The DIETITIAN’s Role in the Care of the Bariatric Surgery Patient

MOVE TIME/Bariatric Clinic Dietitians

• Our dietitians are experts at motivational learning around eating styles and habits.

• They collaborate with the Veterans to optimize nutrition and food choices.

• Ensure healthy, nutrient-rich foods with individualized programs based on each Veteran’s specific circumstances and support structure.

• Help support patients in changing their relationship with food and eating.

Why See a Dietitian?

• A healthy diet, sound food choices, and good eating habits are fundamental to a successful weight loss program.

• The dietitian will assist you with these components throughout your process before and after weight-loss surgery.

• Dietitians help assess, monitor and counsel patients before and after surgery to improve adherence to recommendations, maximize weight loss, and increase motivation.

Diet after Bariatric Surgery

• Dietitian works with the Veteran to help ensure that:

• Fluid requirements are met – avoid dehydration

• Protein requirements are met

• New eating habits are established and maintained

• Micronutrient deficiencies are avoided

• THEY PROMOTE SAFE AND STEADY WEIGHT LOSS

Typical Diet after Bariatric Surgery

STEP 1 (Post operative day #1 and #2) • One ounce of water every hour

– If nausea occurs, then wait 1 hour and try again

• If feeling of fullness occurs, maintain this step for 24 hours

• If tolerating this step (e.g. no nausea, no feeling of fullness) proceed to nutritional supplements

STEP 1 (Post operative day #1 and #2)

• Nutritional Supplements

–3 “meals” a day consisting of a nutritional supplement drink, 2 ounces at a time

–4 oz. of high-protein gelatin (Jello) split into “snacks” between meals

– This small amount will satisfy you and leave you feeling full!

Typical Diet after Bariatric Surgery

Typical Diet after Bariatric Surgery

STEP 2 (Postoperative week 1-2) Avoid dehydration: • Drink at least 32 oz. of fluids per day

– Calorie-free, non-carbonated liquids • Water Crystal light • Tea Sugar-free Jell-O • Broth Sugar-free Popsicles

• No Gatorade, fruit juice or sugar-sweetened drinks

Typical Diet after Bariatric Surgery

STEP 2 (Postoperative week 1-2) “Meals”/Calories: • You will have 4-5 “meals” a day consisting of a nutritional supplement drink, 2-3 ounces at a time

– Ensure High Protein – Boost High Protein – Boost Glucose Control – Muscle Milk or Premier Protein

• If you still feel hungry, try adding 1 tablespoon of fat-free milk powder per 2 oz of liquid

• Take a chewable Multivitamin daily!

Typical Diet after Bariatric Surgery

STEP 3 (Postoperative weeks 2 – 6): • Transitioning to Food

– Increase fluids to greater than 60 ounces per day – Eat high protein foods: goal of > 60 grams protein/day – Protein is important! We want you to lose weight in fat,

not muscle

• Soft high-protein foods are well-tolerated – Eggs or Egg substitutes – Lowfat Cheese or Cottage Cheese – Non-fat, Sugar-free Yogurt – Fish - poached, baked, or boiled – Chicken – grilled, baked

• Avoid for now: fruits/vegetables, breads, grains, starches – They fill you up quickly and you will have no room for protein!

High Protein Soft Foods - Examples

Food Type Grams of Protein • 1 jar baby food meat (plain) 13 grams • ½ cup nonfat cottage cheese 13 grams • 1 envelope sugar-free Instant Breakfast made with 1 cup nonfat milk 12 grams • ½ cup egg substitute (cooked) 10 grams • 1 serving (5 oz) tofu 10 grams • 1 cup sugar-free pudding with nonfat milk 10 grams • 1 cup light nonfat, no sugar yogurt 8-9 grams • 1 cup nonfat milk 8 grams • 1 cup vanilla soymilk (Calcium Fortified) 6 grams • 2 Tablespoons reduced-fat peanut butter 8 grams • 1 can Glucerna (canned supplement) 10 grams

Typical Diet after Bariatric Surgery

Step 4 (After 6-8 weeks):

• Transition to a Balanced Diet

• Drink more than 60 ounces of water per day

• Continue to eat high-protein foods: goal of > 60 grams protein/day

• Introduce other Foods – Meat, Pork – Vegetables (soft steamed will be easier at first) – Soft fruits – Nuts – Grains

Nutrition Helpful Hints

• Drink fluids between meals, instead of with meals

• Wait about 30 minutes before and after a meal

before drinking fluids • When choosing meats, select lean chicken, turkey, fish, or tender cuts of red meat

• Do not add sugar to any of your foods or beverages

• Do not drink carbonated beverages

Bariatric Surgery Nutrition Basics

• Stay hydrated

• Eat slowly and chew food thoroughly

• Listen to your body! Stop drinking and eating if

you feel full or uncomfortable

• Monitor portion sizes

• READ FOOD LABELS! Avoid foods or liquids with added sugar or fat

• Take nutritional supplements as advised - Set up a schedule for taking your supplements and medications

Dietitian/Nutrition at the Palo Alto VA

• We look forward to meeting you!