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After your procedure - advice and information

Congratulations! Your procedure is over. Now you can look forward to future weight loss success.This section covers general information about what to expect following your procedure and how Healthier Weight is committed to help you achieve your weight loss goals. We are here for you at every stage of your weight loss journey.

before_aftercare.jpg

You are entitled to fully inclusive aftercare support until 2 years after your procedure date. This includes:

  • Medical and nutritional reviews with the bariatric nursing team

  • Blood test and review at 6 and 18 months post operatively.

  • General support by telephone during office hours on 0121 693 4488 (9am - 5.30pm)

  • Medical emergency assistance by telephone on 07747 563 189 (7am - 10pm)

  • Access to online patient forum on Facebook


Support and advice

General enquiries: 0121 693 4488

Please remember that we are here to help and reassure you so if you have any questions or concerns, however small, do please call us. Your call will be answered within office hours (Mon – Fri, 9am – 5.30pm). If your call is made outside of office hours, please leave a message and we will call you back the following day.

Booking appointments: 0121 693 4488

  • Within your aftercare package, there is no charge for a review appointment

  • You can amend or cancel your appointment, provided you give at least 24 hours notice. If you do not give sufficient notice, you will be charged an administration fee of £45

  • Our appointments are in great demand and if your preferred date is full, you can ask to go on the reserve list. If any appointments are cancelled in advance, we will offer them to patients on the reserve list in order of the date they were added

  • Regardless of where you had your surgery procedure, you can book an appointment at any of our nationwide clinics


Seeking help when you are experiencing symptoms that concern you

There is a detailed emergency advice section on this website which covers the most common causes for concern. Here you’ll find information and video clips with advice on suitable medication including tried and tested tips to help alleviate any symptoms.

If your concern is not answered by this section, call the Emergency Helpline on 07747 563 189. Your call will be answered Mon-Sun 7am – 10pm.

If you are seeking help outside of these hours and, after reading the advice on the emergency advice pages, you are still concerned about your symptoms, please go to your nearest Accident and Emergency Department or walk in centre for investigation.

View emergency advice section

Taking medications

  • With the exception of NSAIDs (see below), the general advice is to continue to take prescribed medication but please refer to the advice given to you by our medical team. If you are in any doubt, please call a bariatric nurse on 0121 693 4488

  • If your tablets are large, some medications may need to be crushed or taken in liquid form for the first six weeks after your surgery. Please check with your doctor whether your medication is available in a liquid or soluble preparation. Seek medical advice before crushing your pills as many common medications are slow-released and cannot be crushed

  • If you take medication for diabetes, please check with your doctor before restarting medication after your procedure as your requirements are likely to be much less than they were prior to your surgery

  • Medications that irritate the stomach should be avoided, especially non-steroidal anti-inflammatory medicines such as aspirin, Ibuprofen, Diclofenac, Sulindac, Celecoxib, Diflunisal, Naproxen, Piroxicam etc. If you are unsure, call to speak to a nurse



Vitamin and Mineral Supplements

Vitamins and minerals are vital for appetite regulation, fat storage and metabolic rate so are important for good health, weight loss and long term weight maintenance. After gastric sleeve surgery, portion sizes are smaller, some food groups may not be tolerated and you may not absorb vitamins and minerals as effectively. It is, therefore, essential for all sleeve patients to take multi-vitamins for life. Failure to do so may lead to health complications. The Bariatric Nurse will discuss this with you during your pre-operative call. You need to start taking vitamin supplements at week 3 and we recommend that you take each of the following supplements daily...


Multivitamin & Mineral
To include Selenium, Copper (minimum 2mg), Zinc (at a ratio of 8-15mg to every 1mg of Copper)
. Suitable preparations include:
  • Forceval
  • Centrum Fruity Chewables for Adults
  • Bassett’s Active Health Multivitamins with Minerals for adults
  • Sanatogen A-Z Complete
  • Superdrug A-Z Multivitamin & Mineral
  • Lloyds Pharmacy A-Z Multivitamin & Mineral


Calcium and Vitamin D
To include 1200mg Calcium and 800IU Vitamin D per day. Suitable preparations include:
  • 2 x Adcal D3 (chewable) - 2 tablets per day
  • 2 x Boots Calcium with Vitamin D (chewable) + 1 x Boots Vitamin D 10 μg (tablet)


Iron   
  • Males & post-menopausal females
    45-60mg Iron equivalent to 200mg ferrous sulphate, 210mg ferrous fumarate or 300mg ferrous gluconate

  • Menstruating females
    100mg Iron equivalent to 200mg ferrous sulphate or 210mg ferrous fumarate twice daily


Ferrous sulphate 200mg tablets are also available to purchase OTC at Superdrug


Vitamin B12
Included in your package is a blood test at 6 months after your procedure to check your B12 levels. If you are deficient, a high dose of oral Vitamin B12 or intramuscular injections will be required. You may wish to have your B12 level checked by your GP on an ongoing basis. Your GP will advise but this is likely to be once or twice a year.

 

Caring for your wounds after gastric band surgery
During your operation the surgeon makes a number of incisions through which surgical instruments are inserted. When the procedure is completed, these wounds are stitched, stapled using clips or glued to bring the skin edges together. The number of incisions and how they were closed will depend on your surgeon. The skin edges usually form a seal within a day or two of the operation, though the rate of healing varies between individuals. Some early discomfort around the wound sites is inevitable and is a perfectly normal part of the healing process. It is also quite common to have a small amount of bruising of the skin immediately surrounding the wounds.

Stitches, Clips and Glue: The medical term for stitches is sutures. Most often the stitches used are dissolvable and don't need to be removed. This usually takes around 10-14 days. Occasionally small stitch “ends” may be seen in the scar, if this is the case please contact your Bariatric Nurse. Special skin glue can also be used to close wounds and this usually peels off in 5-10 days. Surgical clips may also be used.

Dressings: At the end of the operation, your surgeon may apply adhesive dressings to the single incision and/or other wounds. Some surgeons do not use any dressings post operatively. If applied the purpose of a dressing is to:

  • absorb any leakage from the wound
  • provide ideal conditions for healing
  • protect the area until the wound is healed

Prior to discharge from the hospital the ward will provide you with a change of dressings. If you don’t have enough you can buy some from your local pharmacy. If glue has been applied to the wound, dressings are not supplied.


