Bariatric surgery, also known as weight loss surgery, refers to a variety of procedures performed on people who are obese. The goal is to help them lose weight and improve their health by changing how their digestive system works to limit how much food they can eat and absorb. Some common types of bariatric surgery include gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch.
After undergoing bariatric surgery, patients need to follow a specific diet to allow the digestive system to heal, promote weight loss, and prevent issues like nutritional deficiencies. The post-op diet typically progresses through several stages, starting with clear liquids, advancing to puréed foods, and eventually returning to solid foods over a period of a few weeks. However, the specific diet and timeline varies based on the type of bariatric procedure performed.
In the initial post-op period, the diet is very restrictive to give the gastrointestinal tract time to heal without being overburdened. As the weeks progress, more textures and varieties of food can be added to the diet as tolerance improves. However, even in the long-term after surgery, patients may need to follow special dietary guidelines to ensure they are getting proper nutrition and adapting to anatomical changes from their procedure.
Clear Liquid Diet Stage
Initially after bariatric surgery, patients are restricted to only clear liquids. This stage usually lasts for 1-2 days after surgery. The focus is avoiding dehydration and easing back into oral intake as the gastrointestinal system recovers from surgery.
Liquids tolerated in this phase include:
- Water
- Clear broths like chicken, vegetable, or beef broth
- Clear juices without pulp like apple, white grape, or cranberry juice
- Flavored waters
- Weak decaffeinated tea or coffee without cream
- Clear carbonated beverages like ginger ale or lemon-lime soda
- Clear nutritional supplement shakes or drinks
- Plain gelatin
- Frozen popsicles without fruit or cream
The clear liquid diet does not provide adequate calories, protein, vitamins or minerals. It should only be followed short-term after surgery with oversight from the healthcare team. Patients may advance to the full liquid diet once they are tolerating clear liquids without significant nausea, vomiting or discomfort.
Full Liquid Diet Stage
The full liquid diet stage allows the introduction of thicker, milk-based liquids and usually lasts for 1-2 weeks after surgery. The fuller liquid options provide some key nutrients like protein, calcium, and vitamins that were lacking in the clear liquid phase.
Examples of items permitted on the full liquid diet include:
- Low fat milk, soy milk, or almond milk
- Low fat yogurt or Greek yogurt
- Creamy tomato or vegetable soups
- Protein shakes or liquid meal replacements like Ensure or Glucerna
- Smoothies or liquid nutritional supplements without fruit chunks
- Custards, puddings, ice cream, milkshakes made with milk only
- Mashed potatoes with broth, milk, or water
- Strained cream based soups without chunks
Patients should focus on getting 60-80 grams of protein daily through high protein shakes and dairy products. The healthcare team may recommend taking chewable multivitamins and other supplements to prevent nutritional deficiencies.
Puréed Foods Diet Stage
Once tolerated on full liquids, the diet advances to puréed foods for approximately 2-3 weeks after bariatric surgery. Puréeing food breaks it down into a smooth, pudding-like consistency that is easier to digest. The puréed diet allows the gradual introduction of smooth, nutritious solids while the gastrointestinal tract continues healing.
Puréed foods permitted include:
- Cottage cheese
- Unsweetened applesauce
- Mashed bananas
- Refried beans
- Puréed meats like chicken, fish, or tofu
- Cooked vegetables blended with broth, milk, or water
- Oatmeal or cream of wheat thinned down with milk
- Smooth nut butters thinned into smoothies
- Low fat cream soups
- Yogurt
- Mashed avocado
Texture and adequate chewing should be monitored when advancing through the purée stage. Patients may begin introducing soft, moist solid foods once able to tolerate puréed foods without difficulty swallowing or other discomfort.
Soft Foods Diet Stage
Approximately 3-6 weeks after surgery, the diet progresses to soft, moist solid foods that require little chewing. This continues the gradual reintroduction of solid foods while avoiding foods that could aggravate the healing gastrointestinal system.
Soft foods recommended in this stage include:
- Canned fruit in natural juices
- Well cooked vegetables
- Soft scrambled eggs
- Tender deli meats
- Tuna or chicken salad made with low fat mayo
- Cottage cheese
- Ricotta cheese
- Postum cereal soaked until very soft
- Peeled, soft fruits likes peaches, pears, bananas
- Beans, lentils, and split peas cooked until very soft
- Soft breads with thin layer of nut butter
- Tofu
- Pasta, grains, and rice very well cooked and moistened
Chew all foods extremely well, taking small bites and eating slowly. Continue to focus on meeting protein and fluid needs. The diet can progress to solid foods once soft foods are tolerated well.
Normal Healthy Diet Stage
Typically starting 4-6 weeks after surgery, patients can begin reintroducing a wider variety of solid foods as tolerated. However, the diet remains structured compared to pre-surgery eating habits. Dietary changes are necessary long-term after bariatric surgery to promote weight loss and overall health.
