gastric sleevecmcwls.com/files/full_sleeve_manual_01012017.pdf · that weight loss should be...

Gastric Sleeve

Owner’s Manual

January 2017

Phone: (615) 342-1231

Website: cmcwls.com

1. Drink 64 ounces of zero calorie, non-carbonated fluids daily

2. Consume 60+ grams of protein daily

3. Take my vitamins daily

4. No snacking or grazing

5. Exercise – move more every day

6. Attend support group

7. Keep my follow-up appointments

8. Eliminate liquid calories such as juices, smoothies, coffee drinks

9. Keep a written or online food journal daily

10. Stay in touch with the program via our online groups, Facebook,

Twitter, Instagram, Pinterest, YouTube

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Dear Patient,

Congratulations on your “Decision of a Lifetime”! By deciding to take control of your weight with bariatric surgery and using all of the support services* included at TriStar Centennial Center for Weight Management, you will have the tools you need to help win the battle with the scale.

We have developed this Owner’s Manual to help guide you through this exciting time. Please review this manual at home and bring it with you to the preoperative surgery class, the hospital and all follow up appointments. Your Owner’s Manual covers pre-operative and post-operative care, along with important dietary and lifestyle changes that are necessary to optimize your success after surgery.

We appreciate the opportunity to care for you at TriStar Centennial Medical Center. We look forward to seeing you soon.

Sincerely,

Centennial Center for Weight Management Staff

*Support Services:

Registered Dietitians

Certified Diabetes Educators

Certified Bariatric Nurses

Online support groups

Peer led support groups

Professionally led support groups

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Surgeon’s Contact Information

Douglas Olsen, M.D. 2200 Murphy Avenue Nashville, TN 37203

(615) 342-5840 Fax: (615) 342-5845

Office Staff: Kendra and Gaye

David Dyer, M.D. 2200 Murphy Avenue Nashville, TN 37203

(615) 342-5830 Fax: (615) 342-5835 Office Staff: Holly

Hugh Houston, M.D. 2200 Murphy Avenue Nashville, TN 37203

(615) 342-5820 Fax: (615) 342-5816

Office Staff: Holly, Kristen, Lauren [email protected] [email protected]

mailto:[email protected]

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Center Contact Information

Main Phone Number

615-342-1231 or 1-800-251-8200

Pam Davis, RN, CBN, MBA, Program Director

615-342-7490 [email protected]

Kristi Cotham, Program Manager


Windy Rhoton, RN, Assistant Program Coordinator


Jan Claussen, Registered Dietitian

615-342-7492 option 1 [email protected]

Pam Helmlinger, Registered Dietitian and

Certified Diabetes Educator 615-342-7492 option 2

[email protected]

Valerie Hawkins-King, Registered Dietitian 615-342-7492 option 1

Dallas Street, Insurance Specialist [email protected]

Stephanie Rice, Insurance Specialist [email protected]








Centennial Center for Weight Management –Vertical Sleeve Gastrectomy Owners’ Manual revised 01/2017 prd - 1 -

Vertical Sleeve Gastrectomy surgery is NOT the easy way out. Our inter-disciplinary team of surgeons, nurses, mental health providers, dietitians, exercise physiologists, and insurance specialists provide you with a complete program. These services are only helpful if you access them! To achieve and maintain the greatest success, you will need to follow up with this program on an on-going basis for the rest of your life. Please read this manual thoroughly and refer to it often. While gastric sleeve surgery will greatly reduce the capacity of your stomach to hold food, it will not control what you choose to eat. The recommendations in this manual are for life-long, lifestyle changes to maximize your success.

Sleeve gastrectomy is a tool to facilitate weight loss. You are responsible for

operating the tool properly!

Obesity related health conditions


This Owner’s Manual will provide you with the instructions you need to use this surgical tool properly. What are the Potential Benefits and Risks of Bariatric Surgery? The many benefits of achieving appropriate weight and eating control are obvious. Everyone feels better physically and emotionally when his or her weight is under control. In addition, high blood pressure, diabetes, cholesterol problems, and other health problems are improved and/or easier to control with less medication if significant weight control is established. It is important to understand that weight loss should be gradual, sustained, and accompanied by careful attention to proper nutrition.


Sleeve gastrectomy surgery is major surgery. Patients who undergo any operation incur a certain amount of surgical risk. A patient affected by obesity’s risk for complications following major surgery is increased when compared to non-affected patients undergoing similar surgery. The occurrence of various complications after bariatric surgery is recognized and anticipated; although complications can be minimized, they cannot always be avoided. Below is a partial list of the complications patients must consider when thinking about proceeding with surgery. These complications will be listed on an operative consent form and will be reviewed with you prior to surgery. Possible Complications 1. Death: national data reports a 0.1 death rate.

2. Cardiovascular Problems: (especially with unidentified pre-existing heart

disease): heart attack, stroke or death. 3. Respiratory Problems: pneumonia (inability to clear secretions from lungs,

aspiration of stomach contents), asthma, need for respiratory support for under-ventilation or possible tracheotomy.

4. Wound Problems: infection in wound <5% hernia development (3%). 5. Circulation Problems: blood clots in legs, pulmonary embolus (blood clot in

lungs). 6. Stomach/Intestinal Problems: leak from stomach surgical sites requiring

additional surgery, dumping syndrome (cramping, bloating, diarrhea after eating) while not as likely with a sleeve gastrectomy as a gastric bypass, may still occur.

7. Nutritional Problems: excessive weight loss, vitamin and mineral deficiencies (may need ongoing medications or injections), hair loss, bone weakening, gallstones or kidney stones.

8. Injury to Nearby Organs: spleen - resulting in possible need for splenectomy;

liver – with possibility of bleeding, or potential for transfusions. 9. Numerous Other Less-Common Complications


In Preparation for Vertical Sleeve Gastrectomy (VSG) Surgery This section will outline for you and your family what you can expect before and after gastric sleeve surgery. Patients typically go home 2 - 3 days after surgery; however, each patient is different. If any changes are needed, your physician and nursing staff will keep you informed. Maximizing Your Success Preparation for bariatric surgery includes several steps to optimize a patient’s health in anticipation of an operation. Careful attention to personal hygiene can help reduce the risk of infections after surgery. Daily bathing several days before surgery with any good soap will be helpful. Careful attention should be given to cleansing the abdominal area (from breasts to groin), making sure to clean well between folds of skin. Good oral hygiene with careful brushing and flossing of teeth will be beneficial as well. Establishment of an exercise and dietary program before surgery is important. Even a small amount of weight loss before surgery makes surgical exposure of the stomach easier and safer. In addition, establishment of proper exercise and eating habits pre-operatively will be easier to continue in the post-operative phase. Pre-operative diets vary per surgeon. If warranted, your surgeon’s office will give you direction on what type of diet and when to begin the diet as well as any other instructions they want you to follow. Minimizing GI Distress As you will be required to drink protein supplements in the first couple of stages of the diet following surgery, it is not uncommon to experience diarrhea or stomach upset during this stage. It is recommended to start a probiotic prior to surgery in order to help maximize your tolerance of liquid protein, by assisting in the maintenance of healthy normal bacteria or “flora” in the digestive system as well as to support overall digestive health and wellbeing after surgery. We suggest that you try Bariatric Advantage chewable probiotic and take one daily.


Two Weeks Prior to Surgery

Do not take Aspirin, Ibuprofen, or arthritis medications for two weeks before surgery, because these medications can make you more prone to bleeding. Birth control pills and other estrogen hormones should be discussed with your surgeon. Prescription and over the counter appetite suppressants should be stopped two weeks before surgery. If you are unsure about which

medications to stop, contact your surgeon.

If you have not begun to increase your activity, now is the perfect time to do so. The goal is to move more. Plan to work up to walking or swimming 5 – 10 minutes per day prior to surgery.


Pre-Operative Shopping List

The following is a list of food items you might find helpful to have at home after your surgery. Selections are based on each individual preference. Items should contain no added sugar.

Blender or Food Processor

Vitamin and Mineral Supplements (see nutrition section) Calorie-free, caffeine-free, non-carbonated beverages

Examples:

Broth Powdered diet drink mix (Crystal Light, sugar-free Kool Aid, sugar

free Hawaiian Punch, Wyler’s Light, other sugar free drink mixes available at Kroger, Target, Walmart) in moderation

Flavorin gs and seasonings such as True Lime, True Lemon, True Orange

Fruit 2 O or other zero calorie, sugar free, non-carbonated spring water

Decaffeinated coffee or tea Sugar-free Jell-O Sugar-free popsicles (NO Fudgsicles) Calorie-free artificial sweetener of

choice o Equal (NutraSweet, Aspartame) o Sweet n Low (Saccharin) o Splenda (Sucralose) o Stevia

Protein Supplements (see stages 1 & 2 in

Nutrition Section)


Two days before surgery: CLEAR LIQUIDS ONLY Nothing to eat or drink after midnight. This includes gum, breath mints, and cigarettes. Have clear liquids available that you will need after surgery in stage 1 (examples listed above.) Clear liquid protein supplements such as Isopure zero carb or GNC’s Amplified Wheybolic Extreme 60 (fruit punch) are available at local health stores (GNC, Vitamin Shoppe) and online. High protein, low carbohydrate whey protein powder such as Unjury in unflavored, chicken soup, or strawberry sorbet, or Nectar in fuzzy navel, roadside lemonade, kiwi strawberry, etc. are additional options. Protein powders should be mixed with water or clear liquid beverages. Your surgeon may put you on a low sugar, liquid diet for 10-14 days prior to surgery.

• The purpose of this is to deplete glycogen stores in your liver, which in turn will make laparoscopic surgery easier and decrease the risk for complications.

• This diet also helps to shrink the fat around your organs, which helps make you a better candidate for laparoscopic surgery.

• IF it is recommended by your surgeon that you follow a low sugar, liquid diet for 10-14 days prior to your surgery, then please follow the guidelines on the next page.


Please follow these guidelines if you are placed on a 10-14 day low sugar, liquid preop diet:

• Limit to two cups per day – consume these liquids in moderation as they contain larger amounts of sugar:

o Juice (choose fruit juices lower in sugar such as apple, orange, grapefruit juice, or tomato juice)

o G2 Gatorade o PowerAde

• Limit to three or less servings per day: o Regular Jell-O o Popsicles o No sugar added Fudgesicles

• Limit to three or less servings per day:

o 1 cup of milk (skim, soy or Lactaid) o 6 ounces light/fat free yogurt o ½ cup low fat cottage cheese

• Protein Supplements: (Choose 1 of these)

o Bariatric Advantage/Syntrax Nectar whey protein powder 3-4 scoops per day, any flavor

o EAS Advant Edge Carb Control Shakes/ Myoplex Carb Control/ Muscle Milk Light/ Atkins Advantage, 3 shakes per day

o Premier Nutrition shakes, 2 shakes per day (available at Sam’s or Costco)

The following liquids can be taken in any amount as they do not contain sugar: • Sugar-free beverages such as Crystal Light, sugar-free Kool-aid, sugar-free

Tang, Fruit 2 O, Fuze Slenderize • Coffee or tea with artificial sweetener • Chicken/Beef/Vegetable Broth • Sugar-free popsicles and sugar-free Jell-O

*Please note the liquid stages after surgery will consist of protein supplements and calorie-free beverages, NOT the sugar sweetened beverages, Fudgesicles, etc. allowed on the pre-op diet.*


Sample Menu for 10-14 Low Sugar Liquid Pre-Surgery Diet

Breakfast: 1 cup orange juice or V8 Splash 1 cup coffee (optional, with artificial sweetener and 2 tsp. nondairy powdered creamer) Mid-morning: 1 scoop Bariatric Advantage protein powder mixed with ½ cup skim milk and 6-8 oz. water and ice in blender or shaker cup Lunch: 1 cup G2 low-sugar Gatorade 1 cup chicken or beef broth 6 oz. regular Jell-O gelatin, layered with Kroger Carbmaster yogurt if desired (i.e. parfait) Mid-afternoon: 1 scoop Bariatric Advantage protein powder mixed with ½ cup skim milk and 6-8 oz. water and ice in blender or shaker cup Sugar-free Jell-O or sugar-free Popsicle Dinner: 6 oz light/fat free yogurt, any flavor OR ½ cup 1% low fat cottage cheese 6 oz regular Jell-O gelatin 1 scoop Bariatric Advantage protein powder mixed with ½ cup skim milk and 6-8 oz. water or sugar-free beverage of choice and ice in blender *Suggestion: Try vanilla protein powder mixed in Orange sugar-free drink mix, such as Crystal Light Orange Sunrise, for a creamsicle taste. Bedtime: 1 no sugar added Fudgesicle Optional: 1 scoop Bariatric Advantage protein powder mixed with 8-16 oz. water or sugar-free beverage and ice Between meal liquids as desired: water, sugar-free beverages, propel, diet soda, broth, coffee or tea with artificial sweetener, sugar free popsicles, sugar free Jell-O If you have any questions about this diet, please contact one of our dietitians at (615) 342-7492.


