Dietary guidance after gastric band surgery

Introduction

This information will guide you through the post-operative stages step by step following insertion of a gastric band.

The texture progression phases from fluids to solids are important to reduce the risk of unpleasant side effects such as nausea, vomiting, pain and discomfort. It is important not to skip any of the stages.

You will need to follow a modified texture diet for 4 weeks before returning to a regular texture diet. The diet is separated into 4 stages:

• Liquids
• Purée
• Soft
• Regular

The day after your surgery, your surgical team will tell you when it is safe for you to begin to sip fluids.

Stage 1: Only smooth liquids for 1 week (days 0–7)

You can start to take sips of fluids as soon as you feel able to. Drink small quantities throughout the day. Do not allow yourself to become too thirsty as you will not be able to drink large quantities at a time.

Start with sips, little and often, and if you feel comfortable then gradually increase the amount.

Choose liquids that are high in protein to help you meet your protein requirements. Aim to have 1.5–2 litres of fluids each day to stay hydrated.

Always prioritise protein-rich fluids over others, such as tea and coffee. Begin by sipping your drinks little and often and gradually increase the quantity until you begin to feel full.

Which liquids are suitable?

Choose at least 1 litre (2 pints) of protein-rich liquids each day to help your body recover, such as:

• skimmed or semi-skimmed milk, with dried skimmed milk powder or protein powder if required
• high-protein shakes, either powdered or ready-made
• high-protein soups, such as Optifast, Meritene, Build-up, Complan or Fast 800 soup
• low-fat natural or plain yoghurt drinks
• kefir or ayran drinks
• protein water
• liquidised and sieved smooth high-protein homemade soups with a milk-like consistency, such as lentil, chicken or chickpea soup (you can add skimmed milk powder or flavourless protein powder)

Other fluids you can have

• still water
• Marmite® or Bovril®
• clear soups
• herbal or fruit teas
• tea and coffee, using sweeteners rather than sugar
• no-added-sugar or sugar-free squash
• sugar-free jelly
• diluted vegetable juice with no bits

Fluids to avoid

• fruit juices, malt drinks and fruit smoothies
• fizzy drinks, including fizzy water, as the gases may cause bloating, pain and can increase your stomach size
• all alcohol

Sample meal plan

• Breakfast: High-protein shake
• Snack: 200ml glass of skimmed milk with 1–2 teaspoons of skimmed milk powder
• Lunch: High-protein soup
• Snack: Yoghurt drink
• Evening meal: High-protein shake
• Snack: 200ml glass of skimmed milk with 1–2 teaspoons of skimmed milk powder

How much and when?

Try to have 1.5–2 litres of fluids each day. Aim for at least 1 litre (2 pints) of milk-based fluids and always prioritise protein-rich fluids over others, such as tea and coffee.

Begin by sipping your drinks little and often and gradually increase the quantity until you begin to feel full.

It is important to stop as soon as you feel full. If you drink too much, your stomach may overfill and cause pain, nausea and vomiting.

Stage 2: Only puréed foods for 1 week (days 8–14)

All food during this stage should be puréed and completely smooth with no bits or lumps.

Puréed foods are smooth and can pass through your stomach easily. You must use a blender, liquidiser or food processor to purée your food to the correct consistency. Aim for a smooth consistency like yoghurt.

Try to include foods that are high in protein in your meals to keep you fuller for longer.

How much and when?

Eat 5–6 small meals throughout the day during this stage. Start with 1–2 tablespoons at your meals and snacks and, if you feel comfortable, gradually increase the amount.

As you progress through the purée stage, you may find that your portions gradually increase. However, remember to stop eating at the first signs of fullness or if you feel uncomfortable.

If you eat too much, you may experience pain, nausea and vomiting.

• Aim to have 1.5–2 litres of fluids each day to stay hydrated.
• Avoid fizzy, carbonated or sugary drinks and alcohol.

Which foods are suitable?

All of the foods below are suitable and will need to be puréed.

Protein

• chicken, lamb, beef and turkey
• fresh or tinned fish
• Quorn or soya mince
• beans and pulses, such as lentils, chickpeas, kidney beans and baked beans
• light cream cheese or low-fat cottage cheese
• smooth low-fat high-protein or natural yoghurt, or fromage frais
• low-fat smooth hummus
• soup containing a protein-rich food

Carbohydrates

• white potato and sweet potato
• yam, cassava and plantain
• Weetabix or Ready Brek with plenty of milk
• pasta or rice
• porridge

Fruit and vegetables

• fresh, frozen or tinned vegetables without skins or seeds, cooked and puréed, such as carrots, courgettes, parsnips and broccoli
• fresh, frozen or tinned fruit, peeled, cooked and puréed, such as apple, pear and blueberries

Foods to avoid

Avoid any food that has not been puréed with a blender, liquidiser or food processor.

