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Dietitian Answers Questions on Weight Loss Surgery

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Reading Time: 9 minutes

Weight loss surgery can be considered daunting, and you may have questions that run around in your head before making that decision and going for it. However, bariatric surgery is life-changing and can lead to a longer and happier life by allowing you to finally ditch that excess weight and become an all-round healthier person. 

We know that research is the start of your journey and finding out what is best for you is crucial. Recently, we had a Live Q&A webinar with our very own bariatric dietitian Heather Fry to answer all the burning questions you may have. We have the live questions and answers in this blog from Heather, and the likelihood is that it will answer the questions in your head right now. 

Skip to a section by clicking a question below!

EATING & DIET

WHAT IS A POST-OP DIET?

It is a question that people are very unsure about due to different advice from different providers and surgeons. But this is the general breakdown of the post-op diet:

  • Two weeks of a liquid diet – this is where you consume meal replacement shakes, protein shakes or soups.
  • Once the two weeks of liquids are complete, you then move on to two weeks of pureed foods (soft foods), portions are tiny, and you should eat very slowly. 
EATING & DIET

WHAT IS THE BEST EATING TECHNIQUE

The twenty, twenty, twenty! This eating technique, where you eat bites of your meal that are the size of a twenty pence and chew everything well. Then, once swallowed, wait twenty seconds and repeat the process for twenty minutes! 

EATING & DIET

"A friend of mine has the band and said she often feels sick and feels food backed up and can feel it drop through the band?"

When food is backing up, that usually indicates that it is sticking above the band and building back up the oesophagus, and this could be down to two things: 

  1. Food building back up the oesophagus can be due to not eating correctly, such as consuming bigger bites or eating quickly. 
  2. The most likely scenario is that the band is too tight and starts collecting food above the Gastric band. Leading to the risk of pouch dilatation, and over time if it’s not looked at, the constant discomfort can cause the stomach to stretch.

Heather's Top Tip

maybe check your eating techniques and use the twenty, twenty, twenty or have fluid removed from the band to loosen it and allow the food to pass through comfortably”. 

EATING & DIET

WHAT WOULD YOU SUGGEST FOR THE LIQUID STAGE AS I DISLIKE SOUP?

There is so much out there you can have now in comparison to ten years ago! Your options will be meal replacement shakes or milk to make low-calorie coffee or light hot chocolate. 

There is a lot of variety when selecting protein shakes, and there are even vegan options!

Bariatric Dietitian Top Tip

when consuming liquids such as light hot chocolate, ensure they are always the light options, and you are not having many of them because the sugar content will soon add up. 

EATING & DIET

What shakes do you recommend, ready-made or the powder?​

Either! It doesn’t matter, whatever is easy for you. We recommend 1 gram of protein per kilogram of your ideal body weight. So when picking your shake, you want to ensure it has at least 15-25 grams of protein. 

Bariatric Dietitian Top Tip

You don’t want to choose protein shakes that have 10 grams or less. Your daily consumption of protein generally should be around 70 grams. 

MEDICATION

SUPPLEMENTS AFTER SURGERY?

Generally, we don’t recommend taking supplements straight away. You have a lot going on! There is a lot to gather with your new diet; having enough fluid and adding supplements as well… can be pretty tough going at the start. 

That said, though, if the supplement is a chewable or a powder form, you can take that straight away after surgery because you are breaking it down to the point where it dissolves. 

Bariatric Dietitian Top Tip

I have tried the chewable ones, and they just break down”. So you should be able to have the chewable supplements earlier than five weeks if you want to

MEDICATION

CAN I TAKE SOLID TABLETS

You should avoid solid tablets for at least six weeks after the bypass and sleeve. However, you are generally ok to take them with the band if they are small, but you should dismiss the “big bullet” type of tablets. 

