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Having Bariatric Surgery

© G14040704W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2014. Document for issue as handout. Unique Identifier: SURG37(14). Review date: August 2016


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This booklet aims to describe: l What is bariatric surgery page 2

l How the surgery works page 2

l What will happen before you surgery page 3

l What will happen to you while you are in hospital page 4

l What will happen on the day of your discharge page 5

l Follow-up care page 6

l Diet after surgery page 7

l Liver reducing diet page 21

l Becoming pregnant after surgery page 28

l Further information and useful websites page 29

What is bariatric surgery?Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with a Gastric Band or through removal of a portion of the stomach (Sleeve Gastrectomy) or by resecting and re-routing the small intestines to a small stomach pouch (Gastric Bypass).

Information on each surgery is available and should be provided along with this booklet. Each booklet will include detailed information about each operation including the risks and benefits and how each operation works.

The booklets available are:

l Having a Gastric Bypass

l Having a Sleeve Gastrectomy

l Having a Gastric Band

How the surgery worksAll of the operations work by restricting the amount of food that the stomach can hold at any one time. This has the effect of making you feel fuller after smaller meals.

A sleeve gastrectomy removes part of the stomach that produces an appetite inducing hormone called Grehlin, and this reduces your hunger.

There is an element of reduction in hunger after gastric bypass too, but not after gastric banding. With the band the doctor or nurse is able to increase or decrease the restriction that the band places on you, thereby making it easier or more restrictive when eating meals.


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What will happen before surgery?l You will see a specialist nurse

who will go through the operation with you and talk through your hospital stay.

l You will be seen by a dietician who will discuss your required pre and post-operative diet plan. You will be asked to adhere to a “liver reducing diet” (see eating plan page 21) for two weeks before your operation. This helps reduce the size of your liver making your operation easier and safer. If you have not followed the diet prior to your operation you may be denied your surgery on the day

l You may have to have some breathing tests (sleep studies) performed to check if you have sleep apnoea. If you do, you may then require a special machine to help you breathe when sleeping (CPAP)

l You will be seen and assessed by a clinical psychologist

l You will see a surgeon who will be carrying out the operation, so you can discuss the risks and benefits associated with the surgery

l You will be seen by a nurse and an anaesthetist in the pre-operative clinic, where you will have your bloods taken and a heart tracing (ECG)

What will happen to you while you are in hospital

On the day of your surgery You will be admitted to the hospital in the morning and you will need to be nil by mouth for at least 6 hours before your operation.

You will be admitted by the nursing staff a surgeon and an anaesthetist.

You will be asked to wear a hospital gown and elasticated stockings to help prevent blood clots in your legs. You will also be given a small injection of heparin in order to thin the blood and help to further prevent blood clots.

You will then be taken to theatre for your operation after which you will go to a recovery area until you are stable and your pain is well controlled. You will then be transferred to the ward.

When you return to the ward Your pulse blood pressure, temperature and breathing will be regularly monitored.

You will have a further injection of heparin and will have to wear special boots (Flowtrons) which will massage your legs overnight to help prevent bloods clots in your legs.

You will be given regular anti-sickness medication to prevent nausea and vomiting.

You will also be given pain relief which may include Patient Controlled Analgesia (PCA) which contains morphine. This will be discussed and explained by the anaesthetist.

When you are fully awake you will be able to have sips of water, which may be increased later.

You will then spend the night on the ward where you will be regularly monitored by the nursing staff.


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What will happen on the day of your discharge

On the day after your operationYou will be encouraged to mobilise as soon as possible.

Your PCA will be stopped and you will start on oral pain killers. You will also be given regular anti-sickness medication.

You will continue on your liquid diet and before you can go home will need to be able to manage some soup.

You will be seen by the specialist bariatric nurse who will discuss your operation and answer any questions you may have and also discuss all the information you will need to know before you go home.

You will be seen by the specialist bariatric dietician to discuss your eating plans for the coming weeks.

You will also be seen by the pharmacist in order to ensure that all your medications are changed so that you can take them with a liquid diet.

If you are diabetic you will also be seen by the diabetic nurse specialist.

You will be seen by the surgeon who will discuss your operation it’s outcome and plan. Usually the surgeon will then be happy for you to go home later that day.

Before you are discharged

You will be given all the medication you require including heparin injections (usually for 5 days), which the nurses will show you how to use.

Information and contact numbers are provided in this leaflet for any advice and support you may need.