Wound care instructions

To minimise infection, please wash your hands thoroughly before caring for your wounds. Wherever possible avoid touching your wounds until they have fully healed.


Patients of Mr Hamouda / Mr Hayden / Mr Kelly / Mr Mehta / Mr Riera

  • You will be discharged with a wound care pack. Please follow the wound care regime below:

  • Remove all dressings 5 days after your procedure and replace with new dressings
  • After another 5 days remove all the dressings and leave exposed to fresh air


Patients of Mr Jambulingam / Mr Li / Mr Singhal / Mr Whitelaw / Mr Loy / Mr Smellie / Mr Humadi / Mr Monkhouse

  • A wound care pack will not be required
  • You will have surgical glue over your wounds which will simply peel off after time
  • You can shower but please ensure that the glued wounds are totally dry afterwards by patting the skin gently with a clean towel


Patients of Mr Kasem

  • A wound care pack will not be required
  • You will have surgical clips over your wounds which will be covered with a waterproof dressing
  • You will be advised to have them removed at the hospital 10 days after surgery



Wound FAQs

When can I shower or bathe?
We advise that you keep the wounds as dry as possible and avoid showering for 10-days, please also be careful when bathing. This is because if the wounds get wet, there is a significantly increased risk of developing a wound infection. When you start to shower or bathe, gently pat the wounds dry with a clean towel and avoid rubbing. However, if you have had glue applied to your wounds it is quite safe to shower immediately after your surgery.

How long will it take for the wounds to heal?
Usually your wounds will be healed in about two weeks following the procedure. However, some heal faster than others so please don’t be alarmed if yours take a few days longer.  

Is it normal for the wound to itch?
Yes. This is a normal accompaniment to wound healing and is probably due to new skin and nerve endings growing into the area.  However, it may also be due to a skin reaction to the dressings used to cover the wounds. If it becomes a problem, please contact your Bariatric Nurse for advice.

How do I know if the wound is infected?
If a wound becomes tender, looks inflamed, red or swollen, or if it weeps offensive smelling liquid, pus or blood, you should speak to your Bariatric Nurse. However, redness on its own is not necessarily a sign of infection.

What about antibiotics?
If your wound does become infected, it will be necessary for you to take a course of antibiotics. We recommend Augmentin for which you will need a prescription from your GP. Healthier Weight do not have the facility to issue prescriptions.


If you have any concerns, please call 0121 693 4488 to speak to a Bariatric Nurse

Administering injections

You will be required to administer a series of subcutaneous injections in the days following your surgery. You have been prescribed heparin (under the brand name Clexane®) to prevent the formation of blood clots and to protect against complications that may arise following surgery or a period of hospitalisation. It is essential that you do not miss an injection and that you complete the course as directed by the bariatric team.

If you have any queries or concerns, call to speak to a nurse on 0121 693 4488

What is a subcutaneous injection?

A subcutaneous injection is given in the fatty layer of tissue just under the skin. It is required because there is little blood flow to fatty tissues and the injected medication is generally absorbed more slowly, sometimes over 24 hours.

Locating a suitable site for heparin injections

Choosing an injection site

  • Subcutaneous injections can be given in the legs or abdomen but we recommend the abdomen (see right)

  • To locate a suitable injection site on the abdomen, place your hands on the lower ribs and draw an imaginary line below them. Use the area below your hands for injections, as far around as you can pinch up fatty tissue. Do not use a 1-inch area around the navel

  • It is extremely important to rotate injection sites to keep the skin healthy. Repeated injections in the same spot can cause scarring and hardening of the fatty tissue that will interfere with absorption of medication

  • Subcutaneous injections should not be administered into a skin site which is burned, hardened, inflamed, swollen, or damaged by a previous injection

 

Giving the injection

  • The skin is the body’s first defence against infection so it must be cleansed thoroughly with soap and warm water before the needle is inserted

  • Wash your hands thoroughly with soap and water. Dry on a clean towel

  • Check the label for the correct medication. It should state heparin under the brand name Clexane®

  • Take the cap off the needle. Be careful not to contaminate the needle. Place the cap on its side

  • Hold the syringe in one hand like a pencil

  • With your other hand, pinch a fold of skin where the injection will be made

  • Hold the syringe at a 90° angle, about 2 inches from the skin surface

  • Insert the needle with a quick jab. The needle should go all of the way into the fold of skin

  • After the needle is completely inserted into the skin, push down the plunger into the skin that you are grasping

  • With skin fold still grasped, pull needle out and discard of the empty syringe and needle into the yellow sharps container provided by the hospital. The syringe has a safety lock mechanism system to ensure safety from the needle

  • Once your course of injections is completed, please seal the rigid sharps container, by sliding the movable part of the cover across the lid until you hear a “click”. You should not be able to slide the lid once this action is successfully completed

  • Return the sealed sharps container to your nearest clinic for safe disposal when you come to the clinic for future appointments

  • Sanofi Aventis the manufacturers of Clexane® / Tinzaparin (heparin) have produced a short video on Youtube called 'How to Inject Clexane at Home: A Patient Guide'’ which demonstrates how to administer the injection

 

Nutritional advice

General advice for the liquids only stage

  • For the first 24 hours after your bypass surgery, take nothing but still water, dilute fruit juices and tea. Drink slowly but regularly in small sips and not more than 100mls at a time

  • On day 2 and for the remainder of the first 2 weeks, drink only liquids to allow your stomach to settle after your procedure

  • Liquids should be smooth without ‘bits’ as they may cause discomfort or pain or get stuck. Use a sieve if you are unsure

  • Drinks should be thin enough to go through a straw but don't use a straw as this will increase air consumption, causing discomfort

  • Drinks can include water, tea or coffee (preferably unsweetened and with little / no milk), zero calorie squash etc.

