Bariatric (Weight Loss) Surgery

Dietician advice

Before your Surgery

What is Optifast?

Optifast is a meal replacement which is very low in calories and high in protein. It is available in shakes, soups, bars, and as a dessert.

Why do I need to take Optifast?

To reduce the size of your liver so that surgery is safer and easier.
To improve your recovery after surgery.
To kick start your weight loss.

How do I take Optifast?

You need to be on the Optifast diet for 2-3 weeks before your surgery as advised by your dietician

You should take:

Optifast products (as advised by dietician) per day.
Two cups of low starch vegetables per day. (see examples on the next page)
One serve of fruit per day (optional. See examples on the next page).
At least two litres of calorie-free fluids per day (see examples on the next page).

Warning

If you eat foods that are not permitted, it may reduce the effect of Optifast and your liver may not shrink. This can make the surgery more difficult and may result in your operation being cancelled.

What do I do if I have Diabetes?

You should not need to make any changes to your diabetes management whilst you are on Optifast if:
- Your diabetes is diet controlled or
- You take metformin

Please contact the Diabetes team, your GP or Diabetes specialist to discuss any changes when using Optifast if:
- You take any other medication such as gliclazide or insulin

Where can I buy Optifast?

Most pharmacies stock Optifast.

How will I feel while taking Optifast?

The first four days are the most difficult. Keep going - it will get easier! You may feel hungry, tired and emotional. Doing more exercise may help you to get through these first few days because it provides distraction and releases 'feel good' endorphins.

Constipation can be a problem for some people. To help, make sure you are eating two cups of the allowed vegetables and drinking at least two litres of calorie-free fluid every day. You may find drinking alpine tea, adding Benefibre to liquids, or Phloe helps. These are all available in most supermarkets.

Additional foods allowed while on Optifast

	Allowed	Avoid
Vegetables 2 cups /day	alfalfa sprouts asparagus beans beetroot bok choy broccoli brussel sprouts celery cabbage capsicum cauliflower carrot courgette cucumber eggplant kale lettuce leeks mung beans mushrooms onions radishes shallots silverbeet snow peas spinach tomato watercress /puh	avocado corn green banana green peas kumara legumes e.g. baked beans /chickpeas lentils parsnip potato pumpkin taro yam
Fruit 1 serve /day (Optional)	1 small apple 2 apricots ¼ cup blueberries ½ cup canned fruit in juice- drained 10 cherries 1 kiwifruit 1 small orange / mandarin I small nectarine 2 passion fruit 1 small peach 1 small pear 2 small slices pineapple 2 plums 3 prunes 1 cup cooked rhubarb 5-10 strawberries	All other fruit NO BANANA
Herbs and Spices	All
Sauces and condiments	Lemon juice Balsamic vinegar Soy sauce Chilli Mustard Tomato paste 2 tsp canola / olive oil	Mayonnaise (all types) Butter / Margarine
Soups	Stock cubes, miso soup, broth Vegetable soups using allowed vegetables Weight watchers zero point soup
Drinks	Water Herbal & fruit teas Tea and coffee - no milk & no sugar Diet / low calorie cordial diet soft drink	Alcohol Fruit juice Milk
Other	Unsweetened gum / lollies artificial sweetener Diet jelly Essence - banana, mint, orange, vanilla, strawberry

Eating after Weight Loss Surgery

How it works

Weight loss surgery reduces the size of your stomach.
This restricts the size of the portions you can eat.
Your stomach size is smaller than it was.
To begin with, there will be a lot of swelling and your stomach will only hold about 30 ml.
During the year, this will gradually increase to about 150-200 ml.

General recommendations:

Eat slowly and eat until you feel full.
Chew your food well.
Allow 20 - 30 minutes to eat each meal.
Use a teaspoon, as this will help control the amount you eat.
You may only be able to eat one to two teaspoons at each meal. This will increase slowly over
the next few weeks.
Avoid chewing gum, lollies and mints, even if they are sugar free.
Flavour your food. You can use all types of herbs and spices.

Protein

Having enough protein is vital for your surgery wounds to heal properly. Protein will help preserve your muscle and encourage your fat stores to be used as energy.

Include two protein shakes (Optifast) per day.
Have one shake as a meal and one shake as part of your fluid.

