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Making dietary changes before your surgery
It is important to start making changes to your diet and lifestyle before surgery because surgery alone will not change your eating habits.
If you make these dietary changes now, you will be better prepared for the diet you need to follow after your surgery. This will help you to achieve the best possible outcome.
For long term weight loss you will need to eat small meals and snacks, choose healthier foods and keep active.
Important
People who develop good eating habits before surgery tend to lose more weight afterwards.
People who do more exercise are less likely to regain weight after their operation.
How your dietitian can help
Your dietitian can help you with advice on how to make these changes.
We suggest you gradually prepare yourself for the changes ahead. If you do not, you may find it hard to make changes following surgery.
Your dietitian will work with you to help you set goals and make these changes prior to surgery.
Attend all your appointments with the dietitian. Let us know if you are unable to attend an appointment. If you fail to attend and do not contact us, or cancel multiple appointments, we may discharge you.
Preparing mentally for weight loss surgery
It is important to prepare yourself mentally for the changes that will occur in your lifestyle after weight loss surgery.
Some people notice that their mood improves after their operation.
Some people find it hard to adjust to the changes that can affect:
- their enjoyment of food
- their sharing of meals with others
- a change in their body shape.
Food is often a source of comfort. Many of us use it to help cope with anxious or distressing situations, or as a treat or reward.
You are likely to experience stressful or difficult times at some point after your weight loss surgery and you will need to find alternative ways of coping with these.
If you continue comfort eating, you may find you do not lose the amount of weight you want to lose after your surgery. Or it may lead to post operative complications.
It is a good idea to start thinking how you can divert your focus from food onto something else (for example exercise, reading or hobbies).
Develop coping strategies
You will need new coping strategies (other than food) and will have to begin planning ways to change your behaviour.
We recommend you start now to analyse your eating behaviour and identify any triggers for comfort eating or overeating. These might be certain situations, moods or certain times of day. Writing a food and emotions diary can help you see patterns in your behaviour.
Once you have identified some triggers, start to find alternative ways of coping. Think about other things that you can do to take yourself away from the triggers or distract yourself from cravings.
For further information about this, ask your dietitian for our leaflets ‘Emotional Eating’ and ‘Food and Mood Diary’.
Understanding barriers to healthy eating
Start to explore any barriers which prevent you from making healthier food choices. These may include the following.
- Knowledge: do you think you have any gaps in your understanding of healthy eating? Do you find food labelling confusing? Do you struggle to know whether to choose low fat or low sugar etc?
- Cooking skills: do you lack the confidence to cook healthy meals?
- Time pressure: do you find it difficult to shop for or cook healthy meals due to work or family commitments?
- Other people: is there anyone who might encourage you to make less healthy choices or who may not support you as you try to make changes?
- Takeaways and eating out: do you rely on these instead of cooking meals from scratch?
- Cost: do you find it too expensive to make healthier food choices?
You can discuss your barriers and triggers with the dietitian at your appointment.
You can find further sources of useful advice at the end of this leaflet (see More information section).
Getting used to regular meals
We recommend you get into the habit of having 3 meals a day before surgery. This will help you to maintain healthy habits after surgery.
Eating regular meals can do the following:
- stop you getting too hungry and eating too fast
- make sure you get all the nutrients you need
- reduce cravings and binge eating
- reduce feelings of tiredness
- improve your mood.
Do not miss meals. Missing meals after surgery can lead to malnutrition (not eating enough essential nutrients).
- Avoid long gaps between meals and have healthy snacks in between if you need them.
- Do not graze all day. Grazing (eating small amounts of food throughout the day) can reduce the amount of weight you lose after surgery and lead to weight regain.
For further information, ask us for our ‘Healthy Snacks’ leaflet.
Healthy food choices
After your operation you will only be able to eat small meals.
These meals need to be healthy, balanced and nutritious. This will ensure that you get the nutrition you need to avoid nutritional deficiencies (shortages).
