If you have been researching bariatric surgery as a tool to help you return to a healthy weight and lifestyle, you will understand that your eating habits and diet following surgery will need to change significantly. Not only as a result of structural changes to the digestive system because of the surgery, but a healthy diet and lifestyle are always required to ensure a life-long change and to avoid weight regain.

You may have read that you need to follow a diet before your surgery (you can check out our blog about the pre-bariatric surgery diet here), but although this is required to make surgery safer, the post-bariatric surgery diet is a bit more complicated and more important. 

Post-op diet

Once you have had bariatric surgery your recovery diet will last six weeks. 

First 2 weeks – fluid diet

During your first two weeks following surgery, you will still be in recovery. You should aim to consume a diet of thin blended soups or smoothies, that are high in protein; some patients may choose to continue with the use of meal replacement shakes for convenience (for example Formulite as pictured below). Patients are all encouraged to ensure they are consuming adequate fluids during this time to reduce their risk of dehydration. During this time, you will also start your chewable multivitamins.

As you are still in recovery, ensuring you follow strict guidelines during this period is essential.

• No eating and drinking at the same time once you move to solids to avoid unwanted gut symptoms. 
• No fizzy fluids are allowed. 
• Meal portions should be ¼ to ½ cup to avoid overeating. 
• Very lumpy food could get stuck, leading to vomiting and putting unwanted pressure on staple-lines and surgical join. Very lumpy foods could contribute to leaks in some circumstances. 
• Protein is vital and requirements need to be discussed with your dietitian but typically you are aiming for between 60-80g of protein per day. Most patients only achieve 30-40 grams per day in the first few weeks, however.
• Discuss supplements such as whey isolate powders or protein water and how to incorporate them into your diet in order to keep your protein levels up. 

Weeks 3 and 4 – Puree diet

Once you have made it through the first couple of weeks you are most certainly over the hardest part. Introduction of thicker food makes things a lot more interesting however most people still have some fluid meals for convenience. The eating guidelines around small portions and aiming for protein still apply. 

Weeks 5 and 6

Weeks five and six see the much-anticipated introduction of actual food as opposed to just shakes or purees. During this time, you can begin to consume a diet of soft foods, although solid foods can cause problems, and you should still be following the same eating guidelines as specified during the first two weeks.

Week 6 onwards

Congratulations, you have made it to week six! Those first weeks following bariatric surgery are certainly challenging as they require significant dietary and lifestyle changes, so congratulations for making it through. 

During this period of recovery and adaptation, you will also have started to lose a significant amount of weight each week, which will continue as you follow your new diet and lifestyle.

From week six onwards you can start to slowly introduce solid foods to your diet. It is important during this time to ensure that you are using the new limited amount of space that you have to consume the right foods that are of high nutritional value.

A question we are often asked by our patients is whether or not they need to go on a diet before they have bariatric surgery. So today we thought we would explain the pre-surgery diet that we recommend to our patients and why. 

Why do I need a special diet pre-bariatric surgery? 

Although bariatric surgery is a very safe procedure, it is still major surgery and with all surgery, there are risks involved. The pre-bariatric surgery diet is designed to assist in making your surgery as safe as possible by increasing the amount of space in your abdomen to allow easier laparoscopic surgery.

When someone goes on a high protein Very Low Energy Diet (VLED) ½ the weight they lose comes from their abdomen. A 6kg weight loss will lead to an increase of 3 litres of intra-abdominal space for surgery to occur for example. This leads to less pain and faster recovery for you as internal cuts and bruising is less.

Other benefits;

1. Patients with bad diabetes will get a reduction in their blood sugars which significantly reduces their risk of post-operative infections.
2. Patients with sleep apnoea will reduce their risk of post-op breathing complications by over 50%
3. Weight loss improves overall immunity
4. Weight loss softens the abdominal wall, so if other issues such as hernias are found during surgery, they can be fixed without needing further surgery down the track.
5. This diet allows people to try different formulations of VLED that they can use for the post-op diet.

How much weight someone “needs” to lose before surgery is different from person to person, however for many, 2 weeks on a VLED pre-op is sufficient to do the job. This equates to 4-8 kg for most people.

