Bariatric surgery is an excellent tool to help you limit the amount of food you eat and to facilitate weight reduction.

After bariatric surgery, you will need to significantly adapt your diet and lifestyle to achieve maximum success. You will be losing weight rapidly and proper nutrition is essential to maintain lean body mass, hydration, and skin elasticity, as well as to minimize hair loss.

The post-bariatric surgery meal plan requires a significant change in meal planning for most people. We recommend that you begin adapting your current meal plan now to prepare for this change.

The primary nutrition goals after surgery are as follows:

• Learn proper eating habits that will promote weight loss while maintaining health at a reduced weight
• Consume adequate amounts of protein to minimize loss of lean body mass and facilitate healing
• Take adequate amounts of fluid to maintain hydration
• Obtain adequate nutrients for optimal health through vitamin and mineral supplementation

Post-Weight Loss Surgery Meal Planning Guide

Most weight loss surgery patients will be discharged from the hospital on a liquid-only meal plan for two to three weeks. After three weeks the diet is usually advanced to soft foods for the next six to eight weeks with a gradual transition to regular consistency foods over the next six to nine months.

Depending on your medical history and surgical procedure, it will be recommended that you take a multivitamin with iron, calcium, and -- with some procedures -- vitamin B12, additional iron, and/or vitamins A, D, E, and K.

Included here are suggestions for making this a safe and uncomplicated transition.

• Stage 2: Modified Full Liquids
• Stage 3: Soft Foods
• Stage 4: Solid Foods
• How to Make Your Transition to Solid Food a Success

Stage 2: Modified Full Liquids

Starting on the day you go home from the hospital, you should drink two ounces, (60 ml), or 1/4 cup of a high-protein liquid nutrition supplement every hour, on the hour, while you are awake. This must be a nutritionally complete liquid that would pass through a standard strainer.

In addition to the nutritionally complete liquid, you should strive to consume two ounces of non-carbonated, non-caffeinated, low- or no-calorie liquid every 15 minutes after the hour for a total of eight fluid ounces each hour.

Your first priority is to drink enough fluid to prevent dehydration; protein is a secondary priority. You should drink a total of six to eight cups of fluid each day to avoid getting dehydrated.

It is not uncommon to feel a sensation of fullness from liquids after surgery. This sensation may limit your ability or desire to take the goal volumes in the first several days after surgery. As you progress from surgery you should find it easier to meet the daily goals.

For best tolerance, do not use straws, take small sips, and start with room temperature liquids.

The liquid-only diet is prescribed for three weeks. Please do not start solid foods until your three week follow up visit with your surgeon and dietitian.

Sample Meal Schedule

8:00 a.m. -- 2 oz. Boost High Protein
8:15 a.m. -- 2 oz. water
8:30 a.m. -- 2 oz. broth
8:45 a.m. -- 2 oz. diluted juice

Choose a high protein liquid nutrition supplement with no more than 15-20 grams of sugar and at least 13 grams of protein in an eight ounce serving.

Protein

Protein is essential to aid in healing and maintaining muscle mass after weight loss surgery. It may also help avoid (but not necessarily prevent) hair loss associated with rapid weight loss. Try to consume at least 40-60 grams of protein per day.

Examples of Stage 2: Modified Full Liquids

High-protein liquids:

• No sugar added Carnation Instant Breakfast and skim or 1 percent milk
• Eight ounces skim milk with 1/3 cup nonfat dry milk powder (16 total grams of protein)
• Boost High Protein or Ensure High Protein, available at grocery stores
• Whey or soy protein (Carb solutions, Spiru-tein, Designer Whey)
• EAS high protein drinks
• Ensure or Boost (Glucerna or Boost Glucose Control), available at grocery stores
• Isopure, available at nutrition specialty stores

Low-calorie liquids:

• Water
• Crystal Light
• Sugar-free Kool-Aid/Wyler’s drink mix
• Unsweetened decaffeinated tea
• Decaffeinated coffee
• Clear juice diluted 50/50 with water
• Fruit2O
• Broth
• Sugar-free popsicles
• Propel Fitness Water

Follow-Up

Three weeks after surgery you will follow up with your surgeon in clinic and have a diet advancement class with the program dietitian. In this class you will learn how to successfully incorporate soft solid foods back into your meal plan.

Please do not start solid foods until after your three week clinic visit!

Stage 3: Soft Foods

Soft foods will be added gradually to your meal plan over the next six to eight weeks.  While on the soft diet you must continue to focus on high protein foods and avoid foods that are high in fat, sugar, or fiber.

You may still need to get some of your protein from supplements until you are able to eat enough solid food to meet your nutritional needs (see the list of protein supplements above).

Consuming adequate protein in your diet will help you maintain muscle mass and heal as you lose weight. Because you will not be able to eat a large volume of food at one time you should plan to eat a small meal four to six times each day.