  • Avoid fruit juices and alcohol due to the high calorie content and fizzy drinks as these can cause severe pain from trapped wind

  • Weight to Go shakes and porridge are suitable at this stage but porridge must be prepared as a drink and thoroughly blended

  • Sip slowly but frequently throughout the day at the start of the liquid stage, allowing a few minutes between sips. Progress to cupfuls of drinks taken slowly over a 15-20 minute period as the days go by. In the first two weeks after surgery, you can build up to taking around 200mls at any one time. If you experience pain, discomfort or regurgitate your drinks, take smaller sips and allow more time between sips. Some people find warm drinks go down more easily to start with; others find that sucking ice cubes can help if you are struggling to get fluids down

  • Aim to take about 1.5 litres each day, it's a good idea to keep a water bottle with you to sip frequently throughout the day. During the first few days, you may not be able to manage 1.5 litres of fluid in one day; do not worry but ensure that you progress towards this amount as the first week goes by or you may become dehydrated and suffer with headaches, urine infection or constipation

  • Some people get a ‘furry mouth’ in the first month because when you have nothing to chew on, you produce less saliva to protect your teeth. It can help to use a mouthwash and brush your teeth well. You can also try drinking pineapple juice which contains an enzyme that breaks down debris in the mouth

 



Suggested foods to include in your 1.5 litres of fluid each day

PROTEIN list (choose 4 items per day)

  • Weight to Go shake (hot or cold) made with more water than advised on the packaging to achieve a consistency of milk
  • Weight to Go soup (blended to remove any lumps)
  • Weight to Go porridge made into a thin drink
  • 400mls (2/3rd pt) semi-skimmed or skimmed milk
  • 400mls (2/3rd pt) soya milk with added calcium
  • 2 smooth low calorie yogurts (125g each) blended with milk/water to a ‘drinkable’ consistency
  • 3 heaped tablespoons skimmed milk powder
  • 15g dairy-free protein powder e.g. soya or pea-protein (from health food shop / pharmacy). Mix into soups or fruit / veg juices


LIMITED list (choose 1-2 items per day)

  • Oxo, Bovril, Marmite or Stock cubes added to hot water
  • Soups - tinned, dried, cuppa, homemade. You may need to dilute with extra water or sieve to ensure there are no ‘bits or lumps’.
  • 1 small glass (150mls) unsweetened fruit juice. If you have a juicer you can try your own combinations e.g. beetroot and orange, carrot, celery and apple. Dilute with approximately 150mls of water then sieve to ensure no ‘bits or lumps’
  • 1 glass (200mls) vegetable juice e.g. carrot, tomato, mixed vegetable, V8
  • 1 x 100ml low fat, low sugar Actimel or similar drink
  • 1 x 100-150mls of a smoothie drink 
  • Low calorie Hot Chocolate, Ovaltine or Horlicks drinks
  • ½ banana or small portion of soft fruit blended with milk into a ‘smoothie’ of thin consistency. Sieve to ensure no bits or lumps


FREE list (unlimited: choose as many as you like)

  • Water; plain or low calorie flavoured (not carbonated)
  • Low calorie, no added sugar or sugar free squash
  • Tea including herbal teas
  • Coffee, preferably decaffeinated




Sample menu

8.00am      150-200mls tea / coffee / unsweetened juice / water

9.30am      ½ -1 Weight to Go shake

11.00am
    200mls tea / coffee / squash / water

1.30pm
      ½ -1 Weight to Go shake or soup

3.00pm
      200mls tea / coffee / squash / water

4.30pm
     ½ - 1 Weight to Go shake

6.00pm
      1 small glass (150mls) unsweetened orange juice

7.30pm
      ½ - 1 Weight to Go soup

10.00pm
    200mls milk / yogurt blended with milk/water


 

Using Weight to Go After Surgery

Many patients find that using Weight to Go foods removes the decision anxiety and confusion over food in the early stages. The benefits of Weight to Go foods are that they are:


  • Portion controlled to help you identify correct portion size

  • High in nutrition to ensure you stay healthy

  • Full of protein to keep you feeling full


Preparing Weight to Go Shakes

For the best, creamiest results we recommend mixing with an electric jug / handheld blender. If you don’t have a blender, mix your shake by hand or in a shaker.
 
Ice cold shake: Blend with 260mls cold water or 200mls cold water and 4-6 ice cubes for a thicker shake.

Filling smoothie: Add a handful of fresh/frozen berries or a banana and blend
 
For a satisfying hot drink: Add 200mls hot (NOT boiling) water and blend on low speed for 5-10secs. All shakes can be made into hot drinks but chocolate and vanilla are the most versatile eg make a vanilla shake with black coffee for a café latte

How to prepare your Weight to Go shake

Preparing Weight to Go Porridge

Porridge makes a wholesome breakfast or a filling snack any time of the day. Weight to Go Porridge Oats are already sweetened but you can add calorie free sweetener to taste.

Microwave: Mix with 120mls cold water in a bowl and microwave on full power for 90 seconds. Stir then leave for 1-2 minutes before consuming.

Hob: Empty sachet contents into saucepan and mix with 120mls cold water. Heat gently on low heat until piping hot. Stir and serve. 

Recipe tips: For something a bit different, porridge can also be used to make oaty pancakes or added to a chocolate shake to make oaty hot chocolate. View recipe ideas at Weight to Go

 

How to prepare your porridge
Nutritional advice

General advice for the purees stage

Three weeks after your sleeve operation, the stomach tissues are still healing and it remains important not to stretch the slim tube 'sleeve' of stomach that remains with foods that are hard or indigestible. You should begin to make the transition from liquids to puréed foods. Do not eat larger quantities than recommended even if you feel that you could. Your newly created stomach pouch will stretch and if you begin to eat larger quantities of food you may lose sensitivity to fullness and food could stretch your oesophagus as well. 

During this stage, you can continue to take drinks only if you prefer (as in the first two weeks) or start to have puréed food with a consistency like thick yogurt or a combination of both liquid and puréed foods. As an example of the progression in textures that you should aim for, start with your Weetabix as a sloppy mixture with plenty of low fat milk but progress towards your Weetabix being more solid with much less milk towards the end of this stage. You can begin to add fruit to the Weight to Go® shakes and use less water and more ice (as instructed on the box) to achieve a thicker consistency.

It's best to avoid more ‘difficult’ foods at this stage such as red meat, shellfish, bread (especially really fresh), fibrous fruit and vegetables including skins, dried fruit, nuts and rice. Fish and white meat are generally softer than red meat and can be mashed, although well cooked lean minced meat in sauce would be fine. If your food is ‘spoonable’ it is the correct consistency.

  • Firstly, if you don't feel hungry, don't eat! There is nothing wrong at all in not eating at this stage (so long as you are drinking) and you should make the most of your loss of appetite

  • Start by eating up to 5 small puréed ‘meals’ per day, then try to establish a pattern of 3 soft meals a day by the end of this stage

  • Your portion size should be 3-6 tablespoons per meal. Never exceed 6 tbsp even if you feel you could eat more. You maybe surprised by how little you can eat!

