The modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss. Most important is that you adhere strictly to your surgeon’s recommended guidelines. Post-Operative Diet The postoperative diet will be progressed by the surgeon and dietitian and will gradually transition to whole foods. It is important to follow the progression and adhere to the specific instructions in order to maximize healing and minimize the risk of complications. Post-operative diet is divided into three phases: Liquids (Phase I), Softs (Phase II), and ―Regular ‖ Bariatric (Phase III). Phase I Diet:

• Phase I consists of a full liquid diet. The most important aspects of the first months after surgery is proper hydration and protein.
• Should not consume carbonated or high-calorie sugary beverages. Avoid becoming dehydrated. Avoid fluids high in caffeine as they can increase your risk for dehydration.
• Milk and liquid protein supplements will be included to ensure proper healing. Longterm protein goal is 60–80 grams per day; however, during Phase, I, a more realistic and the obtainable goal is 30–40 grams per day.
• Nutrition guidelines with a more comprehensive list will be given.
• This phase is for about the first 7–10 days after surgery, depending on the type of surgery and surgeon’s instructions.

Phase II Diet:

• Phase II diet includes soft, easily digestible foods. This phase will be about four weeks. These foods may be slowly introduced into your diet like soft meats/fish, soups, cooked vegetables, fruits, low-fat or fat-free dairy, lean meats, and low-sugar items.
• Begin by eating 3 small meals per day.
• Should not snack throughout the day.
• Eat the protein portion of the meals first and get in the habit of eating protein-rich the food at each meal.
• Everyone’s tolerance is unique, and you may have more difficulties with some foods than others. Moist, well-cooked foods are initially tolerated better.

Phase III Diet:

• Phase III diet is a ―regular‖ bariatric diet.
• Will be able to eat foods of a regular consistency.
• However, this does not mean you should go back to your old eating habits.
• Continue to eat nutrient-rich foods such as lean meats, poultry, pork, low-fat dairy products, vegetables, and fruit.

Nutritional Pyramid for Post-Bariatric Patients

Exercise

Commit to an exercise plan preoperatively and get started. Benefits of Exercise: The Surgeon General’s report on physical activity and health states that exercise helps to: 1. Reduce the risk of dying prematurely 2. Reduce the risk of dying from heart disease 3. Reduce the risk of developing diabetes 4. Reduce the risk of developing high blood pressure 5. Reduce blood pressure in people who already have high blood pressure 6. Reduce the risk of developing colon cancer 7. Build and maintain healthy bones, muscles and joints 8. Reduce feelings of depression and anxiety 9. Control weight Getting Started: Remember: The key to weight loss is using more calories than you take in!!!! Walking is an excellent way to start an exercise program. 1. A walking program can be started before surgery and resumed once home from the hospital. 2. A walking program can be followed year round. Walk outside during good weather and move indoor to a gym or mall on cold, rainy or humid days. 3. Start by walking on a flat surface and gradually add hills or slopes, as you get stronger. 4. Gradually increase the distance or amount of time you walk. 5. Alternate your walking routes will keep you from getting bored with your walking program. 6. It may help to join a walking club or walk with a family member or friend to keep you motivated. 7. Walk only where you feel safe. 8. If you can, invest in a good pair of walking shoes. 9. If you have not exercised in a long time, it might make you feel better to take a cell phone with you on your walks. 10. Take a bottle of water with you on long walks. Sip water at intervals, especially if you walk outside on hot days. Aerobic Exercise: 1. Check with your doctor before starting any form of strenuous exercise program. 2. The best form of aerobic exercise is one that you will enjoy. It is difficult to stick with an exercise program you don’t enjoy. 3. A variety of aerobic activities can help you from becoming bored with your exercise program. Try doing different activities on different days. 4. Swimming and water aerobics are a good form of exercise, especially if you have joint problems or joint pain. 5. If you want to take an aerobic class, always start with a low impact class. Make sure the class is geared for beginners. 6. Research has shown that increasing lifestyle activities can have the same effect on health and weight loss as a structured exercise program. Examples include:

• Taking the stairs instead of the elevator
• Parking at the far end of the parking lot and walking to the office or store.
• Mowing the lawn and raking leaves
• Getting up from your desk to deliver a message instead of email
•  Walking to do errands instead of driving

