Bariatric surgery is a transformative journey that requires significant lifestyle adjustments, particularly in diet. If you've recently undergone bariatric surgery or are considering it, understanding the various dietary stages is crucial for a successful recovery and long-term weight management. This article provides a detailed overview of the bariatric surgery diet stages, offering guidance on what to eat, how to eat, and why each stage is important.
Introduction: Embracing a New Way of Eating
Embarking on a journey through bariatric surgery is a life-changing decision. Post-surgery, your stomach’s capacity is significantly reduced, which means you’ll need to adjust not just what you eat but also how you eat. Adjusting your diet post-bariatric surgery isn’t just about weight loss-it’s about adopting a healthier lifestyle. The right diet ensures you get the nutrients you need while adhering to your new stomach’s limits. Each step is designed to optimize healing, nutritional intake, and ultimately, your weight loss journey.
The Bariatric Diet Stages: A Step-by-Step Progression
The bariatric surgery diet has several stages, each designed to support where you are in your healing. This short-term diet takes you through the first 4 to 6 weeks right after weight-loss surgery. It helps you gradually ease back into eating solid foods. The diet described here is used after the most common types of weight-loss surgery, sleeve gastrectomy and gastric bypass. If you have another type of weight-loss surgery, such as gastric banding, your diet plan may be different.
1. Clear Liquid Diet: The Initial Phase (Days 1-2)
While you are in the hospital, for the first 24-48 hours after surgery, you will be on a bariatric clear liquid diet. This stage usually begins within hours after surgery. This diet is designed to keep you hydrated without stressing out your stomach. At this time, you may be nauseous and fill up quickly.
Recommended Foods:
- Water
- Clear broth
- Sugar-free gelatin
- Sugar-free popsicles
- Decaf tea
- Decaf coffee
- Sugar-free, non-carbonated beverages
Goals and Tips:
- Take frequent, small sips rather than trying to drink a lot at once.
- Start by drinking 1-2 ounces every hour.
- Once discharged, you should increase fluid intake to 3-8 ounces every hour to avoid dehydration.
- The goal is for you to drink 48-64 ounces daily.
- Stay hydrated!
2. Full Liquid Diet: Transitioning to More Nutrition (Week 1-2)
Once you are discharged from the hospital or on day 2-3 after surgery, your diet should be advanced to a bariatric full liquid diet. You will usually remain on this diet until day 15 (week 3) after surgery. This diet is designed to keep you hydrated and start to provide more nutrition (protein) for healing.
Read also: Diet Before Bariatric Surgery
Recommended Foods:
- Plain low-fat yogurt
- Low-fat or skim milk (or unsweetened non-dairy milk)
- Diluted 100% fruit or vegetable juice
- Strained low-fat cream soups
- Sugar-free fat-free pudding
- Protein shakes
Goals and Tips:
- Sip drinks frequently throughout the day.
- Within several days, work up to at least 7½ cups (60 ounces) of fluid daily to prevent dehydration.
- Start protein shakes to help meet your daily protein goal (whey protein is typically recommended after surgery).
- Consume 60-80 grams of protein daily in this phase through six liquid meals, with no solid foods allowed.
- Your meals should be spaced out. Your meal times could look like the following example schedule -8 am, 10 am, 12 pm, 2 pm, 5 pm, and 7 pm-each consisting of 2 liquid ounces.
- To meet your protein needs, incorporate protein powders or liquid protein into your diet, as determined by your dietitian.
- While ready-made protein shakes and waters are available, they alone won't suffice for your daily requirement. Thus, making your own protein shake every day is essential.
3. Pureed Diet: Reintroducing Solid Food (Week 3-6)
At this point, you can tolerate slightly larger portions and are ready to start eating a bariatric pureed diet. The food will need to be blended/pureed to the consistency of baby food. This will allow you to build up tolerance to solid food.
Recommended Foods:
- Applesauce
- Soup with no chunks of food
- High-protein foods that can be pureed include lean meats, poultry, fish, and cooked eggs.
- Soft-cooked vegetables
- Soft, skinless fruits
Goals and Tips:
- About 10 to 14 days after surgery, your dietitian may tell you to add foods you can eat without chewing.
- Pourable protein - At this stage, foods need to be put in a blender to achieve a smooth baby food consistency for 3 weeks. This is necessary to avoid serious complications and to increase your tolerance to new foods.
- Each meal is about 2 ounces (1/4 cup) of blended protein foods.
- Protein remains a top priority, with a goal of consuming 60-80 grams daily.
- To achieve this, incorporate unflavored protein powders or liquids into every meal to make your food smooth, soft, and easy to digest.
- Adhere to a structured schedule of six protein-rich meals a day, with each portion ranging from 2-4 ounces.
- Blend a variety of fruits, vegetables, and thoroughly cooked meats to the required consistency, emphasizing that no chewing should be necessary.
- You can enhance flavors with spices, and for added convenience, you can refrigerate or freeze your meals.
- You will need to continue to focus on protein and will probably need to continue with the protein supplements to help meet your protein needs.