  • Serve your meals on a 7 inch side plate or small bowl

  • Eat very slowly (take at least 20 minutes for each meal) to recognise the new feeling of your pouch filling up until you don’t want to eat more. Your pouch only holds about 2tbsp at the most so when you have a meal of 3-6tbsp, some of the food will need time to pass through to the rest of your stomach

  • Stop eating at the first sign of fullness. If food is left on your plate, throw it away

  • Food can contain soft lumps but not any hard lumps, skins, pips etc as they may cause discomfort or pain or get stuck

  • Drink frequently up to 15 mins before your meal then leave 1-2 hours after the meal before drinking again (prevents your puréed/mashed meal from becoming liquid and leaving your stomach sleeve too quickly)

  • Consume a minimum of 1.5 litres of fluids every day. There is no maximum amount, you should drink to thirst but not excessively

  • Remember to drink calorie free liquids, avoid alcohol and choose low fat, low sugar foods to purée/ mash

  • To make sure that you drink enough fluids over the day, carry a water bottle with you

  • Start to take a multivitamin and calcium supplement every day

 



Suggested foods to eat each day


PROTEIN list (choose 3 items per day)

  • Thick Weight to Go shake (blended with or without fruit)
  • Weight to Go porridge
  • 1 soft/runny scrambled egg
  • 1-2 tbsp puréed chicken, quorn, tofu. Use gravy or sauce to make a smooth consistency.
  • 2 tbsp minced lamb, pork or beef. Use sauce or gravy to make a smooth consistency
  • 2 tbsp soft fish mashed into fine flakes
  • 125ml plain dairy / soya yogurt (with or without blended fruit)



CARBOHYDRATE list (choose 3 items per day)

  • ½ - 1 Weetabix with plenty of skimmed or semi skimmed milk
  • 1-3 tbsp Ready Brek / Weight to Go porridge
  • 1-2 tbsp mashed potato
  • 1-2 tbsp soft mashed pasta
  • 200-300mls thick vegetable soup



FRUIT AND VEGETABLES list (choose 3 items per day)

  • 1-2 tbsp puréed /mashed vegetables, fresh, frozen or tinned
  • 1 - 2 tbsp stewed/mashed fruit 
  • Fruit smoothie (blend 2-3 portions fruit with 150-200mls of juice or milk)
  • 1 inch slice of ripe melon if soft enough to mash/puree
  • 250 ml glass of fruit juice




Sample menu

8.00am      ½ - 1 Weetabix with lots of skimmed or semi-skimmed milk OR 1 - 3 tbsp thin Weight to Go porridge OR 1 thick Weight to Go shake blended with fruit OR 1 soft scrambled egg with mashed tinned tomatoes

10.00am      DRINKS (this is 2 hours after your food)

10.30am
     1 small smooth/plain yoghurt OR 2 tbsp puréed fruit

12.30pm
      DRINKS (this is 2 hours after your food)

1.00pm
       1-2 tbsp puréed chicken / fish in sauce AND 1-2 tbsp puréed vegetables AND 1-2 tbsp mashed potato / puréed pasta

3.00pm       DRINKS (this is 2 hours after your food)

3.30pm
      1 small smooth plain yogurt / 2 tbsp puréed fruit / 1 Weight to Go shake or porridge

5.30pm       DRINKS (this is 2 hours after your food)

6.00pm       1-2 tbsp puréed chicken / fish in sauce AND 1-2 tbsp puréed vegetables AND 1-2 tbsp mashed potato / puréed pasta

8.00pm      
DRINKS (this is 2 hours after your food)




Nutritional advice

The gastric sleeve operation is designed to help you lose weight by restricting your food intake and increasing your sense of satiety (fullness) so that you feel satisfied from eating less. It also acts by reducing the absorption of food from the upper part of the small bowel. But if you are to be successfulsleevebypass will be a tremendously powerful aid to weight loss but if you expect the surgery to do all the work, you are going to be very disappointed.

This stage is really the start of learning how to work with your gastric sleeve developing lifelong healthy eating habits to achieve your health and fitness goals. You must leave soft, sloppy food in the past and discover solid textured foods that remain longer in your stomach to stop you from feeling hungry. 


Recognising the full feeling
You must learn to recognise new feelings of hunger and fullness from your new small stomach sleeve. This is completely different from your previous ‘rumbly tummy’ hunger or ‘whole tummy; uncomfortably stuffed’ feeling of fullness. Your new tummy can still make rumbly, gurgly noises but actually you may not be hungry! Physical hunger is also completely different from eating out of boredom or comfort because when you do this, you will NEVER feel full because your body does not need food at this time. Most people acknowledge some sort of ‘emotional eating’ or ‘head hunger’. Your gastric sleeve cannot help you with this. You will need to identify times when this is likely to happen and develop behavioural strategies to tackle it before it sabotages your weight loss.

Your new stomach is roughly the size of a medium banana and situated somewhere behind your breastbone and this is where your new feeling of fullness will be felt. People describe the full feeling in different ways; ‘indigestion’; ‘like I’ve had a huge meal’; ‘wind’, ‘if I had another mouthful I’d burst’, ‘discomfort’; ‘I don’t want to eat more’. If you have eaten too much you will feel pain or may even feel a choking sensation, ‘as if something is stuck’. This means your sleeve is TOO full.

There is considerable variation in how full people feel at any given time. Your stomach will feel smaller and more restricted on some days than others, so that whilst you may cope with a particular food on one day, you may not manage it quite so well on another.  Accordingly, it is always important to eat slowly, chew slowly and sense when to stop eating so that you feel comfortably full and not in pain or that food is stuck. There may be times, perhaps due to illness where you need to revert to softer foods or even drinks for a few days but do not do this permanently.



What should I eat?

For your sleeve to work effectively, food now needs to be of a ‘drier’ consistency, eaten and chewed slowly in small mouthfuls so that you learn to sense fullness and stop eating when you think you've had enough. From now, you can eat all foods but if you are introducing a food for the first time, we recommend you try it at home and chew it well so that you are confident you can eat it without discomfort or regurgitation. Be particularly careful with any of the ‘difficult’ foods that you may have avoided last month i.e. red meat, shellfish, bread (especially really fresh), fibrous fruit and vegetables including skins, dried fruit, nuts and rice. If you experience discomfort or food ‘sticking’ the first time you eat it, try again a week or two later perhaps chewed slightly longer and eaten even more slowly so that you know how much you can manage.