You will also be informed of the follow up service that will be provided over the coming weeks

Follow-up carel You will be contacted over

the phone one week after your operation by the specialist bariatric nurse to make sure you are recovering well and that you have no anxieties or concerns. A further call is made two weeks after your operation.

l At three weeks you will be contacted by the specialist dietician to ensure you are managing well and that you are well prepared to progress with your specialist diet (see eating plan page 21)

l At 6 weeks and 4 months you will be seen in the nurse led outpatient clinic by the specialist nurse and the dietician

l Regular follow up by the dietician will be provided for 2 years

l You will also be seen on a yearly basis by the Medical Weight Management Team (MWMT)

For gastric band patients:You will also be seen in radiology outpatients approximately 4-6 weeks after your operation for your first band fill. This is done under x-ray to make sure it is working correctly. After this further band fills are carried out in a general surgical outpatient appointment.


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Diet after surgery

Initially after surgery you will be given 30-60ml (1-2 medicine cups) of water to sip. When the team are happy, you can progress to free fluids. This means you can sip as much water (or no added sugar squash), tea and coffee as you can manage.

Usually, the first day after surgery you are given some clear soup at lunch. Take your time and eat what you can; you are not expected to have it all. If you can tolerate this you can then progress to the recovery diet.

Recovery diet:After your operation you will need to follow a diet which will help you to heal but also result in weight loss. It has three stages lasting for 2-3 weeks depending on the surgery (see table below):

Surgery / Diet

Liquid

Puree

Soft

Band (Weeks)

2

2

2

Sleeve (Weeks)

3

3

3

Bypass (Weeks)

3

3

3

Do not rush through the stages; it will take time for your body to get used to the operation. Everyone is different, so if you think it was too soon for you to progress, go back a step for a couple of days before trying again.

From the day of your operation you have to try and clear your mind of what you were able to eat before - things will be very different from now on. Taste changes are common.

Remember, this is an opportunity to change your relationship with food. Surgery will help you reduce your portion size; you must make the right food choices to lose weight. Surgery will not cause long lasting weight loss on its own; you will have to work with it to achieve that. That starts with the Liquid diet.

Surgery will not affect emotional eating. If you are struggling with emotional eating, please contact any of the team who can refer you to a psychologist if necessary.

High protein liquids:

Stage 1

Liquid diet (for 3 weeks):Upon discharge you will be allowed a liquid only diet. This means you can have any liquid (unless told otherwise), provided it meets the following 5 rules:

1) It is thin enough to be sucked through a straw

2) You should be able to pass it through a sieve (no ‘lumps’ or ‘bits’)

3) It must be low in fat and sugar

4) free from alcohol and

5) not fizzy

It is very important to have enough protein after surgery to help with recovery, keep your immune system strong and prevent hair loss. Try to have a nourishing drink every 2-3 hours with other fluids in between (see below).

Aim to drink a minimum of 2 litres of fluid per day, but monitor your urine colour, aiming for a pale straw colour.

TIPl Aim to include at least 1 pint of milk every dayl To increase your protein

intake add 4 tablespoons of skimmed milk powder (e.g. Marvel or supermarket own brand) to one pint of milk

l You can use this enriched milk to make a latte or add some sugar free flavouring to make a milkshake

Semi-skimmed or skimmed milk (preferably with added milk powder)

Low fat/diet yoghurts (no lumps or bits)

Blended and strained high protein soups (including meat, fish, chicken or pulses)

Smoothies made with milk/yoghurt and fruit (no lumps or bits). No more than 125mls per day


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Other liquids:

Liquids to avoid:

Fruit juice (limit to 1 portion per day - small glass of approx. 125mls)

Sugar free squash (or ‘no added sugar’)

Water / flavoured water (still, not sparkling)

Sugar free jelly

Low fat ice cream

Tea / coffee

Horlicks / Ovaltine (light options)

Hot chocolate (light options)

Oxo / Bovril / Marmite

Fizzy, sparkling drinks

Alcohol

High fat liquids

High sugar drinks

Any liquids with bits or lumps

Sample menu for liquid stage:Breakfast: Latte made with 1/3 pint semi-skimmed milk (with added milk powder)

Mid-morning: 1 diet yoghurt (dilute with milk if needed)

Lunch: 1/3 pint home-made chicken and vegetable soup (blended and strained)

Mid-afternoon: Latte made with 1/3 pint semi-skimmed milk (with added milk powder)

Evening meal: 1/3 pint tomato and bacon soup (blended and strained)

Supper: 1/3 pint semi-skimmed milk (with added milk powder)

During the day: Drink 1000ml water, 2 cups of tea and 125ml orange juice

AlcoholWe advise that you should stay away from alcohol completely for the first 6 months after your operation.

After 6 months, if you would like to drink alcohol, then drink small amounts with caution. Remember alcohol is very high in calories and can prevent weight loss.

