Pre-Surgery

• Begin taking a once-daily multivitamin - this will help to develop a habit of taking vitamins and minerals daily. 
• Develop an exercise routine - even if it is walking for 5 minutes each day.  Moving your body will not only help you in your weight loss journey, it will also help with managing immediate post-op symptoms, such as constipation and bloating.
• Take smaller bites - this will help to prepare yourself for eating after your procedure. Use a baby spoon if you have to!
• Set down your utensil between bites - This will help to ensure that you have chewed your food completely. 
• Sip your beverages - do not take several swallows or "chug" drinks. After surgery, if you drink too quickly you will rapidly fill your pouch, which can lead to vomiting. 
• Educate - Familiarize yourself with your program's recommended post-operative diet stages.  Begin to purchase items on each stage of your diet so that you have everything on hand when you will need it.  
• Increase your fluids - Most people do not meet their daily fluid goals.  Keep a fluid log of your daily intake and work on sipping towards your goal.  This will be a major benefit in helping to prevent dehydration after surgery.
• Attend a support group - Nothing will prepare you more than engaging in an environment with other individuals who are going through the bariatric surgery process with you.  

 

Shopping & Cooking

• Plan Your Weekly Menu in Advance - When you know what you're going to eat ahead of time, you avoid impulsive high-fat, high-calorie food selections. Try to plan weekly menus (including meals and snacks) on the weekend, and shop for the ingredients you'll need. This will make weekday mealtimes a lot less hectic.
• Make a List -You would be surprised at how much making a grocery list can help you stay on track, and save you money! Make sure your list includes all of the food groups; start with your protein, then produce, and then complex carbohydrates. Plan to make dinners in bigger portions, so you have leftovers for a quick and easy lunch the next day. Don’t like leftovers? Freeze them for a later date. Make sure to pick up quick sources of “grab and go” high protein snacks; some examples might include your protein powder, protein bars, nuts/seeds, string cheese, yogurt, and more!
• Save money - Eating healthy does not have to be more expensive! Here are some money saving tips for your next grocery haul.

1. Make a list:And stick to it!
2. Protein:Meat can be expensive. When shopping for meat, don’t be afraid to shop the sales. If buying in bulk, which can be cheaper, freeze whatever you won’t use that week to save for later. Look for inexpensive sources of protein such as beans, lentils, canned/pouch tuna, peanut butter, and eggs.
3. Produce: Buy your fruits and vegetables in its raw form. If it’s pre-packaged, you’ll pay for the convenience! For example, instead of buying the pre-cut baby carrots, buy the full-sized carrots and cut them yourself. A little extra work at home will save you a lot of money at the store.  Also, opt for produce that is in season. If your favorites are out of season, opt for its frozen version with no added ingredients, which is just as nutritious as fresh.
4. Carbohydrates: Look for 100% whole wheat or whole grain; it’s typically the same price as it’s white counter-parts but is packed with more fiber to keep you fuller longer.
5. Hydration: Skip the bottled water. Instead, invest in a good reusable water bottle and a water-filtration pitcher to save money and plastic waste in the long run.
6. Buy generic brands:They are typically the same ingredients/nutrition as the brand name, but at a cheaper price.
7. Don’t go hungry:Be sure you’ve had a nutritious meal or snack beforehand, so you’re not tempted by the chip and candy aisle as you’re walking by and throwing extras in your cart.

 

• Don't Be a Frequent Fryer -Choose cooking methods that don't add fat to your foods such baking, broiling, grilling, roasting, poaching and steaming. Use nonstick cooking spray in place of oil to reduce fat.
• Low-Fat Flavor -Instead of using high fat options to flavor your food such as butter, sour cream, creamy salad dressings, etc., opt for the low-fat options such as light butter, low-fat sour cream, and/or plain Greek yogurt.
• Carbs -Instead of swearing off rice, pasta, and bread altogether, dietitians recommend choosing whole wheat/grain products. Identical portions of whole-wheat pasta, bread, and brown rice pack more fiber than their refined, white counterparts, which helps prevent heart disease, diabetes, and keeps you fuller longer.

