Nutrition Guidelines for weight loss surgery
Safe effective weight control following surgery requires the close adherence to the Weight Loss Surgery team plan. You will need to follow specific nutrition guidelines as a part of the plan. The following information provides an overview of the diet and nutrition instructions you will be receiving from our dietitian.
Goals of Medical Nutrition Therapy for the Bariatric Surgery Patient
- To promote safe and successful weight loss
- To maintain good nutrition with reduced food intake
- To progress diet in a way to prevent discomfort, intolerances, and complications
- To teach lifetime behaviors that aid in achieving and maintaining a desirable and healthy body weight.
There will be many changes in your food intake after surgery. The changes will occur in:
- How much you eat
- What you eat
- When you eat
- Why you eat
How much you eat
After your surgery, your stomach will hold no more than 1-2 ounces of food at a time. It used to hold 40 ounces! Therefore, you will need to decrease your portions to 1 ounce or 2 tbsp (the size of a medicine cup) You will need to use measuring cups, baby spoons, and a smaller plate to maintain correct portion sizes. Your meals will progress from 2 ounces to 4-5 ounces maximum.
What you eat
In order to get the right nutrients after surgery, it will be important to understand what the different nutrients are in our body. The main nutrients are carbohydrate, protein, and fat. Water intake is also a critical factor and will be discussed.
Carbohydrates
Carbohydrates are the major energy source for the body, and are needed for the body to be able to use all the food and vitamins eaten. When you eat carbohydrate-containing foods, the body turns them into fuel for energy. Examples: Starches (bread, cereal, rice, pasta) and Sugars (fruit, milk, table sugar, candy)
Proteins
• Provides the body with the building blocks needed for rebuilding new cells and tissues.
• Provides for the transport of nutrients, oxygen and waste throughout the body.
• Provides the structure and contracting capability of muscles. They are important for the structures of the tissues of the skin, hair and nails.
Examples of protein include: meat, cheese, eggs, soy, dried beans and peas, yogurt
Fats
Fats are used for many body functions including protection of internal organs, hormone balance, and long-lasting energy. Fats are the most concentrated source of calories in the diet, so it doesn’t take much of a high fat food to add a lot of calories. Examples: oils, margarine, butter, sauces, “marbling” on meats.
Vitamins and minerals in the form of chewable tablets or liquid.
The easiest way to do this is with a children’s type chewable vitamin/mineral supplement (Such a FlintstonesTM Complete). It is important that the vitamin contains additional iron. Take one tablet in the morning and one in the evening with food or protein supplement. Other formulations of multivitamin supplements are available, as well. Any other nutrient that may need to be supplemented will be determined by your surgeon.
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When you Eat
Eat three meals a day, no snacks
It will be important to think about the timing of your meals. You must make a commitment to eat three regular meals a day, with no snacking in between meals. For the first month after surgery, you will use your protein supplement between meals, but after the first month you should use the time between meals to sip your fluids.
Eat slowly and chew, chew, chew
20-30 minutes should be planned for each meal. Set a timer at first to pace yourself and help you pay attention to your food. You will need to learn to savor each bite by becoming aware of flavor, texture, and consistency of each food type.
Stop eating when you first feel uncomfortable
An indication of fullness may be present in the center of your rib cage, as nausea or a dull pain in your shoulder or upper chest. By eating past fullness you may vomit the food that does not fit. Over time this will stretch your stomach pouch, inflame the opening, cause band slippage and decrease your ability to lose weight.
Why you Eat
Work to develop new coping strategies
After surgery, you should no longer use food as a coping mechanism to deal with stress, boredom, depression, or for comfort. Using food in this way, or emotional eating, can decrease your ability to lose weight and you may even gain weight.
Work to disconnect diet from lifestyle
Do you eat to live or live to eat? Work toward using food as a fuel for your body rather than a complete source of enjoyment and entertainment.
“Live in the Future”
Diet and Lifestyle Preparation for Weight Loss Surgery
Making changes in your diet and lifestyles are important for success after surgery. Use the checklist below to make sure you have addressed the following items, ideally 2-3 months before surgery.
Changes in the Diet
- Add more low fat protein to your diet (lean meats, poultry, low-fat cheese, egg/egg substitute, etc.) daily
- Remove sugars (candy, cake, sweets, soda) refined carbohydrates (white breads and flour, white rice) and high fat foods (fast food, fried foods, chips, ice cream) from your diet
- Add green vegetables and fresh fruit to all meals daily
- Remove caffeine (regular and diet soda, regular coffee, regular tea) from your diet
- Stay away from alcoholic beverages (beer, wine, distilled liquors)
- Start trying protein shakes that meet the requirements of the program and when you find one (or more) that you like, begin replacing at least 1 meal a day with the protein shake mixed with water or skim milk.
- Increase water intake to 6-8 cups/day
Changes in Behavior
- Chew all food to the consistency of baby food before swallowing – allow about 20-30 minutes per meal
- Sip liquids instead of gulping- stop drinking liquids before meals and wait 20 minutes to begin drinking again
- Use smaller plates and utensils
- Develop consistent eating times and places
- Work on ways to take care of your emotions without using food
- Keep a food journal to help record your intake and identify patterns
Items to have on hand before surgery
- Protein supplement
- Vitamin and mineral supplements
- Timer
- Blender/food processor/strainer
- Measuring cup/spoons/medicine cup
- Baby spoons
- Meal planner/ food diary
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Exercise Guidelines for Weight Loss Surgery
Activities and Exercise - The Role of Physical Therapy
Physical activity and exercise are essential elements of your weight management plan, in order to achieve and maintain your weight loss goals.