MEDICATION

Are Tesco Multivitamins and Minerals ok?​

Absolutely! As long as you’re taking them twice a day, they only give you 1mg of copper per tablet. According to the British Obesity & Metabolic Surgery Society (BOMSS), you should consume 2mg of cooper daily. 

Bariatric Dietitian Top Tip

When taking Tescos multivitamins and minerals, take the tablets separately as you are more likely to absorb as much as possible from each tablet. 

MEDICATION

In the vitamin list, it mentions chewable baricol vitamins. Are these suitable as I thought we couldn't have solids until 5 weeks?

Baricol is a Swedish brand that formulates a complete bariatric multi and mineral vitamin supplement and covers everything the British Obesity & Metabolic Surgery Society advises. 

Over the years, the British Obesity & Metabolic Surgery Society did a lot of research. As a result, they developed a formulation for people who have had the bypass and sleeve to reduce the risk of developing a deficiency.  

Bariatric Dietitian Top Tip

Baricol includes a high dose of vitamin B12, meaning you may not require b12 injections every two weeks. However, you should have regular checks.

MEDICATION

Would you recommend Baricol or Forceval? ​

It’s more of a personal choice! However, both brands are close in terms of the micronutrients and what they can provide for you. With forceval, you only need to take one a day, whether it’s a soluble or a capsule form. Though the soluble form is not well tolerated, ” it doesn’t taste very nice”. The capsule is quite extensive. If you struggle with that, the next best thing is Baricol. 

MEDICATION

Is it ok to take my usual medication everyday?

Most of the time, yes! You can take your usual medication every day; however, it depends on what they are. There are some medications we advise to avoid life long after surgery, such as NSAIDs (non-steroidal anti-inflammatory drugs), e.g. ibuprofen, naproxen, diclofenac, which can cause gastric ulcers. 

Bariatric Dietitian Top Tip

You should avoid tablets for the first six weeks after a bypass or sleeve. We advise an alternative form such as liquid or crush the tablet. Please speak to a GP or Pharmacist prior. 

MEDICATION

Can I still take Anadin extra for headaches?

Yes, you can take Anadin extra. Though it is a low dose of non-steroidal anti-inflammatory, you have to be careful and not take it regularly. 

Bariatric Dietitian Top Tip

if you can get another form that can manage your headaches, that would probably be better than taking aspirin regularly.

MEDICATION

Is it ok to have Depot injections after getting the sleeve done?

Absolutely! Conception is a vital topic to discuss. The pills are not the preferred method after surgery. 

We do want you to avoid pregnancy for the first 18-24 months after the procedure, and this is because this time frame is when you will lose weight quickly. Waiting for your weight to be stable is essential. 

Bariatric Dietitian Top Tip

Having the depot injections are much better!

EATING & DIET

How to consume enough water after the sleeve? I am worried about feeling faint.

In the initial stage, you are on fluids only, you can manage it quite well, like soups and protein shakes will account for your total fluid intake. However, after that, introducing food can become more of a challenge. You will be advised not to drink with a meal and not to drink at least half an hour after a meal. So you will need to plan out your day around food and fluid. 

Bariatric Dietitian Top Tip

Sip slowly, have small cups and know how much volume you will be consuming, so you have a rough idea. Most people manage 1 litre and do ok! However, it would be best if you weren’t anxious about it. The more worried you get, the more difficult it can be. You want to be nice and relaxed. You can manage it! You can maintain about 200ml, it should take you thirty minutes, but you should be ok to do that frequently to ensure your getting enough liquid throughout the day.

EATING & DIET

Why can't we drink fluids 30 minutes before and after eating?​

If your drinking with a meal, you can run the risk of diluting your food. Essentially, it thins the food out, and it flows through your stomach quicker. Meaning it runs past the intestines a lot faster, and you won’t feel satisfied. However, you may feel hungry again within an hour, and then you can begin eating more and potentially putting weight back on.

Bariatric Dietitian Top Tip

We want you to avoid drinking with and soon after a meal.  

