Adjustment to life after surgery

To continue to maintain weight loss and avoid weight regain following bariatric surgery, certain eating behaviours should be followed lifelong.  These include:

• Eating small portions by using small plates or bowls for meals to avoid over-eating.
• Taking 60-80g protein per day for satiety and to meet the nutritional requirement.
• Chewing food well and eating slowly (20-30 minutes for a meal) to minimise symptoms of nausea or pain on eating and to increase fullness.
• Leaving a 30-minute gap between eating and drinking to increase fullness and reduce dumping syndrome.
• Avoidance of fizzy drinks.
• Limiting alcohol.

For more information on eating after bariatric surgery please see the information in the patient area of the website.

Sample menu – 80g protein
Breakfast: Porridge with greek yoghurt and tablespoon of chi seeds
Half an hour later: glass of semi skimmed milk

Snack: small banana

Lunch: Tuna nicoise (1/2 can tuna, egg, green beans, tomatoes and 1 new potato)

Snack: small handful nuts

Evening meal: 1/2 small chicken fillet with 2 egg sized boiled potatoes, gravy and broccoli

Evening snack: 3 oat cakes with 2 tbsp cottage cheese
Half an hour later: Hot milky drink

Sample menu – 60g protein
Breakfast: 1 poached egg, 2 spoonfuls of baked beans and 2 spoonfuls of mushrooms
Half an hour later: glass of semi skimmed milk

Snack: small banana

Lunch: Half a tin of sardines in tomato sauce on crackers with a few cherry tomatoes

Snack: small handful nuts

Evening: Shepherds pie (4 tablespoons) with a 1-2 spoons of mixed vegetable, high protein yoghurt

In tea and coffee through the day: 200mls semi skimmed milk

It is essential that patients continue with regular physical activity for life to help maintain weight loss and reduce the risk of developing comorbidities associated with weight gain along with post-op risks such as osteoporosis and muscle loss.

 

Recommended physical activity guidelines for adults, Department of Health:

1. Adults should aim to be active daily. Over a week this should add up to 150 minutes (or 30 minutes on at least 5 days a week) of moderate intensity activity in bouts of 10 minutes or more.
2. Adults should also undertake physical activity to improve muscle strength on at least two days per week.
3. Moderate intensity physical activity will cause adults to get warmer, breathe harder and their hearts to beat faster. Examples include walking or cycling.

Weight loss tends to significantly slow down around 12-18 months post-surgery, and for some, this is when it becomes clearer that surgery is only a tool and that keeping weight off in the long term will require lifelong changes in diet and physical activity.

Common difficulties include:

• Slower weight loss than anticipated, weight plateau or weight regain, ability to manage more food over time, stressful life events and disappointment that surgery does not solve particular life difficulties. These may result in a feeling of loss of control over eating, difficulties with motivation and mood, or getting back on track after lapses.
• Challenges in dealing with changes in relationships or unwanted sexual attention.
• Intense fear of weight regain, which may lead to unhelpful rules about food and eating which are difficult to follow, or coping with changes in body image from the point of view of weight and/or excess skin.
• Worry about surgical complications. For example, difficulty swallowing due to strictures post-op can lead to a fear of swallowing foods of a certain type or texture even when the stricture has been dilated and there is no physical blockage remaining. Others may experience worries about what has happened to the pouch, or in rare cases, develop signs of trauma following surgery.

While some worry and fears are a normal part of adjusting to the surgery, it is important to discuss any concerns if they persist or if they are impacting negatively on weight loss or quality of life. Consider whether a referral to a local psychological service may be helpful, or whether it would be useful to refer back to the bariatric service.