Education

Permanent Diet and Behavior Changes After:

Roux-en-Y Gastric Bypass, Lap Band, Gastric Sleeve, Duodenal Switch

View your new stomach pouch as a “tool” to help you improve your health and quality of life by helping you feel “full” while changing your food choices, eating behaviors, and habits. With support from your surgical team, dietitian, and psychologist, you will learn how to redefine your relationship with food. Proper use of your new “tool” will optimize long-term weight loss while minimizing risk of weight regain and nutritional deficiencies.

6 Lifelong Rules for Weight Loss Maintenance:

1. Fluids. Drink at least (8 cups) 64 oz per day between meals to avoid dehydration. Symptoms of dehydration include fatigue, dizziness, nausea, vomiting, and diarrhea in severe cases. Do not drink beverages with more than 40 calories per 8 oz serving and avoid carbonated beverages as they tend to cause more gas pressure.
   Avoid: fruit juice, punch, carbonated drinks, or beverages with more than 40 calories per 8 oz serving with the exception of nonfat milk. Drinking beverages with calories adds up. Save your calories for the enjoyment of nutritious and healthy food.
2. Rule of 30. Wait 30 minutes before and after a meal or snack to drink fluids. You can resume drinking fluids 30 minutes after a meal has finished. Drinking with meals leads to weight loss plateaus and weight regain.
3. Protein. Not only do proteins (proteins are made up of amino acids) serve as essential co-factors in daily organ function (heart beating, breathing, muscle contraction…), but are also important to preserve lean muscle tissue and assist with post-op healing. Make sure you eat protein FIRST at EVERY MEAL!
   Examples of Protein Foods: eggs, low fat dairy products, poultry, fish, beef, legumes, soy products
4. Chewing. Eat slowly and chew food thoroughly. Chew food until it is a pureed consistency in your mouth. You should be able to chew food and spit it into a sink drain. If the food could clog the drain, it could do the exact same thing to you by blocking the stoma or outlet. Try chewing your food 20 – 30 times before swallowing and wait between each bite to allow food to settle into the pouch. Try to reduce bite size to ½ teaspoon.
5. No Snacking/ Grazing; 3 fixed meals per day.
6. Exercise. Aim for 30 minutes of purposeful exercise 5 days per week. Exercise helps increase metabolism so you burn more calories at rest, decreases anxiety and increases the secretion of “feel good” endorphins.

BEHAVIORAL CHANGES NECESSARY FOR SUCCESSFUL LIFELONG WEIGHT LOSS

1. Read Food Labels. Pay particular attention to portion size, total calories, sugar, and protein content. Also look for 20% under the vitamins and minerals.
2. Keep a Healthy Food Environment in the home or office. Use planned grocery lists when shopping. Avoid buying your trigger foods.
3. Use tea plates and small bowls at meals to make smaller portions look more satisfying.
4. Self Monitor Portions and Duration of Meals. For the first month you will eat 3 mini meals and a snack high in protein. You are also encouraged to drink 1-2 protein supplements per day. Do not allow more than 20 minutes per meal, or 5 minutes per course of a 3 course meal. Keep a food journal.
5. Full Feels Different. Listen to your body to avoid overfilling the pouch. A “full” feeling is not the same as before surgery. You should notice pressure/ mild discomfort in the chest area.

The following eating and drinking behaviors cause stomach pouch discomfort and or pain, nausea or vomiting, due to overfilling the pouch.

1. Eating or drinking too quickly
2. Eating or drinking a large quantity
3. Eating & drinking together
4. Eating / drinking concentrated sweets or any foods or beverages with a combination of fat and sugar.
5. Drinking with a straw can cause gas as you may tend to swallow more air
6. Rule of 30. Do not have a beverage on the table at meals.
7. Avoid doing while eating. Be conscious of what and how you are eating. Use all 5 senses to taste and enjoy food. Make sure you cut up all food so that it is easier to chew and swallow.
8. Personal Responsibility. Surgery is not a solution. It is a tool and your surgical team is here to support you. It is ultimately up to YOU to stay in control and continually self-monitor your food intake, exercise, and be aware of emotional eating patterns. Weigh yourself once per week, read food labels, stick to a pre-planned healthy grocery shopping list, use low fat cooking methods, and keep a food/ thought journal to assist you in this goal.

DIET CHANGES NECESSARY FOR SUCCESSFUL LIFELONG WEIGHT LOSS

1. Avoid Beverages with Calories and/or carbonation. Avoid fruit smoothies, JambaJuice, Starbuck’s coffee drinks, and sports drinks. They have a lot of calories. Carbonated beverages are often associated with salty foods/ snacks. They may also cause gas and pain initially.
2. Avoid Sugary and Concentrated Sweet foods and beverages: all caloric beverages, regular coffee drinks, yogurt, pudding, jello, hard candy, low carb candy and chocolate, ice cream, pastries, donuts, popsicles, cookies, pie, and cakes. They have a lot of calories and little nutritional value. Look for less than 6-10 gm of sugar per serving on the label.
3. Avoid High Fat Foods: bacon, creamy sauces, soups, and salad dressings; mayonnaise, butter, fried foods. The same portion of fat has more than twice the amount of calories than carbohydrate or protein. Fat = 9 calories per gram. CHO/ PRO = 4 calories per gram.
4. Dining at a restaurant. Share entrees, order appetizer plates or tapas and stay away from “fried,” “sauteed,” “stir-fried,” “light cream sauce,” and other high fat foods/sauces to avoid excessive calorie intake. Allow no more than 5 minutes to eat each course for a total of 15 – 20 minutes per 3 course meal.
5. Avoid alcohol. Alcohol intake leads to weight loss plateaus and regain.
6. 3 Meals per Day. ˜ ¼ Cup to ½ Cup of food per meal. (unless other wise discussed with your physician or dietitian). Avoid unnecessary grazing or snacking to eliminate unwanted calories.
7. Use Caution When Trying New Foods.
   Try one food at a time. If you have trouble tolerating a particular food at first, try eating the same food again a week or two later. It is not uncommon that you may tolerate a food one day and not the next. Also, your food preferences may have changed. You may find that you now enjoy some foods that you once did not, and dislike other foods once craved. Food and beverages often taste different after surgery. It is important to be patient and not to get discouraged. We encourage you to journal your food intake and tolerance/ intolerance during this time.