ONE MONTH POST BARIATRIC

SURGERY CLASS… PLEASE STANDBY

(WE WILL START SOON)

ZOOM

We are going to take a few moments to review how

to use some of the functions in Zoom, which may

be helpful to you during our class today

Where you communicate with clinic staff and ask questions

Press the Raise Hand button

Mute/Unmute

CONSENT FOR VIRTUAL CLASS

Ensure that you are in a private location

Eliminate sources of distraction

Engage in the virtual visit as if you were meeting in-person

Please respect yours and the other patients’ confidentiality

No recording devices are permitted during this virtual visit

We are taking attendance for this session in order to confirm you have attended the one-month class

Week 3 and beyond – introducing foods

Eating Techniques

Nutrition Goals

Vitamin and Mineral Review

Physical Activity

Challenges and Symptom Management

TODAY’S DISCUSSION

QUESTION TIME…

How are things going for you?

What has been good so far?

What are you having challenges with?

IN THE EARLY STAGES

You are still healing

Fatigue is normal at this stage

Introducing new foods

Starting to figure out your new stomach,

managing new feelings & experiences

o Appetite, fullness, taste, smell

INTRODUCING NEW

FOODS

*

PROGRESSING TO SOFT FOODS

Weeks 3-5 is the soft food diet

Avoid introducing foods ahead of your

diet stage

Skipping ahead can lead to:

Placing added pressure on the staple line

Increased potential for food intolerances

Nausea and vomiting

Mark your weeks on a

calendar

WEEK 3 TO 5 SOFT FOODS

Can still eat all foods from previous weeks

Add new foods each week

Focus on soft protein foods

That are easy to chew and digest

Limit grains and starches until you are meeting

protein target

WEEK 3 – SOFT FOODS

Tofu

Fish Moist chicken

or turkey

Scrambled or

poached eggs

HummusCottage

cheese

Peanut

butter

Extra lean

ground meat

WEEK 4 – SOFT FOODS

Focus: Increase your fibre intake

Vegetables and fruits

o Soft, peeled, seedless fruits

o Canned fruit packed in water

o NO raw vegetables or lettuce/salad

Grain products

o Low sugar cereals

o Couscous and quinoa

WEEK 5 – SOFT FOODS

Grain Products and Starches

Whole wheat toast

Whole grain crackers

Whole wheat pitas, tortillas and wraps

Baked or oven roasted potatoes/sweet

potatoes

WEEK 6 – DIET FOR LIFE

Eat small portions every 2-3 hours

o i.e. 3 small meals & 2-3 snacks daily

Eat your protein first, then vegetables and

fruits, then grains

You will eventually be able to eat about 1-1.5

cups of food per meal

EATING TECHNIQUES

HOW you eat is just as important

as WHAT you eat!

*

MAIN GOALS FOR SUCCESS

1. Keep track of your eating

2. Get enough fluids

3. Get enough protein

4. Meal balance

5. Meal planning

6. Take your vitamins every day

7. Participate in activity

TRACKING YOUR DIET

Continue to track your food and liquids

Helps you to achieve your goals

Have your food records available for your

appointments

This will help us give you feedback and

suggestions

You can track by hand or electronically

*

TRACKING WEEKS 3-5

During weeks 3-5, most people:

Can eat ½ cup to ¾ cup of food per meal

Take 30-45 minutes to eat a meal (or longer)

Require help from protein shakes to meet protein and

fluids goals

Prioritize protein, with limited fruit, vegetables or

grains/starches

Can eat between 600-1000 calories daily (this can vary)

HIDDEN CALORIES

Liquid calories

Juices, pops, sugar rich beverages, cream, etc.

Limit juice to ½ cup daily (100% fruit juice)

Sauces and Condiments

Best choices: mustard, vinegar, and hot sauce

Choose small amounts: ketchup, relish, mayonnaise, salad dressings, sauces

Portion control for high calorie foods

Nuts, avocados, peanut butter, cheese, frozen yogurt/frozen treats

A NOTE ABOUT CALORIES &

OTHER MACRONUTRIENTS

You don’t have to track calories, carbohydrate,

sugar or fat intake

For those that want to know…usually by about 3

months you will want to have at least 1000-1200

calories daily as this is what your body needs for

basic functions

Do not over-restrict calories, it will usually lead

to more weight regain long-term

GET ENOUGH FLUIDS

Aim for 1.5-2 L or 6-8 cups of fluid each day

All fluids count

Carry a refillable water bottle

Set alarms for reminders or add additional fluid to your routine

(eg drink upon waking up, keep water beside your bed)

Try different temperatures or add flavour, if not tolerating

Sucking on ice chips or sugar-free popsicles if nauseous

*

GET ENOUGH PROTEIN

What has worked for you?