What to Bring to the Hospital It is not necessary to bring anything with you for your hospital stay unless you would like. You do not need money for the phone or television, as these are part of your room accommodations. The hospital will provide the basic toiletry items such as toothbrush, toothpaste, deodorant, soap and comb. However, some patients have found it more pleasing to have some of their own personal items. In addition, you are welcome to bring the following if you desire:

Your shaker cup and this manual Your own pillow if you prefer Shampoo (you will be able to shower on the 2nd or 3rd day after surgery) Robe and slippers for walking (spacious hospital gowns are provided) Underwear for 2nd and 3rd day when urinary catheter is removed Change of clothes for discharge day (select clothing that fits loosely) Chap stick or lip balm Feminine hygiene products for menstruating females. (Even if you have

just completed your cycle, sometimes the stress of surgery can start your cycle again.)

C-pap or Bipap machines

What NOT to Bring to the Hospital

Home medications

Guest Lodging A family member may stay in your hospital room overnight if you choose. Considerations for lodging include:

• Holiday Inn Select- contact 615-327-4707 • Hampton Inn Suites- contact 615-320-6060

Please contact both hotels for rates and mention that you are family of a Centennial patient.


Day of Surgery You will report to the 2nd floor Early Morning Admissions (EMA) area of Women’s Hospital 2 hours before your surgery is scheduled. All valuable items should be left at home. If you would like to wear your wedding band, the nurses will secure it with a piece of silk tape.

One or two family members may stay with you in the EMA area until you leave for operating room. You will be evaluated by an anesthesiologist and IV lines will be inserted. The surgery takes anywhere from 1 – 2 1/2 hours, the surgeon will speak with your family after the procedure is completed. Once you go to the surgical suite, your family will be taken to the waiting area. If family members have questions or concerns, they may go to the information desk to check on your status. Your family may be given a beeper while you are in surgery to facilitate updates on your status.

After your surgery, you will be transported to the Post Anesthesia Recovery Area (PACU) located in the OR area. A nurse will monitor your heart rate, blood pressure, and oxygen saturation. Your nurse will give you pain medication injected directly into your IV (intravenous) line. Every effort will be made to make you as comfortable as possible.

You may receive a patient-controlled pain medication button (PCA pump) to use when you are awake enough. Your nurse will show you how to use the PCA pump. When you push the PCA button you’ll receive a set amount of pain medicine prescribed by your doctor. The medication starts working very quickly, usually within minutes. Built-in timers on the PCA will make sure your doses are accurately timed during your course of treatment so that you receive only the medication you need throughout the day. The PCA infuser is specially designed so that you cannot give yourself more medication than your doctor thinks is right for you. It is common to feel sleepy after giving yourself the medicine. Family members and visitors are not allowed to push the PCA button for you. The nurse will help you regulate your pain medication. Although we cannot make you totally pain free, we can help to make it very manageable.

You may have oxygen either by mask or nasal prongs. You will have air stockings on your feet or legs that will inflate and deflate at alternate times to prevent blood clots. These must remain on your feet when you are not walking.

From the PACU you will be transferred to the 4th floor in the main hospital (referred to as the Tower) occasionally a patient may need to stay overnight in the intensive care unit. Your nurse will orient you to the room and ask you to begin your


breathing exercises using the incentive spirometer 10 times every hour while you are awake. We do encourage you to have a family member stay with you overnight.

Continue to cough and breathe deeply using a pillow to splint your abdomen. Although it may be uncomfortable when you cough, you cannot hurt your surgical sites by deep breathing and coughing. Your nurse will help you with getting up out of bed and walking the evening of surgery.

Day 1 After Surgery

Continue to cough and breathe deeply using a pillow to splint your abdomen. Although it will be uncomfortable when you cough, you cannot hurt your surgical sites by deep breathing and coughing. You will be encouraged to get up and walk in your room, this helps to prevent blood clots from forming and helps prevent pneumonia. Your nurse will help you get up out of bed and walking several times today.

The nurse will help you regulate your pain medication. Although we cannot make you totally pain free, we can help to make it very manageable. You will receive injections of a medication to prevent blood clots. The injections are given with a very small needle, usually in the abdominal area. The urinary catheter is typically removed on the first postoperative day.

If indicated, you will be taken to the X-ray department for a “swallow test”. This will require swallowing some “dye” so that we can make sure that there are no leaks inside your abdomen. After the results of the test are on your chart, you will be allowed to have clear liquids and ice chips. If the swallow test is not felt to be indicated, you will be started on liquids. Broth, sugar free Jell-O, crystal light and water are generally served the first day. On each tray, you will receive a packet of Nectar protein supplement. Most patients report mixing only half the packet of Nectar in their crystal light improves the taste. Sip these items slowly over 30 - 40 minutes. You do not have to finish everything on the tray. Drink as much as is comfortable. Most patients do not feel hungry for days and sometimes weeks after surgery.


Day 2 After Surgery-The majority of patients will be ready for discharge on day 2.

The second day after surgery, you will be expected to walk in the hall, working up to 4 times per day. This is extremely important to prevent post-surgery complications such as pneumonia and blood clots. Your water pitcher will be filled and you should try to sip as much fluid as possible. If you require other medications that you take on a regular basis at home, the doctor will prescribe them in crushed or in liquid form. Your incision can be covered with plastic so you can get into the shower. Discharge teaching begins at this time and a dietitian may visit you.

Day 3 After Surgery

If not discharged on day 2, then today will likely be your day of discharge. At the time of discharge, you will be given instructions for taking care of yourself at home. A nurse will discuss the instructions with you and make sure all your questions are answered. A prescription for pain medication and possibly an anti-ulcer medicine will be given to you. If you have a fever, are not taking proper nutrition, or are having any other difficulty, you may need to stay an additional day or so. You will follow up with your surgeon and/or the bariatric program 7 – 10 days after surgery. Please be aware that acute shortness of breath, chest or leg pain should NOT be ignored, as this might indicate the formation of a blood clot. After discharge, in the unlikely event of pain development in your legs or chest or the onset of shortness of breath, please contact your SURGEON immediately and/or visit the nearest emergency room for evaluation. Fever of greater than 101 should be reported immediately to your surgeon’s office.


TriStar Centennial Medical Center Information

Visiting hours are from 9AM - 9PM. These extended visiting hours may be limited if Nursing Staff feels other patients are being disturbed. Telephone Service: Each patient room has a private phone line, which can dial out locally by first dialing the number 9. There is no charge for local phone service. To place a long distance call you will need to use a calling card or charge the call to your home phone number through the operator. If you would like to have your incoming calls screened or blocked, please dial the operator (dial O) after you are admitted to your room. Parking: Free parking is available across the campus. Valet parking is available at the main hospital (Tower) entrance. Food Court: Located on the 2nd floor of Women’s and Children’s Hospital and on the 2nd floor of Centennial main hospital tower. Vending machines are also available. Gift Shop: Located on the 1st floor of Women’s and Children’s Hospital and on the 2nd floor of Centennial Hospital Tower. Gifts, flowers, snacks, and reading materials can be purchased here weekdays 8 a.m. – 8 p.m. and weekends from 9 a.m. -7 p.m. Your Program of Recovery after Vertical Sleeve Gastrectomy Surgery After Bariatric Surgery, you now join the thousands of people who live healthier, happier lives following surgical treatment of severe obesity. Although this surgery is designed to promote lasting weight loss, you are still in control of your success. You must choose the behaviors that will enhance your surgery. The instructions and information that follow in this manual will help you navigate the path to successful, health-enhancing weight loss. As you leave the hospital, remember that your surgical program is not complete. Remember the importance of your active participation in our follow-up program. This participation includes routine follow-up visits with your surgeon, attention to informational mailings and responses to phone calls and questionnaires. Attendance at both self-help support group meetings and psychologist-led groups is expected. At each follow-up visit, further instructions and important follow-up tests will be given to determine that your health is stable and your


pouch is functioning as it should. You will see the dietician and exercise physiologist at your one-week follow-up visit and at set postoperative intervals. Certainly, if you have questions in between visits, you may call your Surgeon, Program Staff, or Program Dietitian. Remember, small problems can usually be resolved easily. If you wait until the problem becomes major, it is likely that more extensive medical intervention will be required. Medications (please see the Vitamins and Medications tab for additional information)

Medications need to be crushed or in liquid form initially (at least the first six weeks) after your surgery. It is best to check with your physician or pharmacist before crushing your pills, as many common medications are time-released and cannot be crushed. Please check with your surgeon before restarting medications for diabetes, as your requirements may be much different than they were prior to surgery.

Medications that are irritating to the stomach and make you prone to bleeding should be avoided; this includes aspirin, Aleve, ibuprofen (Motrin), Celebrex and other anti-inflammatory medicines. In future years, if any physician prescribes a new medication, it is important to inform him/her of your bariatric surgery.

Nausea and Vomiting

It is not uncommon for postoperative patients to experience some nausea during the first few days or weeks after surgery. If nausea prevents you from getting in adequate fluids, you need to call your surgeon. If you experience an episode of vomiting after eating, you need to go back on clear liquids ONLY for at least 48 hours, then return to stage 3 for 3-4 days. If you experience a second episode of vomiting within 24 hours, or you are not able to tolerate liquids, call your

surgeon. Please do not continue to “wait it out” as you may become dehydrated. You should not expect to routinely experience vomiting after bariatric surgery. Burping is common after Bariatric Surgery. This frequently indicates that you are full, and you need to stop eating.


If you eat too quickly or even a bite or two too much, mucous may back up in the esophagus (throat) and cause frothy clear vomiting. This may also happen when eating foods that are not moist enough, when taking bites that are to large or when food is not chewed properly. Make sure you are eating moist foods, taking small bites and chewing really well. If this persists, please contact your surgeon. Gas Pains Gas pains are common in the first few weeks after surgery. Sometimes these pains can be severe and more uncomfortable than the “surgical” pain. To help relieve these pains try to increase your activity level. You can also try anti-gas over-the-counter preparations such as Mylanta, Maalox, and Gaviscon. Hair Loss

If you notice hair loss/thinning, especially around the third month after surgery, you should consult the dietary section of this manual and identify foods that will increase your protein intake. Hair loss is often attributable to protein deficiencies, and by increasing your protein intake, you may reduce hair loss; however, there are no “guarantees”. Hair re-growth frequently occurs after several months. Another possible cause of hair loss is an Essential Fatty Acid Deficiency. Omega 3 fatty acid supplements are recommended if you do not eat fish regularly 2 – 3 times a week. Bowel Habits

It is common to have some temporary bowel changes following surgery. These changes range from constipation to diarrhea. If you do not move your bowels by the first or second day at home, you may try a mild laxative such as Milk of Magnesia. Follow the instructions on the bottle. Dark or blood-tinged stools should be reported to your surgeon, IMMEDIATELY!

Laparoscopic Incision Site Care Your incision sites will be healing over the next few weeks. Your incisions will be closed with steri strips, these look like pieces of tape. These pieces of tape will curl up and fall off over the next couple of weeks. You may or may not have a clear dressing over the sites, if so, this clear dressing can be removed the third day after surgery.


Bathing You may take a shower when you get home. An incision will heal faster if it is kept dry during the first week you are home. If you get the incisions a little wet, it will not cause a problem. Simply pat it dry. Do not take a tub bath or go swimming for the first two weeks postoperatively or until surgeon approval (usually at your first follow-up visit). Sleeping You may sleep in whatever position is comfortable when you get home. Many people find that sleeping on their stomach will not be comfortable for many weeks due to abdominal discomfort. Some people find that taking their pain medication before sleep will help them feel more comfortable and allow them to go to sleep. You may also try a mild crushed sleeping aid such as “Tylenol PM” to help you rest if the problem persists. Returning to Work Return to work is patient specific; in general, most are able to return to work within two weeks. If you need “return-to-work” or other insurance papers completed, please bring them to the office at your pre-operative visit, and we will be happy to assist you with their completion. Breathing Exercises The Incentive Spirometer (plastic breathing exercise tube) is yours to take home. Please use it as you have been instructed in the hospital. Ten deep breaths every 1-2 hours during the day are highly recommended to enhance your recovery.

Remember, if you cannot take in adequate liquids over 24 hours you should contact your surgeon’s office for further advice. You can become dehydrated very quickly.


Activity It is important to be up and out of the bed or chair and active when you return home. You might notice that you tire easily and need to take frequent rest periods. You may resume sexual activity when desired, keeping the restrictions on other physical activity in mind. Exercise Exercise is one of the most important things you can do for yourself after surgery to keep healthy, increase your energy level, and lose the maximum amount of weight. Walking will burn about 200 calories per mile (there are 3,500 calories in one pound). Start a walking program to your tolerance. In addition to a walking program, you should be active and walking as you would normally around your house. If you begin to feel short of breath, tired, or exceed your target heart rate during the walking program, slow your pace or stop. You can substitute another type of exercise you enjoy for the walking program if you are feeling strong enough. The exercise should have an aerobic component that raises your heart rate to a healthy target rate. The Long Term Goal is 45 – 60 minutes of exercise on most days of the week (at least 6 days). Start with the amount that you can tolerate safely and gradually add time to it to reach your goal. Pregnancy after Surgery As you lose weight and hormone levels begin to stabilize, fertility may improve and women who previously thought they were unable to conceive may now be able to do so. Women of childbearing age should be on a reliable method of birth control until their weight has stabilized (usually 18-24 months after surgery). We DO NOT recommend pregnancy until at least 12 months after surgery! Pregnancies after this time frame have been normal in course. Be sure to see our Registered Dietitian about your nutritional needs during pregnancy to keep you and the baby healthy. If you experience nausea or vomiting during pregnancy, please contact your surgeon.