 

With all of the marketing in the stores these days, it can be hard to determine which products are best. To ensure you’re buying whole wheat/grain, look for “100% Whole Wheat/Grain” on the front of the packaging, and/or be sure that “Whole Wheat/grain” is the first ingredient listed on the ingredients list.

 

• General Guidelines for Home

1. Store tempting foods out of sight:Put these foods on the highest shelves of cabinets, or on the lowest shelves of the refrigerator so they will be less noticeable and harder to reach. Out of sight, out of mind! Keep your healthy foods and snacks stored at eye level so you’re more likely to grab those instead.
2. Eliminate Distractions:Don't talk on the phone, read, or watch TV in the kitchen or while eating. Be mindful and pay attention while you’re eating.
3. Make your plate in the kitchen:For meals, bring your portioned plate to the dinner table. For snacks, don’t eat right out of the bag or container.  To ensure fullness at meals and snacks after bariatric surgery start with protein first, then non-starchy vegetables, then move on to your fruit/starchy vegetable/carbohydrate.
4. Eat and don't be afraid of food: Food is the fuel for our bodies. While we are losing weight, it is important to incorporate balanced meals instead of swearing off certain foods or food groups. Remember, if your health habits are not sustainable, the results won’t be either!
5. Beating cravings: Are you hungry, or just bored? Maybe it’s a habit? There are many different reasons why we get cravings! Next time you’re feeling a craving ask yourself “Have I drank enough water today?”, “Have I ate enough protein today?” “Is there something else I could do instead; like going for a walk, reading a book, or cleaning around the house?” Try to find the patterns that lead to your cravings, so you can avoid them in the future!

 

Eating out

• Fast Food - A big problem with fast food is that many innocent-looking nuggets and patties are loaded with added fats, flavorful chemicals, and high-fructose corn syrup, which wreak havoc on your blood sugar levels. When you find yourself in a situation where fast food is the only option, review the menu online before getting there. You will be able to find food choices along with nutrition information at most places. If for some reason they do not list the nutrition info, choosing white meat, grilled potions, side of fruit/salad are always safe options. 
• Ask for Substitutions - Ask if you can substitute the grilled chicken breast for the breaded chicken breast, wheat buns for white buns, lettuce cups for buns, or ask for extra veggies. It does not have to stop at substitutions. You can ask for things to be removed just as easy! Ask to hold the cheese, creamy sauces, and extra toppings such as bacon, fried onion strings, fried jalapenos, etc. When eating a salad, get the dressing on the side to allow you to use as much as you want/need. Also be aware that the more added fruit, dried fruit, nuts, and toppings on that salad increase the calories quickly. 
• Skip the High Calorie Beverages - Just because you are eating out does not mean you must get a fun beverage to go with the meal. By choosing a lemonade, soda, or even alcoholic beverage, you are adding at least 100 calories to your meal. And let's not even mention if you get refills on the beverage! If you want something fun to drink while eating out consider choosing unsweet tea, hot tea, coffee (no added sugar or creamers). You can even get water and add a zero calorie flavor packet to it. 
• Get a To Go Box - You are not obligated to clean your plate while eating out. Portions tend to be very large at most eating establishments. Ask for a to go box at the beginning of your meal and box up at least half to prevent overeating. You can also choose to share a meal with someone. 
• Look at the Children's Menu - The kids menu may be a healthier alternative and of course is a smaller portion. While some of the items will still be a fried piece of chicken and fries, many places are now offering fruit and veggies as side items along with a grilled protein source. This is an easy, cost effective option to a smaller portion. 
• Investigate the Meal - Read the meal description in order to help you decipher if it will be a healthy choice. Avoid items that are described as crispy, crunchy, tempura, creamy, breaded, au gratin. Instead look for grilled, roasted, steamed, broiled, and poached options. 