WHY IS PROTEIN IMPORTANT

HOW MUCH PROTEIN DO YOU NEED

Aim for minimum 60-80 grams per day

(Sleeve and Bypass)

OR

Aim for 100-120 grams per day

(Duodenal Switch)

PROTEIN SUPPLEMENTS

You will need to use protein shakes until you

can meet your goal from food alone

Pre-Mixed Shakes include:

Boost Diabetic (16 grams of protein)

Premier Nutrition (30 grams of protein)

Protein Powders include:

Whey Isolate

Soy Isolate

See protein section in your book for more details

PROTEIN SOURCES

Aim to meet your protein needs by eating food

Most people:

Can decrease to 1 shake per day after 2-4 weeks

Can stop protein shakes after 4-12 weeks (or when

able to get enough from solid food sources)

Avoid using protein shakes long-term to replace

meals

HOW TO ENSURE YOU ARE

GETTING ENOUGH

Track your dietary intake

If using written method, use the list of protein

rich foods

Page 76 of bypass and sleeve book

Page 74 of DS book

Read food labels

Add up total protein intake for each day

PROTEIN RICH FOODS

PROTEIN ON FOOD LABELS

Look at the serving size: The

serving size on the label

may be different from how

much of the food you are

actually going to eat.

Protein: This serving has 15g

How much protein if you eat

½ bowl?

COMPARING FOOD LABELS

Greek Yogurt Regular Yogurt

MEAL BALANCE

“Important to have a variety of

foods at each meal to help you

meet your nutrition and health

needs, achieve maximal satiety

and appetite control long-term”

PLATE MODEL FOR BALANCED MEALS AFTER SURGERY

Vegetables/Fruits

(lunch + dinner)

Whole Grain

Quinoa, potato,

rice, pasta, etc.

3-4 oz

~2 Tbsp –¼ cup

~1/2 cup

Small plate

1 cup total

Protein

lean meat, fish,

poultry, dairy,

beans/lentils,

tofu, nuts/seeds

DIET FOR LIFE – SAMPLE MENUTime Food Amount Total

7:30 am 2% fat Greek yogurt, key lime

Berries

Vector Granola

100g container

¼ cup

¼ cup

8 g

7g

21g

7g

21g

10:00 am Banana

Peanut Butter

1

2 tbsp

12:30 pm Salad:

- Lettuce

- Shredded carrot

- Cucumber

- Cherry tomatoes

- Italian dressing

- Chicken

- Quinoa

1 tbsp

3 oz

¼ cup

3:00 pm Cheddar cheese

Whole grain crackers

1 oz

6

5:30 pm Salmon

Mashed potatoes

Green beans

3 oz

¼ cup

½ cup

Time Food Amount Total

7:30 am 2% fat Greek yogurt, key lime

Berries

Vector Granola

100g container

¼ cup

¼ cup

8 g

7g

21g

7g

21g

10:00 am Banana

Peanut Butter

1

2 tbsp

12:30 pm Salad:

- Lettuce

- Shredded carrot

- Cucumber

- Cherry tomatoes

- Italian dressing

- Chicken

- Quinoa

1 tbsp

3 oz

¼ cup

3:00 pm Cheddar cheese

Whole grain crackers

1 oz

6

5:30 pm Salmon

Mashed potatoes

Green beans

3 oz

¼ cup

½ cup

Calories = ~1300

Protein = ~64 grams

MEAL ROUTINE

Skipping meals can lead to:

Increased hunger later in the day

Larger portions and less healthy choices

Evening snacking

Increased food cravings

Binge eating

Challenges managing emotional eating

Risk of malnutrition and deficiencies

Increased difficulty with weight loss/maintenance

MEAL PLANNING

Meal Planning has many benefits:

Can help you achieve your eating and nutrition goals

Helps you stick with what you want to eat

Reduces the stress of figuring out what to eat when you

are hungry

Can limit take-out/fast-food intake

Save money

There are many ways to meal plan. Find the way that

works best for you and your family.

