1. Next Stop: Surgery! Nutrition Session Kevin Thomas, RD LD Jennifer Del Rio, RD LD S T. V INCENT C HARITY M EDICAL C ENTER

2. HYDRATION NUTRITION GUIDELINES POST-OP STAGES PROTEIN VITAMINS AND MINERALS PERSONAL ACCOUNTABLITY

3. Your goal as soon as you get home!! SIP Non-carbonated, no calorie fluid … at least 64 ounces each day!

5. Too much sugar Too much fat Too much protein Eating too fast Drinking with meals

6. Look for foods with 10 grams or less of sugar per meal Remember: your serving may be smaller than that listed on the nutrition label!!! If a food is a fruit or milk product and it has a lot of sugar, check the source of sugar — Natural sugars ARE FINE — Avoid added sugar or processed sugar

7. INGREDIENTS: CULTURED PASTEURIZED GRADE A NONFAT MILK, WHEY PROTEIN CONCENTRATE, PECTIN, CARRAGEENAN. Plain Yogurt: INGREDIENTS: CULTURED PASTEURIZED GRADE A REDUCED FAT MILK, APPLES, HIGH FRUCTOSE CORN SYRUP, CINNAMON, NUTMEG, NATURAL FLAVORS, AND PECTIN. CONTAINS ACTIVE YOGURT AND L. ACIDOPHILUS CULTURES. Fruit-flavored Yogurt: Brown sugar Corn syrup Dextrose Glucose Syrup Honey Invert sugar Maltose Sucrose Corn sweetener Malt syrup Maple syrup Fruit juice concentrates Molasses Raw sugar Sugar High fructose corn syrup Check the ingredients…

8. Choose high-protein foods - Refer to list in packet Keep track of your protein intakes - Food journal, log, etc. Remember: your serving may be smaller than that listed on the nutrition label!!! For example: if you eat only 1 ounce of lean ground beef, how many grams of protein are you getting???

9. Choose high-protein foods Keep track of your protein intake - Food journal, log, etc. Remember: your serving may be smaller or larger than that listed on the nutrition label!!! Is this a high protein, weight-loss supporting food?

10. Is this a high protein, weight- loss supporting food? The top 4 ingredients make up approximately 95-100% of the food.

11. 10 grams or less!!!

13. Fruit Dairy products -Milk, yogurt, sugar-free pudding, etc. Beans

15. Stage 1: Full liquids Stage 2: Pureed (blenderized) foods Stage 3: Soft foods (moist and mushy) Stage 4: Solid food *Each stage is just 2 weeks, except stage 4 (life-time)

17. Skim milk, 1% milk, plain soy milk High protein drinks (such as Isopure) Low fat cream soups (strained) Vegetable juice Make your own high protein shake!

18. Begins when you arrive home Aim to consume 1 daily protein shake (week 1) Aim to consume 2 daily protein shakes (week 2) Shoot for 64 fluid ounces per day Avoid extreme hot or cold temperatures Stop sipping as soon as you feel full or nauseated

20. You should be at your fluid goal of 64 ounces AND You should at your protein goal of 60-80g

21. STAGE 2 RECOVERY: PUREED FOODS Fat free or 1% cottage or ricotta cheeses Scrambled or poached eggs Baby food (Stage 1 or Stage 2) Pureed fruit/vegetables without seeds Natural applesauce Pureed soups Light yogurts Sugar free pudding Sugar free Jell-o

22. All foods must be baby food consistency Eat 4 ounces (1/2 cup or 8 Tbsp) for Breakfast, Lunch, and Dinner Take 20 minutes to finish a meal No fluid with meals, 15 minutes before, or 1 hr after meals Drink high protein supplements between meals to meet protein/fluid goals

23. STAGE 3 RECOVERY: SOFT FOODS Crockpot meals Over-cooked vegetables Cooked or refried beans (fat free!) Baked or canned fish Soft meats (pureed, marinated, stewed, poached) Low sugar cereal (soggy in milk) Hard-boiled eggs, scrambled, or poached Bananas or pureed fruit

24. All foods must be “moist and mushy” Eat 4 ounces (1/2 cup or 8 Tbsp) for Breakfast, Lunch, and Dinner Take 20 minutes to finish a meal No fluid with meals, 15 minutes before, or 1 hr after meals Take tiny bites and chew well Drink high protein supplements between meals to meet protein/fluid goals

25. TRUE!!!

26. STAGE 4 RECOVERY: SOLID FOODS Add chopped meats as tolerated Beef, chicken, fish, pork, etc. Raw fruits and vegetables as tolerated Softer may be best, especially in the beginning Add new foods slowly (try only 1 new food per day) Protein, veggies, and fruit mainly! Limit complex carbohydrates (bread, rice, pasta, potatoes)

27. SOLID FOOD GUIDELINES Eat 4 ounce (1/2 cup) meals 3 times per day - Aim for 2-3 ounces of protein each meal - Protein is always eaten first Take 20 minutes to finish a meal - Take tiny bites and chew, chew, chew!!! No fluid with meals, 15 minutes before, and 1 hr after meals 10 grams of fat or less and sugar to 10 grams or less Drink high protein supplements between meals to meet protein/fluid goals

28. No more than 30 grams of protein per shake

29. For best weight loss, both SHORT term and LONG term, consume a daily protein shake Protein shakes save your muscles = easier to maintain you weight losses long-term

30. Bypassing main absorption site for some vitamins and minerals (gastric bypass) Reduction of acidity (gastric bypass and sleeve) Not eating as much food Essential for baseline health Must be taken everyday!

31. Must be chewable, liquid, or crushable (dissolvable) Multivitamin (2 per day) Calcium Citrate - Better absorbed than calcium carbonate Iron Vitamin B12 Vitamin D

32. Breakfast: Multivitamin, B12, and Calcium, Vitamin D Lunch: Iron Dinner: Multivitamin and Calcium Bedtime: Calcium

34. Breakfast: 2 Chewable Vitamins Lunch: Dinner: 2 Chewable Vitamins * Must be specific Bariatric Fusion® or Optisource® vitamins 

35. 2 weeks after surgery

37. Go shopping!!!! Buy your vitamins, protein, etc. ahead of time Keep track of your progress after surgery Track all fluids and protein

38. Obesityhelp.com