Fluid

Drink at least 1,500ml of calorie-free fluid per day.
Most of your fluid intake should be water.
Stop drinking 30 minutes before and 30 minutes after meals.
Sip your liquids, do not gulp as you may regurgitate or vomit.
Avoid straws as this takes in air that may bloat your small stomach.
Avoid fizzy drinks, they will make you feel bloated and can cause heartburn.

Constipation

Because you are eating less, constipation may be a problem. These strategies may help;
Ensure you are drinking sufficient fluid.
Regular physical activity.
Alpine tea (Red Seal brand).
Phloe
Benefibre - this will only help if you are drinking at least 1,500 ml fluid.

Multivitamin

When you start eating you will need to start a multi-vitamin in the first month post surgery it should be a chewable multi-vitamin (either BN chewable multi or Nutri-chew, take 2 per day) Four weeks after your surgery you can either continue on the chewable multi-vitamin or change to the BN capsule (2/day) or Centrum Women's Multi-Vitamin (1/day)
You will need to take a multivitamin daily for the rest of your life
You will have your blood biochemistry checked routinely in the first year after surgery and then annually to monitor your nutritional status

Bariatric Dietary Progression

3-8 weeks before surgery	Optifast Follow the Optifast diet for 2-8 weeks prior to the surgery as directed by your surgeon or dietitian
↓
Surgery	Surgery
↓
3 weeks after surgery	Puree Diet Eat 3 meals per day Include 2 protein shakes every day You should be eating mostly protein You will be eating about an egg size volume of food per meal
↓
3-6 weeks after surgery	Soft Diet Eat 3 meals per day Include 2 protein shakes every day Eat mostly protein Start taking a daily multivitamin such as Centrum
↓
6 weeks after surgery	Solid Diet As you are able, slowly progress to solid food Eat 3 meals per day Include 2 protein shakes every day At 6 months, most people can eat a portion equivalent to 2 eggs or 1/2 a cup at each meal 1 year and beyond most people can eat a portion equivalent to 3 eggs or cup of food at each meal

Recommendations

Stop eating as soon as you feel full
During all stages make sure you are drinking enough fluid.
You should be drinking at least 1.5l per day and more in hot weather; when you are exercising or if you have diarrhea

Puree Diet - Start 1 week after surgery

General recommendations:

Eat three meals per day and don't have any snacks.
Stop drinking 30 minutes before and after your meals.
All food must be a smooth puree Use a blender or food processor to puree food to a thick soup consistency, with no lumps.
Avoid all solid foods.
Remember to drink at least 1,500ml of low-calorie fluids per day.

The majority of your pureed food should be focused on protein:

Meat, chicken, fish and seafood are the best sources of protein. Include meat, chicken, fish, seafood, eggs, lentils, legumes, tofu and low fat dairy products with every meal.
Have two protein shakes per day.
You can add protein powder to your meals to increase the protein content of your food.
If you are vegetarian, you will need to add protein powder to your meals.

How to puree

Put chopped cooked meat, chicken or fish into a blender.
Then slowly add liquid until it is pureed.

Possible liquids to add:

Soup (homemade, dried packet soup, canned soup, 'pouch' soup)
Stock
Water from vegetables
Gravy (low-fat homemade gravy, Bisto, or a Weight Watchers packet)
Natural juices from a stew or slow cooker meal
Tomato pasta sauce
Light 'Chicken Tonight' sauce
Cottage Cheese
Tofu

Add flavour:

Use flavoured liquids rather than water.
Any seasoning / herbs / spices / garlic / onions / balsamic vinegar / sweet chilli sauce.

Commercial Pre-prepared Options:

The Pure Food Company provide a variety of ready to eat high protein pureed foods
These can be purchased online and delivered directly to your home www.thepurefoodco.co.nz

What to eat

Meal	Food Options
Breakfast	Porridge made with calci-trim milk (make according to directions, and add a bit more milk to make thinner).Weetbix with calci-trim milk Plain smooth unsweetened yoghurt Egg - loosely scrambled Egg - lightly poached Optifast or Protein Shake*
Lunch	Protein-based soup Egg - loosely scrambled Egg lightly poached Tuna / salmon / egg / ChopChop Chicken whizzed with cottage cheese or extra low fat cream cheese ( <10g fat per 100g) until smooth pureed consistency Dinner type meal as below Optifast or Protein Shake*
Dinner	Your meal should be mostly protein with a small amount of sauce to keep it quite moist. Puree all food before eating. Mince (any) with Weight Watchers gravy or low fat bolognaise sauce Chicken with Light Chicken Tonight sauce Casserole with any meat (crock pot meals are usually good) Fish with low fat white sauce Vegetarian protein alternative, pureed smooth with reduced fat sauce. Add unflavoured protein powder to vegetarian meals increase the protein content.
*Optifast or Protein Shake	After bariatric surgery, you may use other protein shakes, instead of Optifast. Look for a protein shake which is low in fat and carbohydrate and has at least 20g of protein per serve. Have two Optifast or Protein Shakes per day Include one Optifast or Protein shake as a meal, and the other as part of your fluids. If you add fruit, add no more than an egg-sized amount of fruit per shake.