Special Cases

People with a BMI over 50 or weighing over 160-200 kg, those with significant and poorly controlled medical problems, and people who have had complex abdominal surgery before may need to lose a greater amount of weight before they can safely have surgery. In these circumstances we may set a specific weight target before surgery, with a plan to delay the procedure until the goals are met.

These goals may include, for example, achieving a 10% bodyweight reduction or getting to a certain nominated weight. In these circumstances the pre-op diet may need to be extended out to 4-12 weeks, depending on the goal.

What is the pre-bariatric surgery diet? 

Our patients are asked to follow an intensive phase of VLED (very-low-energy-diet) or VLCD (very-low-calorie-diet), of three meal replacements and two cups of vegetables (sometimes an additional protein serve to ensure protein requirements are met if BMI is too high) for 2 weeks. Additional fibre and plenty of water are also advised during this VLED period. 

The meal replacement that we often recommend to our patients is Optifast. It is a low carbohydrate, total diet replacement consisting of three Optifast products (meal replacement shakes or bars) that total 600-800 calories per day. Another really good product that we also recommend is Formulite, however any commercially available VLED will be OK as long as it has the protein and nutrients you need.

This diet puts patients into mild ketosis to help them lose weight rapidly, yet safely (on average 1.5 – 2.5kg per week). The low-carb nature is critical to success. Being in Ketosis forces us to burn glycogen and fat, but also suppresses hunger. Most other low energy diets promote hunger which isn’t very tolerated by most of us for more than a day or two.

It is important before you start on any diet to ensure that you have the approval of your doctor or dietitian, to avoid any nutritional deficits and to make sure you are losing weight safely. 

Pre-op Diet Troubleshooting.

VLED’s or “diet shakes” are formulated foods. This means they have a number of natural and synthetic ingredients, and not everyone tolerates them or likes the flavours. It’s worthwhile for people to try different varieties before committing to the diet, not just to make the pre-op diet easier but also to make the post-op diet easier as well.

Common issues include

1. Lactose intolerance which leads to wind and diarrhea in some people. There are lactose-free variants available (Tony Ferguson and some Vegan Shakes) however Lacteze tablets taken with the VLED will sort out most symptoms.
2. Optifast Bars are an alternate for people who want a solid VLED or are lactose intolerant.
3. Soy intolerance and artificial sweetener intolerance is an issue for some patients, in which case an individualised pre-op high-protein and low carb diet can be worked out with our dietician.
4. Headaches/crankiness/hunger. The most difficult time of the diet is the first 24-48 hours when ketosis is “switching on”. Taking regular Panadol and avoiding stressful work over this time will help.

If you are considering bariatric surgery and would like to know more then contact our practice on (02) 9553 1120 or you can

Book an appointment online

For people living with obesity, bariatric surgery can be the beginning of their weight loss journey. We describe the process as a journey as it requires long-term commitment to real change which can often come with bumps in the road. The rapid weight loss after bariatric surgery brings hope and a renewed vitality, so when you hit a plateau in your weight loss or even regain weight some years later, this bump in the road can be incredibly disheartening. 

 

Today we are going to look at the weight loss plateau after bariatric surgery and when you should be concerned, as well as weight regain following surgery and how to tackle it. 

 

Plateaus are a normal part of weight loss. But if you have noticed that your weight has plateaued for an extended period and you’re no longer losing weight, it might be worth checking in with yourself… 

• Have some unhealthy habits returned, like mindless snacking? 
• Are you sticking to your post-surgery diet? 3 meals a day? Plenty of protein? 
• What are your activity levels like, could you be doing more or trying something different? 
• Should we be considering the addition of Anti-Obesity medications such as GLP-1 agonists to help you get to goal?

If you’re still unsure what’s causing it, it is time to make an appointment with your healthcare team or your doctor, who’ll be able to help steer you back on course if need be. 

If the healthy habits cultivated post-surgery are replaced by old, detrimental behaviours, it can contribute to weight regain and the risk of lesser weight loss. This is why follow-up is so important as the team can guide you throughout this journey, you are not alone. 