Activity and exercise should start before weight loss surgery to begin improving your overall mobility, flexibility, muscle strength, and endurance,
in addition to establishing a routine to follow after the procedure. Activity and exercise, if started early and resumed right after your surgery, will help you feel better,
recover faster, and minimize the likelihood of post-surgical complications.
Physical Therapy Goals
- Evaluate and design a structured activity and exercise program for you to follow
- Provide educational resources to increase your overall knowledge of the beneficial effects of activity/exercise
- Encourage your increased participation, on a daily basis, with a regular activity and exercise program. Patients should work on increasing activity level to at least 30 minutes of continuous exercise daily
- Support you along your journey to discover a thinner, healthier, more physically fit you
First Contact with Physical Therapy
- Questions will be asked about your past and current activity level
- Endurance for ADLs (activities of daily living)/ work activities
- Assess mobility, Flexibility, ROM (range of motion), strength
- Monitor pulse and teach you to monitor
- Instruct you on an exercise program to begin prior and continue after surgery
Follow Up with Physical Therapy
- 6 weeks, 10-12 weeks, and 6 months after surgery
- Re-evaluate your exercise program and adjust accordingly
- Answer questions you may have about exercise or your recovery
Your Responsibility
- Participate in creating a follow up exercise program
- Choose the type of aerobic exercise (walk, bike, swim) you want to participate in
- Prioritize activity and exercise time into schedule
- Keep a journal or log of exercise and bring it with you to follow up appointments
- Wear comfortable shoes and clothing to each physical therapy visit
Why Should I Exercise?
- Decreases your blood glucose level
- Improves your muscle tone, strength, flexibility, and endurance
- Decreases your blood pressure, resting heart rate, and breathing rate
- Improves your cholesterol values by raising the level of HDL, also known as “good cholesterol”, and lowering the level of LDL, also known as “bad cholesterol”
- Reduces your stress and positively affects your mood
- Improves your posture and balance, potentially reducing pain and other injuries
- Decreases or prevents potential problems that may occur after surgery
Rules for Exercising
- Wear or carry identification indicating any medical condition that you my have. Such as, medic alert bracelet for diabetes
- Establish a daily time for exercising
- Always warm up, cool down, and stretch after exercises
- Begin slowly and build gradually
- Wear proper footwear and comfortable clothing
- Avoid exercising outside in extreme weather conditions
- Avoid holding your breath while you exercise
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Shoe Buying Tips
- Try on shoes in the afternoon because feet tend to swell as the day goes on
- Choose shoes that are made of leather and/or nylon mesh because they allow air to reach your feet
- Look for a comfortable, padded heel collar, a built in arch and a firm heel cup to provide support for your entire foot and leg
- Check that the ball of your foot matches up with the widest part of the shoes
- Be aware that a shoe does not fit if it has to be “broken-in”
What is Aerobic Exercise?
Aerobic exercise is something you do with enough effort to raise your heart and breathing rates. Bicycling, rowing, cross country skiing, swimming, and walking are all examples of activities that you could choose to perform as a method of aerobic exercise for your program
Initially, walking will be emphasized. Swimming is also an excellent form of exercise as are other aquatic activities such as water aerobics. As weight comes down and muscles become toned, more exercise becomes available in sports, games, aerobics, etc. Patients find their ability to participate in athletic activities with family and friends greatly enhanced. Physical activity becomes more pleasant.
Daily exercise is recommended and we encourage different types of exercise to reduce the risk of overuse, injuries, and boredom. Remember, this is a participatory program. The benefits of exercise cannot be stored. They are quickly lost once regular exercise has ceased. It is important, therefore, to emphasize lifelong exercise habits, not short-term fitness fads.
To Find Your Pulse
Begin by using your first two fingers (not your thumb) and press lightly just below your jaw bone on your neck.
You should be able to feel something pulsating. If you cannot find it, try again- it does take some practice.
Another place you can find your pulse is at your wrist. Take the first two fingers of one hand; hold your other hand palm up and follow your thumb down to your wrist with your two fingers.
Your pulse should be on your wrist, just beneath your thumb. If after some practice, you still cannot grasp the concept, ask your surgical team.
Once you have found your pulse, you are to count the number of times you feel it beat or pulsate in fifteen seconds and multiply it by four.
This will give you the approximate number of times your heart is beating per minutes, otherwise known as your pulse.
Example Aerobic Exercise Prescription
A good aerobic program includes a plan to exercise 6 times a week, with enough effort to raise and maintain your heart rate at a level of intensity (known as a training zone or target heart rate zone) that will improve your endurance. Most experts agree that the training zone is between 60-80% of your heart rate maximum, which is determined by your age. Ultimately, the exercise intensity must be maintained for at least 20-30 minutes to achieve aerobic benefit. Once you and your therapist have determined the method of aerobic exercise that you will be participating in, a discussion of your intensity, duration and frequency will occur.
Intensity
Estimated maximum heart rate is equal to 220 minus your age. (Example: a 20 year old person would have an estimated maximum heart rate of 200 beats per minutes)
- Lowest Level of workout benefit:
0.6 x (estimated maximum heart rate) = beats per minutes
- Moderate Level of workout benefit
0.7 x (estimated maximum heart rate) = beats per minutes
- Higher Level of workout benefit
0.8 x (estimated maximum heart rate) = beats per minutes
Frequency
Your beginning frequency will vary with your tolerance; you may start slowly, exercising 1-2 times a day, 4-5 days each week and as your duration increases your frequency should decrease to once a day.
Duration
Your goal is to exercise for at least 30-45 minutes a day. You may begin with 5-10 minutes a day and gradually (30-60 seconds) increase your time until at least 30-45 minutes is achieved.
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