VITAMIN & MINERAL

SUPPLEMENTS

Why you need them:

You won’t be able to get enough from food

Some malabsorption of micronutrients after

bariatric surgery

To prevent nutrient deficiencies (easier to

prevent than correct after surgery)

NUTRITIONAL DEFICIENCIES

Vitamin deficiencies can have serious consequences,

and can even be life-threatening

You can prevent them by:

Taking your vitamins every day

Taking the correct vitamin doses

Getting your bloodwork done

Showing up to all of your follow-up visits

Close monitoring after surgery is essential!

VITAMIN & MINERAL SUPPLEMENTS

Some of your vitamins may be too big to swallow

whole for the first 3 months

Cut or crush large pills

Pills may be split in half or crushed and mixed in

applesauce, pudding, or yogurt

You can use liquid/chewable vitamins

Do NOT use children’s or gummy vitamins

SUPPLEMENT TIPS Take calcium and vitamin D at the same time

Do not take calcium with any iron containing products

(eg. Prenatal multivitamin and iron supplements)

Tips for tolerating iron (in prenatal and iron

supplements):

Take at bedtime

Try taking with small snack

Use a stool softener/laxative if experiencing

constipation

PHYSICAL ACTIVITY GUIDELINESWhat Avoid

First 8 weeks

• Walking - Increase the

length of walking as

tolerated

• Easy stairs

• Light household chores

• Water exercise

• Abdominal exercise

• Moderate to vigorous

intensity exercise

• Strength/resistance

training

• Heavy lifting, pushing or

pulling (vacuuming or

carrying heavy groceries)

PHYSICAL ACTIVITY GUIDELINES

What Avoid

8 weeks &

beyond

• Swimming or water exercises

• More frequent or longer walks

• Low/moderate/vigorous intensity

cardiovascular activities as

tolerated

• Abdominal exercises as tolerated

• Strength/resistance training

• Activities requiring balance or

coordination

• Increase the variety of physical

activity

• Flexibility exercises

• Exercises that cause pain or

discomfort

• Over-exercising

Consult with your doctor

before starting any

strenuous activity

ACTIVITY TIPS Pick activities that you enjoy

Physical activity has many forms:

Walking, biking, swimming, chair exercises, resistance

bands, yoga, etc

Activity should be in addition to daily household chores,

gardening, and working

Make sure that what you are doing and how much

is sustainable for you long-term

Goal: Minimum 150 minutes of activity weekly (eg. 30

minutes, 5 days/week) at this stage

CHALLENGES AND

SYMPTOM MANAGEMENT

Nausea and vomiting

DehydrationDumping Syndrome

Constipation Diarrhea Gas/Bloating

Hair LossLack of

AppetiteFood

Intolerance

NAUSEA AND VOMITING

Common Causes Prevention

Eating too quickly

& Overeating

Constipation

Food feeling stuck

Not chewing well enough

Measure your food portions, avoid

distractions, put your fork down

between bites, & time your meals

Chew your food 20-30 times per

bite

Avoid dry foods, by using moist

cooking methods & adding gravy or

sauce

Keep bowels moving regularly

Common Causes Prevention

Dehydration

Eating and drinking

together

Prolonged periods between

meals

Taking large bites Cut food into small pieces

Do not drink 30 minutes before

or after a meal

Aim for 3 meals and 2-3 snacks

a day

Drink 6-8 cups or 1.5-2 litres of

low-calorie fluids every day

NAUSEA AND VOMITING If your vomiting persists for

more than 3 days, contact

the Bariatric Clinic

DUMPING SYNDROME

When the new, smaller pouch after a bypass empties into

the bowel too fast. Symptoms include:

Abdominal pain

Nausea

Cramping

Bloating

Diarrhea

Sweating

Feeling faint

Increased heart rate

Shakes or chills

DUMPING SYNDROME

To prevent dumping syndrome:

Eat protein and fibre with each meal

Separate your food and fluid by 30 minutes

Avoid deep fried and greasy foods

Avoid foods that are high in added sugars

DUMPING SYNDROME

Greek Yogurt

½ Cup (vanilla)