 

Importance of Protein

• Protein first - Focus on eating protein at meals, followed by vegetables/fruit, ending the meal with carbs.  This will lead to an overall well-balanced meal structure and be the most effective at preventing weight regain.  This structure will also aid in reaching your daily protein goals, and prevent dumping syndrome.

• Protein Slushy - Try mixing up your favorite protein and putting it the freezer for a ½ hour. A protein slush on a hot summer day is as good as any cold treat around. Try it-you will be surprised!
• Use a cup with a lid - Many patients will swear that they can smell the protein in a shake or drink regardless of the flavor. Putting a lid on will block the protein smell and allow you to enjoy the drink (and the protein)!

• Protein from food - As you get further out from surgery, and when it is safe per your care team, try to rely less on protein powder for your protein source. Try to consume as much protein from other sources as you can. You want your new stomach anatomy to learn to digest these foods. You will probably always need some supplemental protein to help you meet your goals, but remember to try for real foods.

 

Movement and Exercise

• Track your steps with a health app or pedometer -Find your starting place. If you're currently at 4000 steps today, think about what you can do to get to 5000. If there is a day of the week where you tend to walk less, is there something you can do on that day to increase your step count? Try adding a walk at lunch time or in the evening. Find a walking partner in your neighborhood or get your dog out for an extra walk each day, they will appreciate it! Use walking as a chance to listen to music and podcasts, or just take in the sounds of nature. The ultimate goal is to get to 10,000 steps per day, but know that this doesn't happen overnight. Make small changes each day to walk more and track your progress over time. 
• If your joints will not tolerate walking, try a recumbent bike or get in a pool - Cycling and swimming take the impact off your joints for safer and more comfortable exercise. If you don't have a local YMCA, then check with your local hotel to see if they allow pool use for the public. Stationary bikes or elliptical machines reduce the impact and are a fun way to get cardio in. Other ways to exercise while reducing impact on joints include resistant training, Pilates, rowing, and more! Just avoid jumping, running, and stepping as a rule of thumb.

• Use the FITT principal to improve your fitness level - FITT stands for frequency, intensity, time, and type. To improve your fitness level, focus on increasing the frequency first. If you’re currently exercising 1-2 days per week, work on getting to 2-3 days consistently before trying to increase the intensity. Time can also be modified to make fitness work for your schedule. Try breaking up daily exercise into smaller time intervals if you don’t have time for a full hour of excise. Type of exercise is up to you, pick what you like best! 

 

Coping with Nausea

It is not abnormal to deal with nausea in the early months following bariatric surgery. There are a number of causes that may include not chewing food thoroughly, eating too fast, eating too much at one time, eating solid foods too soon following surgery, food intolerance, low fluid intake, stenosis or stricture, use of NSAIDS, dumping syndrome, or sensitivity to odors.

If you experience nausea that causes you to vomit, it is important to contact your healthcare provider quickly to find resolution. If you are just dealing with nausea, below are some tips that may be helpful.

Helpful Tips

• Antiemetic medications prescribed by your surgeon.
• Drink warm fluids (peppermint or chamomile tea, chicken bouillon) 15-30 minutes prior to a meal.
• Make sure you are getting at least 64oz of water to help with nausea. Up to 100oz water per day may help to decrease the risk of nausea.
• Ginger root (drops or tea), chamomile, peppermint can help with nausea.
• Chew food well and swallow before putting more food on your fork or spoon.  Use a timer, if necessary. Meals should take 20-30 minutes to complete.
• Add one new food at a time. If it makes you sick, try the food again in another month.
• If eating too fast, try eating in front of a mirror, utilizing smaller utensils to take smaller bites, or try taking dime-sized bites.
• If food feels "stuck," stand up and walk around or put your arms straight up in the air.
• Don't lie down immediately after meals.
• Pour protein drinks in 1oz shot glass. Sip 1-2 oz. every 15 minutes for 1 hour 3-4 times per day (depending on amount of protein in the product and the stage of diet after surgery).
• Marinate meats or use something acidic (like marinara or taco sauce) to cook with your meat.
• Stay away from carbonated beverages and beverages that are caffeinated.