Diversional Activities Following surgery you may find yourself spending a lot of time thinking about your operation. Constant focus on the changes happening to your body can get tiring or even distressing. It is important to take some time to exercise another part of your body….your mind. The first six weeks after surgery, while your body is healing, is a good time to participate in activities that are fun and good for you. Get involved in non-food-related activities such as reading, art, music, or other hobbies. Contact an old friend, go to a concert, movie, museum, or surf the Internet. By making activities and people the center of your life, food will decrease in importance. Go to support group! The Internet The Internet has a wealth of information and online support groups for bariatric surgery patients. Please visit our site, http://cmcwls.com/ often for new blog posts, support group meetings and links to all of our social media outlets. Great resource sites include:

• http://www.obesityaction.org/ • http://www.calorieking.com/ • http://fitday.com/ • http://www.getfittn.com/ • www.sparkpeople.com • www.myfitnesspal.com • www.loseit.com

Support Groups One of the assets of our program is the post-operative care provided to our patients. Medical studies on bariatric surgery patients conclude that the most successful patients are those who take advantage of the follow-up activities provided by comprehensive programs.

Our programs offer you the opportunity to discuss your experience with other patients in one-on-one, informal settings, as well as provide educational sessions each month on topics of interest to you. We strongly encourage you to attend support groups. They are listed in your Seminar Book and on our Website.

http://cmcwls.com/

http://www.calorieking.com/

http://fitday.com/

http://www.getfittn.com/

http://www.sparkpeople.com/

http://www.myfitnesspal.com/


Bariatric patients who participate in post-surgical support groups have significantly better results than those who do not. Centennial provides one of the most comprehensive postoperative recovery programs available. Our patients report they enjoy and benefit from our support groups. In an effort to provide ongoing support following weight loss surgery, Centennial Center for Weight Management has contracted with a team of behavioral health specialists to provide psychological support throughout your journey. These professionals provide a comprehensive program specifically designed to assist with the challenges of recovering from obesity. This program is available to all Centennial patients without any additional fee.

Most weight loss surgery patients will experience a number of emotional, psychological, and social challenges in the months following surgery. While many of these challenges are very positive in nature, some of the more difficult issues can become stumbling blocks in an otherwise wonderful discovery process. Common problems our patients encounter include lingering self-esteem problems, "head hunger", self-defeating behaviors, assertiveness issues, anger management problems, self-confidence, boundary problems, difficulty adjusting to new social expectations, intimacy issues, challenges in their primary relationship, body image issues, and a host of others. Many of these challenges are temporary in nature but feel overwhelming at first. Our program is designed to assist our patients during a critical time in their transformation to a healthy enhanced life style.

Participation in support groups is expected of all patients, including preoperative patients. We encourage you to seriously consider this commitment. You have made a decision to change your life dramatically; support through this transition can make a positive difference in the results you experience. You are encouraged to invite concerned friends and loved ones to attend the program with you. A complete listing of all groups is available on our web site: www.cmcwls.com.

PROFESSIONALLY LED SUPPORT GROUPS

Most weight loss surgery patients will experience a number of emotional,

psychological, and social challenges in the months following surgery. While

many of these challenges are very positive in nature, some of the more

difficult issues can become stumbling blocks in an otherwise wonderful

discovery process. Common themes discussed in group include lingering

self-esteem problems, “head hunger”, self-defeating behaviors,

assertiveness issues, anger management problems, self-confidence,

boundary issues, difficulty adjusting to new social expectations, intimacy

issues, challenges in their primary relationship, body image issues, and a

host of others.

Group Discussion with the Nurse Every Tuesday and

Thursday 12:00 – 1:00

1st Tuesday night of the month 6-7 PM

“Back on Track”

2nd Tuesday night of the month 6-7 PM

“Preparation for Surgery”

3rd Tuesday night of the month 6-7 PM

“Medical Weight Loss”

4th Tuesday night of the month 6-7 PM “Celebrate

Success-Maintenance”

TRISTAR CENTENNIAL CENTER FOR WEIGHT

MANAGEMENT 2200 Murphy Avenue Nashville, TN. 37203

cmcwls.com

For details on our peer led

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Library (Glass Room)

350 Pageant Lane

Tamra Leach

615-775-4053

[email protected]

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Medical Center

Education Room #2

Jane Ellen

Jon Gerfen

931-252-5263

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615-342-1231

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Medical Center

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615-509-5432

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NUTRITIONAL GUIDELINES AFTER SLEEVE GASTRECTOMY

You may reach the dietitians by calling 615-342-7492.

Pam Helmlinger, RD, LDN, CDE (Monday through Friday, press option 2)

Jan Claussen, MS, RD, LDN, CNSC

(Tuesdays and Thursdays, press option 1)

Our Registered Dietitians are dedicated solely to our bariatric surgery patients.

They have years of experience and have

researched nutritional guidelines to specifically

optimize your success after surgery.

Centennial Center for the Treatment of Obesity –Sleeve Gastrectomy Owner’s Manual – revised 01/2017 ph/jc 2

DIET ADVANCEMENT STAGES 1 - 4 There are 4 stages of your diet after surgery. Your surgeon/dietitian will discuss with you when and how to advance your diet. This is a general overview of each stage. STAGE 1 CLEAR LIQUID DIET Begins in the hospital and continues for 2 weeks. You are required to drink clear liquid protein supplements for nutrition. STAGE 2 FULL LIQUID DIET Stage 2 also lasts for 2 weeks. You are required to drink protein shakes for nutrition in addition to clear liquid beverages. STAGE 3 BLENDED DIET Begins following stage 2 and lasts for 2 weeks. STAGE 4 SOLID DIET Begins approximately week 7. This stage lasts until you have lost 75% of your excess body weight. Once you have lost 75% or more of excess body weight, new foods may be added to your diet. The dietitian or surgeon will tell you when, what and how to add these foods. Please note that the concepts of stage 4 should be practiced forever as new lifestyle behaviors!

Healthy eating habits and lifestyle behavior changes are learned and practiced throughout the first year after surgery and should continue throughout your lifetime. FOLLOW-UP

You are expected to see the Registered Dietitian at the following intervals: pre-op class,

follow up visits, including: 1 week, 6 months, 1 year, 18 months, then annually (*note, you will see the surgeon more frequently) or as determined by you and your surgeon. We encourage all patients to make individual appointments as needed.


Men

Height Weight5’4” 1405’6” 1455’8” 1515’10” 1576’0” 1646’2” 171

NUTRITIONAL GOALS UNTIL 75% OF EXCESS BODY WEIGHT IS LOST INCLUDE:

<500 CALORIES PER DAY

60 - 80 GRAMS PROTEIN PER DAY

64 OUNCES FLUID MINIMUM PER DAY Post op visit

4-6 weeks 3 months 6 months 9 months 1 year

Expected excess body weight loss after surgery

20-25% 35% 55% 70% 75-80%

Calculation for excess body weight loss (EBW) percentage: Pre-op weight - Ideal body weight (IBW) = Amount to lose Amount lost divided by the amount to lose (x 100) = % of excess body weight lost

Example male patient: Pre op weight: 295# height: 5’10” IBW: 157# 3 month post op visit with 50# weight loss: Example: Pre-op weight = (295#) - Ideal Body Weight (157#) = 138# (wt to lose) 50# lost divided by 138# (x100) = 36%

At six months, most patients have achieved about half of the weight loss expected related to surgery. This is an average expected weight loss. Individual results will vary.


DAILY FOOD DIARY Date: _______________

Calorie level (circle one): 400-600 600-800 800-1000 Other__________ Protein goal: 60-80 grams Fluid goal: 64oz minimum calorie-free, sugar-free, caffeine-free fluid

MEAL GRAMS OF PROTEIN

CALORIES

NOTHING TO DRINK 30 MINUTES BEFORE OR AFTER MEALS

Brea

kfas

t

TOTAL


Lunc

h

TOTAL


Dinn

er

TOTAL

TOTAL FOR ALL MEALS

Circle each 8oz of fluid you drink and check off your vitamin supplements

___ Multivitamin ___ Calcium (400-600 mg) ___ Calcium (400-600 mg) ___ Iron (as needed)

___ Calcium (400-600 mg) ___ Vitamin D (as needed) ___ Omega 3 fatty acid ____ B-12

http://images.google.com/imgres?imgurl=http://us.i1.yimg.com/us.yimg.com/i/us/he/hw/dg/i/water.gif&imgrefurl=http://health.yahoo.com/drug/d04532a1/&h=34&w=34&sz=1&tbnid=RsYSoTtUK-8J:&tbnh=34&tbnw=34&hl=en&start=9&prev=/image













STAGE 1 - CLEAR LIQUIDS - FLUIDS

SIP liquids SLOWLY. NO GULPING. It is okay to use a straw if desired.

NO FRUIT JUICES EVER! Fruit juice adds a lot of calories and carbohydrates. Juices will slow down your weight loss as well.

Caffeine should be limited to 1-2 (8 ounce) cups per day and caffeinated beverages DO NOT count toward fluid needs.

Carbonated beverages (usually introduced 6 mos. post-op) should only be used if approved by your surgeon, as these can cause gas and bloating.

Other sugar free, calorie free, caffeine free NON-carbonated beverages are acceptable and DO count toward your fluid needs. Please make sure you are reading nutrition labels. Zero to 5 calories per 8 ounce serving is considered “calorie-free.”

You will use these fluids during every stage of the diet.

Remember 64 ounces of fluid per day is only the minimum, not the GOAL!

FLUIDS THAT MAY BE USED TOWARD HYDRATION:

Water Chicken, beef, or vegetable broth Sugar free Jell-O gelatin Decaf coffee Decaf tea Crystal Light or Mio Sugar Free Popsicles (no Fudgesicles) Sugar Free Kool-Aid Sugar Free Country Time Lemonade Sugar Free Tang Big K diet pink lemonade (Kroger) Fruit 2O (zero calorie non-carbonated fruit flavored water) Dasani fruit flavored water Fuze Slenderize diet flavored beverages Glaceau Vitamin Water Zero Glaceau Smart Water


After your diet order for Stage 1 is written, the hospital will provide you with an approved protein supplement. You may bring your own “approved protein supplement” to the hospital if you wish. Usually patients tolerate Unjury and Nectar best during the 1st week after surgery. STAGE 1 PROTEIN SUPPLEMENTS - CLEAR LIQUIDS

You may choose from the following approved protein supplements during the clear liquid stage: UNJURY, NECTAR (available in your surgeon’s office), ATKINS LIFT, or ISOPURE ZERO CARB. SEE TABLE.

Protein supplement/ serving size

Protein Grams

Calories and

Carbohydrates

Amount needed daily/ how to use

Where available for purchase

Unjury protein powder

1 scoop

20 grams protein

80 calories 1-3 gm CHO

3-4 scoops per day to provide 60-80

grams protein and 270-360 calories per

day.

Via the internet: www.unjury/.

com/reg/bariatric/ or call toll free # 1-800-517-5111

Syntrax Nectar protein powder

1 scoop

23 grams protein

90 calories 0 gm CHO

3-4 scoops per day to provide 69-92 grams protein and 270-360 calories/day.

The Vitamin Shoppe or Call toll free #

1-866-333-7403 AVAILABLE AT CENTENNIAL!

Bariatric

Advantage High Protein Meal Replacement

2 scoops

27 gm protein

150 calories 7 gm CHO 5 gm fiber

5 scoops/day per day to provide 68 gm protein and 375 calories/day.

Find it at via our e-store at cmcwls.com or

bariatricadvantage.com AVAILABLE AT CENTENNIAL!

Atkins Lift

Protein Drink

Orange, Lemon, or Berry

(16.9 oz bottle)

20 grams protein

100 calories 1 gm CHO

Need 3-4

bottles/day 60-80 gm protein 300-400 calories

Local grocery stores

www.atkins.com/products/atkins-lift-protein-bars-

drinks/protein-drinks Isopure Zero

Carb Alpine punch,

grape, etc. 20 ounce bottle

40 grams protein

160 calories

Need 1 ½-2 bottles

per day. 60-80 gm pro

240-320 calories

Nutrition stores such as GNC or Vitamin Shoppe

www.Netrition.com

Remember: Stay on Stage 1 clear liquid diet for two weeks. Do not advance your diet without surgeon approval! *You will need to purchase enough clear liquid protein supplements to last up to 10-14 days.

http://www.unjury/


STAGE 2 - FULL LIQUIDS This stage begins as instructed by your surgeon and dietitian. This stage lasts for 2 weeks (14 days). Discontinue use of clear liquid protein supplements at this time, unless your surgeon or dietitian recommends otherwise. Continue drinking at least 64 ounces of the approved clear liquid beverages allowed in Stage 1, in addition to protein shakes. These are the only beverages allowed in Stage 2, absolutely nothing else. They provide you with the recommended calories and protein per day to meet your nutritional goals. Drink protein supplements SLOWLY. Liquid protein supplements beyond these stages may be recommended by your surgeon or dietitian if you are routinely struggling to meet your protein needs- they may also be used to replace up to one meal daily if needed.


