Mini Case Study

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Gastric
Bypass/Sleeve
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Roux-en-Y Gastric Bypass Surgery

§ 2-3 hour procedure

§ Restricts the amount of food the

stomach holds

§ Short term weight loss (60-80% excess

weight loss)

§ Limits calories and nutrients the body

can absorb

§ https://www.youtube.com/watch?v=TaD
05ukqqgM#action=share
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Vertical Sleeve Gastrectomy
§ 40-70 minute procedure

§ 75-80% of the stomach is removed

§ Can result in improvement of

health conditions such as T2DM,
HTN, sleep apnea, fatty liver
disease, joint pain, and
hyperlipidemia

§ Reduced secretion of hunger

hormones

§ https://youtu.be/TjQkCeFcBv4
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Surgery Qualifications

§ Most insurance companies cover bariatric surgery, when the

following criteria are met:
§ BMI greater than 40, or
§ BMI of 35-39.9 with one of the obesity related health problems such
as:
§ Hypertension

§ Type 2 diabetes

§ Sleep Apnea

§ Fatty liver disease, or

§ Hyperlipidemia
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Risks Before Surgery

§ Vitamin and mineral deficiencies

§ Examples:
§ Thiamine

§ Vitamin D

§ Vitamin C,E,A

§ Zinc

§ Carotenoids
§ Zinc

§ Selenium

§ Advised to take MVI prior

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Mindful Small
Eating Bites
Behavior
Changes Chew
Eat Food
Slowly REALLY
Well
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Pre-Surgery Diet
§ High Protein Liquid Diet:
§ 2 weeks prior

§ Reduces size of liver

§ Aim for:
§ 1000 kcals

§ 125 g CHO

§ 115 g Pro

§ Can have non-starchy veggies

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Post Surgery : Day 1

§ Clear Liquids

§ Advance 1 oz every 15 mins (4 oz every

hour) and then advance to 2 oz

§ Track with fluid check sheet

§ Goal: 80 oz/day
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Post Surgery : Day 2

§ High Protein Liquids
§ Only is 80oz clear liquids tolerated

§ Milk introduced

§ 7oz clear, 1oz protein per hour

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Post Surgery : Day 3, Day of

Discharge
§ Continue high protein liquid diet
§ Liquid protein supplements and clear liquids

§ Goal 80 oz fluid/day (1-2 cups/hr)

§ 1oz liquid protein/hr

§ NO STRAWS

§ Continue until follow up appointment with RD and surgeon

§ Recommended for 2 weeks post-op

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Post Surgery: 7-10 Days

§ Soft, High Protein Foods

§ Only a few tablespoons each meal

§ No fluids with meals

§ 15 minutes before and 30 minutes after

§ Protein shakes between meals

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Examples: Eggs/ Egg subs

Cottage cheese (low fat, fat free)
Cheese (LF/FF)
Light yogurt/ Greek yogurt
Minced/chopped chicken/fish
Cooked beans/ soup
Cream of wheat
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Post Surgery: 4 Weeks

§ Re-introduce soft, well cooked vegetables

§ Reintroduce soft and/or well peeled skinless fruits

§ Recommended 1 new fruit/veggie per day

§ Protein first

§ Examples:

§ Ripe bananas

§ Steamed carrots, green beans

§ Salsa

§ Canned fruit (rinsed and drained)

§ Cooked peas
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Post Surgery: 5
Weeks
§ Re-introduce solid meats

§ Chicken (ground)

§ Fish

§ Lean ground beef

§ Turkey (lean lunch meat,

ground turkey, deli turkey)

§ 1-2 tablespoons

§ No dry meats
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Post Surgery:
Weeks 8-10

§ Peanut butter (1 tbsp/day)

§ Healthier fats (1-2 tsp./ day)

§ olive, canola oils

§ Canned beans and legumes

§ Whole grains

§ Pasta, cold cereal, raw fruits

and veggies (peeled)
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Foods to Avoid

§ Foods high in fat and § Red meat

sugar
§ Fried foods
§ Breads (untoasted/
doughy) § Highly seasoned or spicy foods

§ Carbonated drinks § Nuts and seeds

§ Raw vegetables § Popcorn

§ Cooked fibrous § Hard boiled eggs

vegetables, such as
celery, broccoli, corn or § Coconut
cabbage
§ Dried Fruit
§ Tough meats or meats
§ Citrus fruits membranes
with gristle
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Eating Habits to Remember

§ Eat 3 meals/ day § Do not drink fluid with

§ Protein food first meals

§ Eat slowly, small bites (baby § Drink water, sugar-free, or

fork, teaspoon, toothpick) decaf fluids between
meals (1-2 cups/ hr)
§ Chew food until baby food
consistency § Avoid bacon, sausage,
fried items
§ Stop eating/drinking at first
sign of satiety § Choose nutrient dense not
empty calories
§ Take vitamins/ mineral
supplements correctly
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Protein Supplement

§ 1st ingredient : Whey protein

isolate

§ 90-120 cals/scoop

§ 20-25 g PRO/scoop

§ 0-6 g CHO/ scoop

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Importance of
Vitamins
§ Chewable vitamins first4 weeks post
surgery
§ After can do capsules

§ RD will provide info on vitamin

supplements

§ Bariatric vitamins

§ Calcium
§ Sublingual B12

§ Iron (ferrous fumarate)

§ Vitamin schedule provided by RD

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Post Surgery Complications

Dumping syndrome. Dehydration. Constipation. Blocked opening of Weight gain or

your stomach failure to lose
pouch. weight.
If too much food Because you're not A lack of physical Food can become
enters your small supposed to drink activity and fiber or lodged at the opening
intestine quickly, you fluids with your meals, fluid in your diet can of your stomach
are likely to some people become cause constipation. pouch, even if you
experience nausea, dehydrated. carefully follow the
vomiting, dizziness, diet.
sweating and diarrhea.
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Questions?
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Sources

§ Mayo Clinic

§ Memorial Bariatric Services

§ Nutrition Care Manual

§ UCLA Health

§ ASMBS