EATING & DIET

Will we always sip water, or eventually will we be able to drink normally again?

You will find as time goes it will be easier to drink. So, after surgery, you take small sips and wait, but as the months and years progress, you will consume a drink ‘normally’.

Bariatric Dietitian Top Tip

You might find it uncomfortable to down a drink, but eventually, you should find you can drink normally. 

LIFESTYLE & FTINESS

EXERCISE AFTER SURGERY?

Once you are recovered and back on a solid food diet, generally leave exercise till six weeks post-surgery. After the operation, we want you to be walking to help reduce the risk of DVT (blood clot forming from the calve).

So, you can go out for walks, but avoid anything strainful until that six weeks (post-op). 

LIFESTYLE & FTINESS

Post-surgery - if you work out, are you at risk of being undernourished if you can't eat enough?

Potentially yes! Even if you don’t work out. If you don’t eat a balanced diet, you don’t take the proper supplementation; there is always a risk of being undernourished. 

Quite rare, though, from what we see, we review a lot of blood tests of people who have surgery and most of the time, they are relatively normal. There are a few common deficiencies; iron, folate and vitamin D. 

Bariatric Dietitian Top Tip

If you are not getting enough protein and then work out hard in the gym, your body will start breaking down! If you’re not nourishing yourself with a diet and you’re still trying to function, your body will start finding nutrition elsewhere. It begins to look at the muscle, and we begin to see muscle wastage. 

LIFESTYLE & FITNESS

Is it ok to walk my dog for 30 minutes a day from post-op? ​

It depends on the size of your dog. If you have a small who is brilliant on or off the lead, then a little stroll is fine! You will know yourself if you feel well enough. 

LIFESTYLE & FITNESS

How to cope with head and emotional hunger?

Something that a lot of people struggle with! Heather spoke to her daughter before the live Q&A and asked, why do you eat? She replied, “to be healthy and stay alive”. At what point in our life did we think we needed food for other reasons? Whether it is for comfort, stress, what made us believe it is ok? It is that trigger that needs to work on rather than the types of foods. So we select foods high in fat and sugar when our body is stressed because it wants quick energy. 

Bariatric Dietitian Top Tip

If you are eating through emotional hunger and that seems to be your main issue, try and work on that first. Try therapy sessions to help manage it a little better. 

LIFESTYLE & FITNESS

WHEN CAN YOU DRIVE AFTER SURGERY

Generally, about a week, so check with your insurance to make sure they are happy for you to drive. From our point of view, ensuring your incisions have started heal is essential. So make you don’t put any pressure on them if you are driving. 

LIFESTYLE & FITNESS

Can Hair loss be expected after the sleeve?

It can be expected with any procedure, the reason it happens:

  • not meeting your nutrition requirements
  • You are not taking your supplements.
  • The rate of your weight loss; even if you take all your supplements and complete the correct nutrition requirements, you can begin to lose hair through losing weight quickly. 

Once the weight loss slows down, the hair loss slows down, and as long as you are in a healthy nutrition state, you start to grow back hair. 

Bariatric Dietitian Top Tip

the best thing to do! Ensure you are in the best nutrition state before surgery. So have your vitamin and mineral intake and a decent diet.

LIFESTYLE & FITNESS

EXCESS SKIN

If you are older and your skin has been stretched due to carrying excess weight for a long time, you are more likely to have loose skin. It doesn’t matter how much exercise you do; the skin is still stretched. However, you can exercise to bring the muscle back from underneath. 

LIFESTYLE & FITNESS

Does having your Gallbladder removed help?​

In terms of the operation, it doesn’t help the surgeon; it only helps you long term when getting the Gallbladder removed, and it decreases the risk of gallstones. 

Bariatric Dietitian Top Tip

In terms of the operation, it doesn’t help the surgeon; it only helps you long term when getting the Gallbladder removed, and it decreases the risk of gallstones. 

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