  • Choose healthy, wholesome foods and no junk food. Your new eating plan has no room for wasted calories from sugary, fatty foods and your emerging new body needs good nutrients to keep you healthy and full of energy. Most fast foods and snacks are high in fat, salt or sugar. These are not good for your health or energy levels

  • Always choose foods low in fat and sugar. Yogurts and similar products like fromage frais should be ‘diet’ i.e. low in fat AND sugar. Meat and poultry should have fat and skin removed. Food should be baked, grilled, micro waved, steamed or stir fried, not deep fried. You then taste the food, not oil.


What shouldn't I eat?

Leave behind the milkshakes, smoothies, gravy and sauces that you had in the last few months. Soft and liquid foods are not recommended because you tend to eat large volumes of them quickly, they pass through your system and you will soon be hungry again. If you frequently consume soft foods and drinks that are high in fat and sugar e.g. ice cream, cake, chocolate, milk shakes etc OR high calorie ‘crunchy’ foods such as crisps, biscuits etc you will not feel full and you will be tempted to consume larger quantities. This will prevent further weight loss and may lead to weight gain.


How much should I eat?

An appropriate quantity of food should fit in the palm of your hand e.g. half an apple and this will keep you feeling full for longer. Use the timer provided to control the time you take between each mouthful.Your main meal should fit onto a 7 inch side plate or small bowl and be composed of foods in the following proportions:

  • One quarter protein (eg meat, poultry, fish, pulses)
  • One quarter starchy (eg potato, pasta, rice, bread, couscous)
  • One-half vegetables or salad (without butter, mayonnaise or rich dressings)


Start to ‘think thin’! 

People who weigh less tend not to think about food too often, they eat slowly and consciously, don’t eat large portions, stop eating when they think they are full and often leave food on their plate. It is useful to develop these skills for permanent weight control. Get used to looking at your new portion size, eat without any distractions e.g. away from the television and concentrate on your food. Relax when eating, eat slowly and savour the tastes in each mouthful. It is a good exercise to try putting down your knife and fork between mouthfuls. Try it! Sit on your hands between mouthfuls if you are still trying to rush your food. You will soon start to eat in a more relaxed way and recognise when to stop eating so that you are comfortably full but not in discomfort. If food is left on your plate, throw it away; don’t keep it for later or act as the rubbish bin.


General advice for the solid food stage

  • Aim to eat 3 small meals per day and no snacks between. This will help you to establish new and appropriate hunger and fullness responses and keep your metabolism going. You will learn to eat when you are truly hungry and not for other reasons

  • Throw away the large plate and bowl and use a smaller diameter plate/bowl as research shows that when people eat from large plates and bowls, they tend to eat more. You might also want to try using a cake fork – very small bites indeed!

  • Take small mouthfuls. Large mouthfuls will fill your stomach too quickly and you may suffer regurgitation. Also large mouthfuls are more likely to trap air in your stomach pouch, causing discomfort

  • Eat and drink SLOWLY. Each time you swallow it takes 10-20 seconds for food to pass from your mouth into your stomach and then 20 minutes for nerve and chemical signals to reach your brain from your stomach to register a ‘feeling of fullness’. If you eat too quickly, you pass the point of fullness before you stop eating and will suffer pain, choking or regurgitation. Chew slowly, put your knife and fork down between mouthfuls. Use the timer provided to control the time you take between each mouthful

  • Allow at least 20 minutes for each meal. You may need to plan extra time for meals so that you are able to eat slowly, not gulp large mouthfuls and recognise fullness. A rushed meal may be uncomfortable

  • Stop when you're no longer hungry – NOT when you are full. You will need to learn the point at which you feel physically full but not in pain or discomfort. If you experience pain rather than ‘fullness’ you have had too much to eat or drink. Learn to become aware of the type and quantity of food that makes you feel full without discomfort. If you frequently go past being full you could risk stretching your stomach or oesophagus and lose the sensitivity to fullness

  • If you choose to eat ‘soft’ foods, you MUST restrict your portion size to 1-2 tablespoons then fill the rest of your side plate with vegetables or salad. The stomach pouch will not tell you to stop eating these types of food. You may finish a ‘soft’ meal with ½ apple or other crunchy fruit to remain in your pouch.

  • Drink low or zero calorie drinks water eg Bovril, low calorie squash, herbal teas, tea or coffee (restrict to 4 cups per day with a little low fat milk and no sugar to avoid excess caffeine)

  • Keep alcohol to a minimum. Alcohol is full of calories that will stop you losing weight so it is best avoided. It may also make you forget your good eating plans!

  • Drink frequently. Sometimes you may actually be thirsty rather than hungry.  Always try a drink before reaching for something to eat. Have 1.5 litres of fluid every day, this will help to avoid constipation, headaches and dehydration

  • Don’t drink with your meals. You will need to drink up to 15 minutes before your meal then leave 2 hours after your meal before drinking again; this will help you to feel full for longer by not washing your food out of your stomach pouch


The Balance of Good Health

This plate model shows the proportions of different food groups that make up a healthy eating plan. To stay healthy with your gastric sleeve, follow the advice and guidelines given earlier and choose a variety of foods from the four main food groups below.

