Initial Weight Loss Surgery Nutrition Education

1. Initial Weight Loss Surgery Nutrition Education

2. The primary nutrition goals before and after surgery are: 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 healthy food choices and vitamin and mineral supplementation.

3. For most individuals Bariatric Surgery meal planning requires • a significant change in how and what you eat and drink. • We recommend that you begin adapting your current diet pattern • and health behaviors now to prepare for this change!

4. Band RNY Sleeve DS1-2 oz. 30-60 ml. 1/8-1/4 cup 1-2 oz. 30-60 ml. 1/8-1/4 cup2-4 oz. 60-120 ml. ¼-1/2 cup 4-6 oz. 120-120ml.1/2-3/4 cup

6. How Your Diet Will Advance: • Weeks 1&2: Liquids Only • Week Three: Liquids and Semi-solids • Week four: Liquids and Soft Foods

7. Weeks 1&2: Liquids Only Ability to see light coming through Milky or creamy consistency

8. Weeks 1&2: Liquids Only Hydrating Fluids Clear Liquid Protein (1st 48 hrs after surgery) No Bubbles No Sugar No Caffeine Full Liquid Protein (Start Post-op Day 3)

9. Choosing a Protein Supplement • Choose a liquid protein supplement with at least 15 grams of protein in an 8-12oz serving. • Choose a liquid protein supplement with 20gm or less of carbohydrate and 10gm or less of sugar.

10. Understanding The Nutrition Facts Label < 10 g total fat < 20 g Carbs < 10 g Sugar ≥ 15 g protein

11. Drink fluids in no more than 2 ounce or ¼ cup portions every 15 minutes 1-2 oz Protein drink 1-2 ounces every 15 minutes About 1 cup or 8 oz. total each hour. 1-2 oz Fluid for hydration 1-2 oz Fluid for hydration SIP on this fluid over 10-15 minutes ***Drinking to quickly or drinking too much at one time may cause pain or discomfort*** 1-2 oz Fluid for hydration

12. Liquids Diet GOALS, Weeks 1&2 • Preventing dehydration- 12-14 hours of fluid intake • 64 oz fluid per day / 60-80 grams protein • Controlled fluid volume • Preventing discomfort • FULLNESS • Pressure • Tightness • Heaviness

13. Semi-solids and Liquids, Week 3

14. Semi-solids and Liquids, Week 3 Allowed Semi-Solids Semi-Solids to Avoid

15. Semi-solids and Liquids GOALS , Week 3 • Begin separating fluids from foods • DO NOT DRINK WITH MEALS • Measure out no more than ⅓ cup food • Applesauce consistency foods

16. Soft Foods, Weeks 4-8 • Group Soft Diet Class, 3-4 weeks after surgery • Fork Tender Foods • Foods to avoid on the soft diet: • Carbonated drinks (avoid) • Sugar sweetened, caffeinated beverages (use diet or sugar free) • Simple carbohydrates like chips, crackers, rice, pasta, and noodles • Shredded coconut (use coconut extract) • Tough dry meats (steak, pork chops) (use moist heat preparation, stew, boil, roast) • Rubbery meats like ham and hotdogs • Skins, membranes and seeds of fruits and veggies (peel and or section prior to eating) • Fibrous veggies (i.e. corn, celery, sweet potatoes) • Fresh doughy bread like yeast rolls and biscuits (use toast, or crackers) • Fried or high fat foods (bake, broil, grill, use added fats conservatively) • Whole milk products (use skim or 1% milk products)

17. Meal Planning • Plan to eat ⅓ cup protein every 3-4 hours • Breakfast will be within 1 hour of waking • Last mini-meal at least 2 hours before sleep

18. Soft Foods GOALS, Weeks 4-8 • 60-80 grams protein per day • 64oz fluid • Start with ⅓ cup protein • **Plan to eat ⅓ protein every 3-4 hours • Thumbnail size bites • Chew foods to applesauce consistency • 20-30 minutes to eat • No Drinking with Meals.

19. Move clockwise Around the plate

20. Dumping Syndromeonly a side effect of RNY Gastric Bypass • Limit FAT and SUGAR • Single digits • <10 grams/serving • Avoid fried greasy • and sugary foods. • Alcohol?

22. Vitamin and Mineral Supplements in Chewable or Liquid ONLY A chewable or liquid B-Complex is the only vitamin needed 1 month after surgery!

23. Things to Do Before Surgery • Choose and purchase a chewable or liquid B-Complex Vitamin • Choose and purchase a variety of protein fortified fluids for the first two weeks after surgery • Begin planning a small meal every 3-4 hours • Practice eating without drinking • Practice sipping on fluid between meals – 64oz daily. • Practice chewing foods to an applesauce consistency • Practice eating with smaller utensils • Practice eating with your non-dominant hand • Practice mindful eating, try to eliminate distractions during meals, TV, Phone, tablet

24. Things to Do Before Surgery • Begin decreasing high fat/fried and high sugar foods. • Begin or continue an exercise program. Try starting with a pedometer and strive for 10K steps per day. • Attend Gastric Bypass Support Groups, both before and after surgery. • Begin or continue food journaling to increase mindfulness to food/fluid choices and diet pattern • Begin or continue reading and self-education prior to surgery • Maintain weight within 2-3 pounds of your current weight or initiate weight loss

25. Liver Reduction Diet, 2-4 Weeks Prior to Surgery 2-4 Weeks Before Surgery Liquids only the week before surgery 5 shakes per day

26. Download our patient app “BSNC” in the app store or google play!

27. NUTRITION FOLLOW UP? • Do I need to see the dietitian again before surgery? • Case Managers: • Barbara Satterfield • Michelle Harvey • Maggie Pope • Kevin Edinger • Michael Parker • Jamie Sandy