Learning to recognise fullness after bariatric surgery is one of the most important parts of your new relationship with food. In the early weeks after surgery, your body’s hunger and fullness signals can feel unfamiliar, and that’s completely normal. With time and practice, you’ll learn to understand these new cues and respond before discomfort sets in.

Why does fullness feel different after bariatric surgery?

Your stomach is now smaller and while it empties more quickly, any food you eat will pass more slowly into the stomach; when it arrives there stomach pressure rises quickly to create “full” signals that then switch off hunger. This means it takes less food to feel satisfied, and the sensation of fullness arrives faster. Instead of the “stretched” feeling you may have noticed before surgery, fullness now tends to feel higher in the chest or throat, or as a subtle tightness beneath the sternum.

It’s also important to remember that true fullness can lag behind your last bite by a few minutes. Eating slowly gives your body time to send accurate signals to your brain.

Tips to help you recognise fullness sooner

• Put your fork down between bites. This simple act slows you down and allows signals to catch up.
• Pause mid-meal. Take a break after a few bites – you might realise you’re already satisfied.
• Avoid distractions. Turn off screens so you can pay attention to how your body feels.
• Use smaller plates and cutlery. This encourages portion control without relying on willpower.
• Reflect after eating. Ask yourself, “At what point did I feel comfortable?” Over time, this builds awareness.

Remember, fullness will evolve

As you progress through your recovery, your capacity and signals will change. Early on, fullness may come after a few spoonfuls; months later you’ll be able to enjoy small, balanced meals. The key is to always eat mindfully and stop before discomfort.

If you’re unsure whether you’re eating the right portions or recognising fullness correctly, reach out to your dietitian or bariatric team. They can help you fine-tune your portions and habits to suit your stage of recovery.

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

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.

The Mediterranean diet has long been established as the ‘gold standard in preventive medicine’ (Mediterranean diet and life expectancy; beyond olive oil, fruits and vegetables). It’s true that people who live in the Mediterranean and embrace the diet and lifestyle live longer lives, free from many of the diseases that other places face such as heart failure, strokes and diabetes. 

The diet is based on the traditional foods found in the countries that border the Mediterranean Sea, such as Italy, Greece, Spain or France. It’s not complicated to follow, as it includes such a wide variety of foods with endless combinations, preferably flavoured with herbs and spices instead of salt. 

The focus is on fresh fruit and vegetables, seeds, whole grains, legumes, fish and seafood, whilst not forgetting olive oil. Also poultry, yoghurt, cheese, eggs or even red wine, but these food groups are consumed more moderately while limiting (or avoiding altogether) red meat, highly processed meat or food, refined grains, sugar-sweetened drinks or alcohol.  

Mediterranean diet for bariatric surgery patients – do’s and don’ts

Rather than thinking of it as a diet (which are often restricted and not sustainable), think of it as a new Mediterranean way of life. Here are some do’s and don’ts to help you follow the diet as a weight loss surgery patient. 

Do

• Eat lots of plant foods, i.e. fruits, vegetables, legumes and nuts/seeds. They can be fresh, dried, canned or frozen (just check that they don’t have any added sugar or high salt content). 
• Include seafood in your diet at least twice a week, whilst aiming to reduce meat (red or processed) in your diet. Poultry and eggs are a great source of protein. 
• Switch to wholegrains for your rice, pasta or bread to follow the Mediterranean diet. 
• Have a healthy source of fat in your diet, from using extra virgin olive oil in your cooking to avocados, nuts/seeds, tahini or milk (within reason). It’s important to use extra virgin olive oil, as not all olive oils are considered high in antioxidant phytochemicals. 
• Get creative and use fresh herbs such as basil or rosemary, garlic or spices to keep your dishes tasting delicious. Don’t forget an important part of the Mediterranean lifestyle is sharing food and enjoying dishes together, embrace this. 
• Drink plenty of water, and maybe even enjoy a small glass of red wine with your meal! But remember, as a bariatric patient we don’t really want you to drink while you are eating, so this should be an occasional treat. 

Eating out on the Mediterranean Diet

It’s even easy to eat out on the Mediterranean diet. Choose a fish or seafood dish, which is usually accompanied by vegetables or salad (and if it isn’t you can always order that). Opt for grilled rather than fried wherever possible, you could always ask your waiter what the options are. Not forgetting to choose whole grains over refined grains if you have bread to choose from.

Benefits of the Mediterranean Diet for Weight Loss Surgery Patients

1. Easy to follow and includes a huge variety of foods, making it sustainable for long-term weight management. A quick Google search will lead you to countless recipe ideas to try at home.
2. As it includes foods that are high in fibre and protein, you are more likely to feel full for longer and less likely to snack. It’s the combination of different food groups that make the diet so effective.
3. Studies have suggested that the diet can help to maintain healthy blood sugar levels, improve cardiovascular health and brain function. It has also been shown to decrease the risk of some cancers. 

Bariatric surgery can be a step towards a longer, happier, healthier life, the rest is up to you. A diet like the Mediterranean diet provides an easy blueprint to follow that provides enough variation to never become boring, and could be a key to long-term weight management for bariatric patients. 

You may have heard of intermittent fasting, the 5:2 diet, eat-stop-eat, the 16/8 method… there are many different names for intermittent fasting but essentially they all follow the same theory of having periods during which you can eat “normally” and periods of “fasting”. By reducing your calorie intake, no matter what method you choose, you should lose weight or be able to maintain your weight. 

