Life After Surgery

• Dietary Guidelines
• Eating Tips
• Exercise
• Going Back to Work
• Birth Control and Pregnancy
• Long-term Follow up
• Potential Problems
• FAQs

Although gastric bypass surgery is the only proven effective way for morbidly obese patients to lose weight and keep it off, surgery is only a “tool”, not a “magic cure” for this problem.

Recognizing and accepting this enables patients to use the gastric bypass to achieve the goals of weight loss and maintenance. With this sustained weight loss comes unlimited benefits - the most important being improvement or elimination of medical problems related to obesity.

In order to achieve these goals, patients are required to comply with a rigorous recovery, followed by lifetime changes in behavior.

Obesity surgery doesn't mean that you don't have to diet anymore. What it means is that if you adhere to the prescribed diet for the rest of your life, you'll lose the weight and keep it off. If you ever go off the diet, you'll gradually begin to regain lost weight. We want you to implement this diet even before surgery. Weight loss before surgery helps the surgeon by making the laparoscopic approach easier and safer and increases the likelihood that your surgery can be completed laparoscopically.

Other dietary requirements are basic ‘common sense’ eating. With sensible eating and exercise habits (three sensible meals a day with healthy snacks), the weight loss can be easily maintained after surgery.

The long-term goal of weight loss surgery is to lose approximately 70 to 80 percent of your excess weight. The end result of gastric bypass surgery is that you will continue to require only small portions of food, but usually will be able to eventually tolerate all types of foods. You will be satisfied with the smaller amounts of food that you eat and will not have continued cravings for larger quantities of food at mealtimes.

Please remember that you may not progress from one diet plan to the next in the time frame given. It is an individual process, a learning process to adapt to foods. Also remember that it takes approximately six months before you can tolerate all types of foods, especially meats, and there may also be foods that you may not tolerate eating again.

Dietary guidelines

• Phase I Diet
• Phase II Diet
• Phase III Diet

1. Because of the reduced stomach size, the amount of food allowed is limited to no more than  one to two ounces every 30 to 60 minutes.
2. High caloric foods, beverages, or snacks are omitted from this diet.
3. It is recommended that food be eaten slowly and in very small quantities at mealtime. Approximately 20 to 30 minutes should be planned for each meal.
4. To prevent dehydration, at least six cups of fluids daily are encouraged. We advise that you sip one cup of liquid over a one-hour period. Stop sipping liquids within 45 to 60 minutes of mealtime.
5. Because the calorie intake is very low and food choices are limited, it is difficult to meet your body's need for vitamins and minerals; therefore, you should take a multivitamin/mineral supplement in a chewable tablet or liquid form that provides 100 percent of the RDA.

Phase I Diet

For first two weeks after surgery you must take FULL LIQUIDS ONLY. These include:

• Water
• Iced tea
• Popsicles
• Frozen fruit pops
• Clear broth
• Sports drinks
• Crystal Light™
• Unsweetened juices

Suggestions at this time:

1. Pre-freeze plastic bottles with desired liquids to carry with you.
2. Continue with 60cc of liquid every 30 minutes but increase as tolerated to six to eight glasses of liquid over the first 48 hours at home.
3. Using a straw may help, but do not suck air with the straw.
4. Do not gulp liquids or drink quickly. This can cause abdominal pain and intense nausea.

If unable to tolerate liquids as instructed, please call our office at 319-356-7694

Phase II Diet

From week 2 to 6 after surgery, maintain intake of at least 1 to 1.5 liters of liquids every day. Examples of Phase II diet foods include:

1. Oatmeal with skim milk
2. Thinned mashed potatoes
3. Pureed foods
4. Baked potato
5. Canned fruits (no pineapple at this time)
6. Poached or soft boiled egg
7. Applesauce
8. Cottage cheese
9. Yogurt

During this period, you will only need to eat one meal twice a day. Initially 1 to 2 tablespoons of food may be all you are able to tolerate. You must remember to chew foods slowly and thoroughly. It is helpful if your meal is eaten in a relaxed setting, slowly and without repeated interruption. It is also suggested to use a small saucer or a child-sized cup to measure food. Fill this only 1/2 full of food. Do not drink liquids 30 minutes prior to eating and for at least 45 minutes to 1 hour after eating.

Phase III Diet

From week six to six months after surgery, you may ingest regular foods including:

1. Tuna fish
2. Whitefish
3. Shrimp, lobster, or crab
4. Lean ground beef
5. Chicken
6. Peanut butter
7. Pasta
8. Canned soups
9. Vegetables and salads
10. Fresh fruits
11. All foods that are dry and crunchy: pretzels, crackers

Please remember that this phase may not develop until 4 to 8 weeks after successfully completing Phase II. Remember to stop eating when you feel full. All foods must be cooked without added fats. Bake, broil or poach meats, fish, and poultry. Season vegetables with herbs or spices instead of fats.