It is also absorbed by your body more quickly after some operations and you could get drunk a lot faster. Therefore you need to take care and not drive after any alcohol. Go to:

for more details.

www.drinkaware.co.uk

Stage 2

Pureed diet:The second stage is designed to reintroduce food in a way that:

l Continues the healing process

l Helps you to avoid vomiting

l Begins to educate your mind about how your new ‘pouch’ deals with food

Pureed food should be the consistency of baby food or smooth applesauce. It should have no lumps in it.

You will only be able to manage very small amounts at each meal (1-2 tablespoons over 20 minutes). If you try to eat much more than this it may make you uncomfortable or sick.

As you progress through the pureed stage you may eat a little more than when you started.

To puree foods you will need a food processor or hand held blender. Puree food with extra gravy, milk or sauce and flavour with herbs and (mild) spices.


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Each food should be pureed separately rather than together - this way food will look more attractive on the plate and individual foods will be tasted.

Things to remember on the pureed diet:

l Try cooking in bulk and try freezing small portions of pureed meat, fish, vegetables, stews or soup for convenience. Ice cube trays are handy

l Keep in some baby food as useful standbys

l Try not to have foods high in fat and/or sugar as they can cause dumping syndrome. See section on dumping syndrome on page 18)

l If you have problems with a particular food, stop eating it for a few days and then try again

l Puree any nourishing tinned soups such as lentil or pea and ham or make your own!

Planning your days intake

Protein:Introduce foods high in protein first. High protein foods include meat, chicken, fish, beans, pulses and dairy products.

They are very important for healing and should be taken at each meal and snack.

If you find it difficult to eat pureed meat and fish, have more protein from milk or dairy products - but low fat versions. If you are a vegetarian, go for vegetarian sources of protein including quorn, lentils or pulses.

Try to include one of these high protein servings at each meal or snack:

l 1/3 pint of milk - skimmed or semi skimmed

l 1 diet/light yoghurt

l 1 fromage frais

l 1oz pureed meat - beef, pork, turkey, chicken, lamb

l 1oz pureed fish (fresh or tinned) - e.g. haddock, cod, tuna, salmon, mackerel, sardines tinned in brine or tomato sauce

l 1oz low fat cream cheese

l 1oz grated low fat cheese, mixed in hot food e.g. mashed potato

l 3 tbsp custard made with semi skimmed milk

l 1-2oz pureed lentils or beans

l 2-3 tbsp pureed casserole

l 2-3 tbsp pureed cottage or fish pie

l 250ml blended meat, chicken or fish based soup

Once you can tolerate some high protein foods at each meal, try introducing some vegetables and fruit. Suitable options include:

l 125mls vegetable juice or fruit juice (unsweetened)

l 1 tbsp pureed vegetable e.g carrots, cauliflower, cabbage, swede, turnip, courgette, broccoli

l 1 tbsp stewed fruit with sweetener if necessary

l 1 tbsp fresh soft (blended) fruit e.g. bananas, strawberries, raspberries

You can also include some starchy foods from this list, if you are not feeling too full:

l 250ml pureed soup of any kindl 2 tbsp fine ground porridge

(e.g. ready brek) made with milk (puree if too lumpy)

l 1/2 weetabix or wheat biscuit (use plenty of milk to make it soggy)

l 1 tbsp pureed potato / sweet potato / plantain

l 1 tbsp pureed pasta and saucel 1 tbsp (over-cooked) pureed rice


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Sample menu for pureed stage:

Meal ideas:

Breakfast: 2 tbsp cooked porridge1 tbsp pureed banana

Mid-morning: 1 diet yoghurt

Lunch: 1 tbsp mashed potato1 tbsp carrots1oz meat / fish

Mid-afternoon: 1/3 pint semi- skimmed milk

Evening meal: 1oz tuna1 tbsp pureed rice1 tbsp puree broccoli

Supper: 1 tbsp tinned peaches1/3 pint semi-skimmed milk

During the day: Drink water and 1/3 pint semi skimmed milk

l 2 tbsp tinned tuna blended with onion, tinned tomato and herbs, served with 1 tbsp sweet potato puree

l 2 tbsp slow cooked chicken pureed in gravy, served with 1 tbsp puree carrot and 1 tbsp smooth mashed potato

Foods to avoid during the pureed stage

Eggs

Dry or tough meat

Ordinary bread or toast

Most breakfast cereal

Raw or salad vegetables

Celery or stringy beans

Fruit pips, seed, pith and skins

Dried fruit

Biscuits, crackers, crisp & nuts

Sweets and chocolate

Pastry dishes

These foods will not liquidise properly so try not to have them:

If these foods cause no vomiting, heartburn or indigestion, move onto foods that need a little more chewing such as:

l 1oz/25g tender chicken, turkey, beef, pork, lamb

l 1 slice toasted bread (leave un-toasted bread until the very end)

l Raw fruit e.g. 1 small peeled apple

l Small cup of breakfast cereal e.g. bran flakes

l 3 tbsp cooked rice or pasta

l Raw vegetables

l Salads

Stage 3

Soft Diet (re-introducing normal textures):The progression from pureed food to a normal diet should take around 3 weeks, starting with foods that are easiest to digest gradually introducing more solid foods.

