Bariatric surgeries can help people with severe obesity lose weight by restricting the amount of food the stomach can hold, reducing the absorption of nutrients, or both, depending on the type of procedure performed.
Bariatric surgeries can also alter appetite-regulating hormones. After surgery, patients require nutrition management that includes modifications to the content and quality of foods they consume.
A goal of good nutrition
There are several different types of bariatric surgeries. The most common include Roux-en-Y gastric bypass, sleeve gastrectomy, adjustable gastric band and biliopancreatic diversion with a duodenal switch. Post-surgery diet may depend on the type of procedure. However, the goal of the diet after surgery is to promote weight loss and maintain adequate nutritional status at each stage during recovery.
A patient’s diet needs will change with time, so it’s important to work with a registered dietitian during the transition between each recovery stage. The healthcare team will give patients specifics on which foods to eat and which ones to avoid. Patients will also learn how to recognize early signs of satiety. In the beginning, it’s common to overeat and vomit or have stomach discomfort, but most people quickly learn how to control portion sizes to prevent this from happening.
Bariatric surgery patients are at risk for nutritional deficiencies and will likely need to take a multivitamin with a mineral supplement for their lifetime. Additional nutritional supplementation may include calcium, vitamin D, iron and vitamin B12. Routine testing for micronutrient deficiencies is often recommended.
Short-term diet
Diet recommendations vary, but in general, patients will consume clear liquids for the first week or two following surgery. A liquid diet helps to reduce the risk of irritation to the surgical areas of the digestive tract. Progression to regular liquids and possibly pureed foods over the following weeks will be done gradually since the amount of food people can tolerate varies at this stage. After about one month, patients may be able to introduce soft, moist, solid foods into their diets.
Note that people with diabetes will need to monitor their blood glucose levels closely as they progress in their diets. Blood sugar fluctuations can occur due to surgical and dietary changes.
Adequate hydration and protein intake are essential during the early postoperative period. Patients should receive sample meal plans from their surgeon or dietitian to help ensure nutrition needs are being met. In general, patients will need to consume 60–100 grams of protein each day. Some bariatric surgery patients may require more protein depending on their response to surgery or the type of operation performed. Protein is necessary for maintaining muscle mass during weight loss.
The healthcare team will also advise patients when and how much to drink. Dehydration is the most common reason for readmission to the hospital after bariatric surgery. In general, patients should aim to drink 64 ounces or more of water each day.
Long-term diet
As the digestive tract heals, patients will slowly start to tolerate regular solid foods. The details of the long-term diet are individualized depending on the type of bariatric surgery the patient had and his or her ability to adhere to a healthy eating plan. Continuing to work closely with the dietitian is vital during this time. Studies show that people who work with a dietitian have a greater weight loss after surgery than those who do not.
When reintroducing solid foods, a patient may find that some foods are harder to tolerate than others. It’s also common to have aversions to certain foods. Some patients may need to avoid foods that can cause stomach upset, including dry foods, such as nuts and popcorn, and fibrous foods, such as corn and celery.
Several months after surgery, patients tend to tolerate most foods again. However, it’s crucial to adhere to a nutritious diet to maximize weight loss and meet nutritional requirements. The fundamentals of the long-term diet after bariatric surgery are the same as any other healthy diet. Patients should focus on eating fruits, vegetables, whole grains, lean sources of protein and dairy products. They should limit processed foods and foods high in saturated fat, sodium and added sugars. Some patients may be instructed to eat six small meals per day and eliminate snacking, while others may be told to consume three meals each day.
A new approach to eating
Patients will also need to modify how they eat as they heal from bariatric surgery. It’s crucial to eat slowly, taking 20–30 minutes to consume each meal. Patients should chew food completely and stop eating at the first feeling of satiety. Eating too quickly or consuming more food than the stomach can hold can cause vomiting and abdominal pain. Certain foods may be more likely to cause discomfort when not chewed thoroughly, including raw vegetables, pasta, rice, bread and meat.
It’s imperative that patients avoid eating foods and drinking beverages at the same time, waiting at least 30 minutes after meals before drinking any liquids. Fluids can fill up the stomach and prevent people from taking in sufficient nutrients. Liquids can also lubricate foods, which may cause people to eat more at a time than they should.
Patients should know that adjusting to a long-term healthy diet isn’t always easy. They’ll need to learn how to make nutritious food choices, avoid skipping meals and prepare meals regularly. Though a patient’s body has changed, it’s important to note that society has not been altered. This can make it challenging to adhere to new eating habits. The healthcare team can help support patients through both the physical, emotional and behavioral hurdles after surgery.
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Amy Magill, MA, RD, LDN is Manager of Clinical Programs at Walgreens, where you can find omega-3 dietary supplements, including krill oil. Amy enjoys educating others on how to improve their health through diet.
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