Life After Gastric Sleeve Surgery
By Farah Palomas, RD
Once reaching the last diet stage after your surgery, it will be very important to continue following a healthy lifestyle to sustain the weight loss process and ensure long-term weight loss maintenance. The following recommendations are intended to serve as a guide to help you lead a healthy lifestyle (1).
Maintain a daily meal and snack pattern.
Following a daily meal and snack pattern has many benefits. Now that you have a smaller stomach, it is essential to ensure you are eating enough to receive the adequate amount of nutrients throughout the day. A common meal pattern to follow is eating 3 meals with 2-3 snacks in-between per day. Make sure you are starting your day with breakfast and avoid skipping meals. By establishing your daily meal pattern, you can plan your healthy meals and snacks ahead of time. This will help you enjoy your meals without being overly hungry and have better control over your portion sizes. If you are the type of person that forgets to eat, set alarms on your mobile device to remind you when it is time for you to enjoy your next meal or snack.
Make times for meals and snacks.
Meal times should be moments when you sit down and enjoy the foods you are eating. Take at least 20-30 minutes per meal, eating slowly and chewing your food well. This will ensure you recognize your fullness cue to avoid overeating and feeling any discomfort. Chewing thoroughly helps with better digestion and nutrient absorption. Most importantly, if the food is not chewed well, you may block the passage in your stomach and cause nausea or vomiting. Pause between bites, set your eating utensils down, and take a moment to savor your food. Remember to relax and enjoy your food. Eating is not a race and it is perfectly okay to finish your food last when eating with others.
Choose small portions of solid foods.
After the gastric sleeve surgery, your stomach has reduced about 70% in size. Therefore, you will need to closely monitor your portion sizes, limiting them tono more than 5-6 ounces. Your new stomach pouch can stretch in size over time, so it is important to avoid overeating.Remember to eat your protein first. If you are having trouble finishing your meal, then prioritize the protein.
Choose mostly solid food during meals and snacks.
Unless you have major problems with chewing and swallowing, solid foods will be the best choice. Chewing is the first stage of the digestion process as it prepares digestive enzymes, increases secretion of stomach acid, and activates gut hormones (2,3). By chewing your food, you are more likely to eat slower and savor it, which affects your satiety levels. Chewing is also important for promoting and preserving our general health. Research shows that chewing helps maintain cognitive function, specifically in memory and learning (4).
Avoid textures that are difficult to chew.
Textures that are harder to chew are best to avoid as they may cause discomfort and vomiting due to obstruction in the opening of the stomach pouch. Hard to chew textures might include tough, sticky, stringy, and doughy foods (1). For example, avoid eating a stringy piece of celery or a tough, overcooked piece of chicken or steak.
Separate solids and liquids by 30 minutes.
After the gastric sleeve surgery, do not drink fluids with your meals or snacks. It is recommended to avoid drinking at least 30 minutes before and after meals. You want to ensure you are eating enough food during meals and snacks for adequate nourishment, instead of filling up your small stomach with fluids.
Choose calorie-free beverages.
Beverages can be loaded with calories, making it easy to mindlessly drink excess calories that only lead to weight gain. It is important to save your daily calorie intake for meals and snacks that will provide your body with the proper nutrients. Water, as pure as possible, will always be the best calorie-free beverage option (7). Two-thirds of our body is made up of water, and we constantly need to replenish it since we lose water daily through sweat, urine, exhalation, and other physiological functions. Drinks containing sugar, artificial sweeteners, and chemical additives are not recommended for good health (7). The most recent research shows that even calorie-free beverages containing artificial sweeteners may have adverse effects on our brain and metabolic health (7). Try adding a slice of lemon, lime, orange, cucumber, or some mint leaves to your water for added flavor.
Take all vitamin and mineral supplements as recommended.
Vitamin and mineral deficiencies are common among post-bariatric surgery patients. The reduction of food consumption after gastric surgery leads to a decrease in overall nutrient intake, making it essential for patients to take the recommended vitamin and mineral supplements (5,6). Establish a follow-up plan with your medical provider to assess lab tests and determine your individual vitamin and mineral supplement needs. This will also help to prevent potential nutritional deficiencies. Check out our supplement guide for general recommendations.
Make time for activity each day.