STAGE 2 FULL LIQUID PROTEIN SUPPLEMENTS You will be required to drink protein supplements in stage 2 of your diet. The use of protein drinks after this stage should not be included in your diet unless your surgeon or dietitian recommends them as a meal replacement and/or following an adjustment. There are many brands of supplements available (ready-to-drink or powders). • Look for those made with whey protein isolate, as this is absorbed well, versus whey protein

concentrate, which contains lactose, or milk sugar. • Strive for a supplement with at least 20 grams of protein per serving. • Aim for a product that contains less than 5 grams of total carbohydrates per serving. • Stage 2 supplements may be a milk-like consistency, including vanilla and chocolate flavors.

Note: Milk is not recommended during active weight loss due to its carbohydrate content. • Examples: Ready to Drink- Premier Protein, EAS Advant Edge Carb Control, Pure Protein, or

Bariatric Advantage Ready-to-Shake. Powders - Unjury, Syntrax Nectar or Matrix, Bariatric Advantage HPMR, or GNC Amplified Wheybolic Extreme 60.

Please see the table on the following page for approved full liquid protein supplements.


STAGE 2 PROTEIN SUPPLEMENTS - FULL LIQUIDS You may choose from the following protein supplements during the full liquid stage:

Protein supplement/ serving size

Protein Grams

Calories and

Carbohydrates

Amount needed daily/ how to use

Where available for purchase

Unjury

1 scoop

20-21 gm protein

90 calories 3 gm carbs 2 gm sugar

3-4 scoops per day to provide 60-80 grams

protein. Can be used with any

of the approved calorie-free

fluids.

Can be ordered at

www.unjury/. com/reg/bariatric/

Or call toll free # 1-800-517-5111

Syntrax Nectar Sweets, Lattes,

or Matrix 1 scoop

23 grams protein

100 calories 1 gm carb

3-4 scoops per day to provide 69-82 grams protein. Mix

with water or any other

approved fluid.

Find via our estore at

cmcwls.com Or call toll free # 1-866-333-7403

AVAILABLE AT CENTENNIAL!

EAS Advant Edge Carb Control RTD Shakes 11 oz. box Chocolate, Vanilla, etc.

15 grams protein

100 calories 3-5 gm carbs 0-1 gm sugar

4-5 boxes per day to provide 60-75 grams

protein.

www.eas.com

local grocery stores, discount stores, or pharmacies

Premier Protein RTD

Shakes 11 oz box

Chocolate, Vanilla, Caramel,

Bananas and Cream,

Strawberry

30 grams protein

160 calories 5 gm carbs 1 gm sugar

2-3 boxes per day to provide

60-90 gm protein

www.premiernutrition.com

some local grocery stores,

Sam’s Club and Costco membership clubs

http://www.unjury/

http://www.eas.com/


PROTEIN INTAKE POST OP

• Following bariatric surgery, protein is the main nutrient in your diet. • Protein is important for wound healing and hair growth. • Without adequate protein, our bodies will favor burning muscle tissue in the place of fat

stores. • Protein assists in maintaining lean muscle mass. • Lack of protein can cause fatigue. • Without adequate protein intake, significant hair loss is likely to occur. • These are VERY important reasons to make sure you are meeting your protein needs. Please

call the dietitian for any assistance on meeting protein needs. • Protein goal: 60-80 grams per day • For proper nutrition and healing the first few weeks after surgery, you are required to drink

protein supplements. Stages 1 & 2 of the diet are entirely liquid.

• Stages 3 and 4 of the diet are semi-solid to solid food. Generally, one ounce of protein is approximately 7 grams of protein. You should aim for 3 ounces of protein at each meal in order to meet the minimum of 60 grams of protein per day. A deck of cards is the size of a serving of cooked meat/poultry and a fish serving should be the size of a checkbook.


STAGE 3 - BLENDED DIET

• Begins after full liquid diet (stage 2) and lasts for 2 weeks.

• You will need to mechanically blend some foods to a finely chopped consistency. Soft foods do not have to be blended.

• You will eat 3 meals per day. NO SNACKING.

• Protein supplements may not be used after stage 2, unless you are unable to meet protein needs, or as a meal replacement.

• Remember to record your daily food journal.

• Starting with this stage, you should separate eating and drinking together by 30 minutes. NO liquids 30 minutes before a meal. You may resume drinking liquids 30 minutes after a meal. Also your mealtime should last for approximately 30 minutes. In order to meet your fluid needs, start early and continue sipping throughout the day to ensure you will meet or exceed your hydration goals of at least 64 ounces per day.

• You should eat at least 3 ounces of protein or 20 grams of protein at every meal.

• We recommend that you ALWAYS eat protein first, followed by a low carbohydrate vegetable if there is room. During the weight loss phase the vegetables are for variety only. If you are full from protein, you do not have to eat them.

The following pages list the foods allowed in Stage 3.


Foods allowed in Stage 3 Group A - Protein (Eat 1st, 3 ounces every meal)

Food: Serving Size: Protein (grams): Calories: Eggs (scrambled or soft boiled) 2 12-14 140-150 Egg Whites 4 14 70 Egg Substitute ½ cup 12 60 Cottage Cheese (1 %- low fat) ½ cup 14 90 High protein, low carb yogurt (Kroger CarbMasters- ANY flavor)

6 oz. 8 60

Kroger Greek Lite Yogurt- (ANY Flavor with 80 calories)

5.3 oz. 14 80

Plain, Greek-style Yogurt (such as Fage/Chobani- may sweeten with Splenda, Mio, sugar-free jelly)

6 oz. 18 100

Cheese, mozzarella (part-skim) 1 slice 6 70 Ocean Perch, Flounder, Tilapia (poached/steamed and flaked w/ fork)

3 oz. 21 100

Tuna, packed in water/foil pouch (blended)

3 oz. 21 90

Salmon, packed in water/ foil pouch (blended)

3 oz. 17 120

Chicken breast, canned/foil pouch or boiled (blended)

3 oz. 21 90

Turkey breast, canned (blended) 3 oz. 20 90

Group B - Low Carbohydrate Vegetables Eat 2nd (if you have room)... Choose 1 vegetable per meal and eat up to a ½ cup serving. These contain 25 calories and 5 grams of carbohydrate per ½ cup serving.

o Asparagus o Beets o Carrots o Green Beans o Spinach o Turnip Greens o Mushrooms o Tomatoes, canned

*Vegetables should be canned and mashed

with your fork (during stage 3 only)


“Free Food Items” (These may be used in stages 3 and 4)

Food Amount Protein grams Calories Fat free margarine (Smart Squeeze)

1 Tablespoon

0

5

Fat free butter spray 10 sprays 0 0 Nonstick fat free cooking spray

average spray

0

0

Butter Buds or Molly McButter Cheese Flavoring

1 teaspoon

0

5

Fat free Mayo 1 Tablespoon 0 10 Low fat Mayo ½ Tablespoon 0 13 Fat free Italian dressing 2 Tablespoons 0 10 Fat free sour cream 1 Tablespoon 1 15 Mustard 1 Tablespoon 0 5 Salsa, mild 2 Tablespoons 0 10 Herbs and Spices ½ teaspoon 0 0 Lemon juice 1 Tablespoon 0 3 Mt. Olive no sugar added or Dill Pickle Relish

1 Tablespoon

0

0

Heinz One-Carb/ Reduced Sugar Ketchup

1 Tablespoon

0

5

Walden Farms Calorie-Free Salad Dressing

2 Tablespoons

0

0

Walden Farms Calorie-Free or Hershey’s Sugar Free Chocolate/Strawberry Syrup

2 teaspoons (*helps mask taste of

bitter meds)

0

0-5

Walden Farms Calorie-Free Condiments (BBQ sauce)

2 Tablespoons

0

0

Wishbone Salad Spritzers or Ken’s Steak House lite accents one-calorie spray

10 sprays for 1 cup salad

or to flavor protein

0

10

Vinegar (any variety) 2 Tablespoons 0 0


SAMPLE MENU FOR STAGE 3 BLENDED DIET

MEAL: Protein grams Calories Breakfast 2 eggs (soft, scrambled, poached or soft boiled) 14 150 1 slice of low fat cheese 5 40 ¼ cup mushrooms 0.8 6 salt and pepper Total: 19-20 196 or ½ cup egg substitute 12 60 1 slice low fat cheese 5 40 2 ounces Carb Masters yogurt 4 26 Total: 21 126 Lunch 3 ounces chicken boiled and blended 21 90 2 tbsp fat free Italian dressing 0 10 ½ cup carrots 0.6 27 salt and pepper Total: 21.6 127 or 3 ounces of chicken boiled and blended 21 90 1 tbsp fat free sour cream 1 15 ½ cup green beans 0.8 13 salt and pepper Total: 22.3 118

Dinner 3 ounces of salmon packed in water and blended 17 118 ½ teaspoon herbs and spices 0 0 ½ cup asparagus 2.2 20 Total: 19.2 138

or

3 ounces of tuna packed in water and blended 21 90 1 tbsp fat free mayo 0 10 ½ cup beets 0.8 26 salt and pepper Total: 21.8 126


STAGE 4 - HIGH PROTEIN LOW CARBOHYDRATE DIET

• Begins immediately after 2 weeks of blended foods and lasts until approximately 75% or more of excess weight loss is achieved.

• The most significant changes during this stage include:

You should now be able to tolerate regular consistency foods. You are allowed more variety of protein sources, including grilled foods.

Please see protein list following for additional protein choices allowed at this time.

The choices of group B vegetables are still limited for the first 3 months. You may add frozen and/or fresh COOKED vegetables at this time; however you need to avoid raw vegetables for the 1st 3 months. Raw vegetables are more fibrous and gas-producing. All vegetables should be cooked thoroughly and cut into small pieces.

• Do not force yourself to eat if you are still full from the last meal, but do try to consume 3 meals each day, with a minimum of 60 grams of protein per day. Meals should be spaced 4-6 hours apart. If you are having trouble meeting your protein goals, please contact the dietitian for further recommendations.

• Begin to add new foods from the protein list into your meals. When you try a new food for the first time, do so in small amounts and at home, just in case you do not tolerate it. If you do not tolerate a particular food, wait a couple of weeks and try it again.

• NO SNACKING

• NO LIQUID CALORIES – this includes items such as ice cream, milk shakes, frozen yogurt, milk, fruit juice, smoothie king, coffee drinks, etc.

• For the first 6 months or until you have lost ≥75% excess weight, avoid: RED MEAT (BEEF) and PORK

• UNTIL YOU HAVE REACHED YOUR GOAL WEIGHT: (≥75% excess body weight lost) NO PASTA, RICE, FRUIT, POTATOES, BEANS, OR BREAD/BREAD PRODUCTS (INCLUDING CRACKERS, CEREAL, TORTILLAS, ETC.)

• NOTE: Please do NOT add any foods to your diet prior to surgeon/dietitian approval!


PROTEIN INFORMATION

• Remember to CHEW, CHEW, CHEW (27 times) so that the food can pass through the small stomach opening.

• As a general rule of thumb, 1 ounce of protein = 7 grams of protein. You need 3 ounces

of protein per meal to reach the minimum goal of 60 grams of protein per day. Scales are a good idea in the beginning, but are not necessary.

• Turkey or chicken breast: white meat only (no dark meat) and not breaded or fried. • Lean protein sources should be baked, broiled or grilled. Remember to remove the

skin from chicken or turkey. Fish or shellfish (shrimp, crab, lobster, scallops, oysters, and clams) are good choices. These protein sources provide 35 calories per ounce.

• Ground turkey or chicken may be used for hamburger patties • Finely chopped, cooked chicken or turkey breast may be used for salads (make with

light mayo or light salad dressing) or used for stir fry • “Flavored packages” of salmon, tuna and chicken are available such as lemon pepper,

etc. Check the total carbohydrates to make sure it is less than 5 grams per serving. • Canned water-packed tuna or salmon (1/4 cup = 1 ounce of protein) • 1 egg, 2 egg whites, or ¼ cup of egg substitute = 1 ounce of protein • Tofu = 2.5” x 2” square = 1 ounce of protein (Tofu takes on the flavor of whatever it is

cooked with). Tofu is used in stir-fry, added to scrambled eggs or chicken, etc. • ¼ cup of low fat or fat free cottage cheese = 1 ounce of protein • Choose low fat or fat free cheese in your diet. Do not use cheese as a main protein

source; instead use cheese to add to eggs or meats as a condiment. • Red meat and dark meat are higher in calories than lean meats and fish. Beef and

pork contain 55 - 75 calories per ounce of meat compared with only 25 - 35 calories per ounce of fish and poultry.