Eating plan

CARBOHYDRATE list (choose 3-4 items per day)
Have one or two portions at each meal time and try to choose wholegrain, wholemeal or high fibre varieties to help your digestive system. Examples include:

  • 1 slice bread or toast / 1 crumpet / 1 scotch pancake
  • 2 crisp breads / 3 small crackers / 2 small oat cakes
  • ½ large pitta / 1 small pitta / 1 small chapatti
  • 3 tablespoons dry porridge oats / breakfast cereal
  • 2 egg-sized potatoes
  • 2 heaped tablespoons boiled rice / pasta
  • 2 rich tea / 1 digestive biscuit
  • 1 small corn on the cob

FRUIT AND VEGETABLES list (choose 2-3 fruit items AND 3 vegetable items per day)
Include fruit as a snack if necessary, chopped on cereal or as a dessert after a meal. Make sure that for your main meals, at least half of your plate (side plate size) is full of a variety of vegetables/salad. You can use tinned, frozen or fresh fruit and vegetables. Examples include:

  • 1 medium sized piece of fresh fruit eg apple, orange, pear, (½ banana)
  • 2-3 small fruit eg plums, apricots
  • 150g (5oz) strawberries, raspberries, blackberries
  • 1 handful of grapes
  • 1 tomato
  • 7 cherry tomatoes
  • 3 tablespoons stewed or tinned fruit (no added sugar)
  • 100ml glass fruit / tomato / vegetable juice
  • 1 heaped tablespoon dried fruit
  • 3 heaped tablespoons cooked vegetables
  • 1 side salad (half a side plate size)

PROTEIN list (choose 2-3 items per day)
It is vital to include at least two portions daily from this group, because on your new eating plan it may be difficult to obtain enough protein in the small portions that you will be eating. If you struggle to eat protein or worry about not getting enough then Weight to Go shakes and porridge are high in protein but in an easily digestible form, making them a good choice for gastric sleeve patients. Examples include:

  • 100g (3 ½ oz) very lean cooked beef, pork, lamb, mince, chicken, turkey, liver, kidney, pilchards, salmon
  • 150g (5oz) cooked white fish or tinned tuna (in brine or spring water), tofu or quorn
  • 2 eggs (limit to 6 per week)
  • 4 tablespoons cooked peas, lentils, beans (including baked beans), kidney beans etc

DAIRY list (choose 2-3 items per day)
This group is important for calcium to keep your bones and teeth strong. Choose low fat varieties eg skimmed or semi-skimmed milk. When buying yogurt or fromage frais, make sure that they are both low in fat AND low in sugar. Protein shakes and high protein porridge are also good sources of dairy. Examples include:

  • 200ml (⅓ pt) semi-skimmed milk
  • 1 small pot of diet yogurt / fromage frais   
  • 100g (4oz) cottage cheese
  • 60g (2oz) low fat soft cheese
  • 25g (1oz) low fat hard cheese e.g. cheddar / stilton

SUGARY and FATTY food list (Avoid as much as possible)
There is little room for sugary foods or drink in your eating plan as they contain very small amounts of nutrients but a lot of calories - Avoid them! Fats and oils contain twice the number of calories as any other food ingredient. Be careful with margarine, butter, cream, mayonnaise, nut butters and nuts. Whenever possible choose low fat versions and when cooking only use one teaspoon of oil per person or a low calorie oil spray. Examples of portion sizes when using fats:

  • 1 teaspoon (5g) butter or margarine / oil / mayonnaise / nut butter
  • 2 teaspoons low-fat spread / reduced fat mayonnaise / salad dressing / single cream   
  • 7g nuts (8 hazelnuts / almonds, 5 pecans, 4 walnuts / brazil nuts)
  • 1 heaped teaspoon of seeds e.g. pumpkin, sesame, pine nuts




Sample menu

8.00am      1 shredded wheat with a little skimmed or semi-skimmed milk OR ½ slice toast with scraping of low fat margarine, Marmite and a fresh tomato AND 1 satsuma or pear

   
10.00am     DRINKS (this is 2 hours after your food)
   
1.00pm      ½ tin tuna in brine or spring water AND 1-2 crisp breads or crackers OR ½ slice toast AND mixed salad with lemon and herbs AND ½ apple OR 1 satsuma
   
3.00pm      DRINKS (this is 2 hours after your food)
   
6.00pm      2 fish fingers AND 2 small new potatoes in skins AND crisply cooked vegetables OR a mixed salad AND 1 low calorie yogurt or fromage frais AND ½ banana OR handful of strawberries, raspberries etc.
   
8.00pm      DRINKS (this is 2 hours after your food)

   

Breakfast ideas

  • 3 tablespoons Fruit and Fibre / Special K / no added sugar muesli with a little skimmed / semi-skimmed milk and no added sugar
  • 3 tablespoons All Bran with a little skimmed / semi-skimmed milk, no added sugar AND 1 tablespoon raisins OR ½ banana / 8 - 10 nuts eg hazelnuts, brazil nuts, almonds / 1 flat tablespoon seeds e.g. pumpkin
  • ½ slice toast AND 1 boiled egg AND 2 tablespoons boiled mushrooms OR 1 piece of very lean bacon grilled with 1 fresh tomato



Main meal ideas

•    ½ piece of baked fish with 2 small new potatoes and 2 portions of lightly cooked vegetables.
•    ½ tandoori chicken breast with 1 tablespoon basmati rice and mixed salad
•    Small piece baked or grilled fresh tuna
(size of ‘pack of cards’) with 1 tbsp pasta 'al dente’ with 1 tsp pesto to flavour and salad
•    2 slices roast meat with 2 small ‘dry roast’ potatoes and 2 portions of lightly cooked vegetables and 1 tsp sauce or gravy
•    ¼ large pizza with mixed salad
•    Stir fry with chicken / beef / tofu / pork, sugar snap peas, mini sweet corn, carrot, onion etc, and a little soy sauce. 3 tbsp serving
•    1 tbsp pasta, 'al dente’ mixed with 1 tsp pesto, 1 fresh chopped tomato and ½ boiled chicken breast. Serve with salad
•    1 small baked potato served with mixed salad and tuna in brine / spring water mixed with 2 tsp low fat mayonnaise and lemon juice / vinegar
•    2 pieces of liver*, lightly brushed with oil, baked or grilled with 2 small new potatoes and 2 portions of lightly cooked vegetables
•    2 small slices of bread (wholegrain or granary) with 2 slices of lean meat or chicken and salad

* Do not eat liver if you are pregnant


Dessert ideas (if required)
•    1 small low calorie yogurt with fruit
•    1 small low calorie fromage frais with fruit
•    1 plain low calorie yogurt with 1 small portion of fruit e.g. ½ banana, 1 satsuma

Getting active after surgery

Physical activity is going to be a key part of your post-op routine and you will be much more successful if you get into the habit of regular physical activity early and maintain it. Naturally, the more exercise you do, the better your weight loss results will be. To ensure that you don't strain your body, we recommend that you start with a graduated walking programme. It's the ideal exercise to start with as you can gradually build up the intensity as you become stronger and fitter, you don't need any special equipment and best of all, it's free to do!

