Are you confused about what to eat after weight loss surgery (WLS)? The beginning phases are pretty set and well documented; however, it starts to get fuzzy the further out from surgery you go. There are general guidelines, but each surgical facility or health practitioner may have their own twist on it. Which is fine, but it can get really confusing on forums when people are posting “my surgeon/RD said…” and all 20 responses say something different. And really, they are all right, it just depends on the variables.
No two bodies are the same…especially after WLS. There are so many variables that need to be considered: the person, the surgeon, the type of surgery, the length of time post-op, the activity level, and how compliant the person is. All of these factors can affect hunger and fullness levels as well as calorie needs. WLS can be a clean slate in that there are new sensations of fullness. And the more that these signals are recognized and listened to, the longer they will last and thus the more successful the person will be with weight loss.
Ideally, it’s best when people practice this form of mindful and intuitive eating from day one post-surgery. It can be challenging further down the road when foods sometimes are tasting “too good” or emotional use of food for coping can easily dismantle hunger and fullness levels. It also takes a lot of trust in oneself to eat this way. For many people, years and years of dieting and fighting with the scale, counting calories is the only way they know to keep themselves on track. However, this can be a challenge because there really isn’t a set calorie level that everyone agrees on, primarily because everyone is so different.
Three Months Post-Op
For most people, weight seems to drop effortlessly during the first couple of months after WLS. The rapid weight loss can often start to slow by the 3rd month. This is typically when more solid foods are being consumed. A natural fear that most people have who have chronically yo-yo dieted is they will start to gain and need to start cutting back. Even with consistently losing each week, a little seed of doubt can be planted because it wasn’t as fast as weight loss as it was before.
At 3 months, protein and hydration is still the primary goal. WLS patients should be focusing on getting high quality protein sources and hydrating with non-caloric (or carbonated!) drinks throughout the day. For most people they tend to fall into the 600-800 calorie level during this phase. Listening to those hunger and fullness signals are critical. It is essential to not wait too long between meals, which can lead to fast eating and not chewing adequately. In addition, when we eat too quickly, we don’t really hear that fullness signal until we are TOO full. And the more we push that limit the more the pouch stretches.
Six Months Post-Op
By 6 months, the weight loss may have slowed a little more, and some may have even experienced a plateau week. Again this can be frightening, but the important thing is to go over the checklist: “Am I getting my protein, am I staying hydrated, am I getting my vitamins in, am I listening to my hunger and fullness levels”? Calories tend to creep up at this point with most people consuming around 800-1000 daily. This is normal and ok. The intention with WLS was never to have you stay at 600 calories a day.
The protein shakes tend to be decreased to one a day and the focus is more on “real” foods. The slowed weight loss is normal because your body can’t survive in breakdown mode long term. Plus, when you lose weight, you get smaller, and there is less of need to drop the extra weight, so the metabolism shifts; it’s a survival mechanism.
A key factor at the 6 month mark is to create and maintain new healthy habits and not fall back into the older problematic ones. Usually by this point, a holiday or birthday or some type of celebration has passed. There are likely old temptations around. The best and most effective way to get through these experiences is to prevent it from being a problematic one. Planning and anticipating that these triggers will be around will set you up so you are not caught off guard and may be more likely to make a healthier choice. Listening to your fullness signals is also key. If there is one bite left, but you are full, leave it. The more you rationalize “it’s only one bite”, the more that pouch will stretch. Lastly, if you do “go for it”, don’t beat yourself up about it. Have you ever really “learned” from a self attack? Usually not. Look at the event as objectively as possible (like a scientist, anthropologist, or reporter would) and determine what you would do differently without the self deprecation.
Twelve Months Post-Op
At 12 months, it is all about habits and continuing to live the new healthy lifestyle. Foods may have changed at this point which is expected. Most people are around a 1000-1200 calories at this point. There is less emphasis on protein and more on balanced eating. During this phase, it is essential that some type of exercise routine is in place. It has been shown that diet has the strongest influence on weight loss while exercise is connected with maintenance of that weight loss. It is critical to establish an exercise routine that is realistic, but also has some challenging goals, which can inspire you to work towards them.
Your exercise routine should also be something you enjoy. If it is not, it probably won’t work long term because at some point you will be able to talk yourself out of going. Some people enjoy participating in games, sports or dancing to feel more like a hobby rather than exercise. Others love the challenge of entering events and seeing their times get faster or distances get longer. With the greater the activity level comes the increase in calories. For those exercising at higher intensities 8-10 hours a week, their calorie level would likely be up closer to 1500 or more.
Five Years Post-Op
The shiny, new bariatric lifestyle sometimes has faded by 5 years out. For most people, they can eat more “normally” at this time. Ideally around the 1200-1500 calorie range, but this is where some people have returned to old eating habits where they consume well over 2000 calories. People often get complacent and sometimes old coping mechanism of emotional eating can return. We really want people to focus on developing new, active, healthy hobbies to prevent weight gain. In addition, seeing a therapist to work through emotions and develop new healthier forms of coping to prevent emotional eating is key.
If weight does start to creep up and you feel like your eating habits are getting “out of control”, it may be a good idea to restart your system. And by this, I don’t mean going back to the liquid diet which some websites recommend. Most dietitians would not recommend going back to a liquid diet because your body is not really designed for this 5 years post op. In addition, it can trigger that diet mentality. Fad diets are often the towel underneath the leaky faucet; they don’t actually “fix” the problem area. If weight regain has occurred, I would recommend going back to the basic checklist: Are you staying hydrated, getting your protein, exercising, having balanced meals, protein, vitamins…? I would breakout the food logs and start monitoring what you are eating and some of the thought processes around food. Knowledge is power, and if you don’t know what it is that is causing the weight gain, you won’t be able to “fix” it. The fad diets are only a temporary solution. When I have a client who is struggling, the first thing I suggest is self monitoring, and usually within the first day they have identified the problem area. The other great thing about self monitoring it has you reconnect with hunger and fullness signals, and it has you think twice before eating something.
There are a lot of different guidelines out there, but for good reason, we are all different. The most important thing is knowing YOU and what works best for you. There are plenty of resources and support systems to help you stay on track.
The pureed food phase can be one of the hardest. Many patients I have spoken with were repulsed by the idea of blending chicken or eating baby food meats. Below is a tasty option that may help make this phase a little more manageable.
2 cups chopped spinach
1 cup low fat ricotta
3 cloves garlic
Put ingredients in food processor and blend. Heat mixture on stove or in microwave and top with tomato sauce.
When you are able to have softer solids, include thinly slices cooked zucchini and wrap around ricotta mixture as the “noodle”