LEAN PROTEIN SOURCES: (YOUR NEW FAVORITE FOODS) FOOD PORTION PROTEIN CARBS CALORIES DAIRY: LOW FAT 1% COTTAGE CHEESE ½ CUP 14 3 90 LOW FAT CHEESE 1 SLICE 5 1 40 CARBMASTERS (KROGER) DAIRY BEVERAGE, ORIGINAL OR VANILLA

1 CUP 11 3 60

FAGE GREEK YOGURT, PLAIN 6 OZ 18 7 100 STONYFIELD OIKOS GREEK YOGURT, PLAIN 5.3 OZ 15 6 80 CHOBANI NON-FAT GREEK YOGURT, PLAIN 6 OZ 18 7 100 KROGER CARB MASTERS YOGURT, FLAVORED 6 OZ 8 4 60-80 KROGER LIGHT GREEK YOGURT, FLAVORED 5.3 OZ 14 7 80 SEAFOOD: BASS- STRIPED BAKED OR BROILED 3 OZ 19 0 105 BLUEFISH BAKED 3 OZ 22 0 135 CARP BROILED AND BAKED 3 OZ 19 0 138 CATFISH, BAKED 3 OZ 16 0 130 CLAMS CANNED OR STEAMED ½ CUP 12 4 70 CODFISH BAKED 3 OZ 20 0 90 CRAB KING STEAMED 3 OZ 16 0 82 CRAB BLUE STEAMED 3 OZ 17 0 87 CRAB CANNED 3 OZ 17 0 84 FLOUNDER BAKED 3 OZ 21 0 99 GROUPER BAKED 3 OZ 21 0 100 HADDOCK BAKED 3 OZ 21 0 95 HALIBUT BAKED 3 OZ 23 0 119 HERRING ATLANTIC BAKED 3 OZ 20 0 172 LOBSTER BROILED NO BUTTER ½ CUP 15 1 71 MACKEREL BAKED 3 OZ 20 0 223 MUSSELS CANNED OR STEAMED 3 OZ 20 6 147 OYSTERS STEAMED 3 MED. 15 2 123 OYSTERS CANNED 3 OZ 10 3 100 PERCH BAKED 3 OZ 21 0 99 POLLACK BAKED 3 OZ 21 0 100 POMPANO FLORIDA BAKED 3 OZ 20 0 179 ORANGE ROUGHY BAKED 3 OZ 16 0 75 SALMON BAKED 3 OZ 22 0 155 SALMON CANNED PINK 3 OZ 17 0 118 SALMON SMOKED 3 OZ 15 0 99 SCALLOPS BAKED 3 OZ 14 0 75 SHRIMP CANNED 3 OZ 20 0 102 SHRIMP BOILED 3 OZ 17 0 90 SOLE BAKED 3 OZ 21 0 99 SQUID STEAMED 3 OZ 15 3 149


SWORDFISH COOKED 3 OZ 22 0 132 TILAPIA BAKED 3 OZ 17 0 82 TROUT BAKED 3 OZ 23 0 162 TUNA PACKED IN WATER 3 OZ 21 0 90 POULTRY: PORTION PROTEIN CARBS CALORIES CHICKEN OVEN ROASTED NO SKIN 3 OZ 16 0 90 CHICKEN DELI THIN SMOKED BREAST 3 OZ 16 0 90 CHICKEN SAUSAGE 1 LINK 15 1 130 TURKEY BOLOGNA 3 OZ 12 0 165 TURKEY BREAST 3 OZ 20 0 92 TURKEY BREAST TENDERLOIN 3 OZ 22 2 100 TURKEY GROUND COOKED 3 OZ 21 0 170 TURKEY BREAST GROUND 3 OZ 26 0 120 TURKEY HAM DELI SLICES 4 OZ 20 0 143 TURKEY BACON SLICES APPLEGATE FARMS ALL-NATURAL

2 SLICES 12 0 70

EGGS: EGGS HARD COOKED OR POACHED 1 6 0 75 EGG SUBSTITUTE ½ CUP 12 0 60 EGG WHITES 4 14 0 69 VEGETABLE PROTEINS: TOFU, FIRM ½ CUP 20 1 183 TOFU, SOFT ½ CUP 10 0 60 TRADER JOE’S ORGANIC TOFU 3 OZ 8 0 60 TRADER JOE’S ORGANIC FIRM TOFU 3 OZ 10 1 90 TRADER JOE’S ORGANIC EXTRA FIRM TOFU 3 OZ 12 1 100 YVES MEATLESS HOT DOG 1 LINK 10 2 50 YVES MEATLESS BEEF STRIPS ½ PKG 23 4 120 YVES MEATLESS BOLOGNA 4 SLICES 12 2 80 YVES CANADIAN BACON 3 SLICES 17 2 80 BOCA BURGER FLAME GRILLED 1 PATTY 14 7 90 BOCA BURGER VEGAN VEGGIE BURGER 1 PATTY 17 7 90 MORNINGSTAR FARM VEGGIE SAUSAGE PATTIES HOT & SPICY

1 PATTY 8 3 70

MORNINGSTAR FARM VEGGIE SAUSAGE PATTIES 1 PATTY 10 3 80 MORNINGSTAR FARM GRILLER ORIGINAL 1 PATTY 15 5 130 MORNINGSTAR FARM MEAL STARTERS CHICKEN STRIPS

12 STRIPS 23 6 140

LIGHTLIFE SMART DOGS 2 LINKS 16 4 90 LIGHTLIFE SMART DELI, BAKED HAM STYLE 4 SLICES 12 3 70 LIGHTLIFE SMART BACON, BACON STYLE STRIP 1 SLICE 2 0 20 TRADER JOE’S CHICKEN-LESS STRIPS 9 STRIPS 20 3 110 TRADER JOE’S BEEF-LESS STRIPS 9 STRIPS 20 5 120 GARDEIN CHIK’N FILETS 2 FILETS 20 7 120


GARDEIN TUSCAN BREASTS 1 PIECE 21 6 120 QUORN NAKED CHIK’N CUTLETS 1 PIECE 11 5 80 WEST SOY CHICKEN-STYLE SEITEN SEASONED WHEAT PROTEIN

5 OZ 20 4 110

WEST SOY SEITEN GROUND WHEAT PROTEIN ⅓ CUP 24 8 140 WEST SOY SEITEN STRIPS WHEAT PROTEIN ⅓ CUP 24 8 140 WEST SOY SEITEN CUBED WHEAT PROTEIN ⅓ CUP 24 8 140 VENISON: VENISON, BONELESS ROASTED 3 OZ 26 0 134

PROTEIN SOURCES THAT MAY BE ADDED ON OCCASION AFTER ≥75% EXCESS WEIGHT LOSS ACHIEVED (PLEASE WAIT UNTIL SURGEON APPROVAL):

BEEF: PORTION PROTEIN CARBS CALORIES GROUND BEEF EXTRA LEAN 3 OZ 21 0 213 TOP SIRLOIN, LEAN, BROILED 3 OZ 26 0 156 ROAST BEEF WELL TRIMMED 3 OZ 18 0 165 BEEF LIVER 3 OZ 23 0 184 VEAL: VEAL CUTLET LEAN 3 OZ 31 0 172 VEAL GROUND BRIOLED 3 OZ 21 0 146 LAMB: LAMB LEAN BRAISED 3 OZ 29 0 190 LAMB LOIN CHOP (LEAN) BROILED 3 OZ 21 0 225 PORK: CANADIAN BACON 3 OZ 18 0 134 HAM, BONELESS COOKED 3 OZ 14 0 90 HAM, HONEYHAM NO GLAZE 3 OZ 15 0 150 LEAN DELI THIN SLICES 4 SLICES 8 0 60 PORK: CENTER LOIN 3 OZ 24 0 265 PORK: PORK ROAST 3 OZ 15 0 105

Make sure to weigh at least once a week, but no more often than once a day in order to track trends in your weight loss. At Centennial, we recommend weighing first thing every morning.


• THREE MONTHS POST-OP: you may add the following vegetables for variety, as tolerated (up to ½ cup cooked or 1 cup raw).

Asparagus Bamboo shoots Bean Sprouts Beets Bell peppers Broccoli Brussels sprouts Cabbage Carrots Cauliflower Cucumbers

Eggplant Green beans Green onions

Greens(mustard/turnip/collard) Kale

Leeks Leafy Lettuce Mushrooms Okra Onions

Peapods (snow peas) Radishes Salad greens Spinach Summer squash Tomatoes Turnips Water chestnuts

Zucchini

• Once you have achieved ≥75% excess weight loss: You will meet with your surgeon and dietitian to discuss what foods may be added and you will be given an appropriate meal plan at this time. You will always follow the same concepts but in order to maintain your weight, your calories will need to be increased some and you can follow a little more of a balanced diet.

• Limited amounts of red meat (beef), pork, and veal may be added at this time at your surgeon/dietitian’s discretion, depending on your weight loss percentage and goal. Keep in mind these foods are more difficult to digest and need to be chewed extremely well (20 times per bite). They also contain up to double or triple the calories per ounce (compared to fish and poultry).

• See sample menus following—note these are for weight loss. Your calories will be increased upon achieving goal weight. See maintenance section.

Remember, you are limited to <500 calories with 60-80 grams protein, and expected to drink at least 64 ounces minimum of fluid every day. You should eat 3 ounces of protein 1st at every meal, then if you have room, up to ½ cup of low carb vegetables.


Sample Menus for a 500 calorie meal plan Breakfast: 1 egg plus 2 egg whites, scrambled 1 oz. mozzarella cheese 1 T. mild salsa ¼ cup mushrooms Lunch: 3 oz. grilled chicken breast ½ c. green beans Supper: 3 oz. baked cod 1 c. salad greens 2 T. fat-free Italian dressing Breakfast: ¾ c. 1% low fat cottage cheese Sprinkle with Crystal Light or Sugar-free Jello powder, if desired OR season with onion powder, garlic powder, oregano, salt/pepper, as desired Lunch: 3 oz. flavored tuna foil pouch 1 c. tossed salad greens 2 T. fat-free Italian dressing Supper: 3 oz. grilled chicken tenderloins ½ c. asparagus


Breakfast: 2 eggs plus 2 egg whites, scrambled 1 slice uncured turkey bacon (such as Applegate Farms) 1 T. green pepper, cooked with nonstick cooking spray in pan 1 T. diced onion, cooked with nonstick cooking spray in pan 1 T. mild salsa Lunch: 3 oz. shrimp ½ c. tossed salad greens 2 T. fat-free Italian dressing Supper: 3 oz. extra lean ground turkey, cooked and drained ½ c. tomatoes and fresh cilantro Breakfast: 6 oz. Kroger Carb Masters yogurt ½ scoop unflavored or strawberry Unjury mixed in for protein Lunch: 3 oz. turkey burger patty (made with extra lean ground turkey) 1 c. lettuce and tomato Supper: 3 oz. grilled salmon ½ c. asparagus


Breakfast: ½ c. 1% low fat cottage cheese 1 hard boiled egg Lunch: 3 oz. crabmeat 1 c. tossed salad greens 10 sprays Salad Spritzers (any flavor) Supper: 3 oz. grilled chicken breast ½ c. broccoli Breakfast: 1 egg plus ½ c. egg substitute 1 oz. mozzarella cheese ½ c. diced tomato and onion Lunch: 3 oz. baked tilapia ½ c. spinach Supper: 3 oz. turkey tenderloin ½ c. carrots


Breakfast: 6 oz. fat free Greek-style yogurt (plain) 1 tsp. sugar-free preserves or Mio water enhancer, to taste Lunch: 3 oz. flavored chicken foil pouch ½ cup green beans Supper: 3 oz. baked scallops ½ c. summer squash Breakfast: ½ cup egg substitute 1 oz. lean turkey sausage Lunch: 3 oz. grilled chicken tenderloins 1 c. tossed salad greens 10 sprays Salad Spritzers (any flavor) Supper: 3 oz. roasted turkey breast ½ cup baby carrots


Sample Vegetarian Menus Breakfast:

½ c egg substitute 1 Morningstar Farms Veggie Sausage Patty Hot & Spicy 130 calories and 20 g Protein

Lunch:

12 strips Morningstar Farms Meat Starters Chik’n Strips 1 slice low fat cheese (melted on top) Salsa (see right) 180 calories and 28 g Protein

Home-made Salsa ¼ cup chopped, fresh tomato 2 tablespoons chopped onion 2 tablespoons chopped bell pepper 2 tablespoons lime juice Salt and pepper to taste

Supper:

½ pkg Yves Meatless Beef Strips 1 slice low fat cheese (melted on top) Homemade Salsa (see recipe above) 160 calories and 28 g Protein

Breakfast:

½ c egg substitute 1 Morningstar Farms Veggie Sausage Patty 140 calories and 22 g Protein Lunch:

½ cup low fat, 1% Cottage Cheese with seasonings to taste 4 slices Lightlife Smart Deli Ham Style 160 calories and 24 g Protein

Supper:

½ cup low fat, 1% Cottage Cheese with seasonings to taste 4 slices 170 calories and 26 g Protein


Breakfast: ½ c egg substitute 1 slice Low-fat Cheese 2 slices Lightlife Smart Bacon, Bacon Style Strips 140 calories and 21 g Protein Lunch: 2 Yves Meatless Hot Dogs 100 calories and 20 g Protein Supper: 2 Lightlife Smart Dogs with 1 slice low fat (melted on top) 130 calories and 21 g Protein Breakfast: 6 oz Chobani Greek Yogurt, plain with packet of artificial sweetener & extract (vanilla, almond, orange, etc.) 2 slices Lightlife Smart Bacon, Bacon Style Strips 140 calories and 22 g Protein Lunch: 1 patty Morningstar Farm Original Griller with 1 slice low fat cheese (melted on top) 170 calories and 19 g Protein Supper: 1 patty Boca Burger Flame Grilled with 1 slice low fat cheese (melted on top) 130 calories and 19 g Protein


List of foods recommended and foods to avoid starting STAGE 4 Food/Beverage Foods Recommended Foods to AVOID

Protein Eat 1st 3-5 ounces per meal

*See lean protein list* Eggs, egg substitute, fish, chicken, turkey, low fat cottage cheese and cheese.

