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The DIETITIAN’s Role in the Careof the Bariatric Surgery Patient

MOVE TIME/Bariatric Clinic Dietitians Our dietitians are experts at motivational learning aroundeating styles and habits. They collaborate with the Veterans to optimize nutrition andfood choices. Ensure healthy, nutrient-rich foods with individualizedprograms based on each Veteran’s specific circumstances andsupport structure. Help support patients in changing their relationship with foodand eating.

Why See a Dietitian? A healthy diet, sound food choices, and goodeating habits are fundamental to a successfulweight loss program. The dietitian will assist you with thesecomponents throughout your process before andafter weight-loss surgery. Dietitians help assess, monitor and counselpatients before and after surgery to improveadherence to recommendations, maximizeweight loss, and increase motivation.

Diet after Bariatric Surgery Dietitian works with the Veteran to help ensurethat: Fluid requirements are met – avoid dehydrationProtein requirements are metNew eating habits are established and maintainedMicronutrient deficiencies are avoided THEY PROMOTE SAFE AND STEADY WEIGHT LOSS

Typical Diet after Bariatric SurgerySTEP 1 (Post operative day #1 and #2) One ounce of water every hour– If nausea occurs, then wait 1 hour and tryagain If feeling of fullness occurs, maintain this stepfor 24 hours If tolerating this step (e.g. no nausea, nofeeling of fullness) proceed to nutritionalsupplements

Typical Diet after Bariatric SurgerySTEP 1 (Post operative day #1 and #2) Nutritional Supplements– 3 “meals” a day consisting of a nutritionalsupplement drink, 2 ounces at a time– 4 oz. of high-protein gelatin (Jello) split into“snacks” between meals– This small amount will satisfy you and leaveyou feeling full!

Typical Diet after Bariatric SurgerySTEP 2 (Postoperative week 1-2)Avoid dehydration: Drink at least 32 oz. of fluids per day– Calorie-free, non-carbonated liquids Water Tea BrothCrystal lightSugar-free Jell-OSugar-free Popsicles No Gatorade, fruit juiceor sugar-sweetened drinks

Typical Diet after Bariatric SurgerySTEP 2 (Postoperative week 1-2)“Meals”/Calories: You will have 4-5 “meals” a day consistingof a nutritional supplement drink, 2-3ounces at a time––––Ensure High ProteinBoost High ProteinBoost Glucose ControlMuscle Milk or Premier Protein If you still feel hungry, try adding 1 tablespoon offat-free milk powder per 2 oz of liquid Take a chewable Multivitamin daily!

Typical Diet after Bariatric SurgerySTEP 3 (Postoperative weeks 2 – 6): Transitioning to Food– Increase fluids to greater than 60 ounces per day– Eat high protein foods: goal of 60 grams protein/day– Protein is important! We want you to lose weight in fat,not muscle Soft high-protein foods are well-tolerated–––––Eggs or Egg substitutesLowfat Cheese or Cottage CheeseNon-fat, Sugar-free YogurtFish - poached, baked, or boiledChicken – grilled, baked Avoid for now: fruits/vegetables, breads, grains, starches– They fill you up quickly and you will have no room for protein!

High Protein Soft Foods - ExamplesFood Type 1 jar baby food meat (plain) ½ cup nonfat cottage cheese 1 envelope sugar-free InstantBreakfast made with 1 cup nonfat milk ½ cup egg substitute (cooked) 1 serving (5 oz) tofu 1 cup sugar-free pudding with nonfat milk 1 cup light nonfat, no sugar yogurt 1 cup nonfat milk 1 cup vanilla soymilk (Calcium Fortified) 2 Tablespoons reduced-fat peanut butter 1 can Glucerna (canned supplement)Grams of Protein13 grams13 grams12 grams10 grams10 grams10 grams8-9 grams8 grams6 grams8 grams10 grams

Typical Diet after Bariatric SurgeryStep 4 (After 6-8 weeks): Transition to a Balanced Diet Drink more than 60 ounces of water per day Continue to eat high-protein foods:goal of 60 grams protein/day Introduce other Foods–––––Meat, PorkVegetables (soft steamed will be easier at first)Soft fruitsNutsGrains

Nutrition Helpful Hints Drink fluids between meals, instead of with meals Wait about 30 minutes before and after a mealbefore drinking fluids When choosing meats, select lean chicken, turkey,fish, or tender cuts of red meat Do not add sugar to any of your foods or beverages Do not drink carbonated beverages

Bariatric Surgery Nutrition Basics Stay hydrated Eat slowly and chew food thoroughly Listen to your body! Stop drinking and eating ifyou feel full or uncomfortable Monitor portion sizes READ FOOD LABELS! Avoid foods or liquids withadded sugar or fat Take nutritional supplements as advised Set up a schedule for taking your supplements andmedications

Dietitian/Nutrition at the Palo Alto VA We look forward to meeting you!