4. Soft Diet: Advancing to Tender Textures (Week 6-8)
Now that you can tolerate food, you can continue to advance textures to a bariatric soft diet. The food will need to be chopped, ground, mashed, flaked, or pureed. These foods will require less chewing, passing more easily through your gastric pouch.
Recommended Foods:
- Finely chopped or ground meat and poultry
- Flaked fish
- Soft-scrambled eggs
- Cottage cheese
- Soft-cooked beans
- Soft tofu
- Soft-cooked vegetables (no peel)
- Cooked cereal
- Soft fruits (no skin or seeds)
- Canned fruit (in its own juice)
Goals and Tips:
- After about a week on a pureed diet, your dietitian may tell you to add foods that can be mashed with a fork or don’t require much chewing.
- Have 3 to 5 small meals or snacks per day.
- Include protein-rich foods each time you eat.
- You will still need to focus on protein but can start relying more on food sources of protein than protein supplements.
- The soft diet phase is focused on incorporating tender, moist, and easy-to-chew foods such as soft vegetables, fruits, and lean meats, easing the transition to more solid foods.
- Aim for 60-80 grams of protein daily, now incorporating more natural sources like tender meats, along with soft fruits and vegetables.
- This stage is crucial for smoothly transitioning to a more varied diet without straining your digestive system.
- Focus on foods that are simple to chew and moist, ensuring you get the nutrition you need while your body continues to heal.
Sample Meals:
- Lunch: Small servings of finely ground turkey, cooked squash, and applesauce.
- Dinner: Small servings of flaked broiled fish (no breading) with soft-cooked carrots and green peas.
5. Regular Diet: A Lifelong Commitment (Week 9 Onward)
At week 7, you are now ready to advance to regular textures and reintroduce a greater variety of food into your diet. This is the diet that you should follow for the rest of your life.
Recommended Foods:
- Mostly high-protein foods
- Foods from each of the five food groups
Foods to Avoid:
- High-fat foods
- Sugar-sweetened foods
- Spicy foods
Goals and Tips:
- Usually patients are able to safely begin a regular, healthy diet at 9 weeks after weight-loss surgery.
- You will be encouraged to choose mostly high-protein foods and to avoid foods that are usually not well tolerated.
- You will continue practicing all the good eating habits you learned as you were preparing for surgery.
- Meals are about 4-8 ounces (1/2-1 cup).
- Eat slowly, listen to your body, and stop eating when you are full.
- Make sure that you eat slowly, listen to your body, and stop eating when you are full.
- Transition to Regular DietGradually, you'll start incorporating a broader range of foods into your diet. However, the key here is moderation and balance.
- The amount of food you are able to eat at a meal will be reduced.
- Eating three meals per day will be essential.
- Meals should be made up of solid foods.
- Liquids should be consumed between meals.
- Each meal should have at least one to two ounces of a protein source (such as eggs, cottage cheese, fish, poultry, beans, meat, and tofu) and a small amount of vegetables.
- Fruit may also be eaten with a meal or combined with some protein for a snack (i.e.
- Avoid frequent snacking. Snacking can add significant calories and keep you from losing weight. Inappropriate snacking can even lead to weight gain.
- The volume you can tolerate will be limited so choose foods wisely to avoid filling up on foods with little nutritional value.
- Eating foods from each of the five food groups will provide balance.
Key Considerations for All Stages
Hydration
Staying hydrated is key after bariatric surgery. Aim for 48-60 ounces of fluid daily, but don't drink during meals. Wait 10-30 minutes after eating to sip again.
- Drink at least seven cups of liquids per day between meals.
- Do not drink beverages 20-30 minutes before or after meals.
- Choose drinks with under 5 grams of carbs per 8 ounces, avoiding caffeine and carbonation.
- Watch for pale, straw-colored urine to gauge hydration.
- Stick to water, flavored water, and low-carb options like Propel Water or Diet Snapple.
- Use sweeteners like Splenda or Stevia instead of sugar.
- Also, clear broths and sugar-free options like Popsicles can help.
- To avoid dehydration, you'll need to drink at least 8 cups (1.9 liters) of fluids a day.
Protein Intake
Protein aids in healing and muscle maintenance, making it essential post-surgery.
Read also: Bariatric Surgery Outcomes
- Most bariatric surgery programs will recommend 60 to 100 grams per day, depending on the patient.
- This will mean focusing on high protein foods and avoiding foods with high amounts of sugar and starch.
- Eat protein foods first.
Vitamin and Mineral Supplements
Post-bariatric surgery, your body's ability to absorb certain nutrients is diminished. Adhere to the recommended vitamin and mineral supplements to prevent deficiencies.
- After any weight loss surgery, patients will need to take over the counter vitamins and minerals for life.
- Each bariatric surgery program will instruct patients on how much to take.
- These typically include: a multivitamin, Vitamin B12, Calcium, Vitamin D, and Iron.
- Some patients will need chewable vitamins, but some can take pills if tolerated.