Suitable fluids

Try to choose protein-rich liquids between your meals:

• skimmed or semi-skimmed milk, with dried skimmed milk powder or protein powder if required
• high-protein shakes or protein water
• high-protein soups
• yoghurt drinks, kefir or ayran

Other fluids you can have

• still water
• Marmite®, Bovril®, consommé or bouillon
• clear soups
• herbal or fruit teas
• tea and coffee, using sweeteners rather than sugar
• no-added-sugar or sugar-free squash
• sugar-free jelly
• diluted vegetable juice with no bits

Fluids to avoid

• fruit juices, malt drinks and fruit smoothies
• fizzy drinks, including fizzy water, as the gases may cause bloating, pain and can increase your stomach size
• all alcohol

Aim to drink 1.5–2 litres of fluids each day.

Sample meal plan

Breakfast: Weetabix, Oatibix or Ready Brek with plenty of skimmed milk, or a high-protein yoghurt pot or pouch.

Lunch and dinner ideas:

• puréed chicken with potato and vegetables
• puréed minced meat in bolognese sauce with puréed vegetables
• puréed lentil and vegetable soup
• puréed chicken and vegetable soup
• puréed tinned fish, such as tuna, sardines or mackerel, with potato and vegetables
• puréed potato with grated or cream cheese

Snack ideas:

• low-fat yoghurt with no bits
• low-fat hummus
• low-fat custard with puréed fruit
• smoothie with no bits
• homemade milkshake with no bits

Half your meal portion should be from a protein-rich food. Try adding 2 teaspoons of protein or skimmed milk powder to your puréed foods.

Aim for 2–3 snacks across the day. Options include a 200ml glass of skimmed milk with 1–2 teaspoons of skimmed milk powder, a protein shake or high-protein yoghurt.

Stage 3: Soft and moist foods for 2 weeks (days 15–28)

Once you have completed the purée stage, you can move onto soft foods.

What is soft food?

Soft foods have a soft consistency, are well cooked and can be easily mashed with a fork. You do not need to use a blender during the soft stage.

Foods to avoid

Avoid foods that are hard or contain skins, seeds and pips, as these will be difficult to mash into a soft consistency.

• sweetcorn, peas, celery, fresh tomato, potato skin, nuts, seeds and hard cheese
• dry, crumbly foods such as biscuits and crackers
• foods with a mixed consistency, such as minestrone soup or cereal flakes with milk

How much and when?

Eat 3 meals each day and, if you feel hungry between meals, have a snack. Use a side plate for your main meals and fill half of your plate with protein-rich foods.

Start with 3–4 tablespoons at meal times and stop eating at the first signs of fullness or if you feel uncomfortable. If you eat too much, you may experience pain, nausea and vomiting.

Sample meal plan

Breakfast ideas:

• porridge, Oatibix or Weetabix with skimmed milk
• mashed baked beans
• soft cooked eggs, such as scrambled eggs, poached eggs or an omelette

Lunch and dinner ideas:

• tinned or soft flaky fish with mashed potato and vegetables
• shepherd’s pie or cottage pie with mashed vegetables
• minced chicken, beef, lamb or turkey with couscous, mashed potato and vegetables
• minced Quorn or soya mince with pasta and vegetables
• omelette with low-fat grated cheese and mashed, peeled, seedless tomato
• cauliflower cheese
• braised chicken or meat casserole
• chicken, fish or lentil curry or stew with vegetables and mashed potato or couscous
• thick soups such as lentil, ham or leek and potato

Snack ideas:

• 200ml glass of skimmed milk with 1–2 teaspoons of skimmed milk powder
• high-protein shake
• high-protein yoghurt
• low-fat custard
• low-fat yoghurt

Suitable fluids

Try to choose protein-rich liquids between your meals:

• skimmed or semi-skimmed milk, with dried skimmed milk powder or protein powder if required
• high-protein shakes
• protein water
• high-protein soups

Other fluids you can have

• still water
• Marmite®, Bovril®, consommé or bouillon
• clear soups
• herbal or fruit teas
• tea and coffee, using sweeteners rather than sugar
• no-added-sugar or sugar-free squash
• sugar-free jelly
• diluted vegetable juice with no bits

Fluids to avoid

• fruit juices, malt drinks and fruit smoothies
• fizzy drinks, including fizzy water, as the gases may cause bloating, pain and can increase your stomach size
• all alcohol

Aim to drink 1.5–2 litres of fluids each day.