Surgery restricts how much food you can eat at one time. This helps you to limit your food intake overall and therefore helps you to lose weight.
Surgery does not affect your choice of foods. It does not stop you being able to eat high calorie and energy dense foods such as crisps, chocolate, ice cream, cakes and biscuits. You are still ultimately responsible for choosing which food to eat.
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Eating these high calorie foods will slow your weight loss, lead to early weight stabilisation and cause long term weight gain. We recommend you eat high calorie foods only occasionally, as treats. |
Use the drop-down menu for guidance on how to make up your plate of food before surgery and after surgery.
Before surgery, we recommend you make up your plate of food in this way:
- 50% vegetables and/or salad
- 25% starchy carbohydrates such as pasta, rice, potatoes, bread, couscous, chapatti (choose wholegrains)
- 25% protein rich foods such as meat, fish, eggs, beans or lentils.
Use a dinner plate, around 25 to 30cm in diameter, to serve your meals.
After surgery you will need to eat a high protein diet.
Start to include regular sources of lean protein now.
Protein is important because it:
- helps your body to heal.
- makes sure that weight lost is mostly fat and reduces the amount of muscle you may lose. This can help you to avoid weight regain in the future.
- helps you to feel full for longer. This will be important in the long term when feelings of hunger may return.
| Amount of protein needed every day | How to achieve this |
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After surgery, you will need to eat 70g to100g of protein every day (see image box below) Eat at least 20g of protein at each mealtime |
Between meals, add high protein snacks such as a glass of milk, high protein yogurt, a boiled egg or small handful of unsalted nuts Add skimmed milk powder to your foods or drinks to boost their protein content |
To help you get enough protein, after surgery we recommend your make up your plate of food in this way:
- 50% protein
- 30% vegetables and/or salad
- 20% carbohydrates
Use a side plate, around 15 to 18cm in diameter, to serve your meals.
Here is the protein content of a few common foods. You can find a longer list at the end of this document:
- Boiled egg: 6.5g protein
- Small chicken breast: 30g protein
- Pot of yoghurt: 4.5g protein
- Glass of skimmed milk: 7g protein
- Portion of cooked lentils: 5g protein
- Salmon fillet: 24g protein.
Start to follow the ‘golden rules’
For surgery to work effectively, it is important to follow the ‘golden rules’. These will help you lose the most weight and minimise complications following your surgery.
You will need to follow these golden rules for the rest of your life after surgery. Start practising them now, to prepare yourself.
Use the drop-down menu to find the golden rules.
Practise the 20 20 20 technique
If you eat too fast or do not chew your food well, this can overfill your new stomach pouch after surgery. It can also cause foods to get stuck, which will cause discomfort and vomiting.
If you follow the 20 20 20 technique, it can help reduce the risk of these side effects.
- Take small bites, no bigger than a 20 pence piece.
- Chew 20 times per mouthful before swallowing.
- Wait 20 seconds before taking another bite. Put your cutlery down between mouthfuls.
- Time your meals and take no more than 20 minutes per meal. Stop at whichever comes first: 20 minutes or as soon as you start to feel full.
Do not drink fluids with meals
Eating and drinking at the same time can overfill your new stomach pouch and make you sick. It can also push the food through your pouch too quickly.
This can make you feel weak and faint, dizzy and sick and cause diarrhoea (known as ‘dumping syndrome’).
- Aim to stop drinking 30 minutes before you eat.
- Wait 30 minutes after eating before you drink again.
Try to drink 2000ml of fluid per day (at any time except at mealtimes).
We recommend you carry a water bottle with you all day to make sure you get enough fluid.
Eat small portions
After surgery your stomach will be considerably smaller. If you eat too much it can stretch the new pouch and cause pain and vomiting.
Use a side plate, around 15 to 18cm in diameter, and small cutlery. This will help you keep your portions under control.
Eat the protein first
Eat the protein in your meal first, followed by the vegetables or salad and then the starchy carbohydrates. This ensures you have a good protein intake even if you become full and cannot finish your whole plate of food.
