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    Bariatric Diet Module

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    Adina Braha
    The document provides an overview of nutrition practice standards for bariatric surgery. It outlines the criteria for surgery, pre-surgical evaluation process, pre-surgical nutrition goals and education. It then summarizes the post-surgery diet progression from clear liquids to soft foods to solid foods, highlighting goals at each stage. Common post-operative nutrition considerations and complications are discussed for different bariatric procedures. Long-term nutrition goals and resources are also provided.

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    Bariatric Diet Module

    Uploaded by

    Adina Braha
    71 views22 pages
    The document provides an overview of nutrition practice standards for bariatric surgery. It outlines the criteria for surgery, pre-surgical evaluation process, pre-surgical nutrition goals and education. It then summarizes the post-surgery diet progression from clear liquids to soft foods to solid foods, highlighting goals at each stage. Common post-operative nutrition considerations and complications are discussed for different bariatric procedures. Long-term nutrition goals and resources are also provided.

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    The document provides an overview of nutrition practice standards for bariatric surgery. It outlines the criteria for surgery, pre-surgical evaluation process, pre-surgical nutrition goals and education. It then summarizes the post-surgery diet progression from clear liquids to soft foods to solid foods, highlighting goals at each stage. Common post-operative nutrition considerations and complications are discussed for different bariatric procedures. Long-term nutrition goals and resources are also provided.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    71 views22 pages

    Bariatric Diet Module

    Uploaded by

    Adina Braha
    The document provides an overview of nutrition practice standards for bariatric surgery. It outlines the criteria for surgery, pre-surgical evaluation process, pre-surgical nutrition goals and education. It then summarizes the post-surgery diet progression from clear liquids to soft foods to solid foods, highlighting goals at each stage. Common post-operative nutrition considerations and complications are discussed for different bariatric procedures. Long-term nutrition goals and resources are also provided.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 22

    Nutrition Practice Standards for

    Bariatric Surgery

    Dana Eiesland, RD, LDN


    Lisa C. Luz, RN, MSN, FNP-BC
    Mount Auburn Weight Management Center
    Objectives
    • Review criteria for surgery
    • Outline the pre-surgical evaluation
    • Summarize pre-surgical nutrition goals
    • Review nutrition guidelines & diet progression
    following surgery
    • Review immediate post operative and long term
    surgical complications
    General Criteria for Weight Loss
    Surgery (WLS)

    • BMI 35-40 with at least one co-morbidities (exp. DM, Obstructive


    sleep apnea)
    • BMI > 40 without co-morbidities
    • Previous unsuccessful attempts at weight loss
    • Age >18-65 with few exceptions
    • Medically cleared for surgery
    • Mentally & emotionally prepared and motivated
    • No substance abuse, no active eating disorder
    • Support system in place
    • Realistic expectation regarding outcomes
    • Has good understanding of the procedure and dedicated to
    lifestyle change
    Pre-Surgical Evaluation
    • Prior to surgery candidates should be carefully
    assessed by a specialized multidisciplinary team
    including:
    • Bariatrician (MD specializing in the care of the obese)
    • Surgeon
    • PCP
    • Social Worker/ Psychologist
    • Dietitian
    • Nurse
    Pre-Surgical Goals

    • Improvement of nutritional status


    • Correct vitamin/nutrient deficiencies (most common
    include: iron, vitamin B12 and vitamin D)
    • Achievement of better control of nutrition-
    related comorbidities
    • Development of lifestyle and eating habits that
    will promote positive post-weight loss surgery
    outcomes and weight loss maintenance
    • Promote 5-10% weight loss to reduce surgical
    risks
    Pre-Surgery
    Nutrition Education

    • Intensive Education is provided


    during group & one-on-one • Fluid, calorie, and protein
    requirements
    sessions • Diet instruction: Stages 1-3
    • Label reading
    • Behavior modification
    • Supplement/product information
    • self-care & lifestyle choices • Vitamin & mineral requirements
    • self-monitoring (keeping a • Exercise
    food journal)
    • healthy food selections
    • eating behaviors (speed,
    schedule)
    Post-Surgery
    Nutrition Guidelines

