can lead to 
                                                                         increased risk of developing health problems or even                           All fluid foods should be completely smooth with no        Fluids for hydration: drinks included between 
              Other medications                                          weight regain. It is very common to experience                                 bits or lumps. The liquids you drink should be thin        meals for keeping hydrated. 
                                                                         hair loss in the first six months after surgery.                               enough to pass through a straw. After weight loss          •	 Tea	or	coffee,	with	milk.	Use	sweetener	if	desired	
              All other medications, unless in the form of a tiny        This is often due to the stress of rapid weight                                surgery your appetite will be greatly reduced and you      •	 Stock	cube,	Marmite	or	Bovril	in	hot	water	
              tablet should be taken in liquid, dissolvable form         loss or poor nutritional status over the longer                                will only be able to manage small amounts at any           •	 Diluted	fruit	juice	(½	juice,	½	water)	
              or crushed until after week six. Capsules can be           term. Your hair will return to normal in time                                  one time. For this reason it may become a challenge        •	 Plain	water,	flavoured	water	(sugar	free),	sugar	
              opened and added to a small amount of water or             with a healthy diet.                                                           to get enough protein and fluid during the day. It is         free jellies or no added sugar squash 
              other drink to mask the taste. Please check with your                                                                                     therefore important to choose nutritious protein rich      •	 Avoid	sparkling	water	or	carbonated	beverages	
              GP as some capsules are designed for slow release          You should talk to your dietitian or clinical nurse                            fluids and drink little and often. 
              and this may be an issue. You can get a pill crusher       specialist if you have any questions relating to the 
              from your pharmacist or ask for one on the hospital        diet or if you experience difficulties.                                        Quality protein rich liquid choices
              ward before discharge. If you are taking multiple                                                                                         •	 Milk	-semi-skimmed	or	skimmed.	Try	to	include	a	
              medicines you may need to space them at five to ten        Dietitian: 020 8725 1022                                                          pint of milk each day. 
              minute intervals so they are softer on the stomach. If     Nurse: 020 8725 4238                                                           •	 Soups	are	ideal.	Fresh	ready	made	soups	are	a	
                                                                                                                                                           good choice. There is a good variety of flavours 
                                                                                                                                                           available in most supermarkets. Any supermarket 
                                                                                                                                                           home brand fresh soups will do. You will find 
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