Eat mindfully
Sit at a table to have your meal. Avoid distractions such as watching television or looking at your phone or computer. This can help you to eat slowly and limit portion size.
Take an A to Z multivitamin and mineral supplement every day
After your surgery you will need to take vitamin and mineral supplements for the rest of your life. These supplements are available from pharmacies, health food shops and supermarkets.
These vitamins and mineral supplements are essential to prevent deficiencies in your nutrition which can lead to serious complications. These complications can include osteoporosis (weakened bones and fractures), loss of muscle function, increased infections, anaemia (low iron levels leading to low red blood cells) and nerve damage (which can lead to problems such as muscle weakness, confusion and memory loss).
- You will need to take a complete multivitamin and mineral supplement and extra iron, calcium and vitamin D supplements.
You will need to buy these yourself if your GP does not prescribe them.
- You will also need to have vitamin B12 injections every 3 months.
You will need to arrange for your GP to give you these injections.
- Some people need additional supplements. The regular blood tests we give you at your review appointments will assess whether you need these.
If you start taking these now, it will help to treat any nutritional deficiencies you may already have. It will also get you used to taking supplements which you will need to take for the rest of your life.
Start taking an over the counter A to Z multivitamin and mineral complete supplement before you have your surgery.
Start to increase your physical activity levels
Regular exercise is essential to achieve the most weight loss. Exercise can help you lose weight and keep this weight off in the long term.
Use the drop-down menu for guidance on increasing your activity levels.
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Aim for a minimum of 30 minutes of moderate intensity activity per day. To lose weight, increase to 45 to 60 minutes per day. |
You do not have to do this exercise in one go. You can break it down into 10 to 15 minute bursts. |
Moderate intensity physical activity includes anything where your body is moving and your breathing and heart rate increase, for example:
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| Include some muscle strengthening activities on at least 2 days of the week. |
This is important as it can limit the amount of muscle loss when you lose weight. It can also help to maintain your bone strength. |
Muscle strengthening activity includes:
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See the More Information section below for online strength exercise resources.
Do not worry if your physical health means that you cannot reach the goal of 30 to 60 minutes per day.
Do what you can and aim to gradually increase the amount of moderate exercise you do.
Include exercise in your daily life in the following ways:
- Design a realistic exercise plan. It must fit with your lifestyle. If it does not, you will find it difficult to keep it going.
- Pick an activity you enjoy or try a new one.
- If you have not done regular activity before, start with gentle exercise and increase it slowly.
- Get support from a friend or partner who will encourage you and exercise with you.
- Use a step counter app or smart watch to track your activity and see if you can gradually increase the amount you are doing.
- If you have never enjoyed exercise, start by reducing your inactive time. For example you can spend less time watching television or using the computer. You can also use stairs instead of lifts or get off the bus 1 or 2 stops earlier than you need to.
- If you prefer to walk rather than go to the gym, you can try walking more quickly or gradually walking further and faster.
- For an outdoor activity, have a backup type of exercise that you can do when the weather is wet or cold.
- If mobility is difficult, try chair based, seated exercises (see More information below).
There are lots of free resources online that you can use for ideas or support (see More information below). You can also look for local clubs that run activities in your area.
Some GPs may be able to refer you to a local health centre for subsidised exercise sessions. These offer support from a personal trainer or gym instructor until you have the confidence to continue on your own.
Ask your GP for details of subsidised exercise sessions.
Pre-operative and post-operative diets
We will ask you to follow a special diet before your weight loss operation and a different special diet after your operation.
Use the drop-down menus for details about the pre-op and post-op diets.
We will ask you to start following a liver shrinkage diet 2 weeks before your operation.
Your surgeon will advise you if you need to follow it for longer (possibly up to 4 weeks).
It is important that you follow this diet. It will help to reduce the size of your liver before surgery. This will enable the surgeon to (temporarily) move it out of the way so they can safely access your stomach. If you do not follow this diet, we may have to cancel your surgery.