Amount

To start with you will only be able to eat very small amounts.

Gradually over the first few weeks your portion sizes will increase.

It is normal to be able to eat as little as 1-2 teaspoons or as much as ¼ cup of food.

You may be able to eat more of some foods and less of others.

Stop eating as soon as you feel full.

Soft Diet - Start 4 weeks after surgery

The soft diet is the transition between the puree diet and a solid diet. A soft diet includes foods that are easy to eat and can be mashed with a fork. You may also be able to manage some crispy foods, such as Cruskits. You should stay on a soft diet for two weeks before gradually introducing more solid foods. Everyone progresses at a different rate - you may need to stay on your puree or soft diet longer.

General recommendations:

Remember to stop drinking 30 minutes before and after your meals.
Eat three meals per day and no snacks.
Remember the majority of your intake should be focused on protein.
You can add protein powder to your meals to increase the protein content of your food.
A sauce such as tomato pasta sauce, salsa, hummus, cottage cheese, or ricotta may help you to manage meat more easily.
Remember to drink at least 1,500ml of low-calorie fluids per day.

What to eat:

Food Group	Suitable Foods
Meat, chicken and Fish	Tender chicken, fish and meat in bite-sized pieces or minced Shaved ham, turkey or chicken Tinned salmon, tuna in spring water ‘Chop Chop' chicken
Milk and milk products	Low fat milk, cottage /ricotta cheese Low fat yoghurt (less than 2g fat per 100g)
Vegetables	Cooked vegetables - mashed, stir fries, grilled or boiled Introduce salads slowly
Fruit	Soft fruits - peeled pears, apples, stone fruit, melon, berries
Fluids	Most of the fluid you drink should be water. Try to limit the number of cups of coffee you have per day. You may have a maximum of 4 coffees per day (no more than 1 milky café coffee), or 6 cups of tea If you have milk in your tea or coffee, always use trim milk. Trim milk contains more calcium and protein.

Multivitamin

Start taking a multivitamin every day.
We recommend the Centrum Womens or Centrum Advance 50+ or Celebrate Bariatric Multivitamin.
If you find this difficult to swallow try cutting it in half or having with a teaspoon of yoghurt.

Meal ideas

Meal	Food Options
Breakfast	Weetbix /porridge /cereal with calci-trim milk Low fat yoghurt with a small amount of fruit Eggs - scrambled or poached
Lunch	Cruskits with; tinned fish chop chop chicken smoked chicken shaved ham or lean thinly sliced deli meat You may also include some hummus / cottage cheese / tomato / cucumber or other soft vegetables. Thick meat-based soups (avoid cream based ones), for example Left overs from dinner with small amounts of soft cooked vegetables Rice paper spring rolls filled with soft meat Thinly sliced deli meat rolled and filled with mashed egg, hummus or cottage cheese Sashimi (raw fish) Baked beans
Breakfast	Aim to eat an egg-sized portion of protein and include soft vegetables for the remainder of the meal. Lean mince (any) with Weight Watchers gravy Mince with bolognaise sauce / chilli con carne sauce / taco sauce (or similar) Chicken with Light Chicken Tonight sauce Casserole with any tender meat or chicken and vegetables (crock pot meals are usually good) Fish with low fat white sauce Fish that flakes apart easily Prawns Scallops Tofu
Optifast or Protein Shake	Try to have 1 protein shake per day as part of your fluid intake for the next 3 weeks

Over the next few months your portion sizes will gradually increase.

It is normal to be able to eat as between 1-2 eggs size portions of food or up to about ½ a cup per meal.

You may be able to eat more of some foods and less of others.

Use your stomach as a guide and eat until you feel full.

Stop eating as soon as you feel full.

Fluid - After surgery

Why is fluid important?

