Center for Bariatric Surgery
Confidentiality: Because confidentiality is essential, we expect that each person will respect and maintain the confidentiality of the class. What is said by individuals attending the class is not to be repeated or discussed at any other time or place. "What is said here - stays here." Who attends the class is also confidential.
Eating enough calories with small, frequent meals ◦ Too little calories = muscle mass breakdown, difficulties managing weight, bowel movement irregularities ◦ Realistic goals: 1st month post-op: Average 500-800+ calories/day 2-6 months post-op: At least 900-1200+ calories/day 6+ months: ~1200-1800 calories/day
Variety of food choices in your diet
Adequate fluid intake ◦ 64-80 oz. fluid each day for most adults
Adequate protein intake PLUS healthy carbohydrate & fat sources
Plan meals / food choices (in advance)
Focus on adequate protein ◦ Average 60-80 grams of protein daily
Choose high quality, protein rich foods ◦ Legumes (beans, lentils also great fiber sources!) ◦ Oats or quinoa (also great fiber sources!) ◦ Poultry & eggs ◦ Beef (limit due to higher saturated fat, cholesterol content) ◦ Yogurt & low fat/fat free cow’s milk ◦ Soy milk & soy-based yogurts ◦ Tofu ◦ Cheeses (limit due to higher saturated fat content) ◦ Vegetables & leafy greens ◦ Nuts & seeds
Supplement with protein powders/drinks as needed
Product Examples
Where to Buy
TMH Cafeteria
Bariatric Fusion
Grocery stores
Convenience stores
IsoPure
Pharmacy stores
Cytomax Achieve One
Target/Wal*Mart
Performance Nutrition
New Whey Protein Bullets
World Wide Pure Protein Shake
(Warwick & Seekonk locations)
GNC
Nectar Whey Protein Isolate
Vitamin World
Unjury Chicken Soup
Performance Nutrition
GNC Pro Performance
www.bariatriceating.com
www.bariatricadvantage.com
Optimum Nutrition Gold Standard 100% Whey
Guidelines Isolate or Concentrate varieties are preferred • Protein sources: Whey, Soy, Pea, Hemp, Brown Rice, Egg White Aim for 20-35 grams protein per serving size Avoid casein, collagen proteins, added sugars
The Miriam Hospital does not recommend one product over others.
Carbohydrates ◦ Preferred fuel source for brain & muscles (especially during exercise!) ◦ Foods: Low fat or fat-free milk / yogurt Fruits Vegetables Legumes (beans, lentils, peas) Whole grains (ex: oats, quinoa ,buckwheat)
Fats ◦ Heart healthy fats provide energy & help absorb certain vitamins Choose monounsaturated and polyunsaturated fat sources in moderation: Olive oil or Grapeseed oil Nuts & seeds Avocado Fatty fishes (salmon, mackerel, tuna, sardines, anchovies)
Reading Nutrition Facts Labels • Aim to limit products with
added sugar or fat sources (often found in highly processed food products)
• If product contains added
sugar/fat, be sure that the grams of total fat and grams of sugar do not exceed 5 grams each per serving size
• Foods that naturally contain
sugar or fat (such as fruits and vegetables, milk/yogurt, nuts and seeds, avocados and fatty fish) are acceptable to eat.
Ingredients that are considered refined sugar or oils/fats: • • • • • • • • • • • •
Sugar (white, brown & powdered/confectioner’s) Invert sugar High fructose corn syrup (HFCS) Evaporated cane juice Brown rice syrup Malt & malt syrup Sucrose / Maltose / Fructose / Dextrose Nectars (i.e. peach/pear nectar) Molasses Honey Palm oil Hydrogenated/partially hydrogenated oils
Consider limiting sugar alcohols (found in many “diet” or “sugar –free” foods) which may have a laxative effect or cause significant gas/bloating: • Sorbitol • Erythritol • Mannitol • Xylitol • Isomalt • Malitol • Hydrogenated starch hydrolysates
Clear liquids only o “See through” liquids o No foods Options for clear liquids: o o o o o o
Water / flavored waters (i.e. Vitamin Water, Sobe Life Water, etc.) Clear broths / bone broth Tea Coconut water Gelatin (any color is acceptable) Fruit popsicles
Nothing to eat or drink after midnight
o No food intake o Consume Ensure Pre Surgery day of surgery (provided by hospital) ďƒ˜ Start drinking 4 hours prior to surgery time and finish drinking 2 hours before your arrival to the hospital
Begin on post-op day #1 Aim to slowly drink about 3-4 oz. per hour (or 1 oz every 15 minutes) and increase as tolerated with each passing day ; Optimal goal fluid intake each day: ~64-80 + oz.