At meal times it is important to focus on high protein foods, making sure you eat them first. You will be instructed to add only one new food at a time to establish tolerance to foods slowly. If you do not tolerate a food well, the problem may be with the food itself, how it was prepared, or the way it was consumed.

Learn to recognize when you are full. Indications of fullness may be a pressure, tightness, or heaviness in the center of your abdomen just below the breast bone. Feelings of nausea, regurgitation, or heartburn are indications that too much has been eaten or the meal was eaten to rapidly.

Nausea, abdominal pain, or discomfort is most often the result of eating inappropriately and rarely a complication of surgery. Common eating-related causes of discomfort are: eating too fast, not chewing food well, eating too much food at once, eating solid foods too soon after surgery, or drinking liquids either with meals or right after meals.

Following are lists of foods allowed and those to be avoided while on the soft diet. The foods on the avoid list are there because most patients do not tolerate them for the first two to three months after surgery. Some patients do tolerate these foods, but it is best to start with the foods on the recommended list.

Once you have learned how to eat with your new gastric anatomy and have healed from surgery, you can start to add other foods one at a time over the next few months. If you follow these suggestions, your transition to solid foods and weight loss will be a success.

Recommended Food for Stage 3: Soft Foods

High-protein foods:

• Eggs (cooked with minimal fat)
• Light or low-fat yogurt
• Low-fat cottage cheese
• Soft fish (baked, broiled, grilled)
• Small or baby shrimp, scallops, crab
• Tuna fish (fat-free mayo is okay)
• Tender cooked or ground poultry
• Tender cooked or ground beef or pork
• Bean and lentil dishes and soups
• Fat free refried beans
• Low-fat luncheon meats (turkey, roast beef, sliced thin)
• Shredded or soft low-fat cheeses
• Tofu (soy) mixed in soup or vegetables

Other foods:

• Oatmeal, cream of wheat, grits (thinned)
• Softened cold cereal
• Cooked, soft vegetables
• Soft fruits without skin or canned in natural juices
• Crackers and pretzels chewed well
• Potatoes
• Low-fat soups
• Very dry toast
• Soft lettuce (green leaf or Boston Bibb)

Soft foods to avoid:

• Sticky foods
• Bread (may tolerate if toasted)
• Sticky rice
• Pasta (especially overcooked or large noodles)
• Melted stringy cheese
• Macaroni and cheese
• Peanut butter

Crunchy fibrous foods:

• Raw vegetables
• Fruit and vegetable skins
• Nuts
• Popcorn
• Chips
• Coconut
• Iceberg lettuce

Tough or rubbery foods:

• Tough meat (steak, pork chops, ham, hot dogs)

High-fat foods:

• Butter, margarine, oils
• Sour cream
• Cream cheese
• Mayonnaise
• Gravy
• Fat back, bacon
• Sausage
• Whole milk
• Salad dressing
• Hard cheeses
• Fried foods
• Bologna, salami
• Chips
• Desserts

Stage 4: Solid Foods

It is now 10-12 weeks post surgery and you are ready to progress from soft solids to regular consistency foods. Eventually, you will probably be able to eat most of what you were eating before surgery, only in much smaller amounts.

Overall you should be making healthy food choices including lean meat or vegetable protein, low-fat dairy, incorporating fruit and vegetables as you are able, and avoiding empty calorie or “junk” foods as they are typically high in fat and sugar.

Long term, patients must choose foods with good nutritional value. Each meal should have at least three ounces of protein. Learn to read food labels and limit fat and sugar intake, choose low-fat (five grams or less per serving), low-sugar (five grams or less per serving), and lean protein foods.

The volume you can tolerate will always be limited so choose foods wisely to avoid filling up on foods with little nutritional value.

Eating Behaviors for Success

• Eat slowly and be aware of when you feel full. When you feel full, stop eating! If you continue to eat, you may develop intense chest pain and vomit.
• Chew, chew, chew! You need to make sure you chew your food very well before you swallow it. This makes it easier to digest and pass from your gastric pouch into your small intestine.
• Avoid drinking fluids 30 minutes before and with your meals. If you fill up your small gastric pouch with liquid, you won't have room for your food. Furthermore, the liquids may accelerate passage of the solid food out of the stomach and possibly cause some discomfort.
• Drink enough fluid between meals to meet your fluid requirements. You need six to eight cups of fluid per day to prevent dehydration.
• Avoid food and beverages high in sugar. High sugar foods can cause "dumping syndrome." After gastric bypass surgery, some people feel light-headed, sweaty, or faint soon after consuming concentrated sugar.
• Limit high fat foods. These foods may make you feel nauseated. They are also high in calories and will slow down your weight loss. Using a low-fat, reduced-fat, or light version of a product is okay.