Preparing for Surgery
Specialist Bariatric Surgery Dietitians
Gail Pinnock
Laura Carstairs
Cleverly Fong
Bariatric Nurse Specialist:
Tamara Ramkalawan
Cecilia Jones
Objectives
1.
2.
3.
4.
5.
6.
5 Golden Rules
Expected weight loss
Physical activities
Food labelling and nutrition
Eating behaviour
Monitoring your own weight before
surgery
1. What would you like to get
out of today’s session?
2. What will surgery change
about your eating habits?
What will surgery change about
my eating habits?
Surgery can…
Surgery will not…
Make you feel fuller
quicker
Stop head hunger or
cravings
Make your portion size
smaller
Make you eat healthily
Reduce hunger for most
people
5 Golden Rules!
• Small portions
– Small tea plate or side plate
•
•
•
•
Stop as soon as you feel full
Eat slowly – 30 minutes
Chew food well
Don’t eat and drink at the same time
Unfriendly foods
• Some foods may not be tolerated after
surgery
–
–
–
–
–
Roast meats
Bread
Stringy vegetables
Fizzy drinks
Alcohol
• Sugary foods and drinks
• Fat and fatty foods
Vitamin & Mineral Supplement
• First 4 weeks: Dalivit 14 drops/ day
• After 4 weeks
• Sanatogen A-Z Complete/ Centrum
Advance once a day
How much weight can I expect to
lose?
• Most rapid weight loss in the first year
• After 2 years: weight maintenance /
slight weight regain
Excess weight loss
Gastric band
Sleeve gastrectomy
50%
50-60%
Gastric bypass
60-70%
Duodenal Switch
70%
Excess Body Weight
• Have a look at…
1.What is your weight today (in kg)?
2.What is your weight at a healthy BMI of 25
(in kg)?
(Height in m)2 x 25
Excess Body Weight (kg)
= Weight today – Weight at BMI 25
Example of excess weight
(Weight in kg)
My weight
127 kg (20 stones)
My weight at a healthy BMI of 25
kg/m2
69 kg (10 stone 12lbs)
Excess Body Weight
127-69= 58kg (9 stone 2lbs)
In 2 years time…
I will bring down a total of…
At 50% Excess Weight Loss
(Excess Body Weight / 2)
29 kg (4 stone 7lbs)
At 70% Excess Weight Loss
(Excess Body Weight x 70/ 100)
40.6 kg (6 stone 5lbs)
In 2 years time… I should be at:
(My Weight minus 50-70% Excess 86.4-98 kg (13 stone 8 – 15 stone 3)
body weight)
(Weight in kg)
My weight
My weight at a healthy BMI of 25
kg/m2
Excess Body Weight
In 2 years time…
I will bring down a total of…
At 50% Excess Weight Loss
(Excess Body Weight / 2)
At 70% Excess Weight Loss
(Excess Body Weight x 70/ 100)
In 2 years time… I should be at:
(Weight at surgery minus 50-70%
Excess body weight)
Importance of being active
Physical Activity
• Build up 30 minutes of moderate intensity physical
activities or exercise, 5 of the 7 days of the week. E.g.
10 minutes + 10 minutes + 10 minutes.
• You will need to accumulate 60 minutes, 5 of the 7
days of the week for effective weight loss.
• Moderate means Heart beats faster, feeling
warmer, slightly breathless though you can
continue a conversation
• E.g. heavy housework, brisk walking, light gardening,
taking the stairs, washing your car
Physical Activity
• Start off slowly, gradually increase what
you are doing to avoid causing injuries.
• Make small changes – Take the
batteries out of the remote, use the
stairs not the lifts, park far away,
change your position every 10 minutes.
Physical Activity
• It is normal to sometimes experience some
general muscle aches after physical activity.
• Pick activities you enjoy so you will look
forward to doing them.
• Get family and friends involved to make it fun
and sociable.
• Check with your GP to see if they can send
you to an Exercise Referral Scheme.
Food Labelling
Per 100g
High
(Just
occasionally)
Medium
(Fine most of
the time)
Low
(A healthier
choice)
Of which
Sugars
15g
5.1- 15g
5g
Fat
(Saturated fat)
20g
(5g)
3.1- 20g
(1.6- 5g)
3g
(1.5g)
Sodium
(Salt equivalent)
0.6g
(1.5g)
0.1- 0.6g
(0.31- 1.5g)
0.1g
(0.3g)
Always look at per 100g!
Portions after surgery
Protein
Vegetables/
salad
Carbohydrates
Protein
• Why is protein important after surgery?
– Building blocks of the body
– Needed for growth and repair
– Body cannot do with out it
• What foods is protein found in?
– Red meat, chicken, fish, eggs, beans and
pulses, dairy foods (e.g. milk, yoghurts,
cheese), tofu and quorn
Calcium
• Why is calcium important after surgery?
– Not as well absorbed
– Needed to keep bones healthy and strong
• What foods is calcium found in?
– Dairy foods: milk, yoghurt, cheese- main
sources
– Non-dairy: tofu, kale, okra, calcium fortified
soya products
Iron
• Why is iron important after surgery?
– Needed to help red blood cells carry oxygen
around the body
– Low iron levels can cause anaemia
– Not as well absorbed after a gastric bypass
– Absorption increased by vitamin C
• What foods contain iron?
– Red meat, offal (e.g. liver, kidney)
– Sardines, pilchards, anchovies
– Fortified breakfast cereals, beans, leafy green
vegetables
What will be different after
surgery?
• ‘Foods that you love, might not love you
anymore’
• ‘Losing a friend’
• Changing your relationship with food
• Life long multivitamins & minerals
supplementation
From our past experience,
people who do well tend to do these…
• Eat regularly to pre-empt hunger
• Plan ahead, only eat what you planned to
eat, but not eating in response to
emotions/ situations
• Activity/exercise
Managing hunger: Ask yourself!
1. When did I last eat?
2. Was it less than 3-4 hours ago?
3. Am I physically hungry or is my head
hungry?
4. Have I had a hot drink yet?
5. What else can I do before I eat?
6. What else is healthy that I can eat before
I have a snack?
What happens if I slip-up?
• The extra that you eat is unlikely to affect
your weight dramatically
• Missing meals or snacks may lead to
further uncontrolled eating.
Plot you own weight graph!
•
•
•
•
Flexible weight control
Normal to have small fluctuations
Only weight yourself weekly!
Overall decreasing trend is more important!
When preparing for your surgery,
Weight loss is not everything
Managing your relationship with food
is as important as watching your
weight
Funding queries
Diane Bushell will contact you directly
regarding funding issues and surgery
date
Any Questions?