The liver shrinkage diet is a low calorie, low fat, low carbohydrate diet. You will be able to choose from 3 different types of diet listed below.
We will give you further information about this diet closer to your surgery.
It is useful to start thinking, now, about which option will work best for you: A or B or C.
| A | 5 bottles of Slimfast drink per day, plus other fluids (no sugar or milk added) and a salty drink. |
| B | 4 pints of semi skimmed milk per day, plus other fluids (no sugar) and a salty drink. |
| C | Low calorie, low carbohydrate food based diet comprising 3 meals a day with snacks. We will discuss portion size with you closer to your surgery. |
Important information
It is essential that you follow this pre operative diet. If you do not follow this diet, we may have to cancel your surgery.
Your stomach will be sore and swollen immediately after surgery and the staple lines will need time to heal.
Your stomach will be much smaller which means you will only be able to eat small amounts.
For 6 weeks after surgery, you will need to follow a modified texture diet to help your stomach to heal and to reduce side effects. This will allow the new pouch to heal, avoid the new stomach overstretching and reduce side effects such as nausea and vomiting.
| Weeks | Texture progression diet: food and drink allowed |
| 1 to 2 | Fluids only for example water, milk, soup with no bits |
| 3 to 4 | Smooth pureed food |
| 5 to 6 | Soft foods for example flaked fish, soft vegetables |
| 7 onwards | Gradual return to normal food texture and small portions of a healthy, balanced diet |
Some common foods that cause problems after surgery
There are a few common foods that people tend to struggle with after surgery.
- Roast meat, or fibrous, dry meat such as chicken breast, chop, steak, bacon, sausage, battered or breaded meat or fish. If you cannot tolerate these foods, avoid them and find a suitable alternative. For example minced or casseroled meat.
- Bread and rice. Doughy textures absorb liquid and can swell which can lead to pain and discomfort. Some people manage crispier textures better, for example toast.
- Stringy vegetables such as beans, celery, peas, sweetcorn. These may get stuck or feel uncomfortable.
- Avoid fizzy drinks longterm (including sparkling water). Your new stomach is much smaller and will struggle to cope with fizzy drinks. They can cause bloating and discomfort after surgery.
- Avoid alcohol completely for the first few months after surgery, and after that only drink small amounts.
- Alcohol can lead to poor wound healing and can lead to weight regain in the long term after surgery.
Important alcohol information
After weight loss surgery alcohol enters the bloodstream in a shorter time and you can feel the effects much more quickly.
If you drive it may affect your legal limit and reaction times.
It can also increase the risk of alcohol dependency.
Expected weight loss after surgery
Weight loss surgery requires a lifelong commitment.
You will lose weight rapidly in the first few months after surgery, then your weight loss will slow down.
Maximum weight loss is typically achieved 18 months to 2 years after surgery. After this time, some people regain weight.
| You can minimise weight regain by following the golden rules listed above, making healthy food choices and adding exercise to your daily routine. |
Other considerations
Smoking
You must stop smoking before we can consider you for weight loss surgery. Smoking can lead to poor wound healing. It also increases the risk of ulcers (open sores on your stomach lining).
Smoking
The aim of weight loss surgery is to improve your health, life expectancy and quality of life whereas smoking damages your health.
Smoking is the single most detrimental activity that you can undertake to affect your health.
It is the biggest cause of death and illness in the UK.
Excess skin
- Significant weight loss can result in loose skin in some areas of your body (for example around your tummy, arms, legs and breasts).
- Some patients are not bothered by this and others find it upsetting. Occasionally, if skin folds are difficult to keep clean and dry, they become infected or sore.
- If you are worried about this, talk to other people. You can attend support groups to meet people who have had weight loss surgery.
- Plastic surgery is only way to effectively deal with loose skin, but it is not usually funded by the NHS.
Pregnancy
- Losing weight can increase your fertility. We strongly advise you to avoid pregnancy for 18 to 24 months after surgery, until your weight has stabilised.
- Rapid weight loss after weight loss surgery can put your baby’s development at risk.
