Step 10: Post-surgical lifestyle changes

Undergoing bariatric surgery is a major life-changing experience. You'll have a whole new set of lifestyle rules for maintaining your weight loss and health goals. In the years leading up to the surgery, you may have struggled with the physical, medical, emotional, social, and professional ramifications of obesity. Bariatric surgery may signify the beginning of your healing process in these areas.

Some people who undergo bariatric surgery find that it's helpful to attend therapy sessions with a counselor. Talking to a professional about your previous struggles with obesity and your current struggles with your new post-surgery lifestyle can help you understand more about yourself, and help you stay focused on your goals.

You may also find that being involved in support groups with other people who have experienced similar struggles can be extremely helpful. Support groups can help you stay motivated.

Carefully following the prescribed diet after surgery is essential both to protect your body and to ensure weight loss.

Typically, for the first 1 - 3 days after surgery the diet will consist only of clear liquids (water, broth, high protein fruit drinks, or other clear liquids). After this initial period, the diet will include pureed or blended foods (yogurt, pudding, cream soup, liquid supplements). After a week or so, you will be able to gradually begin adding soft foods to your diet -- about 1 ounce of a new soft food every 2 or 3 days:

• After 1 week: scrambled eggs, cottage cheese, low-fat refried beans, mashed potatoes, hot cereal
• After 3 weeks: tuna salad, ground turkey, baked fish, canned vegetables, bananas, seedless watermelon or cantaloupe

By a month after surgery, some normal foods can become a regular part of the diet, although limiting food selections may become permanent. You might need, for example, to avoid steaks and chops, apple skins, citrus fruit membranes, incompletely chewed raw or fibrous vegetables, and fresh bread (because of the tendency to form a solid "bread ball" in the stomach pouch -- toasting may prevent this problem).

Although each person is different, and there are different recommendations depending on the specific type of weight loss surgery you have, some of the basic recommendations include:

• You will need to adjust portion size. In general, a small stomach pouch will hold only about 2 ounces of food at a sitting.
• Food choices will need to be blended, soft, or easily chewed. Limit foods that are dry (turkey, roast beef), sticky (peanut butter), gummy (fresh bread), or stringy (fibrous fruits or vegetables).
• Eat a balanced diet that is low in fat, high in protein. Protein is important for healing directly after surgery, and it's also important during weight loss in order to help you preserve muscle mass. About 60 g of protein is recommended daily.
• Avoid foods that contain sugar, especially if you've had gastric bypass surgery. Eating foods that have concentrated amounts of sugar may cause an uncomfortable reaction called dumping syndrome (sweating, low blood pressure, dizziness, abdominal cramping).
• Don't drink fluids just before or with your meals. Drink well before or at least 30 minutes afterwards.
• Eat slowly (at least 20 minutes per meal), and chew your food very thoroughly.

References

Stumbo P, Hemingway D, Haynes WG. Dietary and medical therapy of obesity. Surgical Clinics of North America . 2005;85(4):703-723.

Marcason W. What are the dietary guidelines following bariatric surgery? J Am Dietet Assoc. 2004;104:487–488.

Stocker DJ. Management of the bariatric surgery patient. Endocrinol Metab Clin N Am . 2003;32 :437–457.

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