- Starting two weeks post-op, you should have all your supplements in chewable, crushable, or liquid form for easy digestion.
- Limb Lengthening patients can switch back to pills or capsules once they're home.
- Make sure not to take calcium and iron at the same time-they don't mix well.
- Spread out your vitamin intake across the day.
- The monthly cost for these essential vitamins will be around $30-50, depending on the brand.
- Always choose a bariatric multivitamin that's approved by Southern Surgical to ensure you're getting the right nutrition.
Mindful Eating
Eating slowly and mindfully can help prevent overeating and discomfort.
- Once you start adding foods, take your time eating.
- Allow at least 20 minutes for meals.
- Have liquids between meals, not with meals.
- Don’t drink anything from 30 minutes before a meal until 30 minutes afterward.
Foods to Avoid
- Avoid high calorie drinks such as milkshakes, regular soda, beer and other alcoholic beverages.
- People who had a gastric bypass can sometimes be more sensitive to high-fat and high-sugar foods. This is called “dumping syndrome”.
- To avoid dumping syndrome, take at least 30 minutes to eat your meals and 30 to 60 minutes to drink 1 cup of liquid.
Addressing Potential Challenges
Tolerance to Foods
Tolerance to foods after surgery varies from one individual to the next.
- Once you are back on a more regular diet, through trial and error you may find you are able to tolerate some foods better than others.
- Many things may cause discomfort and vomiting. Sometimes the source may be a specific food.
- Do not avoid a food just because you vomit once after eating it. You may wish to wait a few days, but you should try that food again.
- Tolerance to foods may improve with time.
- Try new foods one at a time.
Dumping Syndrome
Dumping syndrome is a feeling of fullness and cramping which can lead to diarrhea, lightheadedness, headache, shaking, sweating, hunger, and fatigue. This may occur after eating high-sugar and/or high-fat foods or drinking while eating.
Blocked Opening
Food can become lodged at the opening of your stomach pouch, even if you carefully follow the diet. Symptoms of a blocked stomach opening include ongoing nausea, vomiting and abdominal pain.
Read also: Is Bariatric Surgery Right for You?
Additional Lifestyle Considerations
Exercise
Walking frequently, starting within just a few hours after surgery, can help patients recover faster.
- Each patient will be different and should check with their surgeon before they start intense exercise, but once this is started, it should be done with the goal on average to 30 minutes per day of moderate exercising.
- After weight loss surgery, patients often feel they have more energy and may want to exercise.
Medication Adjustments
After surgery, patient will often be able to be taken off certain medications or their dosages will be decreased.
- These decisions will be made with the patient’s primary doctor and their surgeon.
- Some patients will need different forms of medications if they are taking extended-release drugs, and some will need adjustments in dosages very early after surgery.
- Changes such as liquid or chewable medications may be needed, and these should be done under the direction of a doctor or pharmacist.
Smoking and Alcohol
Patients who have chosen to undergo a major surgical procedure to make themselves healthier need to quit smoking for the rest of their life.
- Most bariatric surgery programs will require patients to stop all nicotine products before surgery. This is because tobacco use can cause multiple problems besides just lung cancer.
- Alcohol use after bariatric surgery can have serious consequences. Alcohol is absorbed more quickly into the blood stream after surgery, and bariatric surgery patients will have higher levels of alcohol in their system for a longer period of time after drinking compared to before surgery.
Pregnancy
Female patient should have a birth control plan before surgery and avoid pregnancy for 12 to 18 months after surgery.
- In order to reach their lowest possible weight and ensure that they have adequate nutrition should they want to become pregnant.
- In addition, bariatric surgery patients who had problems getting pregnant before can find that they have a much easier time after surgery.
Follow-Up Care
Early after surgery, patients will follow up every few months for the first year. They should have yearly visits with a bariatric specialist for life.
- These are important visits, since obesity is a chronic disease, and can continue or even return after surgery.
The Role of Pre-Operative Weight Loss
Patients with severe obesity often display micronutrient deficiencies when compared to normal weight controls. Therefore, nutritional status should be checked in every patient and correction of deficiencies attempted before surgery.
- Assessment and correction of the nutritional status before the procedure in BS candidates is considered important for the prevention of post-bariatric MDs.
- During the last few years, several studies demonstrated that patients with severe obesity often display micronutrient deficiencies (MDs) when compared to normal weight controls.
At present, evidences from randomized and retrospective studies do not support the hypothesis that pre-operative weight loss could improve weight loss after BS surgery, and the insurance-mandated policy of a preoperative weight loss as a pre-requisite for admission to surgery is not supported by medical evidence.
- On the contrary, some studies suggest that a modest weight loss of 5-10% in the immediate preoperative period could facilitate surgery and reduce the risk of complications.
Very low calories diet (VLCD) and very low calories ketogenic diets (VLCKD) are the most frequently used methods for the induction of a pre-operative weight loss today.
- Preoperative weight loss by means of a VLCD has been reported to reduce liver size and intra-abdominal fat mass, blood loss, short-term complications as well as operation time and length of hospital stay.