Example full liquid options (choose no carbonation/ & decaffeinated): Water/ sugar-free flavored water Unsweetened almond/soy/rice milk Protein drink/shakes Broth or bone broth Coconut water (unsweetened) G2® / PowerAde Zero® WTR MLN WTR® Sugar-free gelatin Caffeine free tea/ decaf coffee No sugar added popsicles Low fat/fat free cow’s milk
Starts day #2 after surgery & followed through end of post-op week #4
Eat about every 2.5 – 3 hours (total 4-6 “small meals” each day)
Start with 1 oz (1 medicine cup) at a time and slowly progress up to about ½ cup at a time
Most seasonings / spices / salt / pepper can be used
Foods that are already puree consistency: yogurt / applesauce / hummus / guacamole
Use blender / food processor for: Soups / stews / chili / mixed ingredient dishes such as shepherd’s pie, meatballs or meatloaf / cooked vegetables / fruits without any seeds/skin / moist and soft cooked meats or fish / beans or lentils / hot cereals (low sugar Cream of Wheat® or oatmeal)
Be sure to drink plenty other fluids in between meals throughout the day too!
Avoid foods that are too ‘lumpy’ or ‘chunky’, seeds & roughage foods
Adequate hydration is a top concern! Signs of dehydration: Thirst, dry mouth or skin, infrequent urination, headache, dizziness, rapid heart rate and breathing, lack of energy or irritability Avoid eating and drinking at the same time Helps to avoid “flushing” food out through the stomach prematurely Avoid drinking liquids 30 minutes before, during, and 30 minutes after eating Signs/symptoms of eating too much food/ inadequate chewing: o Feeling like food is “stuck” in smaller stomach o Pressure, tightness, heaviness in smaller stomach o Stomach pain o Nausea, regurgitation or vomiting o Foam that comes up into the esophagus (aka “the foamies”) o Sneezing, nasal drainage or coughing o Hiccups Engage in mindful eating practices! Lack of hunger or desire to want to eat is common o Set alarms on cell to remind of fuel periods o Aim to eat small meals every 2.5- 3 hours
Measurement Conversions
= 1 medicine cup
2 tablespoons
=
= 2 medicine cups
4 tablespoons
= 4 medicine cups
1/2 cup
1/4 cup
Early Dumping Syndrome Symptoms
• • • • • •
Causes
• • •
Late Dumping Syndrome
May occur 30-60 minutes after eating and may last for one hour. Abdominal cramping or pain Nausea or vomiting Severe diarrhea Sweating, flushing or feeling light-headed Rapid heartbeat (palpitations)
• • • • • • • •
May occur 1-3 hours after eating Fatigue and/or weakness Flushing/sweating Shakiness Dizziness or fainting Mental confusion Feeling of intense hunger Rapid heartbeat
Small intestine stretches Refined sugars rapidly absorbing water in intestines Hormones affecting blood pressure
• •
Rapid rise and fall in blood sugar levels Worse after eating sweets or simple carbohydrate foods (i.e. white bread/pasta/rice)
To avoid dumping syndrome: • ALWAYS read nutrition facts labels and ingredients list. • Limit or avoid sweets, pastries, baked goods, and fried foods or other foods with high amounts of added sugar/fat • Be careful for any “hidden sugars/fats”. Always ask how meal/food item was prepared and what ingredients are used (when dining at restaurants or going for dinner at family’s house, etc.). • Avoid eating and drinking at the same time • Eat slowly (take 20 minutes to eat your meal and then stop eating at that 20 minute mark). • Take small bites and chew each bite of food thoroughly (at least 20 chews or more!).