NO Fried or high fat meats, fried eggs, highly seasoned or spicy meats, skin of meats and tough meats. Avoid red meat (beef, pork, lamb, veal) during the first 6 months.

Vegetables (low carbohydrate) Eat 2nd Each meal, no more than: ½ cup (serving size adjusted as wt loss goal achieved per RD)

Soft cooked fresh, frozen or canned vegetables such as carrots, beets, mushrooms, spinach, squash, green beans, asparagus, turnip greens. NO RAW VEGETABLES for 3 months.

NO vegetables with tough skin or seeds (such as tomatoes, celery). Cabbage, cauliflower, broccoli, and brussel sprouts may cause gas distress. No acidic vegetables. Avoid FIBROUS foods.

Moderate carbohydrate foods Eat 3rd (serving size adjusted as wt loss goal achieved per RD)

NONE until goal weight NO bread, pasta, rice, potatoes, or fruit until goal wt is reached. No beans/corn/peas/legumes until goal met. When and if pasta and rice introduced in diet, needs to be over-cooked, 3-4 mins beyond time on package. Coarse bran cereals and beans may cause gas distress. Tough skin on corn. Melons and raw apples may cause gas distress. No yogurt sweetened with sugar. NO Concentrated Sweets.

Soups Broth only. This can always be used as part of fluid between meals and is a free food.

All other soups are discouraged. These are not a good protein source. NO creamed soups.

Fats Smart Squeeze, Molly McButter, Butter Buds, Pam, Fat Free Parkay butter spray, fat free salad dressings, nonfat/lowfat mayonnaise. Also refer to free food list in stage 3.

NO regular butter, margarine, oil, regular mayonnaise, salad dressings, sour cream, cream cheese, or peanut butter. Bacon is a fat, not a protein source (Tip: look for uncured turkey bacon).

Sweets Sugar free jello, sugar free popsicles. No other sweets are recommended.

All sweets and desserts, including no sugar-free puddings.

Beverages Water, decaf coffee/tea, Crystal Light, sugar free Kool-Aid, sugar free Tang, Fruit 2 0, Dasani fruit flavored water, any other beverages that do not have calories or carbonation. (Diet carbonated drinks after your surgeon’s approval only.)

Alcohol, milk, beverages sweetened with sugar, specialty coffee drinks, coffee creamer.

Miscellaneous Iodized salt, pepper, and herbs. Strongly flavored dry seasonings as tolerated. Sugar-free breath mints in moderation- watch sugar alcohols

Jalapenos, nuts, seeds, tough skins. Gum-due to risk of accidentally swallowing and getting “stuck” in stoma.


RECIPE IDEAS

TURKEY BURGERS

1 lb. lean ground turkey 1 1/2 tbsp. horseradish 1 1/2 tsp. paprika 1 1/2 tsp. Dijon-style mustard 1/4 tsp. pepper 1/2 tsp. salt In a large bowl, combine turkey, horseradish, paprika, mustard, pepper and salt. Shape meat mixture into 4 patties, each 1/2 inch thick. On lightly greased broiling pan, about 6 inches from heat, broil burgers 3 to 4 minutes per side, or until no longer pink in center.

To spice up your protein, try...

Chicken: ginger, lemon/lime juice, marjoram, oregano, paprika, poultry seasoning, rosemary, sage, tarragon, thyme

Fish: curry powder, dill, dry mustard, lemon/lime juice, cilantro, marjoram, paprika, pepper

Pork: garlic, onion, oregano, pepper, sage Beef: bay leaf, garlic, marjoram, nutmeg, onion, pepper, sage, thyme

For flavoring your vegetables...

Asparagus: thyme, parsley, lemon juice, garlic powder Broccoli: garlic powder, lemon juice, grated parmesan, rosemary Carrots: cinnamon, cloves, marjoram, nutmeg, rosemary, sage Cauliflower: garlic powder, rosemary, cumin, curry powder Green Beans: curry powder, dill, lemon juice, marjoram, oregano, tarragon,

thyme Greens: onion, pepper Summer Squash: cloves, curry powder, marjoram, nutmeg, rosemary, sage,

oregano Winter Squash: cinnamon, ginger, nutmeg, onion


Food Labels

• Read all food labels to determine the nutrient contents and be on the lookout for hidden sugars

• Be careful when reading labels at the market. Quoted nutrition facts are based on the stated serving size, and you may not be able to eat the full serving size. When recording the amount of protein in your food journal, use the following information to help you record the actual amount of protein you are eating. ½ cup = 8 Tablespoons ¼ cup = 4 Tablespoons 1/8 cup = 2 Tablespoons

• Compare the other nutrients...a food high in protein that is also high in carbohydrates or fats would NOT be a good choice. Example: 2 Tbsp. peanut butter = 200 calories, 16 gm fat, 7 gm carbohydrates, 8 gm protein

• Based on your nutritional goals for weight loss, your meal intake should be restricted to less than 200 calories with more than 20 grams of protein and approximately 5 gm carbohydrates.

• Note: Sugar Alcohols are considered a “nutritive sweetener”. Sugar alcohols generally have half the sweetness and half the calories of sugar. BE CAREFUL of these, which can impact your calorie intake significantly and can result in diarrhea. These are different from non-nutritive sweeteners that do not contain calories such as Equal (aspartame) or Sweet ‘n Low (saccharin). Splenda (Sucralose) may be used in small amounts.


KEYS TO SUCCESS

1. Take all vitamin and mineral supplements in the forms and amounts recommended. Do not follow directions on bottles. Refer to dietitian recommendations for correct dosage due to different needs for age and gender.

2. Remember to record food diary daily. This will help you learn to use proper portion sizes, learn nutritional value of foods and to ensure you are meeting protein needs, not exceeding the recommended calorie level you need and make you more aware of your fluid intake. Download an app such as myfitnesspal or loseit.

3. NO liquid calories. This includes fruit juice and skim milk in between meals. All beverages should be calorie-free, sugar-free and non-carbonated. Remember that extra calories from liquids can quickly put you over your calorie limit!

4. Do not eat and drink together. Separate eating and drinking by 30 minutes. Stop drinking 30 minutes before the meal, then eat the meal, and then resume drinking fluids 30 minutes after finishing the meal.

5. DO NOT PUT MORE THAN A TOTAL OF 6 OUNCES OF FOOD IN FRONT OF YOU AT ONE TIME! It may help to use a small plate and a child’s spoon to make the food look like more on the plate.

6. Eat slowly and chew thoroughly. It should take you approximately 30-45 minutes to eat a meal. Chew food 20 times or more. Food needs to be chewed into small pieces so that it can pass through the new opening.

7. PORTION CONTROL IS KEY! Stop before you feel too full. Learning this sensation is very important. One too many bites may cause vomiting, which of course we want to avoid. If vomiting occurs, try to learn from it by asking yourself - Did I eat too fast? Did I not chew thoroughly? Did I eat too much? Did I take too big of a bite? In time, you will be able to tolerate most foods, just in smaller portions. Don’t rush.

8. Drink 64 ounce or more fluid each day. 64 ounces is a minimum! Use thirst and urine concentration as a guide. This also helps prevent constipation, along with the recommended small amount of vegetables and plenty of walking. Sip all liquids. Do not gulp.

9. Nutrition tips: Weigh yourself daily, first thing in the morning. Stick to nutritional goals determined by your surgeon and dietitian, and follow up with recommended routine labs to check for nutritional deficiencies.

10. Remember to stay involved with the program, including dietitian, exercise physiologist, and support groups. You are expected to attend support groups on a regular basis. See meetings list for specific times and locations.


Exercise!! Aerobic exercise: Brisk physical activity that requires the heart and lungs to work harder to meet the body's increased oxygen demand. Aerobic exercise promotes the circulation of oxygen through the blood. – www.medterms.com A combined program of aerobic training and resistance training induces a significant increase in muscular strength and aerobic power, a decrease in body fat, and an increase in basal metabolic rate. –McArdle, Katch, Katch Exercise Physiology Top 25 Reasons To Exercise!

1. Achieve…and maintain goal weight 2. Build muscle tissue 3. Increase metabolism 4. Increase strength and endurance 5. Increase flexibility 6. Improve mobility 7. Increase capacity for physical work 8. Improve skin elasticity 9. Enhance mood 10. Improve self-esteem 11. Improve mental alertness and memory 12. Decrease stress, depression, and anxiety 13. Promote sleep 14. Increase energy level 15. Improve heart and lung function 16. Lower blood pressure 17. Lower blood sugar 18. Improve cholesterol (increase HDL, Lower LDL) 19. Strengthen bones and reduce bone loss 20. Reduce stiffness in joints 21. Promote healing 22. Help smoking cessation 23. Improve posture 24. Increase life expectancy 25. Because your Exercise Physiologist said so!

http://www.medterms.com/


4 Steps to a Physically Active Lifestyle

Step 1: Set personal goals. Set goals based on the “Top 25 Reasons To Exercise”

Example: “My goal is to increase my energy level.” Tip: Write your goals down so you can refer back to them for encouragement.

Step 2: Determine how to achieve your personal goals.

Choose activities that fit your lifestyle. Incorporate cardiovascular, strength, and flexibility activities into your plan.

Examples: Cardiovascular – walking, biking, treadmill, water exercises Strength Training – weight machines, free weights, resistance bands Flexibility – stretching before and after exercise

Schedule time for your physical activity. (use FIT) Frequency: number of exercise sessions per week Intensity: use your target heart rate * 220 – age – resting heart rate X .6 + resting heart rate * 220 – age – resting heart rate X .85 + resting heart rate Resting heart rate is the number of beats per minute at rest. The first equation is for the low end of your target heart rate, the second is for the high end. Remember, if you take medications that lower your heart rate this formula will not work. Time: the amount of time you exercise each day

Choose a location for exercise Examples: home, work, park, gym, mall, church, school

Step 3: Implement your plan.

Make a commitment and start today. Get started slowly and pace yourself Stay consistent Fit physical activity into your daily routine

Step 4: Regularly evaluate your plan. Discuss your program with the exercise physiologist Monitor your progress Recognize achievement of your goals


Exercise is an important part of living a healthy lifestyle. An exercise program should be started slowly, increasing in time and intensity as you become accustomed to physical activity. New patients should begin exercising before surgery and continue the program after surgery. 1 Week Post Op At 1 week post op you should be walking on a daily basis. Start walking for 5 to 10 minutes 3 to 4 times a day (or where you feel comfortable). Increase your walking as you feel better and get more energy. You want to be working toward 45 to 60 minutes 5 to 6 days a week of cardiovascular exercise. Walking, biking, elliptical, swimming (after wound sites have healed), and aerobics (water, tapes, or classes) are all great choices. Your goal is to be more active. You also want to be walking with a pedometer. You want to set a goal of 10,000 steps a day and work toward that goal. Your exercise is included in your 10,000 steps. If you are interested in lifting weights you need to wait until you are 4 to 6 weeks post op. Then you may start a light program with 1 to 2 sets of 10 to 15 repetitions every other day. 6 Weeks to 1 Year Post Op You want to continue with your exercise program while you are losing your weight. 45 to 60 minutes of cardiovascular exercise 5 to 6 days a week. You have a variety of choices like walking, the elliptical machine, biking, swimming, and aerobics. Getting in your cardio during your weight loss is very important. If you are lifting weights remember to keep your weight light and your repetitions high. 1 to 2 sets of 8 to 12 repetitions every other day. You may gradually increase resistance as it becomes easier. Ladies, if you are going to Curves, that’s great. Just remember that Curves isn’t enough by itself. Go to Curves 3 days a week and walk 45 to 60 minutes 3 days a week. Also remember my newest recommendation, 10,000 steps a day with a pedometer. Your exercise is included in the 10,000 for the day.


Maintenance Just because you have reached your goal weight does not mean you can stop exercising. You want to continue with at least 3 to 5 days a week for 30 to 45 minutes. This will make maintaining your weight easier and help with your long term health. Feel free to continue with your weight loss program. Maintaining your weight is about balancing calories in and calories out, so look for your best combination of healthy diet and exercise. Using a pedometer daily and getting in 10,000 steps a day with also help with your maintenance.