Strength Training: Note: strength training is not recommended for the first three months post-op 1. Check with your doctor before starting a strength-training program. 2. Strength training may include the use of weight machines, ―free‖ weights (hand-held weights), and resistance bands. 3. It is very important to use the correct form when doing strength training. This will help to prevent injuries. 4. When starting a strength-training program, it may be helpful to take a class or hire a personal trainer. The instructor or trainer will show you the correct way to use the equipment. 5. Strength training workouts should always be preceded by a 10-15 minutes warm-up (such as walking, using the treadmill, riding an exercise bike). This will raise the core body temperature and ready the joints and muscles for the workout. Goals and Motivation Goal: 30 minutes of exercise on most days of the week. This can be broken down into 3-10 minute sessions. Tips to help you maintain your exercise program: 1. Begin your exercise program gradually and progress slowly over time 2. Vary workouts to alleviate boredom 3. Develop specific, realistic and achievable goals 4. Anticipate obstacles—have a back-up plan 5. Keep your walking shoes or exercise clothes in the car Tobacco Patients should stop smoking eight weeks prior to surgery and permanently avoid all tobacco products (e.g., cigarettes, cigars, chewing tobacco, hookah, e-cigarettes). Smoking Effects: 1. Impedes proper lung function. 2. Increases risk of pneumonia post-op. 3. Reduces circulation by constriction. 4. Inhibits healing of surgical sites. 5. Increases the risk of blot clots (DVT) 6. Stimulates production of stomach acid. 7. Increase the risk of ulcer formation. Alcohol 1. Excessive use of alcohol may substantially increase operative risks or may result in cancellation of surgery. 2. Post-operative alcohol use the first three months should be completely avoided while your surgical sites are healing. Alcohol can cause gastric irritation and lead to ulcer formation. 3. It is best to abstain from alcohol. After your three-month recovery post-operative, alcohol may be consumed on a very limited basis. Avoid alcohol taken in high sugar content mixers, this can cause ―dumping syndrome‖. 4. Your tolerance for alcohol will dramatically change after surgery. Use caution with alcohol consumption, a few sips can be highly intoxicating. It will also take longer to metabolize alcohol. 5. Alcohol is highly caloric and may impede weight loss and/or maintenance. Sexual Activity and Pregnancy You can resume sexual activity when you feel able. It is important not to get pregnant until your weight is stable and you are following a healthy lifestyle. This is usually around 15 to 18 months after surgery. Remember A healthy mother = A healthy baby. Rapid weight loss after bariatric surgery can greatly increase your fertility which means you can get pregnant easily. You need to talk to your family doctor and use non-oral hormonal birth control. If you would like to have a baby, it is very important to plan for a pregnancy. After surgery, your nutritional levels may not be optimal. Vitamin and minerals levels need to be checked and followed to ensure the proper growth of the baby. Pregnancy should be followed by an obstetrician who deals with high-risk pregnancies. For the first 18 months after surgery, if you become pregnant at any time or think you may be pregnant, contact the Bariatric Clinic right away. You will need to be referred to an obstetrician for an assessment of high-risk pregnancy. Long-term follow-up: Over time, you will need periodic checks for anaemia & vitamin B 12, folate & iron levels. Follow-up tests will be conducted every 3 to 6 months, or as needed. Follow-up is recommended for life. Keys to Success after Bariatric Surgery Listen to your body: When full – STOP eating Follow the guidelines you are given Follow the nutrition guidelines, for each phase of the diet • Do not go more than 5 waking hours without eating • Eat appropriate types

• Protein first
• Avoid refined carbohydrate foods
• A healthy snack is ok

Separate foods and fluids Wait 60 minutes after eating to drink fluids • NO GRAZING Nibbling or snack throughout the day will add unnecessary calories and is a poor life style habit • Work with your dietitian as directed She is available by phone and email, in addition to the routine follow-ups • Exercise Start immediately after surgery Find something that you enjoy Make this a habit • Sleep Get at least 6 hours of regular sleep, 8-9 hours is best Helps to prevent weight regain • Make and keep your follow up appointments