General healthy eating guidelines include:
- Eating small, frequent meals 4-6 times per day
- Limiting portion sizes to 1/2 – 1 cup at meals
- Consuming adequate lean protein foods first at meals
- Avoiding drinking with meals
- Choosing moist, soft foods over dry, crunchy items
- Chewing thoroughly and eating slowly
- Stopping eating once feeling comfortably full
- Avoiding high fat, high sugar foods
- Following any additional dietary guidelines from your bariatric program
Keeping hydrated with 64 oz of fluid daily between meals is also very important. Continue taking vitamin and mineral supplements as directed by your doctor to prevent nutritional deficiencies.
Example Meal Plan
Here is a sample meal plan reflecting healthy food choices after bariatric surgery:
| Meal | Food Choices |
|---|---|
| Breakfast | 1 scrambled egg + 1 oz low fat cheese 1⁄2 cup oatmeal cooked in milk Small glass juice |
| Snack | 1⁄2 cup cottage cheese 5-6 whole unsalted almonds |
| Lunch | 2 oz grilled chicken 1⁄2 cup cooked green beans 1⁄2 whole wheat dinner roll 1⁄2 cup unsweetened applesauce |
| Snack | 1⁄2 turkey and cheese sandwich on soft bread Baby carrots |
| Dinner | 1⁄2 cup tuna casserole with pasta and cheese 1⁄2 cup cooked carrots Sugar-free gelatin cup |
Foods to Avoid
Certain foods should be avoided or minimized after bariatric surgery. Difficult to digest foods can cause discomfort, nausea, vomiting and compromise weight loss.
Foods to avoid or limit include:
- Tough, stringy meats like steak
- Dry, crumbly breads and cereals
- Raw vegetables
- Fried foods
- Crunchy chips, popcorn, nuts and seeds
- Fibrous fruits and vegetables like celery, grapefruit, corn
- Tough, chewy foods like dried fruit, beef jerky, granola bars
- Doughy breads, pizza crust
- Sugary food like cookies, cakes, candies
- Alcohol
Managing Diet Challenges After Surgery
It is common to experience some diet-related challenges after bariatric surgery. However, there are strategies to help minimize difficulties:
- Nausea – Eat slowly, chew thoroughly, and avoid drinking with meals. Control portion sizes and stay hydrated between meals.
- Fat intolerance – Limit high fat foods which are more difficult to digest. Avoid fried, greasy foods.
- Food aversions – Tastes and food preferences often change after surgery. Experiment to find more appealing food options.
- Dehydration – Sip fluids throughout the day and avoid drinking large volumes at once.
- Dumping syndrome – Avoid high sugar foods. Eat protein first, add fiber, and don’t drink during meals.
- Constipation – Increase fluids, physical activity, fruits, vegetables, and fiber.
Notify your healthcare team if you experience ongoing difficulties tolerating your diet after surgery. They can provide individualized recommendations and adjust your nutrition plan as needed.
Ensuring Adequate Nutrition After Surgery
Due to the anatomical changes and reduced food intake from bariatric surgery, nutritional deficiencies are common. However, there are ways patients can help ensure they are getting adequate nutrition:
- Prioritize high protein foods like eggs, Greek yogurt, fish, poultry, beans, and low fat dairy at meals to prevent protein deficiency.
- Take chewable multivitamins, calcium citrate, Vitamin D, and other supplements as prescribed by your care team.
- Include fruits and vegetables blended into smoothies or soft cooked to boost vitamin and mineral intake.
- Work closely with your dietitian and get regular lab work to monitor nutrition status.
- Report any signs of deficiency like fatigue, hair loss, frequent infections or changes in wound healing to your doctor.
- Adjust your diet and supplement regimen to correct any deficiencies found through lab monitoring.
Long Term Dietary Changes For Weight Loss Maintenance
Permanent lifestyle changes to diet and exercise are necessary after bariatric surgery to successfully maintain weight loss. Recommendations for long-term include:
- Following your surgeon’s guidance for nutrition, meal spacing, and portion control based on your procedure.
- Weighing and measuring foods for portion control.
- Keeping a food journal to track intake and identify problematic eating habits.
- Eating slowly, chewing thoroughly, and stopping at the first signs of fullness.
- Choosing lean proteins like chicken, fish, eggs, Greek yogurt, beans and getting 60-80g daily.
- Including fruits, vegetables, whole grains for fiber and key nutrients at meals.
- Limiting sugar, fat, and calorie-dense foods.
- Drinking 64 oz. of calorie-free fluids daily between meals, not with food.
- Exercising regularly – a mix of cardio and strength training.
- Getting support from your bariatric team, support groups, friends and family.
Making sustainable changes helps patients avoid regaining weight over the long run. Be vigilant about adhering to dietary recommendations from your bariatric surgery team for the best chance of lifelong success.
Conclusion
Transitioning to eating solid foods after bariatric surgery requires gradually progressing from clear liquids to purées, soft foods, and finally regular textures over a period of several weeks. During this post-op dietary progression, the focus is allowing the gastrointestinal system to heal and adapt while providing adequate nutrition and avoiding complications. Small meals, protein prioritization, good chewing, and smart food choices help patients properly recover from surgery and lose weight safely. Permanent healthy diet changes centered around portion control, protein intake, and nutrition monitoring are key for long term weight maintenance after bariatric surgery.
