Manual of Clinical Nutrition

Nutrition Management in Bariatric Surgery

Manual of Clinical Nutrition Management B- 25 Copyright © 2013 Compass Group, Inc.

Postoperative Bariatric Diet Meal Planning
The following meal planning and behavior modification recommendations should be given to the patient after
surgery (1). The meal plan must be individualized based on the type of procedure performed, postoperative
stage, and individual tolerance to food volume and consistency (1,5,). The following stages and meal patterns
are based on a review of bariatric surgery programs and published practice guidelines (1,5,23-25).

Stage 1 (postoperative days 1 and 2)
Days 1 to 2: Bariatric Clear Liquids
 Provide six to eight small feedings of clear liquid foods. Begin with sips of water, then add bouillon or
clear broth, unsweetened juices, diet gelatin, and flat (no fizz) diet soda. In general, avoid carbonated
beverages.
 Portion: Sip 2 to 3 oz (1 to 2 tbsp) at a time.
 Water: Sip 2 to 3 oz at a time throughout the day.
 The combined volume of six to eight small feedings and the water intake should be at least 48 to 64
oz/day (6 to 8 cups) to meet hydration needs.
 If the patient tolerates Bariatric Clear Liquids well, progress to Bariatric Full Liquids and then Bariatric
Pureed/Soft Diet (see below).

Stage 2 (postoperative day 3 and discharge diet)
Days 3 to 4: Bariatric Full Liquids
 Provide six to eight small feedings per day. Begin with high-protein liquids such as diet instant breakfast
(using fat-free milk), GlucernaTM , or specialized high-protein (low-fat, sugar-free, or <15 g of sugar per
serving) drinks. Gradually increase intake to 60 to 80 g/day of protein (1,15). May also use nonfat milk
with whey or soy protein powder (limit to 20 g of protein per serving), Lactaid milk or soy milk with soy
protein powder, light yogurt (blended), or plain nonfat yogurt (1).
 Portion: Sip 2 to 3 oz (1 to 2 tbsp) at a time. May increase to 4 oz (6 to 8 tbsp) by week 2.
 Water: Sip 2 to 3 oz at a time throughout the day.
 The combined volume of the six to eight small feedings plus water intake should be at least 48 to 64
oz/day (6-8 cups) to meet hydration needs.
 Begin a chewable multivitamin and mineral supplement (usually two doses per day) to meet 100% of the
DRIs for age and sex. Also begin chewable or liquid calcium citrate with vitamin D (1). (See Table B-1.)
 A full-liquid menu plan usually lasts 1 to 2 weeks postoperatively.

Stage 3 (weeks 2 to 6)
Weeks 2 to 5: Bariatric Pureed/Soft Diet
 Provide four to six small feedings of pureed or soft semisolid foods. Use high-quality protein foods such
as scrambled eggs, Egg Beaters, low-fat cheese or cottage cheese, or blenderized lean meats such as tuna
fish, chicken, or pork. Strained baby foods are a convenient option. Integrate a high-quality protein food
with each meal or snack (1,5,23-25). (Refer to Table B-2.)
 Portion: 2 to 4 oz (4 to 8 tbsp) at a time of solid foods.
 Avoid rice, bread, and pasta until the patient is comfortably consuming 60 g of protein per day plus fruits
and vegetables (1).
 Consume protein food first, vegetables and fruit second, and starch foods last to help ensure adequate
protein consumption (5).
 Alternate fluid intake with food intake. Avoid consuming fluids with meals. Wait at least 30 minutes after
consumption of solid foods or meals to drink fluids (1). The combination of water with controlled-energy
beverages and milk should equal at least 6 cups/day (48 oz/day).
 Avoid alcohol, as it may lead to dehydration and does not provide necessary nutrients (5).
 Avoid chewing gum. If swallowed, gum can block the stomach opening (5).
 Avoid drinking from straws because the air swallowed can cause bloating and stretch the pouch (5).
 Behavior techniques need to be applied and reinforced (eg, eating small amounts, eating slowly, and
chewing food completely before swallowing).
 At about 4 to 6 weeks, begin a gradual introduction of soft to regular consistency, low-fat, controlled-
energy foods. The patient should keep a food record to document tolerance to foods to discuss with the
dietitian during follow-up visits and to assess adherence to vitamin and mineral supplementation
regimen.