After surgery you will be eating much less food, therefore you need to drink even more fluid to maintain your levels of hydration. The feeling of hunger and thirst are similar and sometimes you may think you are hungry, but you may in fact need a drink. Being even slightly dehydrated will also decrease your energy.

Drink Frequently

Take small, slow, frequent sips throughout the day. You won't be able to drink fluids quickly. Always have a drink bottle with you. Try and drink 500ml by lunch time, 500ml by dinner and 500ml by bedtime.

Your aim after surgery is to drink at least 1.5L of calorie-free fluid per day. You may need even more on hot days, or if you are exercising.

Some people mention that water doesn't taste right or it feels heavy in the stomach after their surgery. If this is the case try experimenting with different temperatures of water. Some people find that ice-cold, room temperature or hot water is better tolerated. Try flavouring water - see overleaf for low calorie fluid ideas.

Tea and Coffee

It's fine to drink tea and coffee after the surgery. Try to limit the number of coffees you have per day. You may have a maximum of 4 coffees per day of which only one is a milk-based café coffee, or 6 cups of tea per day. Always use trim milk - trim milk also contains more calcium and protein.

Fizzy Drinks

Drinking carbonated fluid after surgery isn't recommended. Sometimes people can't burp very well and having excess gas could put pressure on your area of surgery. This may cause heartburn and make you feel bloated. Over time, you should be able to manage carbonated beverages if you would like them. Sparkling water is the best choice.

Alcohol

Alcohol is not recommended in the first six months after surgery. It is high in energy and can increase appetite. Drinking alcohol can slow your weight loss and lead to weight regain.

You will absorb alcohol more quickly after your surgery and reach a higher peak blood alcohol. A little alcohol will have a significant effect. Please be mindful of this, if you intend to drive.

Tempt your taste buds! -Suitable fluid ideas

Slices of ginger in hot water and then pour over ice.
Add a stick of lemon grass in water for a few hours
Hot or cold Herbal Tea - tea bags work just as well in cold water - keepfor a bit longer than normal
Some cubes of honeydew melon and cucumber
Water with a twist of lemon or lime
Water with slices of cucumber
Angostura bitters
Water with a cube of fruit in it
A drop of peppermint essence
Water with mint (crush the leaves a little to release the flavour)
A teaspoon of vegemite or marmite in hot water
Miso soup
Soup Stock
Chicken Broth
Vitalzing Water Drops Water Enhancer (Raspberry, Peach, Coconut and Lemon lime)
Vita Quench (Lemon and Lime, Mixed Berry, Cranberry and Orange, Mandarin, Orange and Mango)
Thriftee (Orange Mango, Raspberry, Lime, Pineapple Orange, Orange, Blackcurrant)
Barker and Halls Low Calorie Cordial (Low Cal Lemon Barley, Low Cal Orange Barley)
Bickfords Diet Lime Cordial
Hansels Cocktail Quench (Mojito, Lemon Lime and Bitters, Cosmopolitan)
H2Go Zero Water (Boysenberry, Lime, Summer Fruits)*
Powerade Zero*
Water with a teaspoon of protein powder (stay away from sugary protein powders)

Exercise Following Bariatric Surgery

Whilst in Hospital

Walk around the ward frequently - at least once an hour when you are awake.

First four weeks after leaving Hospital

Start by exercising 10 minutes per day. If this feels okay, then increase to 15 minutes and continue to increase the duration until you are at your pre-surgery levels of exercise.
Stop if you feel any discomfort.
By four weeks after surgery you should be at your pre-surgery levels of fitness.
There are some restrictions on the type of exercises you can do in these four weeks.
Recommended exercises for the first four weeks after surgery include;
Walking
Exercycle
Biking
Cross-trainer machine
You are able to start swimming or water walking after two weeks as long as your wounds are clean and dry.
Not recommended exercises include:
Avoid lifting weights more than 3kg.
No abdominal strengthening exercises.
Avoid high intensity exercise.

Impact sports such as running, or weights are not recommended in the first four weeks.

Four weeks after leaving Hospital

After four weeks impact sports can be reintroduced at a light intensity.

Six weeks after leaving Hospital

By six weeks following surgery there is no restriction with exercise.
Any and all kinds of exercise are great!
Exercise following bariatric surgery can maximise the results of the surgery and in the long term, can help with weight maintenance.
We recommend exercising 5-6 times per week, for at least 30 minutes per session. If this is not realistic for you, please discuss this with the team to set realistic goals.