General Tips Cardio or Aerobic? Cardiovascular (cardio) exercise refers to exercise that strengthens the cardiovascular system. Aerobic just means in the presence of oxygen, and aerobic exercise refers to exercise that lasts long enough to require oxygen. The same type of exercise satisfies both of these qualifications, and the terms cardio and aerobic exercise are used interchangeably. Aerobic/cardio exercise uses large muscles, usually the legs, in a rhythmic fashion. Examples are running, walking, bicycling, swimming, cross-country skiing, rowing, skating, and machines such as stair steppers and elliptical trainers. No Fat Burning Zone Although you burn a higher percentage of fat calories at slow and moderate aerobic intensities, you burn more total calories, and more total fat calories, when you exercise at higher intensities. You may choose to work out longer and/or slower for various reasons, but never slow down just because you think that´s necessary to be in a "fat burning zone." Which Workout? The effectiveness of aerobic workouts depends on intensity and duration. As long as you get your heart rate into a training zone, any form of aerobic workout will have the same effectiveness if maintained for the same time. So you can use any type of exercise you enjoy, or go from one aerobic workout mode, or one machine, to another. No type of aerobic exercise is inherently better than the others. Your heart doesn´t know the difference.


Fat to Muscle It is a common fallacy that working out with weights will cause your fat to turn to muscle. Muscle and fat are two different kinds of tissue. When you do weight training, you will build up muscle, but that muscle will take the place of fat that you lose. When you first start a weight loss diet program, you may want to concentrate on cardio exercise, along with your healthy eating, and add weight training later. If you prefer, you can start weight training right away, but don't neglect the cardio. Ten Thousand Steps As the old saying goes, the journey of a thousand miles begins with one step. How about 10,000? An interesting new way to make sure you are getting enough exercise to improve your health and fitness is to count the steps you take during the day. The target is 10,000. You can count them however you figure out (it´s a footstrike, so left-right is 2) or use a device called a pedometer. Running or jogging steps count as well as walking, and the device counts steps on the treadmill, StairMaster, elliptical trainer, and pedal revs on the upright but not recumbent bike. Steps taken during sports like tennis or soccer will also count. You´ll probably be surprised at your total, but this is a great health and fitness motivational technique for your fitness workout. 10,000 can help control weight as well as improving cardio fitness, cholesterol levels, blood pressure, and diabetes risk. Fibromyalgia If you have fibromyalgia, don't fear fitness. Although fibromyalgia is characterized by chronic pain, a fitness program relieves the symptoms, as well as improving overall health and fitness. For many people with the condition, exercise works better than any other treatment. Start slowly and avoid activities with a lot of impact. Weight training is good, but start with light weights and one set. Increase weight when you can without causing pain. Exercise at Night Most of us avoid vigorous exercise at night because it might interfere with sleep. Recent research with highly fit cyclists showed that vigorous exercise ending 30 minutes before bedtime did not interfere with sleep. This may apply more to fit people and will vary by individual, but if you have trouble getting your workout in during the day, you can give a nighttime exercise plan a try.


Set Aside Half an Hour There are 32 half-hours left in a day, if you sleep 8 hours. Can you spare one for fitness? Make an exercise plan and schedule your half-hour right now. Go for a half hour of power or anything else that sounds good and gets you moving. Water Exercise Helps Joints Water aerobic exercises and swimming allow people with joint problems and other medical conditions to get a good workout without pain and jarring. People with arthritis should do water exercises in a warm pool, while those with multiple sclerosis need cool water. Spot Reducing Can you spot a scam in strength training claims? There´s no such thing as spot reducing, despite efforts in some bodybuilding magazines to prove otherwise. Although weight training crunches will tighten up your abs and make them look better, as well as protect your lower back from injury, they will not melt the fat on your midsection. You still need a low fat diet and a weight training routine that includes cardio exercise. Wheelchair Exercise If you have use of your upper body, there are a number of exercises you can do in a wheelchair. (If you can't use your arms, check with a physical therapist for exercise you can do.) You can do a lot with elastic exercise bands. There are usually exercises shown on the package the bands come in, including exercises for the chest, back, and arms. You can get some dumbbells and do arm and shoulder exercises with those. Do about 15 repetitions of each exercise and go quickly from one to the next to get cardio benefit as well as strength. Here are a couple of exercises you can do without equipment to get started: Suck your stomach in and hold for a couple of seconds. Relax and repeat; Bend your arms in front of your chest and put your hands together and push. Release and repeat; Push down on the arms of your chair for a second, relax and repeat. Do 6 or 8 repetitions of each. Don't hold your breath! Ankle Weights Never use ankle weights when walking for exercise. Your ankles have enough work to do in fitness walking. Wrist or hand weights are not as likely to cause injury as ankle weights, but can still stress your joints. If you want to burn more calories during walking exercise, walk farther or faster. If you want to get stronger, lift weights.

Centennial Center for the Treatment of Obesity – Vertical Sleeve Gastrectomy Owner’s Manual – revised 01/2017 ph/jc 1

VITAMINS AND MINERALS

• Although there is no MALABSORPTION with vertical sleeve gastrectomy surgery, to ensure continued nutritional health, you MUST take recommended amounts and types of vitamins and minerals for the rest of your life. We recommend sugar-free chewable forms of vitamins and minerals to make certain that the supplement is completely broken down to a form that is easily digested and absorbed.

• No whole pills for at least the first six weeks! At your six week follow up appointment, the surgeon may choose to allow you to resume taking whole pills.

• Please ask your surgeon or dietitian BEFORE beginning any additional vitamin or mineral supplements besides those advised per manual. You may start the recommended vitamin and mineral supplements once you get home from the hospital.

• Medications, vitamins, and minerals that are available in a capsule may be opened and sprinkled over food. This applies to gel caps as well. You should pierce open any gel caps and swallow content- DO NOT swallow gel caps. Tablets also need to be crushed or split into small pieces until your surgeon recommends otherwise.

• Take nutritional supplements only as prescribed by your physician or dietitian. This includes vitamins/minerals, protein shakes, supplements, and protein bars.

• A pill organizer is a good idea to help you remember to take vitamins and minerals. Plan a schedule of when to take your daily, weekly or monthly vitamins. See sample schedule following on page 3.

Remember: your vitamin supplements are forever after surgery!


VITAMIN & MINERAL SUPPLEMENTS DAILY REMINDER AND RECOMMENDATIONS PLEASE FOLLOW THE SPECIFIC RECOMMENDATIONS GIVEN TO YOU BY your surgeon and dietitian. The recommendations are very specific. Please pay close attention to the types and dosage. Do not follow directions on bottle of products. Refer to this page for your needs. (CIRCLE ONE FOR EACH SUPPLEMENT YOU NEED) The dietitian will go over this with you

MULTIVITAMIN &

MINERALS WITH IRON

3 BARIATRIC ADVANTAGE ULTRA MULTI FORMULA

WITH IRON CAPSULES PER DAY

2 BARIATRIC ADVANTAGE

ADVANCED MULTI EA CHEWABLES PER DAY

OTHER BARIATRIC

COMPLETE MULTIVITAMIN/MINERAL SUPPLEMENT THAT MEETS

ASMBS GUIDELINES CALCIUM CITRATE

OR CALCIUM CARBONATE

(MUST SPLIT DOSAGE-

OUR BODIES ONLY ABSORB UP TO 600 MG OF CALCIUM AT ONCE)

1000 MG FOR MEN

1200 MG FOR MENSTRUATING

WOMEN OR FOR NON-MENSTRUATING

WOMEN ON ESTROGEN THERAPY

1500 MG

FOR WOMEN NO LONGER

MENSTRUATING OR NOT TAKING ESTROGEN AND FOR THOSE WHO HAVE

OSTEOPOROSIS, ABNORMAL BONE SCAN

RESULT OR MD RECS

VITAMIN B 12

RX FOR NASCOBAL NASAL SPRAY- 1 PUFF 1 X / WEEK

MONTHLY INJECTION

(Intramuscular)

1000 MCG 1 X PER WEEK

(DISSOLVED UNDER TONGUE)

OMEGA 3 FATTY ACID

(Begin in stage 3)

COROMEGA SUPPLEMENT

1 PACKET PER DAY

(Do NOT Recommend Soft Chews!)

INCLUDE 3 OUNCES OF TUNA, SALMON,

MACKEREL, HERRRING OR SARDINES IN DIET 2-3 TIMES PER WEEK

FISH OIL SOFT GEL- PIERCE OPEN AND SWALLOW

CONTENTS ONLY. TAKE AS MANY AS DIRECTED ON

THE BOTTLE.

IRON

(MUST BE TAKEN 2 HOURS APART FROM

CALCIUM, COFFEE, TEA OR DAIRY PRODUCTS)

BARIATRIC ADVANTAGE CHEWABLE IRON

29 MG

OR 60 MG

IRON POLYSACCHARIDE (MUST OPEN CAPSULE)

150 MG 1X DAY

OR 150 MG 2X DAY

NONE NEEDED

(IRON IS ONLY NEEDED BY MENSTRUATING WOMEN

OR IF IRON LEVELS ARE DEPLETED)

VITAMIN D

(Please Note: Bariatric Advantage capsules may

be swallowed 1 week after surgery)

BARIATRIC ADVANTAGE

DRY VITAMIN D 5,000 IU 1 X DAY

FOR 1ST 4 MONTHS

VITAMIN D WILL BE PRESCRIBED ON AN AS

NEEDED BASIS BY YOUR SURGEON BEYOND 4 MONTHS POST-OP

Bariatric Advantage Supplements are available onsite


Daily Vitamin and Mineral Supplement Schedule

Breakfast

Multivitamins

Vitamin D 1st 4 months, then as directed

Omega 3 Fatty Acid, if needed

Lunch

Calcium

Dinner

Calcium

Bedtime

Iron, if needed

Probiotic, optional

*If you are on an additional iron supplement, it is best to take it

2 hours apart from any dairy products, calcium, coffee or tea for

maximum absorption. Calcium can be rearranged if you choose

to move from bedtime to mid-morning or mid-afternoon.

Sleeve patients need B-12 in one of the following forms:

Sublingual (tablet you place under your tongue) weekly

Prescription nasal spray (once per week)

Prescription injection (monthly)


RECOMMENDED VITAMIN AND MINERAL SUPPLEMENTS AND WHERE THEY ARE AVAILABLE: Multivitamins (Choose 1 of the following): Bariatric Advantage Essential Multi chewables (these do not contain iron), Advanced Multi EA

chewables, or Ultra Multi Formula with Iron capsules: available onsite, or visit www.cmcwls.com- click e-store or call 1.800.898.6888

Flintstones Complete children’s chewables, Centrum Adult Chewables, One-a-day complete

Bugs Bunny and friends sugar free chewables, Centrum kid’s complete, NO GUMMIES! Available at local grocery stores, discount stores or supermarkets

Omega 3 Fatty Acids (Choose 1 of the following): Coromega - orange or orange with a hint of chocolate flavored, pudding consistency, daily

supplement: www.coromega.com, www.vitacost.com, local health food stores *If you are allergic to fish, these may be an option: Neuromins DHA (Brand Names:

Solgar, Tree of Life or Natrol): www.VitaminShoppe.com *If vegetarian: Nature’s Way DHA Veg Neuromins: www.VitaminShoppe.com or Ovega-

3: www.ovega.com or available at local health food stores Eat 3 ounces of salmon, tuna, mackerel, herring or sardines 2 - 3 times per week.

Iron (choose 1 of the following if needed, as recommended on page 2): Bariatric Advantage: available onsite, or visit www.cmcwls.com- click e-store or call

1.800.898.6888. This is a chewable form of iron, available in 3 doses. It contains vitamin C, which helps with the absorption of iron.

Iron polysaccharide Complex: Fer US 150 (generic form) Niferex. This is a capsule form that you

have to open and sprinkle the powder over food. Niferex is the name brand. It must be ordered through a pharmacy, but does not require a prescription.

*IMPORTANT: For maximum iron absorption, iron should be taken at least 2 hours apart from calcium, coffee, tea, and dairy products. Vitamin B-12 (choose one of the following options):

Bariatric Advantage: available onsite, or visit www.cmcwls.com- click e-store or call 1.800.898.6888

Prescription Nasal Spray (Nascobal), taken weekly- obtain from your surgeon Monthly IM injections- obtain prescription and take to your PCP or may self-inject intra-

muscularly

http://www.cmcwls.com-/

http://www.coromega.com/

http://www.vitacost.com/

http://www.vitaminshoppe.com/

http://www.vitaminshoppe.com/

http://www.ovega.com/




Calcium (choose 1 of the following, see dosing on page 2): *Do not choose Viactiv or Citracal Creamy Bites. These contain too many calories and carbohydrates.

Chewable forms: Bariatric Advantage: www.cmcwls.com- click e-store or call 1.800.898.6888

500 mg calcium citrate in each chewable tablet or sugar-free chew, contains Vitamin D; Lozenges available in chocolate, cinnamon, mint, and wild cherry. Chews available in tropical orange, caramel, or peanut butter chocolate. Please Note: Chews contain 15 calories each and should be used in moderation due to sugar alcohols. Lozenges are calorie-free. Example: If you require 1500 mg, you may take 1 lozenge with each meal: breakfast, lunch, and dinner.

