Many people who embark on weight loss surgery have come into contact with at least one dietitian in the past and let’s face it, we aren’t on the top of anyone’s Christmas card list! So when your weight loss surgeon suggests you see yet another dietitian, you shudder...
What Are the Bariatric Diet Stages?
If you’ve thought about surgery, you may have wondered what the bariatric diet stages are that you must adhere to. You may also want to know why it’s important to progress with reintroducing foods after surgery. And even wonder, “is this staged differently depending on the procedure I opt for?” These questions are natural and common questions for a prospective patient to ask, and we try to answer these as best we can in the information below.
Firstly, let us preface this information by telling you that every patient is different. What’s right for one person may be very different for someone else. But it can be reassuring to know what to expect in a general sense. With that in mind, here’s a general overview of the different bariatric diet stages, and why these might be important for you to adhere to after weight loss surgery. If you have actually had surgery, the best protocol is the one given by your surgeon or dietitian who actually knows you and your unique needs.
Does the protocol differ depending on your procedure?
In general, no. We use the same 2/2/2 rule for all procedures. That is 2 weeks liquids, then 2 weeks puree, then 2 weeks soft, before transitioning to “normal” food. The bariatric diet stages may differ in timing depending on how you tolerate them. We make the 2 weeks liquid mandatory but there is some leeway with the puree and soft phases. Either way it will be six weeks before you start on normal food, albeit in very, very reduced quantities. We don’t typically see much difference in the way patients, post sleeve versus post bypass, tolerate the diet.
Why should I see a dietitian after weight loss surgery?
After the surgery, you will be undergoing a complete change in the way you eat, and how you approach it. What doesn’t differ, is your need for optimal nutrition and hydration. A dietitian is best equipped to help you navigate nutrition and hydration to ensure you are meeting all of your needs. A bariatric dietitian will also be invaluable in providing tips and tricks to thrive on a weight loss surgery diet at every stage. We recommend a protein based diet, along with some healthy fats, and minimal carbohydrates, especially the Roux-en-Y where carbs can lead to dumping syndrome.
What are the bariatric diet stages I should follow after surgery?
There are 4 phases to post-surgery diet and there is also a pre-surgery protocol which you need to follow. This timing is very important for your health and safety and is evidence-based. For post-surgery care, we need to ensure that the normal swelling and oedema you would expect after surgery has subsided. Your stomach needs to be healed before reintroducing solid foods. You may feel well, but adhering to your surgeon’s recommendations will reduce the likelihood of complications.
We may ask you to follow a very low-calorie diet (VLCD) for about 1-4 weeks before you are due to have surgery. This varies depending on your BMI. This is to help reduce the size of your liver and help make it more pliable by reducing the amount of fat in it (fatty liver/ hepatosteatosis/ steatohepatitis). This ensures a safer operation. Generally, your preoperative diet will consist of a protein shake/ soup meal replacement such as Formulite or similar liquid diet. We recommend Formulite as weight per volume it has up to 50% more protein and 50% less sugars than other replacement meal shakes and soups. Protein keeps your hunger at bay for longer. The reduced sugar contents helps wean off sugary foods. It also has fibre and macrobiotics essential for gut health. Meal replacement shakes are NOT meant to be fun!! They are NOT the same as a milkshake. They should be palatable, sure, but primarily they are to provide adequate calories and micronutrients for the preoperative weight loss phase of your journey. Most people tolerate Formulite. If not you can talk with our dietitians about a suitable alternative.
Stage 1 bariatric diet post-surgery: liquids
Right after surgery, we need to go very slowly. You will need to sip, sip, sip. Liquids such as plain water, protein water, protein shakes (including those from VLCD phase), clear broths and soups, decaf tea or coffee, sugar-free jelly or flavoured water. The length of this stage is 14 days. You will find each day you can drink just that little bit more as the swelling settles. You need to get AT LEAST 1000 mL each day to avoid dehydration. Sip, sip, sip is the way. Usually around the second post op week you can start on your multivitamin, which you will take indefinitely. If you’re struggling to meet fluid and/or protein requirements contact your surgeon or dietitian.
Stage 2: purees
Stage 3 is the purees stage. and can be likened to the way we introduce food to babies. This is food pureed to a smooth consistency, with a view to providing a gentle introduction back to solid food. Your dietitian will provide recommendations here. Stage 3 is generally 1-2 weeks after stage 1 is completed.
Stage 3: soft foods
Just as with babies, stage 3 is about incorporating more solid (but still soft) foods and an overall protein-based, moderate healthy fats, low card diet. Your dietitian will guide you in eating small meals consisting of protein and vegetables at this stage. This diet will progress to stage 4 depending on your tolerance. generally 3-4 weeks after stage 2. It continues till around week 6 post op.
Stage 4: bariatric diet for life
Over time, you will find your tolerance for solid foods will grow, as will the amount you can eat at each meal. Your goals are to eat for optimal nutrition and of course, enjoyment. For most patients, you will feel full after very small meals. But you will still ENJOY them. The metabolic/ neurohumoral aspect of the surgery tricks your brain- you will feel full, satisfied and content after just a small amount of food. Interestingly your tastes may change. Every patient is different. Some say their tastes gravitate towards healthier options, and foods which are lower in sugar and fat.
As a weight loss surgery patient, you will need to monitor your diet and nutrient levels for life. But it will definitely get easier over time. We recommend seeing your dietitian regularly, especially in the first 12 months. This will help cement the important lifestyle changes you need for lasting weight loss, while the metabolic effects of surgery are in motion. You should also follow-up with your surgeon who will monitor your nutrition and overall wellbeing.
You should check in with your team (surgeon, bariatric G.P, dietitian, psychologist, exercise physio) whenever you feel that you’re steering off course. This happens to the best of us, and your team will quickly help get you back on track. This can be any time in the years after your surgery.
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You can chat to a weight loss surgeon in the strictest confidence about the risks and benefits of each procedure as well as check whether you qualify for surgery. Arming yourself with the right information will help you to make an informed decision that’s the right one for you. Find out where you can book in for a no-obligation consultation.
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