How is Nutrition After Bariatric Surgery?

Obesity is defined by the World Health Organization as “abnormal or excessive fat accumulation in the body that presents a risk to health”, and similarly, having a body mass index over 30 is defined as obesity. Obesity also causes many chronic diseases. Bariatric surgery is a very effective treatment method for obesity.

Nutrition after bariatric surgery is regulated by our dietitians. The days vary depending on the type of surgery, but the stages are the same. It is very important for the person to pay attention to their nutrition for successful weight loss.

For healthy weight loss, adequate macro and micro nutrients are calculated separately for each patient, and personalized diets are created. Since the person is fed very restrictively after the surgery, vitamin-mineral supplementation must definitely be taken. Foods and drinks consumed after surgery should maximize weight loss while minimizing reflux, early feeling of fullness, and dumping syndrome. In order not to experience dumping syndrome, it is recommended that patients eat in small amounts and frequently. A phased diet is applied to achieve these goals.

Nutrition consists of four stages;

• Liquid Phase

The first stage is the liquid phase. In the liquid phase, the person can consume; water, sugar-free and grain-free compote, diluted apple/sour cherry/pineapple juices (sugar-free), fat-free meat/chicken broths, lactose-free milk-kefir-yogurt-ayran, probiotic yogurt, almond/soy milk, decaffeinated coffee, weak tea, herbal teas such as fennel/lemon balm/chamomile/ginger. At least 1.5 liters of fluid should be consumed. The most important is protein powder. Because the person cannot feed on solid foods, protein intake is very low. Muscle loss is experienced as a result of undernutrition from protein. To minimize this, the patient should use protein powder. In this period, everything must be strained and consumed grain-free. Products such as oil, tomato paste, onion, garlic, spices (except a small amount of salt and cumin) should not be used. Since caffeine intake is not desired in the first stage, coffee-tea consumption should be decaffeinated. In order not to experience gas problems, milk and dairy products should be preferred lactose-free. Very small sips should be taken and drunk slowly.

• Puree Phase

In this period, the foods patients eat consist of blended foods or foods liquefied with enough liquid. However, omelets, tuna, well-boiled very soft meat/chicken are not suitable for this diet. Fruit and vegetable purees are consumed in this period. Similarly, a minimum of 1.5 liters of fluid should be taken in this period. Soft-boiled eggs, lactose-free strained cheese or curd cheese, vegetable puree, fruit puree, lactose-free yogurt-ayran-kefir-milk, baby foods with a sugar content not exceeding 10 grams, and again most importantly protein powder should be consumed in this period. When making vegetable puree, oil, tomato paste, onion, garlic, and spices (except salt and cumin) should not be added. As for fruits; fruits containing citric acid should not be consumed because they can upset the stomach. Ready-made fruit yogurt/kefir should also not be used because the sugar amount in such products is high. Too hot or too cold foods should be avoided. In order to well understand which food can be tolerated, only one new food should be tried in a meal. The daily protein intake target is 60-80 grams.

At this point, making a solid-liquid separation is very important. It is necessary to wait half an hour after the main meal to consume something liquid.

• Transition to Solid Phase

In this period, the patient now slowly starts to switch to solid foods. Very well-cooked fish/meatballs/meat/chicken starts to be consumed. At this point, if the person can tolerate it, a small amount of olive oil, tomato paste, onion, and garlic can start to be put into the vegetable dishes made. However, all foods (onion, garlic,..) must be thoroughly cooked. The person can now start consuming; fat-free/low-fat cheeses, boiled eggs, olives, 1 dessert spoon of olive oil corresponding to 1 exchange of fat per meal, well-cooked fish-meatballs-meat-chicken, vegetable dishes with minced meat/meat. The daily protein intake target is 60-80 grams.

• Solid Phase

In line with healthy eating recommendations, depending on the patient’s tolerability, planning is made by encouraging the consumption of first raw vegetables (in the 2nd Month), then dry legumes and nuts (in the 3rd Month), and finally (in the 6th Month) the grain group. The daily protein intake target should be 60-80 grams or 1-1.5 g/kg/day (ideal weight). Protein requirements should be met by including plant-based protein sources, with high bioavailability protein sources in the foreground. In general, protein powder usage is required to not experience any sagging for 6 months and to minimize muscle loss. Integrating solid-liquid separation into the person’s life is also one of the most important points.

From the first stage to the last stage, it is also very important for the person to feed on a probiotic-heavy diet as much as possible so as not to experience bowel problems.