Getting Back on Track – 3 Ways to Tackle Weight Regain

1. The Importance of Checking In – regular follow-up appointments with your healthcare team are designed to monitor progress. If weight regain becomes evident or bad habits begin to resurface, these appointments are the ideal platform for discussion and intervention. It’s a team effort. 
2. Taking Responsibility – reflecting on your current lifestyle habits and identifying areas that may have contributed to weight regain can empower you to make positive changes. This may involve being more accountable for what you are eating, being honest about your physical activity levels (and if you can do better), as well as other areas of your life such as sleep quality and stress management. If reflecting on your lifestyle makes you feel uncomfortable or disappointed in yourself, pick up the phone!
3. Reclaiming the Journey – weight regain is a detour, not a dead-end. It’s an opportunity to reassess, realign and reclaim your journey toward health.

Weight regain after bariatric surgery is a challenge that many face, but it’s not a journey to navigate alone. Recognising when to be concerned and taking proactive steps to address weight loss plateaus or weight regain can set you back on course toward a healthier, more fulfilling life. Embrace the journey and stay connected to your healthcare team. 

If you have had bariatric surgery and experienced weight regain, and would like to discuss this with one of our team, you can make an appointment online or call 02 9553 1120.

If you’re considering bariatric surgery for the first time, the information available online can appear quite daunting. Our own website has information booklets, handouts, videos and hundreds of blogs. So today we are keeping it simple. Here are five considerations you need to be aware of when considering bariatric surgery as a tool to aid weight loss and have success maintaining that new healthy weight for the rest of your life. 

2. Support System

Building a strong support system is essential. Whether it’s friends, family or support groups, having a network to lean on during your journey can be instrumental in your success. At Upper GI Surgery, after having bariatric surgery our patients are enrolled on the Fresh Start program (for 2 years), a professional health coaching team to help guide and support you on your journey. While you’ll have ongoing support from our medical team at your follow-up appointments, you should also try spending time with friends and family whose healthy and active lifestyles you admire. People who “walk the walk” of a healthy life will often have tips they can share to help you. 

Post-Bariatric Surgery Recovery

4. Nutritional Changes

After your surgery, you’ll need to follow a specific diet plan for several weeks before you transition to “normal” food and an eating pattern that you will want to try to maintain lifelong. Understand the importance of proper nutrition, including portion control and taking your required vitamins and minerals supplements. Read more here:

What is the pre-bariatric surgery diet? 

What is the post-bariatric surgery diet? 

At Upper GI Surgery, we’re here to support you every step of the way, from your initial consultation to your long-term follow-up care. If you have any questions or are ready to begin your journey, please don’t hesitate to contact us.

The 4th of March annually marks World Obesity Day – a day that calls for a unified, cross-sector response to the obesity crisis worldwide. World Obesity Day aims to encourage people to recognise the root causes of obesity, increase knowledge of the disease and tackle weight stigma, acting to improve the world’s understanding, prevention and treatment of obesity.

Spreading the Word

World Obesity Day has been operating since 2016, growing with popularity and presence every year. Around the world others are also advocating for those living with obesity. For example, ‘The Big Truth’ is a European advocacy group that aims to promote the ‘real science’ behind obesity and overcome the stigma that obesity is a person’s fault. To find out more you can visit their website – https://obesitythebigtruth.eu/. 

Bariatric surgery is a life-changing step towards achieving weight loss and overall improved health. As patients begin this transformative journey, it’s crucial to recognise the significance of post-operative bariatric care, particularly when it comes to vitamin supplementation. Many patients don’t realise that after bariatric surgery they will be required to take lifelong vitamin and mineral supplements, or potentially face serious health consequences down the line. 

 

In this blog post, we’ll delve into the essential role that vitamins play after bariatric surgery and why it’s important to prioritise their intake for long-term well-being.

 

Vitamin B12 – reduced stomach acid and intrinsic factors after surgery can hinder B12 absorption.

Iron – reduced stomach size and changes in the digestive tract can limit iron absorption

Calcium – changes in the digestive system can impact calcium absorption.