- You will lose less weight overall if you become pregnant too early after surgery.
Certain types of contraception may be less effective after weight loss surgery. Speak to your GP or family planning clinic about the most suitable form of contraception for you.
Summary: preparing for weight loss surgery
| 1 | Identify patterns of comfort eating and develop coping strategies. |
| 2 | Identify and monitor barriers to healthy eating. |
| 3 | Make sure you have a regular meal pattern. |
| 4 | Make healthy food choices and watch your portion size. |
| 5 | Focus on including protein with your meals and with some of your snacks. |
| 6 | Practise the golden rules while you eat:
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| 7 | Take an A to Z multivitamin and mineral supplement every day. |
| 8 | Start to increase your levels of physical activity. |
Protein content of some everyday foods
Use the drop-down menus to find out the protein content of foods.
| Food | Serving size | Calories (Kcal) | Protein (g) |
| Baked white fish | 1 fillet (100g) | 72 | 16.6 |
| Tuna in spring water | ½ can (65g) | 70 | 16.5 |
| Grilled tuna steak | Small steak 75g | 95 | 22 |
| Salmon, small fillet | 100g | 205 | 24 |
| Salmon, smoked | 70g | 125 | 16 |
| King prawns | 50g (about 10) | 35 | 8 |
| Sardines in tomato sauce | ½ tin (60g) | 105 | 10.2 |
| Mackerel, smoked | Small fillet (45g) | 135 | 9 |
| Seafood or crab stick | 1 stick | 14 | 1 |
| Chicken breast, skinless grilled | 1 small (95g) | 140 | 30 |
| Chicken drumstick, no skin roasted | 1 stick, 75g | 140 | 20 |
| Lean turkey mince, raw | 100g (raw weight) | 136 | 31 |
| Lean roast beef, lamb or pork |
1 medium slice (40g) |
90 | 12 |
| Minced beef, extra lean | 100g (raw weight) | 168 | 31 |
| Grilled lamb chop | 54g (1 small) | 165 | 14 |
| Grilled pork chop | 68g (1 small) | 175 | 20 |
| Stewed or casseroled meat | 40g (about 4 pieces) | 80 | 12 |
| Ham slices | 1 medium slice (30g) | 30 | 6 |
| Wafer thin ham | 1 slice (12g) | 13 | 2 |
| Pork sausages | 2 sausages (114g) | 163 | 10.5 |
| Food | Serving size | Calories (Kcal) | Protein (g) |
| Egg | 1 average size (50g) | 70 | 6.5 |
| Quorn chicken style pieces or mince | 50g (about 14 pieces) | 52 | 7 |
| Quorn sausage grilled | 1 | 70 | 5 |
| Hummus, reduced fat | 2 tablespoons | 50 | 2 |
| Baked beans | 100g (1/4 tin) | 80 | 5 |
| Kidney beans or chickpeas, canned | 40g (2 tablespoons) | 40 | 3 |
| Steamed tofu | 70g (size of pack of cards) | 100 | 11.5 |
| Lentils, cooked | 40g (2 heaped tablespoons) | 40 | 5 |
| Quinoa, uncooked | 45g (3 tablespoons uncooked) | 137 | 6.2 |
| Edamame beans in pods | 55g (small handful uncooked) | 17 | 2 |
| Walnuts | 1 tablespoon (10g) | 70 | 1 |
| Cashew nuts or peanuts without salt | 1 tablespoon (10g) | 60 | 2 |
| Almonds | 1 tablespoon (about 10) | 62 | 2 |
| Cashew nut butter | 1 tablespoon (15g) | 100 | 3 |
| Peanut butter | 1 tablespoon (15g) | 91 | 4 |
| Pumpkin or sunflower seeds | 1 tablespoon (10g) | 55 | 2 |
| Nak’d bar cashew cookie |
1 bar (35g) |
160 | 3.6 |
| Nature Valley Protein bar | 1 bar (37g) | 190 | 10 |
| Food | Serving size | Calories (Kcal) | Protein (g) |