    • Dietary consult ordered upon admit


    • Complete nutrition assessment
    • Review diet progression with patient
    • Work with in-patient team to identify & minimize
    complications post-op
    • For all procedures patients will follow the same
    diet
    • Diet advanced from NPO to Stage 1 Bariatric Diet
    on Post op Day 1
    Post Surgical
    Diet Progression

    • Stage 1 - Water
    • Typically start day of surgery; Duration < 1 day
    • NO STRAWS
    • Nursing staff to administer 1oz water per hour via medicine cup
    • Instruct patient to sip slowly & stop if feeling full or nauseous
    • Note: Diet office will be instructed not to send meal trays
    • All medications to be administered in liquid/chewable form
    • IV Fluid until tolerating liquids
    • Patient to begin tracking fluid intake on Patient Intake Diary (provided
    by healthcare team)
    Post Surgical
    Diet Progression

    • Stage 2 - Bariatric Clear Liquids


    • Starts Post op Day1; Duration 1-2 days
    • Non-carbonated liquids without calories, sugar, or caffeine; includes
    broth, sugar-free (SF) ice pops, SF gelatin, water, & ice chips
    • Priority is hydration
    • Instruct to sip slowly & stop if feeling full or nauseous (avoid straws)
    • Will receive 3oz Bariatric Clear Liquids 3 times a day on meal trays
    • Instruct to sip 2-4 oz Bariatric Clear Fluids per hour between meals
    • Will be expected to track intake on Patient Intake Diary
    Post Surgical
    Diet Progression

    • Stage 3 - Bariatric Full Liquids


    • Starts Post op Day 1-2; duration 2-4 weeks
    • Will receive 3oz Bariatric Full Liquids 3 times a day on meal trays
    • Low-fat protein-rich liquids with (exp. Low-fat (LF) broth, LF milk, protein
    shakes; light/LF yogurt, LF cottage cheese; LF/SF pudding) juven/beneprotein
    • Priority on hydration and protein intake (minimize loss of lean body mass)
    • Instruct to sip slowly & stop if feeling full or nauseous
    • Instruct to sip 2-4 oz fluids per hour between meals
    • Note: Patients will go home on this stage. You may not see other stages unless
    patients are re-admitted
    Post Surgical
    Diet Progression

    • Stage 4 - Soft and Moist Protein


    • Start 2 weeks post-op; Duration 4-6 weeks

    • As tolerated replace full liquids with soft & moist protein foods (avoid
    dry or tough meats); ~2-4oz per meal

    • May need to continue with protein shakes to meet protein needs

    • Instruct not to drink fluids with meals; wait 30 min before & after each
    meal to have beverages

    • If meeting protein goals may add well-cooked soft fruits & vegetables

    • Will begin taking chewable vitamin & mineral supplements


    Post Surgical
    Diet Progression
    • Stage 5 Low Fat, Low Sugar, High Protein
    • Start 6-8 weeks post-op; Duration lifelong

    • Balanced solid food diet with protein, fruits, vegetables, and whole
    grains. Can add raw foods as tolerated.

    • Goals:
    • 60-80 grams protein /day
    • 64+ ounces fluid/ day (including protein drinks) sipped between
    meals.

    • Continue to separate fluids from your meals

    • Can advance to supplements in tablet form if tolerated


    Things to Consider Post-Op
    • If having poor diet tolerance:
    • Temperature: If not tolerating ice chips or ice pops consider warm
    liquids. Be aware that tolerance may vary between patients.

    • Speed: Drinking too quickly, gulping, or drinking too much may


    cause pain and discomfort. Patients must avoid using straws and
    focus on taking very small sips from medicine cup.