Folate (Vitamin B9) – Reduced absorption in the small intestine.

Thiamine (Vitamin B1) – Reduced absorption in the small intestine, especially common in gastric bypass patients. 

Zinc – Reduced absorption in the small intestine.

Copper – Limited absorption in the digestive tract.

Vitamin A – Reduced absorption.

It’s important for individuals who have had bariatric surgery to undergo regular blood tests to monitor their nutrient levels. For our patients, we tailor supplementation plans based on individual needs and recommend specific products designed for post-bariatric surgery patients. For example, as part of our Aftercare Program, our patients are provided with a month’s supply of Bariatric multivitamins.

Thiamine – A Critical Component

One of the key vitamins that demand special attention after bariatric surgery is thiamine. Thiamine deficiency can lead to neuropathy, permanent brain damage and even dementia. To combat this, our nurses regularly check in with our patients, providing reminders about taking bariatric multivitamins post-surgery and emphasising the critical role supplementation plays in preventing long-term complications.

Investing in Your Health

Taking the correct vitamins after bariatric surgery is an investment in your long-term health. For as little as $1 a day, the benefits far outweigh the expense. We encourage patients to explore subscription options online or with their pharmacy, where you may be able to get your supply at a lower cost. 

Dispelling Misconceptions – not just any multi-vitamin will do

There’s a common misconception that any multivitamin will suffice post-bariatric surgery, especially if you haven’t undergone a gastric bypass. During the weight loss period after surgery (first 6-12 months) and during times of stress or illness, standard multivitamins are insufficient and some can contain additional items (such as high levels of vitamin B6)  that can be toxic and cause illness. Bariatric multivitamins are specifically formulated to meet the unique needs of post-operative patients. Opting for standard multivitamins or none at all can lead to unwanted consequences, as the body may no longer absorb certain nutrients effectively.

The importance of taking vitamins after bariatric surgery cannot be overstated. At Upper GI Surgery we prioritise the well-being of our patients – it’s not just about taking vitamins, it’s about investing in a healthier, more fulfilling future. Don’t compromise on your post-operative care.

If you are living with obesity and have been trying to lose weight, it can sometimes feel like an impossible challenge. Diet and exercise alone are often not sufficient or even possible for those who have been living with obesity for a long time. Weight-loss medications have emerged as a beacon of hope for those who have ‘tried everything’ to lose weight. But are weight loss medications a temporary fix or a long-term solution? In today’s blog we’ll find out. 

Weight loss medications come in different forms and work through various mechanisms, from appetite suppression to inhibiting fat absorption, assisting individuals in their journey to a healthier weight. They are not prescribed alone but as part of a holistic approach including a healthy diet and increased activity/exercise levels to be most effective. 

Temporary Triumph

While weight loss medications can produce positive results during their administration, it’s important to acknowledge the transient nature of their effects. Many individuals experience initial success only to find that, when they stop taking the medication, the weight creeps back on. The hard truth is that without a fundamental shift in behaviour, relying solely on weight loss medications may not offer a lasting solution. Despite the fact that no-one wants to regain weight after stopping these medications, on average most people will regain >50% of the weight they have lost within a year.

There is also nothing ‘temporary’ about a medication if you have to take it long-term to achieve and maintain weight loss. These medications each come with potential side effects and risks that need to be considered by the individual to determine if they are suitable candidates. 

The decision is a little easier for patients who have had previous weight-loss surgery. Because their stomach is no longer normal, their risk of weight regain is far less because they are protected against the return of their normal appetite by their previous surgery.

It is also important to note that currently in Australia, there have been supply chain issues with certain medications, meaning fulfilling prescriptions has become difficult for many. This in itself can cause issues because if you do not have access to the prescribed medication, you are at risk of regaining any weight lost. 

Weight Loss Medication – for those who have had bariatric surgery

Even with consistent healthy lifestyle changes (diet and exercise), some weight regain can and does occur in patients who have had bariatric surgery. While in some the weight regain is only minor, in others it is progressive which can be very disheartening. If someone is struggling to lose weight that they have regained through diet and exercise alone and are not having any success, weight loss medication is a potential option to help get them back on track and lose the extra kilos they regained. 