Protein: 8.7 g

Sugar: 12 g

Fibre: 0 g

Orange Juice

1 Cup

Protein: 1.7 g

Sugar: 21 g

Fibre: 0.5 g

Banana

1 medium

Protein: 1.3g

Sugar: 14 g

Fibre: 3.1 g

VS VS

CONSTIPATION

Constipation is caused by:

Eating less fibre due to diet progression

Eating smaller portions

Decreased activity level

Not drinking enough fluids

Taking pain medications, including Tylenol 3

Typically bowel movements should be at least once

every 1-2 days

CONSTIPATION

Aim for 1.5-2 litres

of fluid a day

Remain active May try adding prune juice,

followed by a warm beverage

Increase insoluble fibre,

as per diet progressionMay want to try a

fibre supplement

May need a stool

softener or laxative

*

DIARRHEA May take time for bowel to adapt

To help prevent diarrhea:

• Avoid spicy and fatty foods

• Avoid caffeine and alcohol

• Increase soluble fibre

• You may need a fibre supplement

Drink extra fluids with diarrhea

Normal can be up to 3 bowel movements a day

If you have

diarrhea that

continues more

than 3 days,

contact the

Bariatric Clinic

GAS AND BLOATING

Tips to prevent gas and bloating:

Eat and drink slowly

Regular intake helps you to control your pace

Remain active

Avoid items that increase the amount of air swallowed

Includes: carbonated beverages, chewing gum, and using straws

Identify particular foods that may be causing more gas

May include beans, lentils, some vegetables, or dairy

Avoid sugar alcohols

Ingredients that end in -itol

FOOD INTOLERANCES Everyone tolerates foods differently after surgery

Common foods that may not be well tolerated:

Pasta, rice, and fresh breads

Dry, dense or tough meats

Reheated foods

High fat foods

High sugar foods

Try new foods in small portions, chew well, add

moisture, and try at a later time if not tolerated at first

Track your dietary intake to determine your triggers

HAIR THINNING OR HAIR LOSS Usually occurs between 3 and 9 months post op, with

hair regrowth once your body recovers

Caused by stress on the body from major surgery and

the rapid weight loss after surgery

Hair loss in this time period is NOT nutritional

There is no evidence that biotin supplements prevent

or help with hair loss and thinning

LACK OF APPETITE

Not feeling hungry is normal for the first 6-12

months following surgery

Tips on how to overcome

Focus on nutritious foods at each meal and snack

Consume protein first

Eat small portions frequently throughout the day

Aim to eat every 2-3 hours

May need to set alarms to remind you to eat

May need to consume more calorie dense foods to

make up for smaller portions

WEIGHT PATTERNS

Plateaus are a normal part of weight loss and you will likely

have many on your weight loss journey

Many people see their first weight plateau around 4-6 weeks

post-op

Some people lose weight more quickly, some people lose more

slowly

You will see your weight fluctuate day to day – this is normal

Don’t weight yourself more than once a week

WEIGHT PATTERNS

A safe rate of weight loss is an average of 1-2 lb/week

This is what we might see by ~3-6 months post-op

Total weight loss from highest adult weight is normally 20-30%

by 12-18 months post-op

Most people see their weight loss stabilize by 12-18 months

post-op

Remember to also think about the improvements in your

health and/or quality of life along the way!

DO’S AND DO NOT’S

DO:

Aim for 3 meals and 2-3

snacks a day

Aim for 60-80 grams protein

everyday

Track your diet

Have 2 litres (or 8 cups) of

fluid daily

Take your vitamins everyday

Start some physical activity

DO NOT:

Advance your diet too quickly

Experiment with trigger or

tempting foods

Eat foods with minimal

nourishment (i.e. high

fat/high sugar) often

Weigh yourself daily

Hesitate to ask for help as

needed

SUCCESS

We are here to help and support you

You can contact our team through Dovetale or at

the following telephone numbers 905-522-1155

Dietitian extension: 33437

Nursing extension: 34231

BARIATRIC SURGERY SUPPORT

GROUP

Third Tuesday of every month

All attendees have already had surgery

Helpful tool to communicate with those who

are or who have gone through this experience

Currently run through Dovetale

Send a Dovetale message with your email

to the Mental Health Team to get monthly

updates and to register for the group

NEXT STEPS

You are scheduled for your regular follow-up

appointments:

3 month + blood tests

6 month + blood tests (wait list)

12 months + blood tests

Please have your bloodwork completed at least

2-3 weeks before each appointment