1. Dietetic Support for Bariatric Surgery
Maureen Boyle
Senior Specialist Dietitian
April 2015

2. Before Bariatric Surgery
Need to show commitment by losing weight prior to surgery
Patients need an understanding of the basics of healthy eating
Attendance at an NHS weight management group would be useful. Now will be expected to attend Tier 3 weight management programme
Need realistic expectations and realise it is a life long commitment to change in eating habits
Aware of the psychological effects following surgery

3. Tier 3 for Surgery Minimum 6 months from seminar to surgery
Medical assessment – maximise treatment of medical problems Diabetes/Hypertension/Sleep Apnoea
Psychological assessment if required
Intensive dietetic intervention – to improve knowledge and help achieve weight loss target
3 x 2 hour sessions at various times and locations.

4. Role of the Bariatric Dietitian
Bariatric seminar
Initial assessment
Attendance at MDT
10 day pre op diet
Post op Dietary advice
Post op review
Ongoing monitoring

5. Pre op Diet 10 days prior to the gastric bypass, band or gastric
sleeve a pre op - liver reducing diet is required
Milk yoghurt and fruit
Non milk calorie controlled
Diabetic on insulin

6. Pre op Diet 2-3 pints of skimmed or semi skimmed milk
Daily allowance
2-3 pints of skimmed or semi skimmed milk
2 diet yoghurts – any flavour
3- 4 portions of fruit (any variety)
Sugar free Jelly (optional)
 Water, tea and coffee can be taken freely- sweeteners are allowed.
Low calorie drinks or squashes are allowed freely.
One bowl of vegetable soup
No other foods should be eaten
Alcohol is not allowed

7. Gastric Bypass
First day following surgery we suggest a 1 litre water taken as sips over the day.
The following day pureed diet is commenced. We suggest about 1-2 tablespoons at each meal.
The pureed diet must be followed for a minimum of 4 weeks
Fluids are encouraged but not with meals.

8. General advice
In the early stages we encourage 4-6 very small meals a day.
A high protein diet is recommended to aid the healing process after surgery.
Vary the intake as much as possible
Aim for 2-2½ litres of fluid a day. No fizzy drinks
and carry a water bottle around to top up fluids.

9. General advice Gradually increase the consistency of food.
Encourage to eat slowly and chew food well
By 2 – 3 months most foods should be tolerated
At this point establish an eating pattern of regular meals.

10. Vitamin requirements
A Multi vitamin A-Z should be started on discharge.
Ferrous Fumarate one tablet once a day.
Adcal D3 one tablet twice a day
B12 injection once every 3 month
Loading dose not required

11. Important points Constipation Lack of appetite.
Not unusual after bypass
Ensure adequate fluids
Lack of appetite.
Emphasise the need to eat regular meals
Ensure the diet contains adequate protein. The use of protein powders/supplements is not recommended.

12. Important points Alcohol Hair loss/thinning
No alcohol for at least 3 months following surgery
It is absorbed quickly and you can become drunk quicker
Hair loss/thinning
Check weight loss
Reassess diet for protein and vitamin intake
Reassure

13. Dumping Syndrome
Patients feel sick, dizzy or generally unwell either just after or within a couple of hours of eating food.
It happens when sugars are quickly absorbed.
It indicates patients are being less vigilant with the choice of food.
It cannot be treated and is best avoided.

14. Sleeve Gastrectomy
Following a gastric sleeve it is important to follow a pureed diet for 4 weeks.
Other food textures are gradually introduced.
It is important to eat regular healthy meals.
We recommend a multi vitamin A-Z daily
It does not cause dumping syndrome therefore it will allow patients to eat high sugar foods and the weight loss will then be disappointing

15. Rules of a Band
Eat three meals a day – it is important to have small meals.
Eat good quality solid food – because you can only eat small meals the food must be healthy.
The food must be solid, liquids run through the band and you will not feel full.

16. Rules of a Band
Do not eat between meals. Snacking is the major cause of failure to lose weight after surgery. Keep to meal times only.
Do not drink with your meals. You must stop drinking for a minimum of 15 minutes before
and 30 minutes after a meal.
Liquids speed up the process of food going through the band and it is less effective.

17. Warning
Some foods are not affected by the band such as crisps, chocolate, sweets and mints. Alcohol, milk shakes and ice cream will also slip through the band.
If patients continue to eat these foods weight loss will be disappointing.

18. Gastric Balloon To assist portion control To retrain eating habits
Regular meals
Small plate
Healthy eating advice
Eating slowly
Chew food well
Adequate fluids
Exercise as able

19. Follow Up Balloon Diet led clinic review Band 6 week initial inflation
One month and as required for the 6 months
Band
6 week initial inflation
monthly until band correctly adjusted
support for 2 years
consultant at 6months and 12 months
problem bands

20. Follow Up Bypass and sleeves
Consultant review at for first and last appointment
Dietetic review at those appointments and diet led clinics between
Assess weight loss
Assess dietary intake
Assess nutritional intake
Answer questions
Support and encouragement

21. 2 year review in consultant clinic. Annual bloods.
Provided with contact number for Specialist Nurses and Dietitians
Discharge from ward
1 week Specialist Nurse
telephone review
Specialist Nurse Urgent review clinic to assess if required
6-8 week review
Consultant clinic with dietetic support
6 month review in dietetic clinic Routine bloods
Continue consultant clinic and transfer to diet led clinic when appropriate
12 month review in dietetic clinic Routine bloods
18 month review in diet led clinic
Consultant clinic if concerns
Bloods at 6 months and annual
2 year review in consultant clinic.
Annual bloods.
Discharge to postal review

22. Any questions?