In our clinical experience patients that regularly attend follow-ups with the team tend to regain less weight than those who don’t come back. If you’ve regained weight following your bariatric surgery, booking a follow-up appointment with your specialist is the first step; at Upper GI Surgery our specialists can discuss with you the potential option of weight loss medication as part of your treatment. 

If you would like to discuss your eligibility for weight loss medications, you can make an appointment with our Bariatric Care Specialist Dr Jennifer Matthei who will be happy to give you more information. 

As the Sydney summer ushers in the holiday season, those who have undergone bariatric surgery may find themselves navigating a unique set of challenges. The hot weather, special family or social gatherings, and the abundance of delicious, sometimes less-than-ideal foods can trigger old eating habits or temptations to overindulge. In this year’s holiday-themed blog, we’ll delve into the triggers that might arise and offer some strategies to overcome them, helping you make the most of your summer festivities while staying true to your post-bariatric lifestyle.

Strategies to Overcome Triggers

Mindful Choices – practice mindful eating by making conscious choices. Prioritise protein options and vegetables while being mindful of portion sizes. Most functions will have low calorie options such as sliced vegetables that you can munch on, this will sort out any hunger but will also help you “blend in”.

Prepare and Communicate – plan your holiday meals in advance. If you’re attending other people’s gatherings, let your host know about your dietary needs and consider bringing a dish that aligns with your post-surgery eating plan.

Stay Hydrated – often, thirst is mistaken for hunger. Keep yourself hydrated, especially in the summer heat. Drinking water can help you differentiate between actual hunger and thirst. But remember to limit your liquid intake at mealtimes. When going to a social event choose water first, especially if you’re planning to have a glass of wine. Drinking alcohol when thirsty or tired is never a good idea.

By identifying and understanding your overeating triggers and trying some of these strategies, we hope we’ve helped you navigate the summer holidays successfully. This season is about celebrating, connecting and creating joyful memories. With mindful choices and support from loved ones, you can enjoy the festivities to the fullest while staying committed to your post-bariatric surgery goals.

The gastric bypass is known as the ‘gold standard’ weight control operation and has been the most frequently performed bariatric surgery procedure worldwide. But did you know that there are different types of gastric bypass surgery? Here’s a brief overview of the differences between the various gastric bypass procedures. 

Roux-en-Y Gastric Bypass

Roux-en-Y Gastric Bypass, commonly abbreviated as RYGB, is the most frequently performed gastric bypass procedure. It involves the creation of a small pouch (15-30ml) which can be long or short (but is always narrow) at the upper section of the stomach that is then connected directly to the small intestine. This restricts food intake, releases neuropeptides that suppress appetite and create taste changes, and leads to substantial weight loss.

Single Anastomosis Duodeno-ileal Bypass (SADI) and Sleeve+ procedures.

Sleeve Gastrectomy with Duodeno-Ileostomy (SADI) is an advanced surgical technique that combines sleeve gastrectomy with a modified digestive pathway. This restricts food intake, limits calorie absorption and leads to substantial weight loss. It is just one of the many Sleeve+ procedures that combine a Laparoscopic Sleeve Gastrectomy with some type of intestinal bypass to try to improve long-term weight loss.

Choosing the Right Gastric Bypass Surgery

Selecting the most suitable type of gastric bypass surgery is an important decision made after a detailed consultation with your bariatric surgeon. Your surgeon will discuss and assess your unique health conditions, weight loss goals and medical history to guide you to the right choice.

Benefits and Risks

Every type of gastric bypass surgery offers common benefits – substantial weight loss, enhanced health and improved overall well-being. However as with any major surgery, it is crucial to be informed about the potential risks and complications of these procedures. An in-depth discussion with your surgeon will equip you with the knowledge required for a well-informed decision.

At Upper GI Surgery, we are committed to guiding you through the decision-making process and ensuring a safe and effective surgical experience. Whether you’re considering Roux-en-Y, Mini Gastric Bypass or SADI, your journey to a healthier, happier you starts with a consultation.