Nutrition Follow-Up After Obesity Surgery

NUTRITION IN OBESITY SURGERY

The first thing you need to change in the new life you begin with your decision to have surgery is your eating habits. Healthy eating habits that become part of your lifestyle will increase the success of the surgery and reduce the likelihood of regaining weight.

WHAT TO KEEP IN MIND AFTER SURGERY

• Eat small, frequent meals, even if you do not feel hungry.
• Chew food thoroughly until it is well ground, and eat slowly. Main meals should take about 30 minutes and snacks 15–20 minutes.
• At every meal, eat protein sources (plant or animal) first, then high-fiber foods (vegetables and fruit), and carbohydrate sources last.
• Do not consume solid and liquid foods together.
• Fluids may be consumed 30 minutes before and 30 minutes after a meal. Do not drink fluids during meals.
• Stop eating as soon as you feel full. Eating quickly or eating large amounts at once will cause vomiting.
• Avoid very cold or very hot foods and drinks.
• Do not neglect water intake; your daily intake should reach 1.5–2 liters as soon as possible.
• Get into the habit of reading labels and avoid high-calorie foods that contain a lot of fat, sugar and salt.
• Do not neglect physical activity; increase it gradually.
• Do not skip routine check-ups. Be sure to have your tests done at months 1, 3, 6 and 12, and, if necessary, take the vitamin and mineral supplements recommended by your doctor.

WHAT TO AVOID AFTER SURGERY

• All desserts (cakes, pastries, cookies…)
• All fried foods
• Sugar and sugary products (fruit yogurt, chocolate, etc.)
• Carbonated drinks
• Alcoholic beverages
• Full-fat milk and dairy products
• Chewing gum
• Fatty sauces (mayonnaise, cream, etc.)
• Meat with the skin left on
• Very cold products such as ice cream, frozen yogurt and milkshakes
• Very salty foods (pickles, canned foods)
• Pastries and dough-based foods

NUTRITION STAGES AFTER SLEEVE GASTRECTOMY

Stage 1 – Clear Liquid Phase

Stage 2 – Full Liquid Phase

Stage 3 – Puréed Phase

Stage 4 – Low-Fat Solid Phase

Stage 1: Clear Liquid Diet (1–2 days)

This is the first stage of nutrition, started with the doctor's approval after leak tests have been performed in the hospital. The aim of this diet is to get the bowels moving again after the operation. Liquids that do not require digestion in the stomach and intestines are preferred.

Start with pulp-free, unsweetened, non-acidic liquids at room temperature, taken in small sips (30 ml of fluid every 15 minutes).

Liquids You Can Have

• Water
• Linden tea, green tea
• 100% fruit juices (apple, pear, pineapple juice, etc.)
• Strained soups
• Unsweetened compotes and stewed fruit drinks

Note: Acidic fruits (orange, tangerine, etc.) should not be used in homemade compotes or fresh fruit juices, and everything you prepare should be strained so that no particles remain (strained through cheesecloth).

Stage 2: Full Liquid Diet (2 weeks)

During this period, from day 3 to day 15 after discharge, a full liquid diet is followed by adding new foods to the clear liquids.

All drinks should be thin enough to pass through a straw and at room temperature. Avoid drinks that are hard to digest or cause gas.

Liquids should be sipped slowly without using a straw, and you should stop as soon as you feel full.

Do not neglect water intake; aim to reach 10 tea glasses of water a day.

Liquids You Can Have

• Clear liquids
• Soups made with broth diluted with water (blended)
• Lactose-free milk / soy milk / skim milk
• Light ayran (yogurt drink) / light yogurt
• High-protein, lactose-free milks with no added sugar / high-protein probiotic yogurts
• Freshly squeezed fruit juices (except citrus fruits)
• Nutritional products, protein powders, enteral formulas

Stage 3: Puréed Diet (2 weeks)

A puréed diet is followed between days 16 and 30 after surgery. Patients who cannot tolerate purées may return to the previous stage (liquid diet). If the patient cannot move on to the next stage, the puréed diet may be extended to 3–4 weeks.

This is the stage in which foods that meet protein and energy needs are prepared in liquid and/or semi-liquid form. At this stage, it is important that foods do not contain many particles, are well blended, and are neither very hot nor very cold.

Start each meal with 2–3 dessert spoons and increase the amount if you feel no discomfort. Stop eating when you feel full.

Meals should last 20–30 minutes. Eating quickly or eating fatty foods may cause vomiting.

Water intake should be kept between 12 and 15 tea glasses a day.

Foods You Can Have

• Clear liquids + the liquids in the full liquid diet
• Soft-boiled eggs
• Low-fat, low-salt soft cheese
• Blended soups
• Vegetable purées
• Grated fruits that are not acidic and do not contain small seeds (such as strawberries, kiwi, pomegranate)
• Soft fish, minced red meat, blended chicken

Stage 4: Low-Fat Solid Diet

• This diet is started from the first month onward, gradually replacing the purées. At this stage, it is important to try small amounts of each food and to expand your diet step by step under the guidance of a dietitian. Only one new food is tried on any given day; a food that is not tolerated is postponed to be tried again later.
• It is important not to consume solids and liquids together at meals.
• Get enough protein every day.
• Increase your water intake to 2 liters a day.
• Before trying meat in pieces, add it to vegetable dishes and cook it until it is moist and soft.
• Try fruits without the peel first. Citrus fruits can be introduced 1.5–2 months after the operation.
• Dried legumes should be soaked in water to reduce gas before cooking and tried with cumin added.
• Nuts are hard to digest and high in fat, so they should be eaten in moderation; choose unroasted, unsalted varieties.

For bread, you can start with whole wheat, rye or whole-grain bread and oats. Pasta and rice should be avoided for 6 months.