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Nutrition

Nutritional Guidelines

KEY NUTRITIONAL GUIDELINES AFTER BARIATRIC SURGERY

All foods and liquids MUST be low in fat and sugar.
Protein intake is of the utmost importance. Insufficient protein will result in protein malnutrition and loss of lean muscle mass. Protein should be 50 % of ALL meals and must be eaten first. Gastric Bypass (GBP) patients should aim for at least 80g of protein daily and Bilo-pancreatic Diversion (BPD) patients 80-120g daily. Protein-rich foods include lean meat, chicken, fish, fat free milk and dairy products, beans, peas, lentils and eggs. Protein supplements can be taken if needed and will be recommended by the dietitian.
Eat and drink slowly
  • Plan at least 30 minutes to eat each meal
  • Small bites of food should be chewed thoroughly before swallowing – approximately 30 x
  • Liquids should be consumed slowly between meals, not during meals – leave at least 20 min before and after eating to drink and aim for approximately 250ml of liquid over a 30 – 60 minute period.
The potential for dehydration is a concern in the early post-operative period. Adequate daily fluid intake of at least 1.5L - 1.8L (in addition to the fluid present in foods) is recommended to reduce the risk of dehydration
Recommended vitamins and minerals should be taken as prescribed
Carbonated drinks, coffee and alcohol should be avoided preoperatively, and 3 months post-operatively
DO NOT follow dietary recommendations from any other health professional, personal trainer, weight loss clinic, family or friends. Bariatric Surgery is a highly specialized field of obesity management, and listening to others can be detrimental to your health, nutritional status and general well being.


VITAMIN REPLACEMENT
Bariatric (metabolic) surgery is a highly specialized field of obesity management. Other surgical and medical disciplines and practitioners are not always best informed in this rapidly evolving field. Vitamin replacement is not a random act, but rather a carefully considered treatment modality, constructed in such a way that nutrients which are no longer being absorbed in the greater curvature of the stomach and first part of the duodenum, are replaced orally.

Furthermore, only particular types of calcium and iron are absorbed. Other preparations for example iron sulphate, is not. It is advised to take the supplements as prescribed by the treating Centre of Excellence endocrinologist / physician. Replacements should be taken consistently and without fail – it should not be considered as an optional extra. Micronutrient stores become progressively depleted, and only once the levels are dangerously low, will the patient start to experience feelings of sub-optimal performance.

HAIR LOSS
Patients may experience some hair loss post surgery. This is due to the rapid weight loss post surgery. There are no shampoos or supplements to prevent this. The hair will grow back over time.

DIETITIAN CONSULTATIONS

Dietitian visits are of the utmost importance:
  • Pre-operative consultations aim to ensure any existing nutritional deficiencies are addressed and to ensure the patient is getting into good healthy eating behaviours prior to surgery.
  • Post-operative consultations are necessary to ensure an optimal nutritional status; promote wound healing; preserve lean muscle mass; facilitate safe and sustained weight loss; and nurture a healthier lifestyle.
  • Annual follow ups are of high importance to ensure the patient continues in healthy eating behaviours, has achieved the weight loss recommended and is maintaining weight loss. If the patient is not compliant with the post operative dietary recommendations, they can start to regain weight and macro (protein, carbohydrate and fat) and micronutrient (vitamin and minerals) stores can become progressively depleted. Only once the levels are dangerously low, will they start to experience feelings of sub-optimal performance.
  • Data collected from visits are used in evidence based studies and published in international journals.
Initial Consultation
The first consultation is 60 minutes and will include:
  • Explanation of bariatric surgery and the nutritional and dietary implications before and after the surgery.
  • Assessment of individual objectives
  • Full medical, weight and dietary history
  • Weight, Height and BMI calculation
  • Dietary assessment
  • Setting of individual goals
  • Formulation of an eating plan to suit individual need according to the obtained information
  • Behaviour changes
Follow up visits:
30 min consultation

VISIT 2:
  • Assessment of whether individual goals have been achieved
  • Assessment of how the patient is coping with recommended dietary and behaviour changes and compliance with the eating plan
  • To identify any barriers to change
  • Making dietary changes if necessary
  • Setting of individual goals

VISIT 3:
Usually 2 weeks pre-operatively
  • Assessing if the patient is ready for surgery
  • Advising on pre-operative and post-operative dietary progression

VISIT 4:
1 – 2 weeks post-operatively
  • Advising on the post-operative progression of the dietary phases

VISIT 5:
3 months post operatively
  • Assessment of nutritional status and if macro and micronutrient intake is being met
  • Calculation of percentage weight loss
  • Assessment of eating behaviour, habits and general lifestyle

ANNUAL VISITS:
  • Assessment of nutritional status and if macro and micronutrient intake is being met
  • Calculation of percentage weight loss
  • Assessment of eating behaviour, habits and general lifestyle
  • Scoring on nutritional aspects and eating behaviour according to a designed score sheet to be kept in your file