Dietary guidance after intra-gastric balloon insertion

The intra-gastric balloon is a soft silicone balloon that is placed inside the stomach and filled with saline (sterile water) and blue dye.

By taking up space within your stomach, the balloon helps you feel full from a smaller amount of food. Together with a balanced diet and increased physical activity, an intra-gastric balloon can help you lose weight.

What happens during intra-gastric balloon insertion?

The balloon will be inserted through a tube down your throat, either under light sedation or under general anaesthetic. The tube will not interfere with your breathing at any time as it passes down your oesophagus, not into your windpipe.

Once in your stomach, the balloon is inflated with saline and some blue dye. The volume of saline inserted varies from 500–700ml.

Once inflated, the balloon is too large to pass into the bowel and will float freely inside the stomach. The procedure generally takes 20–30 minutes.

How long does the balloon stay in place?

The balloon can remain in place for 6–12 months.

Longer periods of use are not recommended as, over time, the acid content of the stomach will weaken the balloon material and may cause the balloon to deflate.

How much weight will I lose with the balloon?

The amount of weight you lose can vary, but on average people lose up to 20kg through the combination of the balloon, diet and physical activity.

Do I need to follow a specific diet before balloon insertion?

Your stomach must be completely empty before balloon insertion.

You must therefore stop eating for at least 6 hours and stop drinking liquids for 4 hours before the procedure.

If you are required to take any specific medication at a particular time, please speak to your GP or bariatric team for further advice.

Do I need to follow a specific diet before balloon removal?

For intra-gastric balloon removal, you will need to follow a clear-liquid-only diet for 3 days before your scheduled procedure.

During this time, you should consume only:

• water
• black tea or black coffee without sugar
• broth
• vegetable juice with no pulp
• no-added-sugar squash

Post-operative diet

This information will guide you through the post-operative stages step by step following your intra-gastric balloon placement.

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

You will need to follow a modified-texture diet for 2 weeks before returning to a regular-texture diet.

The diet is separated into 4 stages:

• Smooth liquids
• Purée
• Soft and moist (fork-mashed)
• Regular (normal)

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. The average recommendation is 70–100g each day.

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 4 days (days 8–11)

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.

To get the most success from the balloon, you must wait 20–30 minutes after eating before having a drink of water. This will also help to wash away any food debris that may have become stuck to the balloon.

Remember to sit upright during and after meals.

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 cheese 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

Stage 3: Soft and moist foods for 3 days (days 12–14)

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 day 15 onwards

You will now have completed 2 weeks of texture progression 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.
• Aim to have a drink 30 minutes after you have finished eating to rinse the balloon.
• Use a side plate to help guide your portions and follow the plate model.
• 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 will 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 balloon 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.

Heartburn and acid reflux

Heartburn and acid reflux are common after balloon insertion and medication will be prescribed to help control this.

Some foods, such as caffeine, alcohol, spicy foods and fatty foods, can make reflux worse if consumed in large quantities.

Small amounts of low-fat milk and dairy products can help with acid reflux, as can staying upright after meals and stopping eating at least 2 hours before going to bed.

You will be given medication while you are in hospital, usually lansoprazole, to reduce stomach acid and prevent stomach ulcers forming.

You will be given a small supply of this medication to take home when you are discharged.

It is essential that you continue to take this medication for the whole time you have the balloon in place.

Please contact your GP for a repeat prescription once the hospital supply has finished.

Odour associated with belching or burping

Foul-smelling belching or burping can be a problem and is likely to be related to food becoming stuck in and around the mucus that coats the balloon.

To help avoid this, have a drink 30 minutes after eating, chew your food well and try to move around regularly, as this can help stop food becoming stuck.

Bloating

Bloating is common and is caused by the balloon sitting in the stomach.

Unfortunately, there is little that can be done for this other than removing the balloon.

Try to remember that although bloating can be uncomfortable, the balloon is temporary and is there to help you reduce your weight.

If you are unable to tolerate the discomfort from bloating, the balloon will need to be removed.

What happens if the balloon deflates spontaneously?

If the balloon deflates before its scheduled removal, you should notice blue dye in your urine or stools.

Contact the team and come to our A&E Department immediately so we can remove the balloon.

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 start taking 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 balloon 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 balloon remains in situ

Contact the Bariatric Dietitians

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

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