One of the best ways of monitoring your activity is to use a good quality pedometer, FitBit, smartphone/watch etc. As you count your daily step count, you will be motivated to take extra steps to reach the next milestone or to challenge a colleague / family member. You will begin to notice real changes in your physical and mental state with more energy, less stress and better sleeping patterns.

  • On your surgery day, we like you to be up and about as soon as possible, within a couple of hours of returning from theatre

  • On the day after surgery, you should start to mobilise and try walking for a few minutes

  • During the first week, increase your walking until you are up to about 10-15 mins. If you feel any pain then stop – it’s quite common to feel some twinges in the wounds or the shoulders during the first post-operative week. If you have pain in your knees or spine, make sure you increase the distance and time very gradually and stop when it becomes painful. You will find that as your weight comes down your exercise tolerance will increase.

  • From the second week you should continue with your daily walking, aiming to get up to about 30 minutes / 3000 steps each day

  • From the third week you should build up your walking, aiming towards 45-60 minutes / 5-6000 steps each day. You don’t have to do this all at once, if you find it easier you can take in smaller “bite sized” chunks of say, 10 minutes each time.

  • From the fifth week continue to build up your walking to about one hour / 10,000 steps each day – more if you wish. In addition to walking, you can choose other activities that you enjoy. There may be something you never thought you could do before, but now YOU CAN! With the exception of collision sports such as rugby or martial arts which could result in a direct blow to the abdomen, there are no forbidden activities. You can enjoy swimming, golf, badminton, tennis, cycling, hiking, gym-work, running, light weight training, Pilates – almost anything. Exercise burns calories, helps to preserve your lean (muscle) mass and keeps your metabolic rate higher. It also helps to enhance your body shape by providing a firm muscle support for the tissues.


Walking tips with example 12 week walking schedule

  • Walk with your chin up and your shoulders held slightly back

  • Wear suitable footwear, with good ankle support

  • Walk so that the heel of your foot touches the ground first and roll your weight forward

  • Walk with your toes pointed forward and swing your arms as you walk

Week Warm up time
Brisk walk time
Cool down time
Total
 1 Walk slowly 5 mins
Walk briskly 5 mins
Walk slowly 5 mins  15 mins
 2 Walk slowly 5 mins Walk briskly 7 mins Walk slowly 5 mins  17 mins
 3 Walk slowly 5 mins Walk briskly 9 mins Walk slowly 5 mins  19 mins
 4 Walk slowly 5 mins Walk briskly 11 mins Walk slowly 5 mins  21mins
 5 Walk slowly 5 mins Walk briskly 13 mins Walk slowly 5 mins  23 mins
 6 Walk slowly 5 mins Walk briskly 15 mins Walk slowly 5 mins  25 mins
 7 Walk slowly 5 mins Walk briskly 18 mins Walk slowly 5 mins  28 mins
 8 Walk slowly 5 mins Walk briskly 20 mins Walk slowly 5 mins  30 mins
 9 Walk slowly 5 mins Walk briskly 23 mins Walk slowly 5 mins  33 mins
 10 Walk slowly 5 mins Walk briskly 26 mins Walk slowly 5 mins  36 mins
 11 Walk slowly 5 mins  Walk briskly 28 mins Walk slowly 5 mins  38 mins
 12 Walk slowly 5 mins Walk briskly 30 mins Walk slowly 5 mins  40 mins

For Week 13 and beyond, gradually increase your brisk walking time to 30-60 minutes four or five times per week


Frequently asked questions about exercise

How soon can I go swimming after surgery?
You are able to go swimming 6 weeks after your surgery, as long as your wounds are fully healed / closed

Are there any sports I should avoid?
It is possible to enjoy most sports after surgery but if you engage in contact sports that may involve a blow to the abdomen eg rugby / martial arts or play sport professionally, please discuss with a bariatric nurse

Can I do tummy based exercises eg abdominal crunches / sit-ups?
Yes, in principle there is no issue in doing tummy exercises. If you have any concerns, speak to a bariatric nurse for advice

I'm using an activity tracker - how many steps should I do?
Everyone, whether they have had weight loss surgery or not, is encouraged to walk at least 10,000 steps per day. You may find this difficult at first but as you become fitter, stronger and more mobile, you can gradually build up to this as your goal. Of course, the more activity you can fit in, the better your weight loss will be so if you regularly reach 10,000 steps a day, challenge yourself to go for more!

After your gastric band procedure

Let us help you - Get the most from your procedure

  • Read the information provided here carefully
    Follow the post-operative stages faithfully and you should not have any problems

  • Always have our contact details on you in case you need us
    Programme the emergency helpline number into your mobile address book

  • Join our private weight loss support forum on facebook
    and share your experience with fellow patients. An invitation to join the group will be emailed following your procedure

  • Keep a food and activity diary
    to record your calorie intake and expenditure. You may find that this is an invaluable tool on your weight loss journey

  • Keep in touch on social media for all the latest news, weight loss tips and chat
    Like us on facebook or follow us on Twitter or Instagram




Help Us to Help Others - Share Your Success

  • Complete your patient questionnaire
    We love feedback and this helps us to continually improve our service. We'll email you a month after surgery

  • Keep a diary of your feelings and record your progress with photos if you can
    Many patients find that it's helpful to not only record a weekly weight but to take body measurements too. Sometimes you'll find that the scales may not have moved but you've lost inches from your waist, hips etc

  • Write a review of your Healthier Weight experience
    on Trustpilot so that others can benefit and take the plunge. It’s good to share positive experiences

  • Consider doing a photoshoot for Healthier Weight
    and share your story with others on our website or in the media

 

What symptoms are common after surgery?

  • Fatigue: For the first two weeks after your operation you are likely to feel tired and although we would encourage you to walk daily, don’t overdo things. Even when your wounds look healed on the outside, they are still healing inside

  • Neck and shoulder pain: This sometimes happens after any laparoscopic surgery and should diminish over time. Simple analgesics will help and a hot water bottle applied to the shoulder may also relieve the symptoms

  • Aches and pains: You may be aware of aches and pains in your chest wall and abdomen especially when you are moving about and taking fewer painkillers. These are referred to as musculo-skeletal pains and are a normal part of the keyhole cuts healing inside and forming scar tissue that is a bit less flexible than your tissues were before

  • Bloating: Your stomach may feel bloated for a few days after surgery as your body returns to normal. You may not be able to get rid of excess wind by belching and it will take longer for this wind to pass downwards. Herbal teas such as peppermint or fennel and Windeeze or grape water can help

  • Rumbly tummy: You may experience gurgling or rumbling in the lower part of your stomach; it takes a while for your whole stomach to get in tune with the reduced food or drink that is delivered from your new stomach pouch. BUT notice that this does not mean that you are hungry!