    • Administering Medications:
    • Note all medications given in the hospital should be crushed or in
    liquid form.
    • Chewable/liquid vitamins will begin 2weeks post-op
    Immediate Post-Op Nutrition
    Considerations

    • Hydration status

    • Food tolerance issues

    • Appropriate diet advancement

    • Address individual complaints


    Common Problems
    After All Weight Loss Surgeries

    • Dehydration
    • Monitor for signs and symptoms of dehydration as patients are at
    greater risk given their dietary restrictions. Patients should strive
    for 64 ounces of liquids per day.

    • Nausea and Vomiting


    • Eating too quickly or too much, drinking with meals or drinking too
    close to meals, not chewing thoroughly, or advancing the diet too
    quickly can all lead to nausea and/or vomiting. Persistent
    vomiting can lead to thiamin deficiency. Encourage patients to
    drink and eat slowly, stop if feeling full or nauseous, and take
    small bites and chew their foods thoroughly.
    Common Problems
    After Gastric Bypass Surgery
    • Dumping Syndrome
    • Usually occurs ~30 minutes following a meal. Undigested contents of the stomach
    are transported or "dumped" into the small intestine too rapidly. Symptoms may be
    similar to the flu and include nausea, sweating, bloating, abdominal cramps, and
    diarrhea. To avoid these symptoms patients should avoid high fat and high sugar
    foods. For example instead of 100% fruit juice; dilute 1:1 with water.

    • Diarrhea
    • Some patients can develop post-operative lactose intolerance. Symptoms could
    include bloating, abdominal cramps, excessive gas, and diarrhea. Treatment
    includes following a lactose-free diet.

    • Anatomical complications
    • There may be reason to suspect a possible surgical complication if a patient has
    persistent nausea, vomiting, and abdominal pain.
    Common Nutrient Deficiencies
    • Gastric Bypass:
    • Most common: Iron, Vitamin B-12,
    Folic acid, Fat soluble Vitamins A, D, & E
    • Thiamin (seen in patients with frequent vomiting)
    • Calcium
    • Protein malnutrition
    • Gastric Banding:
    • Except for folate, nutrition deficiencies are less commonly seen post
    gastric banding
    • Sleeve Gastrectomy
    • Possible B-12
    Long Term Outcomes
    • Lifelong compliance with vitamin/ mineral
    supplementation is important to reduce the risk
    of serious nutrient deficiencies

    • Self-monitoring intake and avoiding high calorie


    foods and beverages to prevent weight re-gain

    • Remaining connected with post bariatric surgery


    support groups
    Resources

    • American Society for Metabolic & Bariatric Surgery http://www.asmbs.


    org/

    • L. Aills et al. ASMBS Allied Health Nutritional Guidelines for the Surgica
    l Weight Loss Patient.
    Surg Obes Relat Dis. 2008; 4:S73-S108.

    • If you have any additional questions contact:


    • Lisa C. Luz, RN, MSN, FNP-BC
    • Bariatric Program Coordinator, Mount Auburn Weight Management Center
    (Phone) : 617-499-6769 (Email) : [email protected]
    Bariatric Nutrition Quiz
    1. It would be appropriate to allow a patient on Stage 2 to have
    all of the following fluids except:
    • A. Water
    • B. Low sodium vegetable broth
    • C. Ginger ale
    • D. Crystal light

    2. All medications & vitamin/mineral supplements should be taken


    in which form after surgery?
    • A. Chewable
    • B. Liquid
    • C. Tablet
    • D. A&B
    Bariatric Nutrition Quiz
    3. Patients should wait 30 minutes before and after meals to drink
    any fluids.
    • A. true
    • B. false

    4. Which of the following are associated with Dumping Syndrome?


    • A. Drinking too much water
    • B. Flu like symptoms including nausea, sweating, bloating, abdominal
    cramps, and diarrhea occurring ~30 minutes after a meal
    • C. Eating high fat or high sugar foods like 100% fruit juice or ice cream
    • D. B & C
    Bariatric Nutrition Quiz
    5. Following bariatric surgery it is important to monitor for:
    • A. Hydration status
    • B. Tolerance of oral intake (nausea/vomiting/diarrhea)
    • C. Diet to be advanced appropriately
    • D. All of the above

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