Dietetic Support for Bariatric Surgery

Maureen Boyle

Senior Specialist Dietitian

April 2015

Before Bariatric SurgeryNeed to show commitment by losing weight prior to

surgeryPatients need an understanding of the basics of

healthy eatingAttendance 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

Tier 3 for SurgeryMinimum 6 months from seminar to surgeryMedical assessment – maximise treatment of

medical problems Diabetes/Hypertension/Sleep Apnoea

Psychological assessment if requiredIntensive dietetic intervention – to improve

knowledge and help achieve weight loss target3 x 2 hour sessions at various times and locations.

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

Pre op Diet10 days prior to the gastric bypass, band or

gastricsleeve a pre op - liver reducing diet is required

Milk yoghurt and fruit

Non milk calorie controlled

Diabetic on insulin

Pre op DietDaily 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

 

Gastric BypassFirst 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.

General adviceIn 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.

General adviceGradually 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.

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 monthLoading dose not required

Important pointsConstipation

Not unusual after bypassEnsure adequate fluids

Lack of appetite.Emphasise the need to eat regular mealsEnsure the diet contains adequate protein. The use of

protein powders/supplements is not recommended.

Important pointsAlcohol

No alcohol for at least 3 months following surgeryIt is absorbed quickly and you can become drunk

quicker

Hair loss/thinningCheck weight lossReassess diet for protein and vitamin intakeReassure

Dumping SyndromePatients 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.

Sleeve GastrectomyFollowing 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 dailyIt does not cause dumping syndrome

therefore it will allow patients to eat high sugar foods and the weight loss will then be disappointing

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.

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.

WarningSome 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.

Gastric BalloonTo assist portion controlTo retrain eating habits

Regular mealsSmall plateHealthy eating adviceEating slowlyChew food wellAdequate fluidsExercise as able

Follow UpBalloon

Diet led clinic review

One month and as required for the 6 months

Band6 week initial inflation

monthly until band correctly adjusted

support for 2 years

consultant at 6months and 12 months

problem bands

Follow Up Bypass and sleevesConsultant review at for first and last appointment Dietetic review at those appointments and diet led clinics between

Assess weight lossAssess dietary intakeAssess nutritional intakeAnswer questionsSupport and encouragement

Discharge from ward

6-8 week reviewConsultant clinic with dietetic

support 6 month review in dietetic clinic

Routine bloodsContinue consultant clinic and transfer to diet led clinic when

appropriate

12 month review in dietetic clinic

Routine bloods

Provided with contact number for Specialist Nurses

and Dietitians

Consultant clinic if concerns

Specialist Nurse Urgent review

clinic to assess if required

Bloods at 6 months and

annual

1 week Specialist Nursetelephone review

18 month review in diet led clinic

2 year review in consultant clinic.Annual bloods.Discharge to postal review

Any questions?