Caltrate: 1 tablet = 600 mg calcium carbonate; available at most drugstores and discount stores. Available in cherry, orange and fruit punch. Example: 1500 mg= 1 at breakfast, 1 at lunch, ½ at bedtime.

Powder form: Bariatric Advantage: available onsite, or visit www.cmcwls.com- click e-store or call

1.800.898.6888 2 scoops calcium crystals contains 600 mg calcium. Mix in flavored beverage.

Liquid form: Tropical Oasis Calcium: http://www.tropicaloasis.com or call 1.800.815.9354

contains vitamin D; 1 Tablespoon provides: 1200 mg Calcium citrate, 100 IU vitamin D, 720 mg Mg, 60 mg Boron. Example: 1500 mg= ½ Tbsp with breakfast, ½ Tbsp with lunch, and 1 teaspoon with dinner. 1½ teaspoons = 1 Tablespoon.

Tablet form: Citracal:

Available at most drugstores and discount stores 1 Petite Caplet (HAS TO BE CRUSHED) provides 200 mg Calcium citrate or 2 large tablets provide 600 mg. If you need 1200 mg, you should crush 3 petites or 2 large tablets twice/day.

Vitamin D: DO NOT TAKE 5,000 IU dose of VITAMIN D SUPPLEMENT beyond 4 months post-op without your surgeon/dietitian’s recommendation.

Bariatric Advantage: www.cmcwls.com- click e-store or call 1.800.898.6888 Dry Vitamin D 5,000 IU per capsule. Open capsule and sprinkle dry powder in mouth or over food. Take 1 capsule daily for the first 3-4 months post-op.


http://www.tropicaloasis.com/



Multivitamins - Retail Comparison

Tips for Weight Maintenance:

Your calories will be individually adjusted at this point, by the surgeon or dietitian, however you will continue the same concepts and lifestyle changes you have acquired:

1. First, eat 3 – 4 ounces of any low fat protein. 2. Second, eat a low carbohydrate vegetable that has not had any fat added to it.

(NO greasy or fried vegetables) 3. Third, eat a moderate carbohydrate. We recommend avoiding white bread, pasta and

rice. Choose whole grain foods that contain more fiber and will also help you stay full longer.

4. Please see the Dietitian for individualized meal plans to assist you with recommendations for calorie level, protein and carbohydrate grams.

This is the concept you will always follow. Protein should always make up half of your meal and should be eaten first. This way, if you fill up before eating the whole meal, at least you have fulfilled your protein requirement. However, try to make meals as balanced as possible.

Goals:

• Choose foods high in protein, low in fat and moderate in carbohydrate. • Continue to chew foods well, at least 20 times to avoid stomach distress. • Three meals per day. NO SNACKING!! • Continue a minimum of 64 ounces of fluid per day, drinking fluids in between meals. If

constipation becomes a problem, it means you have to increase your fluids. • Continue food journal. • Continue to be in contact with the dietitian for follow up. • Avoid whole milk products. Use 1% OR lower. Count milk as part of your total calories for

the day if you include it. • Avoid greasy or fried foods. • NO sugar. This is a source of “empty calories” and will limit weight loss. • Continue to take all vitamin and mineral supplements as recommended by your surgeon

and dietitian. • Avoid alcohol. Please ask surgeon for recommendations on when and how to include

alcohol in diet if desired. Alcohol contains a lot of calories. Also be aware of the potential for alcohol dependence.

Maintenance Food Guide Pyramid

2 servings/day

2 -4 servings/day

1 serving/day

9 – 12 ounces per day 60 – 80 grams/day

Why I chose to have bariatric surgery: _________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Preop weight: ___________ Height: _________ BMI: _________ Goal weight: ____________ My plan to achieve my goal weight: ___________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Weekly weigh-in: 1 9 17 25 33 41 49 2 10 18 26 34 42 50 3 11 19 27 35 43 51 4 12 20 28 36 44 52 5 13 21 29 37 45 6 14 22 30 38 46 7 15 23 31 39 47 8 16 24 32 40 48

DAILY FOOD DIARY Date: _______________

Calorie level (circle one): 400-600 600-800 800-1000 Other__________ Protein goal: 60-80 grams Fluid goal: 64oz minimum of calorie-free, sugar-free, caffeine-free fluid MEAL GRAMS OF

PROTEIN CALORIES


Brea

kfas

t

TOTAL


Lunc

h

TOTAL


Dinn

er

TOTAL

TOTAL FOR ALL MEALS

Circle each 8oz of fluid that you drink and check off your vitamin supplements

___ Multivitamin ___ Calcium (400-600 mg) ___ Calcium (400-600 mg) ___ Iron (as needed)

___ Calcium (400-600 mg) ___ Vitamin D (as needed) ___ Omega 3 fatty acid ___ B-12

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T hese are the thoughts that race through an obese person’s mind daily. Obesity is something that you go to sleep and wake up with. You can’t get away from it. It becomes your identity. There is so much shame and guilt that is associated with being overweight. Having weight-loss surgery causes a ripple effect and many other areas of your life will change. A person will often experience changes in their emotional state; for example, depression may often times go away. Pa-

tients also could experience less physical pain and ob-stacles. Some changes that could occur include:

• Career • Relationships • Marriage • Friendships • Spirituality

Currently, I no longer suffer with the physical co-morbidities. I am able to walk and even sometimes run

Baby Steps

By Lynne Routsong-Wiechers, MSW, LISW

Adjustments

• I look in the mirror (if I get the nerve up) and see somewhat of a familiar face, but unsure as to whom is looking back.

• I look at my body and wonder how on earth I al-lowed myself to get this way… I then cry.

• I see the disappointment in my children’s faces when they ask me to play with them, but I just don’t have the energy nor the will to move.

• I wake up in the morning and dread putting my feet on the ground because of the pain that I know is coming.

• I avoid public places and gatherings with friends because I fear the stares and the comments that may come.

• I look at my closet, and realize that the majority of my closet consists of blue and black stretch pants and wide slip on shoes.

• I dread traveling far distances, especially by plane, for fear that my luggage gets lost and I

can’t find clothes in my size at the stores and the fact that I can no longer comfortably sit in a seat.

• I pretend that my seatbelt fits on an airplane be-cause I don’t want to ask for an extension.

• I go grocery shopping at night so I am not judged by what I put in my cart.

• I am convinced that my arms are becoming shorter because my bathroom habits are becom-ing difficult.

• I notice that walking even short distances feels like I have run a marathon.

• I am always hot and sweating even when it’s cold outside.

• I no longer feel attractive towards my significant other.

• I feel like I have lost all sense of myself.

• I am scared that today may be my last.

after Weight-Loss Surgery

Emotional

around the yard with my children. I even got on a bike! I no longer suffer from depression and my energy level is off the charts. After having undergone my surgery, I realized that many people don’t truly understand what its like to be obese unless they walked in our shoes. Obese patients need a voice and they need to be heard. I decided to open up a counseling practice specifically for gastric bypass patients and obesity-related issues. I see the relief in my patients’ eyes when they see my pre-surgery picture and realize that, “I have walked in their shoes.” There is so much shame and guilt that is associated with being overweight. I try to encourage my patients to let the guilt go and focus on the reality that they will lead a very different life after surgery. The Changes: This is Not the Easy Way out. We dream about it. We think about it. We almost be-come obsessed with the thoughts of being a healthy person. It sometimes keeps us up a night. We finally see the light at the end of the tunnel and realize that we will get there. We wait for weeks sometimes months for that “letter.” You know which one I am talking about - the letter from the insur-ance company. Then one day you go to the mailbox and there it is. You realize that it’s now a reality! All of the preparation has paid off, but now the reality of what is about to happen sets in. Getting patients to realize that weight-loss surgery is not the easy way out is essential in suc-cessful weight-loss. Regardless of what we hear in the media and from society, this is not easy. Deciding to have this sur-gery is difficult, but living as a weight-loss surgery patient is not always easy.

Fear of the Unknown: “Baby Steps” Although we are looking for a change in our lives, change can be scary and unknown. Many of us fear change, but at the same time look forward to it. I can’t tell you how many times patients, including myself, ask themselves, “why did I do this,” right after surgery. Most often this emotion is short lived, but it’s an example of how change can affect us. I realized that I was no longer going to allow food to control me. Food issues become an addiction and we must learn that we no longer live to eat, but instead we eat to live. In addition, we all go through a phase where you have a difficult time realizing the new you. For ex-ample, although patients may reach their goal

I was 285 pounds at 5’4” tall. I had tried every diet known to man, including rigorous exercise programs, usually ending up with only a five to 10 pound weight-loss. I realized that my weight gain was not going to stop. Physically, I was hurting. Emotionally, I suf-fered from depression, and my career became a struggle. I was counseling in a private practice but barely had the energy to see three patients per day, often having to take a nap in between. I came to the realization that “I” was the one who needed to gain control and get help. That’s a tall order coming from a psychotherapist. After all, we are the ones who are supposed to be helping others. I swallowed my pride and decided to take control of my life. I wanted to be free; free of this body and free to “live” life, not just exist. I began living my new life three years ago. I underwent gastric bypass sur-gery in Dayton, Ohio and have not looked back. I lost 160 pounds and went from a size 24 to a size 4/6. My whole life has changed.

Lynne’s Story

“Food issues become an addiction and we must learn that we no longer live to eat, but instead we eat to live.”

weight, they may look in the mirror and ask them-selves, “who is that thin person?” Losing a massive amount of weight can make a person feel vulnerable and afraid. Remember, obese individuals like to “blend in” with the crowd, but all of a sudden we are now the focus of attention. People are watching us. They are now watching what we eat, asking us how much we have lost and even giving us compliments. This can make us feel uncomfortable. I call it taking “baby steps.” We are re-learning who we are in life. In relation to baby steps, we have to re-learn how to eat according to our surgery. We have to adjust to eating smaller portions, chewing food to a pulp, not drinking while eating, avoiding high sugar and fatty foods and changing our eating behaviors for good.

Food is a central part of our life. If you’re an alcoholic, the cure for alcoholism is to stop drinking. Unfortu-nately, we need food for survival. Food issues become an addiction and we must learn that we no longer live to eat, but instead we eat to live. It took me a long time to understand this concept. There were so many things in my life related around food. I realized that I was no longer going to allow food to control me. What’s in my Toolbox: “Surgery as a Tool” Weight-loss surgery is a great tool. This means that it is not the fix all, but if you correctly use the tool then you will have increased chances of success. If you choose to misuse the tool, then chances are you will have less suc-cess. This surgery will enable you to only eat small por-tions and feel a sense of fullness.

Follow your doctor’s orders and recommen-dations. This means following the dietary changes from the start. Get lots of rest and take care of your physical needs. Journal. I know what you are thinking. Jour-naling is boring and tedious and we don’t like it, right? By keeping track of the foods you eat and how you feel will truly help you feel more in control emotionally and physi-cally. This is especially helpful if you find that you are emotionally eating. Set realistic goals and expectations. For many, goals may be getting off their medica-tion(s), walking without getting winded or the ability to cross their legs. So whatever your goals are make sure that you write them down and modify them as needed. Reflect on the past. Although it is important to move on, it’s also important for patients to remember the moment when they decided to have weight-loss surgery. It’s sort of like we have to hit our “low or bottom” to realize that we have to change.

Seven Take lots of pictures, measurements and keep your pants. It is important that we take pre-op pictures and post-op pictures regularly. This reminds us about our success. Measure-ments and pre-op clothing are important es-pecially during the dreaded plateaus. We may be losing inches and it’s important that we have visual aids to help us realize our success. Although you may be a smaller size, you may still view yourself as the larger you. It’s important to have a visual reference point to remind us that we are losing weight. Seek help. It is important to ask for help if you find that you are having difficulty adjust-ing to the many changes after surgery. Seek support via support groups, family, friends and/or professional counseling. Support groups and counseling are especially reward-ing and helpful because we realize that many patients often experience the same adjust-ment issues and it makes us feel less isolated and alone while we travel our journey. Live life to the fullest. You deserve to be healthy, happy and have fun! Enjoy and sa-vor every moment of your weight-loss jour-ney. You deserve it.

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Steps to Improving Emotional Adjustments Post-Surgery

Although this sounds so “simple” it can be difficult. In addition, we go through phases where we long for food. This is also known as “food grief.” It is as if we long for our “friend” of food. We turn to food in times of celebration, sadness, for reward and for comfort. When a person can no longer turn to food to fill the void, they must find other ways. Many of my patients, including myself, find other hob-bies or activities. In addition, this is when bariatric sup-port groups become so helpful and beneficial.

About the Author: Lynne Routsong-Wiechers, MSW, LISW, has worked in private practice counseling since 1996. She under-went gastric bypass in 2003 and has dedicated her practice to working with gastric bypass and obesity patients. She is currently a Bariatric Psychotherapist in Dayton, Ohio, providing consultation to medical professionals and speaking to the public regarding gastric bypass.

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