Eating Tips

Remember - there is no painless way to "melt" the pounds away. Your total calories eaten must be less than your total calories expended in order for you to lose weight.

Avoid overeating! Overeating may cause you to vomit or stretch your pouch and decrease the effectiveness of your surgery. Indications of fullness are:

• A feeling of pressure or fullness just below your rib cage
• A feeling of nausea
• Pain in your shoulder area or upper chest.

Chew foods thoroughly before swallowing.

Eat slowly—30 chews per bite.

Use small plates and bowls; you may want to try a baby spoon.

Put your fork or spoon down on the table between bites.

STOP eating as soon as you feel full.

Drink five to six cups of liquids per day between meals. Recommended liquids are water, broth, low-calorie beverages, tea, or coffee.

Sip all beverages slowly.

Don't drink high-calorie drinks such as milkshakes, soda pop, beer, and other alcoholic beverages. By sipping on such liquids during the day, many calories can be consumed without feeling full. This will result in a poor weight loss record. You may supplement with diet soda and other drinks that do not have many calories.

Don't forget to take a liquid or chewable vitamin supplement with iron daily. Woman over 40 should use calcium supplements daily.

Don't eat high-calorie and low-nutrient foods such as cakes, cookies, pies, candy, pastries, gravies, jellies, jam, honey, sugar, ice cream, etc.

Bake, broil, boil, or steam foods instead of frying to cut down on empty calories. BEWARE: you may also have problems tolerating high fat, greasy foods after surgery.

Exercise

Though probably difficult for you now, this will become part of your daily routine as you lose weight.With weight loss, patients have less joint pain, less shortness of breath, and more endurance. We encourage all patients to adopt an exercise regimen such as walking, swimming, aerobics, or any other form of physical fitness. This not only increases caloric expenditure, but metabolism as well, thus helping with weight loss and maintenance. We also suggest weight training since building muscle tissue (muscle tissue burns calories 24 hours per day) increases and helps maintain maximum weight loss.

In addition to changing eating behaviors, we also require lifetime vitamin supplementation, including multivitamin, iron, B12, and calcium. Occasionally, others (vitamins A, D, and/or E) are required as well.We monitor blood work on a yearly basis to determine appropriate doses of these vitamins.

Going Back to Work

Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Many patients return to full pre-surgery levels of activity within six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a few weeks.

Birth Control and Pregnancy

It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.

Long-Term Follow-Up

Althouh the short-term effects of weight loss surgery are well understood, there are still questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years will need to be studied. Over time, you will need periodic checks for anemia (low red blood cell count) and Vitamin B12, folate and iron levels. Follow-up tests will initially be conducted every three to six months or as needed, and then every one to two years.

Potential Problems

Potential problems following gastric bypass and suggested dietary modifications:

Nausea and vomiting: This is frequently encountered and may suggest either poor dietary compliance or a potential technical problem including narrowing of the gastric anastomosis or an ulcer in the pouch. If nausea and vomiting occur after eating a new food, wait several days before trying it again. It may be necessary to eat more liquid or pureed foods temporarily. Eating too fast, eating too much, or insufficient chewing may also cause nausea or vomiting. Rest stomach for two to four hours and then try eating again. If the problem persists, contact your surgeon for potentially ruling out an ulcer or narrowing.

Dumping symptoms: Try solid meals, low in simple sugars but high in complex carbohydrates. Try to avoid simple sugars. Check tolerance to lactose.

Pain in shoulder or upper chest area: Stop eating if pain occurs during eating and try to eat later after the pain has resolved.

Dehydration: This may occur with inadequate fluid intake or with persistent nausea, vomiting, or diarrhea. At least 6 cups of fluids daily are recommended.

Lactose intolerance: Use lactase-treated milk and lactase enzyme tablets.

Constipation: This may occur temporarily during the first postoperative month but generally resolves with adaptation to changes in the volume of food. The regular use of fruits and juices reduce the risk of recurring constipation.

Diarrhea: Limit ingestion of high-fiber foods, greasy foods, milk and milk products, very hot or cold foods. Eat small frequent meals. Drink plenty of fluids.

Blockage of the stoma: The stoma (connection) may be temporarily blocked if foods with large particles are eaten without thoroughly chewing. If symptoms of pain, nausea, and vomiting persist, a physician should be contacted.

The only things needed during adaptation period are:

1. Liquids
2. Vitamins
3. Small amounts of protein