Daily activity is important for overall good health as our bodies are designed to move. It gets our blood circulating, muscles contracting, joints lubricated, and improves our mood. Choose an activity you enjoy and try doing it with friends or family that will help keep you motivated. Start your exercise routine with a realistic goal and work up to it step by step. It is important for you to listen to your body and recognize your limitations. Your daily activity does not have to include going to the gym, it can simply be taking a 20-minute walk or even two 10-minute walks daily at the intensity that you can tolerate. Other beneficial habits to build include taking the stairs instead of the elevator or escalator, parking a little further when going to the grocery store, and taking walking breaks or stretching breaks every 90 minutes at work (if possible). Note, your daily diet impacts your weight the most, and daily activity helps maintain the weight off and supports your health in general. Do not attempt strenuous physical activities until you are fully recovered and approved by your doctor or physical therapist, as this may alter your caloric intake needs and interfere with your weight loss goals.
Record what you eat and drink.
Keeping record of the meals you are eating and beverages you are drinking can be a useful tool. You can log foods and beverages in a notebook or journal, in a food log app on your phone, or in a document on your computer – whatever works easier for you! Useful information to include in your food log is the time that the meal, snack or beverage was consumed, portion sizes, and the date. Food logs can be especially useful for dietitians and degreed nutritionists to evaluate potential nutritional deficiencies and any areas in your diet that may need improvement. You can keep a record as frequently as you would like, from every day to once per week. It is very important to be honest with yourself and record the actual foods and beverages consumed, and the most accurate portions. Another tip for your food log is to record your daily vitamin and mineral supplements when you take them. Food records may help you feel more accountable of what you are eating and may lead you to make better decisions. They also function as a tool to help review your diet history and identify the food or beverage that caused discomfort, or the portion size that was best tolerated. A dietitian or degreed nutritionist will likely ask you to keep a strict food log if experiencing food intolerances and gastrointestinal symptoms.
Attend all of your appointments.
Research shows that patients who continue attending post-operative appointments have better success with weight loss and long-term weight loss maintenance (8). This includes appointments with your primary care provider, nutrition visits, psychiatric follow-ups, and joining support groups. Nutrition follow-ups are critical to ensure you understand the dietary recommendations and adhere to them to prevent potential malnutrition or vitamin and mineral deficiencies. Therefore, our team at GastricSleeveRecipes.com have made it a mission to provide our members with nutrition services that will help pave the road to success. Myself and the rest of the nutritionist team are here to assist you with any questions you may have. We know some situations are time sensitive, so our pledge is to respond to you within 24 hours. Psychiatric visits may also play an essential role in this life-changing process (8). You are ultimately changing your relationship with food, which can be a very personal and emotional experience. Remember that you are not alone in this process. Not only is your healthcare team there to help you, but also fellow post-bariatric patients who share common experiences with you. Send us a message at any time, we’ll be glad to help.
Carlene JS, Atwal S. Nutrition care for patients with weight regain after bariatric surgery. Gastroenterol Res Pract. 2013;1-7.
Krieger E. Why Chewing is Underrated. The Washington Post Web site https://www.washingtonpost.com/lifestyle/wellness/why-chewing-is-underrated/2015/01/20/b26de5c2-9aa7-11e4-bcfb59ec7a93ddc_story.html?noredirect=on&utm_term=.88cf6d9815e1. Published January 20, 2015. Accessed June 7, 2018.
Shelly. Your Body’s Response to Chewing and Spitting: The Role of Ghrelin and Obestatin. Science of Eating Disorders Web site. https://www.scienceofeds.org/2013/03/06/your-bodys-response-to-chewing-spitting-the-role-of-ghrelin-and-obestatin/. Published March 6, 2013. Accessed June 7, 2018.
Chen H, Linuma M, Onozuka M, Kubo K-Y. Chewing maintains hippocampus-dependent cognitive function. Int J Med Sci. 2015;12(6):502–509.
Wasserman H, Inge TH. Bariatric surgery in obese adolescents: Opportunities and challenges. Pediatr Ann. 2014;43(9):e230-236.
Tack J, Deloose E. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies. Best Pract Res. 2014;28(4):741-9.
Hyman M. Food: What the Heck Should I Eat? New York, NY: Little, Brown and Company; 2018.
Hood MM, Corsica J, Bradley L, et al. Managing severe obesity: Understanding and improving treatment adherence in bariatric surgery. J Behav Med. 2016;39(6):1092-1103.