Following bariatric surgery you are required to follow a specific diet. The post-bariatric surgery diet is designed to allow your stomach to heal properly following surgery (as well as avoiding side effects and complications), help you adjust to eating smaller amounts of food that you can comfortably and safely digest, and of course, help you to lose weight. 

Intermittent fasting is not recommended as part of your initial post-bariatric surgery diet. It is important that you follow the dietary advice given by your dietitian or healthcare professional after your surgery to ensure that you are consuming an appropriate diet that will not only assist in weight loss but also be rich in necessary nutrients. 

In today’s blog, we are going to look at the benefits of intermittent fasting for those that have had bariatric surgery and are already at their target weight and would like to maintain their new lifestyle; or for those who have gained weight since their initial weight loss and are exploring realistic diet options to return to their desired weight.

What is intermittent fasting? 

“Intermittent fasting or intermittent energy restriction is an umbrella term for various meals timing schedules that cycle between a period of voluntary fasting and non-fasting over a defined period. Non-caloric drinks are permitted during fasting periods, contrary to religious fasting.” – Wikipedia

Weight loss is one of the most common reasons for people to give intermittent fasting a try. “Fasting” involves a period of you eating nothing, or very little. Our ancient ancestors didn’t have the abundance of food that we have today, so they were often subjected to periods of fasting in between meals, meaning the human body is very used to enduring periods without food (despite what we may be used to in this modern world). 

By eating fewer meals as a result of fasting, you are reducing your calorie intake. Additionally, intermittent fasting changes hormone levels to facilitate weight loss. Which is why this method can assist in weight loss or long-term weight maintenance. 

Benefits of Intermittent Fasting

Aside from weight loss, which is often the desired outcome, there are many other benefits to intermittent fasting. Although the benefits of intermittent fasting are still very much in the research stages, the indications so far have been nothing but positive. 

• Insulin resistance – when fasting your insulin sensitivity improves and levels of insulin can drop dramatically. Lower levels of insulin make stored body fat more accessible. Intermittent fasting can reduce insulin resistance, lowering blood sugar levels and fasting insulin levels. 
• Cellular repair – during fasting periods your cells initiate a cellular repair process, for example, a process called autophagy, where cells digest and remove old and dysfunctional proteins that can build up inside of cells.
• Increased levels of Human Growth Hormone (HGH) – levels of HGH have been shown to increase significantly as a result of fasting, the benefits being fat loss and muscle gain to name but a few. 
• Brain Health – intermittent fasting increases the brain hormone BNDF and may aid in the growth of new nerve cells. 
• Animal studies – animal studies have suggested that intermittent fasting may prevent cancer. Studies in rats have shown that fasted rats showed an increased life-span. 

Different Types of Intermittent Fasting

The most popular forms of intermittent fasting diets are below. These are the most popular as they have been found to be the easiest to follow, and more importantly, to stick to long-term. Diets often don’t work as they are short term solutions, but if you can introduce long-term lifestyle changes then you are much more likely to lose weight and maintain that weight loss. 

The 5:2 Diet – this method requires you to only consume 500-600 calories (500 for women, 600 for men) on two non-consecutive days of the week, and then to eat normally for the remaining 5 days. 

16/8 Method – this is a flexible approach that you can tailor to your own schedule. It involves restricting your eating period to 8 hours in a day, then fasting for 16 hours in-between. So, for example, skipping breakfast and eating between 12-8 pm, or eating between 9 am – 5 pm. 

Eat-Stop-Eat – this method involves fasting for 24 hours once or twice a week, for example not eating from dinner one day until dinner the next day. 

Whichever fasting method that you decide to follow all have the same benefits and will result in weight loss, as they are all creating a calorie restriction during the fasting period each week. 

How Intermittent fasting can help post-bariatric surgery patients

Unfortunately, many patients who experienced significant weight loss following bariatric surgery find that they may regain some weight eventually or struggle to maintain the weight loss long-term. This is where intermittent fasting may prove to be a useful technique specifically for post-bariatric surgery patients who are still learning to live with significant lifestyle changes.

• Eliminates the ‘what to eat’ factor – making healthy choices can be hard, deciding what to eat whether you’re at home, out for dinner at a restaurant or shopping in the supermarket can be a daunting task. By introducing fasting periods you are eliminating several weekly meals, helping to streamline that thought process. 
• Water consumption – during periods of fasting you are generally not permitted to consume anything other than water or drinks that have no/little calories (such as diet sodas, herbal tea etc.). Followers of intermittent fasting often find that they consume more fluids, meaning they are finally hitting their required daily water intake. 
• Smaller portions – it is easy to think that during the ‘normal’ eating periods you can ‘pig out’, whereas what actually tends to happen is that your tolerance for bigger portion sizes reduces due to the periods of fasting, helping your body and mentality return to that post-bariatric surgery state of mind and eating. 
• Sustainable – unlike other ‘fad diets’ intermittent fasting appears to be sustainable. During periods of non-fasting you aren’t required to eat a specific diet or product (although of course eating a healthy combination of proteins, fats and carbs is always recommended), and there is no restriction meaning that you won’t ‘cave’ and gorge on all of those lovely treats that you haven’t been allowed to eat following a standard ‘diet’. 

There is still a lot of research into the long-term benefits of intermittent fasting but so far the results are looking positive and as a flexible, sustainable lifestyle choice it certainly is getting the thumbs up from us! Are you willing to give it a go?