| Milk, skimmed | 200ml | 70 | 7 |
| Milk, skimmed | 1 pint (568ml) | 193 | 18.7 |
| Milk, semi-skimmed | 200ml | 96 | 7 |
| Milk, semi-skimmed | 1 pint (568ml) | 277 | 18.7 |
| Soya milk, low fat, no added sugar (fortified) | 200ml | 70 | 7 |
| Drinking yoghurt, 0.1% fat | 200ml | 56 | 5.6 |
| Yoghurt, low fat | 1 pot (125g) | 93 | 4.5 |
| Skyr Natural high protein yoghurt | 100g | 63 | 10.6 |
| Danone Danio yogurt | 1 pot (150g) | 120 | 12 |
| Arla protein yogurt |
1 pot (200g) |
140 | 20 |
| Liberte yogurt | 100g | 80 | 8 |
| Total 0% Yoghurt by FAGE | 1 pot (170g) | 97 | 17.5 |
| Arla protein drinks | Bottle (479ml) | 254 | 26 |
| Cheese, cheddar reduced fat | 1 x match box size (30g) | 82 | 10 |
| Cheese, cheddar full fat | 30g | 123 | 7.6 |
| Cheese, low fat cottage cheese |
2 tablespoons (60g) |
45 | 6 |
| Cheese, low fat soft cheese | 2 tablespoons (30g) | 44 | 2.6 |
| Cheese, Babybel light | 1 round (20g) | 43 | 5.3 |
| Soft triangle cheese, light | 1 triangle | 25 | 2.5 |
| Mozzarella | 28g | 75 | 4 |
| Food | Serving size | Calories (Kcal) | Protein (g) |
| Skimmed milk powder added to skimmed milk |
2 tbsp (30g) + 200ml skimmed milk |
175 | 17.5 |
| Slimfast shake |
1 bottle (325ml) |
205 | 15 |
| Sanatogen Protein Drink (powder) | 2 tsp + 200ml skimmed milk | 95 | 12.5 |
|
Meritene shake (previously known as Build Up) |
1 sachet + 200ml skimmed milk | 180 | 16 |
| Complan shake | 1 sachet + 200ml skimmed milk | 312 | 15.4 |
| Meritene soup (previously known as Build Up) | 1 sachet + 150ml skimmed milk | 260 | 12 |
| MyProtein Protein Water | 200ml | 140 | 8 |
| Upbeat Protein Hydration | 200ml | 24 | 4 |
More information
Books on weight loss (bariatric) surgery
- Recipes for Life before and after a sleeve gastrectomy or gastric bypass by Nutrition and Diet Resources UK. To buy online
- Living With Bariatric Surgery (2018) by Denise Ratcliffe
- Cut Down to Size: Achieving success with weight loss surgery (2013), by Jenny Radcliffe
- Return to Slender After Weight loss Surgery: Mouth-Watering Dishes to Nourish, Feed and Inspire You (2010), by Carol Bowen Ball (Kindle only)
Other resources
Weight loss
NHS Better Health Weight Loss Programme (free download)
NHS on how to calculate your BMI
Weight loss surgery
British Obesity and Metabolic Surgery Society on weight loss surgery
NHS information on treatment of obesity
Food and eating
British Dietetic Association on eating on a budget
British Dietetic Association on Food Facts sheets
British Heart Foundation on quick meals
British Heart Foundation on meal planning
NHS food facts and recipe ideas
Smoking
NHS information on how to stop smoking
Exercise
Versus Arthritis on exercises for people with arthritis
Information on Better Bones: an exercise programme people with arthritis or osteoporosis with a GP in Kingston borough or who live or work in Kingston borough
Contact information
Kingston Hospital specialist dietitian. Email: khft.
Kingston Hospital specialist nurse. Email: khft.
Telephone:
Kingston Hospital specialist dietitian: 020 8973 5277 or 07887 340862
Kingston Hospital specialist nurse: 07387 533702