Stage 4: Regular foods from week 5 onwards

You will now have completed the texture progression stages and can gradually introduce regular-texture foods and begin to increase the variety of foods in your diet.

Eating guidance

• Do not graze, which means eating small amounts of food constantly throughout the day, or go for long periods without eating.
• Aim to have 1.5–2 litres of fluids each day to stay hydrated. Avoid drinking large quantities at one time.
• Limit alcohol intake to 1 or 2 glasses of an alcoholic drink on social occasions only.
• Avoid high-fat, high-calorie foods, snacks and sugary drinks as these will not assist with weight loss.
• Eat slowly, chew thoroughly and separate eating and drinking.
• Use a side plate to help guide your portions and follow the plate model below.
• If you are hungry between meals, choose a nutritious snack such as a piece of fruit, high-protein yoghurt, a handful of mixed nuts or a glass of skimmed, semi-skimmed, soya or lactose-free milk.

What should I do if food gets stuck?

If this happens, it may be because you have eaten food that was too solid, eaten too quickly or too much, or eaten certain problem foods. This will feel uncomfortable and you may retch or vomit.

Often it will resolve itself. However, you could try drinking a small amount of cold sparkling water, as the fizz may help to dislodge the food that is stuck.

Possible side effects

Nausea and vomiting

Nausea and vomiting are very common after the procedure. You may be given anti-sickness medication to help control this. It is common to have these symptoms for a couple of weeks after the procedure as your stomach adjusts to the band being in place.

To help with nausea, make sure you chew your food thoroughly, separate eating and drinking and consume small portions.

Try moving around even if you do not feel like it, as this will help food move from the stomach into the gut.

If you are struggling to keep any fluids down after the first four days, or if you are concerned, please contact the hospital team.

Reduced stool volumes or reduced frequency of bowel movements

This is common and normally relates to the smaller amount of food being eaten. Normal bowel movements can range from 3 times per day to 3 times per week.

If your stool is hard to pass, make sure you are drinking enough water throughout the day. Most people need around 2 litres per day.

You should also aim to include fibre-rich foods in your diet, such as fruit, vegetables and wholegrain cereals and breads. These foods can help relieve constipation and also tend to be low in calories and filling.

Vitamins and minerals

Due to reduced portion sizes and overall food intake, you will not get adequate vitamins and minerals from your diet. You will therefore need to take an additional vitamin and mineral supplement once a day.

As soon as you are able to start having liquids, you can begin taking your multivitamin and mineral supplement.

Forceval

Forceval is available on prescription.

Dose: 1 tablet a day
Duration: While the band remains in situ

Over-the-counter alternatives

The following can be used as alternatives:

• Centrum Advance
• Tesco’s A–Z
• Sanatogen A–Z
• Holland & Barrett

Dose: 1 tablet a day
Duration: While the band remains in situ

Gastric band adjustments

Your first appointment for a gastric band adjustment will be 6–8 weeks following surgery. This fill is usually done under X-ray and the position of your band will also be checked at this time.

Further band fills can be arranged through the bariatric nurse specialist in the band clinic in outpatients or under X-ray.

Prior to your first band fill, you may start to feel hungry. This is because the band is usually empty and the swelling around the band from surgery that originally caused some feeling of restriction has reduced.

It is very important that you follow the dietary guidance and eat healthily to avoid weight gain prior to your first band fill.

There are some indications that show whether the band is too loose, too tight or just right.

Please be aware: If the band is too tight, you may either lose weight because you are not able to keep anything down or gain weight because you can only tolerate liquid or very sloppy foods, which may be higher in calories.

Band too loose

You may need fluid added to your band if you experience:

• hunger between meals
• frequent snacking
• larger portions
• weight gain

Band just right – optimal zone

Your band may be at the right level of adjustment if you experience:

• early and prolonged fullness
• feeling satisfied with small meals
• not feeling hungry or needing to snack between meals
• satisfactory weight loss or weight maintenance

Band too tight

You may need fluid removed from your band if you experience:

• difficulty swallowing
• reflux or heartburn
• coughing at night
• regurgitation
• only being able to eat soft or sloppy foods
• poor weight loss or rapid weight loss due to poor eating behaviour

Contact the Bariatric Dietitians

If you have any questions, please contact the Bariatric Dietitians.

T: 020 3315 8161
E: chelwest.bariatric.dietitians@nhs.net