  • Diarrhoea: Some people develop quite severe diarrhoea in the first few weeks after surgery. This can be due to changes in your medications, a change to a liquid diet or an increase in your milk consumption. Make sure that you drink even more fluid to replace what you are losing. If the diarrhoea is particularly troublesome get your GP to check that you do not have ‘overflow diarrhoea’ or an infection. The sleeve is unlikely to be the direct cause

  • Constipation: More commonly, your bowel frequency will be much less than before surgery because you are now taking much smaller quantities and there is very little fibre in your liquid diet. If you suspect that you are constipated, follow this advice:
  • Make sure you are drinking at least 1.5 litres of fluid per day
  • Include 1-2 cups of diluted fruit / vegetable juice per day or try syrup of figs or prune juice as a gentle bowel stimulant
  • Make sure that you are active and not sitting or lying around too much
  • If it is still a problem, take a non-bulk forming laxative such as lactulose (Duphulac), or Senokot Syrup. You should avoid taking bulking agents such as Fybogel which could cause a blockage in the smaller stomach


What should I do if I am regurgitating food / vomiting?

Occasional vomiting after gastric sleeve surgery is not uncommon but you should check the following:

 Are you?
 Solution
 Taking large mouthfuls? Take small mouthfuls. Try eating with a teaspoon / 3 pronged fork.
Eating quickly (short lunchtime or
rushing to meet someone)?
Slow down your eating. Take at least 20 minutes for each meal. Use your timer.
Having too large a volume at a
meal time (the extra mouthful)?  
Serve up a smaller quantity. No more than 6 tablespoons for a full meal. Use a 7 inch side plate or small bowl.
 Gulping air while eating?
 Slow down your eating. Use your timer.
 Taking drinks with your meal?
Drink plenty up to 15 minutes before your meals but wait at least an hour after your meal before drinking again
Not chewing your food well enough, sometimes after introducing new foods? Chew your food slowly at least 20 times before swallowing for a few days.
Eating food that is fibrous or stringy
eg whole spring onions, pineapple, asparagus or chicken drumstick?
Cut these types of foods across the grain or fibre into small pieces before eating and chew well.


Will I only be able to eat tiny amounts for the rest of my life? Will I be able to eat regular food?
At the beginning you will likely only eat approximately two to four tablespoons of food. After around eight weeks you should be eating "regular" food, though still with very small portions.  It is very unlikely that you will get back to normal meal sizes again – nor should you try.  The gastric sleeve works by limiting the volume of food that can be taken at any one time and if you return to your old ways of eating, there is a risk that you will stretch the sleeve and begin to put back the weight which you have worked so hard to lose.

How do I get my protein in when I can eat such little amounts?
Following your surgery, it is important for healing, as well as to aid in weight loss that you consume an adequate amount of protein. Since you are limited in your food intake, it is recommended that you consume a diet which is low in fat and sugar, and high in protein. The foods outlined in the nutrition section above are an excellent guide and you can supplement your protein intake if you wish, by using Weight to Go high protein shakes and porridge. Maintaining a high protein intake not only increases the sense of satiety (fullness) but also helps to preserve lean (muscle) mass. Protein deficiency is not common after a gastric sleeve.

Do I have to take vitamin and mineral supplements for the rest of my life?
Yes.  Because gastric sleeve limits absorption of calories, it can also limit the absorption of essential vitamins and minerals. This is why daily vitamin and mineral supplementation is essential to your long-term health following gastric sleeve.

What about blood tests?
To ensure that you are maintaining the necessary levels of essential vitamins and minerals, you will need to have regular blood tests for the rest of your life. In the Healthier Weight package, your first blood checks will be carried out at 6 months and then we recommend a further test at 12 months with your GP. Depending on the results, the doctor will then be able to advise you on future testing frequency. 

Will I lose all my hair? How do I keep it from falling out?
Around 20% of patients may experience hair loss after a gastric sleeve. The reason has to do with weight loss and not surgery. Anyone who experiences a rapid, sustained weight loss will frequently also experience some temporary hair loss as well. This usually occurs between the fourth and the eighth month after surgery. It is almost always temporary. You can help by maintaining a high protein diet, keeping well hydrated and taking your daily vitamin supplement (which contains lots of zinc). You may also find kelp (a seaweed extract available from health food shops) helpful. Almost all patients will experience natural hair re-growth after the initial period of loss.

Can I get pregnant after weight loss surgery?
When a woman of child-bearing age undergoes gastric sleeve surgery, one of the first things she will hear from the nay-sayers is that after surgery she cannot have a healthy pregnancy because of presumed nutritional deficiencies. The contrary is true. Morbid obesity results in a high rate of complicated pregnancies and a high rate of miscarriage. Women who become pregnant after achieving weight loss with a gastric sleeve generally have lower risk pregnancies than morbidly obese women.

So if you are a woman of child-bearing age and in otherwise good health, you should be able to have a baby after this surgery - but not right away. It is strongly recommended that women wait at least one year after the surgery before a pregnancy. Approximately one year post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished foetus. You should consult your weight-loss specialist as you plan for pregnancy.

Can I still take all my medications after the bypass?
Most medication can be taken normally after a gastric sleeve. Occasionally if the tablets are large, it may be easier to break or crush them or find liquid substitutes.  Not all pills can be crushed (e.g. slow-release) and some are unpalatable in a crushed form.  Speak to your doctor about which of your medications can be taken in liquid form and which can be crushed.

Are there any medications that I must avoid altogether?
Some medications are not to be used because they may cause ulcers or inflammation in your stomach sleeve. You should permanently avoid using any type of non-steroidal anti-inflammatory drugs also known as “NSAIDs”, which include pain relievers such as aspirin, Ibuprofen, Diclofenac, Sulindac, Celecoxib, Diflunisal,  Naproxen, Piroxicam etc. If you are unsure, ask the Healthier Weight team for advice.
 


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*Weight loss surgery results and benefits vary and are different for each individual. As such, Healthier Weight cannot guarantee specific weight loss goals.