Roughage foods (i.e. nuts, seeds, skin on apples/potatoes) – first 6 weeks after surgery Alcohol Foods that expand or “swell” in the smaller stomach o Breads, rice, pasta, marshmallows, carbonated beverages o Possible symptoms: bloating, GI distress, nausea, regurgitation, food feeling “stuck” Significant caffeine intake o Interferes with calcium absorption- can pull calcium from storage in the bones o Limit coffee/tea intake ; Switch to de-caffeinated High sugar, high fat foods & highly processed foods o Poor nutritional quality o Can lead to dumping syndrome (seen with gastric bypass surgery) Dry / dense/ tough to chew foods (i.e. over-cooked meats)
Complements your diet to help prevent any deficiencies. Insurance may or may not cover the vitamins and supplements
There is a required vitamin regimen:  Bariatric Specific Chewable Multivitamin Dose and cost vary per brand Additional vitamins/supplements as needed (per order of your doctor)
1) Plenty of fluid intake (aim for 64-80+ oz. each day!) + baby food prunes 2) Medication options: Some irregularity: Try stool softener (i.e. Colace) Significant constipation symptoms / days without BM: Try ½ dose Milk of Magnesia or Miralax® Consult with surgeon / PA if constipation persists 3) Introduce fiber-rich foods slowly; Wait for normal bowel movements before trying fiber supplements; Optimal fiber intake for most adults: 25-35 grams/day 4) Uncomfortable gas: Chew foods thoroughly; Avoid gas- producing trigger foods; Try simethicone medication (i.e. Gas-X)
• Important in achieving & maintaining your weight loss goals • Other benefits of regular exercise can include: • Lowering symptoms associated with mild depression or anxiety and improving self-esteem • Providing outlet for stress relief • Improving sleep Start with these steps: •
Start slow and set goals for yourself! •
Walk for 10-15 minutes at a time, working your way up to walking 2 miles by two months after surgery
• •
If you do not like to walk, make sure to do an activity that you enjoy doing
Make it a priority! •
Write exercise into your schedule or calendar
•
Bring a friend/relative along for added motivation and ensure commitment
You will be given a time to meet at the hospital. If you were not already given that time call the surgical office after 10 am on the business day before your surgery.
You will be prepared in the prep and holding area
Approximate OR time is anywhere from 2-4 hours. Includes surgical and prep time in the OR
• Doctors: Attending Surgeon and his teams of Doctors and Residents/NP/PA • Nurses: Bariatric Surgery Nurse Manager, Staff Nurses and Nursing Leadership • Registered Dietitians • Pharmacist • Case Managers
Expectations during your hospital stay : • All Staff will courteous and respectful. • We will listen and explain your treatments and medications. • If you do not understand please ask!
WALK EVERY HOUR while AWAKE Leg Exercises Sitting in Chair TED/SCDs Incentive Spirometer Use of Comfort Kit Our goal is to always help with your personal needs in a timely fashion.
Additional Expectations: Shower PO Day 2
Pain Control- reducing and maintaining a level of pain that is tolerable for the patient.
Pain control starts with pre- op anesthesia and local anesthetics in the OR .
Once you are taking liquids, your IV pain medication is discontinued and you are started on the oral pain pills. ◦
PLEASE let your nurse know when you are in pain – don’t wait too long.
You will be asked to rate your pain from 0-10 called a pain scale. A “0” would be no pain at all. A “10” would be the worst pain you ever felt in your life. ◦ We like your pain to remain below a “4”. ◦ Our goal is to always do our best to help you have adequate pain control over the pain that you may have after surgery.
You may be. It is ALWAYS extremely important to tell your nurse if you have any nausea. â—Ś You will be given scheduled anti-nausea medication
BLOOD THINNERS help prevent you from getting a blood clot. Heparin or Lovenox injections will be given to you 2-3X/Day while you are in the hospital. Most of our patients WILL go home with Lovenox for the first week. You will be taught how to use these injections while you are in the hospital and with your visiting nurse when you go home. • This will be based on the individual.
Bariatric Surgery Patients stay one night in the hospital.
You are tolerating the bariatric diet
Homecare RN will see you the day after discharge (if needed)
Yes
No anti-inflammatories for the rest of your life such as Ibuprofen, Advil, or Aleve.
These meds can cause ulcers!
All pills the 4 to 8 weeks after surgery must be crushed or in liquid form if they larger than an M&M NO CAPSULES during the 1st month.
Check with your pharmacist if a medication you are going to continue to take can be opened OR is available in a liquid form. Also ask can you mix them together.
EXERCISE
is very important
Walking (outside or treadmill), stationary bicycle but no resistance NO LIFTING >10-20 lbs NO ABDOMINAL EXCERCISES for 4 WEEKS POST OP
NO
DRIVING for 2 weeks or longer if still on pain meds No submerging abdomen for 4 weeks NO FLYING for 6 weeks Returning to work depends on the individual. We recommend staying out of work between 4 to 6 weeks because you are eating and drinking frequently– THIS IS A FULL TIME JOB!
During your stay you will see the Attending Surgeons, the Teams of Doctors/PA/NPs and the Bariatric Surgery Manager and RD’s: Please be sure to ALWAYS ask any and all questions you may have. After surgery you will receive a phone call from the TMH/CBS to address all questions or concerns that you may have. VNA will be set up for all patients who have had GBP or Sleeve surgery. We have and will continue to review your journey and always answer your questions from the seminars, through surgery, and follow up. Please be sure to fill out the Survey the hospital will send to you in about two weeks after surgery! It will help us to better the Center for Bariatric Surgery Program!