Remember everyone is different with the foods they can tolerate. It is normal to tolerate a food one day and not the next day.

If this happens, leave that particular food and try again at a later stage.

Start by introducing very soft foods such as:

l Soft cooked egg: 1 poached or soft scrambled

l Cottage cheese: 2oz/50g

l Tender fish in sauce 1oz/25g

l Minced meat/quorn in gravy 1oz/25g


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Problem foods:Certain foods often cause problems and you may never be able to eat very much of them. We recommend you introduce these foods with caution, paying extra attention to your bite size and chewing. These include:

l Soft doughy bread (try toast, wraps, pitta or crisp bread as alternatives)

l Pasta and rice

l Tough / dry meat, chicken and fish (try slow cooking or cooking in a sauce)

You may experience problems with other foods as everyone is different.

Remember the following points:

l Continue to have 3 regular meals per day with optional snacks if needed.

l Include some protein at each meal

l Remember to have a variety of foods in your diet, and keep trying different things

l Keep working on your eating habits (see page 17)

l If you find a food difficult to tolerate, leave it and try again after a while. You may be able to manage it eventually

Example of a menu when you are eating food of normal consistency:

Aim to eat regularly - 3 meals a day

You will be able to eat a larger portion of soft textured food. You should choose challenging textures that require chewing, so that you continue to feel full from small portions

Always include at least a portion of protein at each main meal.

Choose small portions and use small plates

Try not to have high fat high sugar food and drink

Take care with alcohol- it’s high in calories and is easily absorbed. It can also increase your appetite

Work on your eating habits (see page 17)

Example of a menu when you are eating food of normal

consistency:Wake up: Small glass of orange juice with supplements

Breakfast: Small bowl of cereal + 1/3 pint of semi-skimmed milk

Mid-morning: 1 diet yoghurt

Lunch: 2oz tuna with ½ medium jacket potatoSmall salad

Mid-afternoon: Piece of fruit

Evening meal: 2oz cooked meat and vegetables in a sauce3 tbsp cooked rice

During the day: 1/3 pint semi-skimmed milk during the day in drinks


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Good eating habits include:The Rule of 20l 20p coin sized bites of food

(5p if struggling)

l 20 Chews per bite

l 20 seconds rest between bites (try putting your cutlery down)

l Stop eating after 20 minutes

Additional good eating habitsl Stop when you are full (most

important!) - don’t return to food and ‘graze’ or ‘nibble’ on it

l Separate eating and drinking - don’t drink 15mins before and 45mins after eating

l Sip fluids regularly throughout the day

l Eat regularly, do not go for long periods of the day without eating

Eating habitsIt is essential to get into good eating habits after surgery. Good eating habits:

l Prevent vomiting and pain

l Improve food tolerance

l Help you recognise when you are full (prevent overeating)

l Enhance weight loss and

l Prevent weight regain

Drinking just before a meal can reduce your food intake, which may mean you are missing out on important nutrition.

Drinking with food or too soon after food can make you sick. Therefore, as a guide, we advise no drinking 15 minutes before and 30-45 minutes after eating.

Make sure that you drink in between meals instead. Get into the habit of sipping instead of gulping fluids because your stomach has reduced a lot in size.

Dumping syndromeThis is caused when too much fat or sugar enter the gut too quickly. This is more of a feature after gastric bypass, though it does occur sometimes after sleeve gastrectomy.

You may experience diarrhoea, bloating, discomfort, dizziness, light headedness, sweating, shaking and vomiting up to 3 hours after eating.

These foods not only cause dumping syndrome, they make it more difficult for you to reach your target weight.

If you continue to suffer with these symptoms despite following the advice above, please speak to a dietitian or a specialist nurse who can advise you further.

Rarely, medications might be required to control low blood sugars. And, in extremely exceptional circumstances your surgeon might have to consider reversal of the gastric bypass.

Try not to have:l Foods high in sugar e.g. sweets, chocolates,

biscuits, cakes

l Foods high in fat e.g. fried food, pies and pastries, takeaway foods, snack foods like peanuts and crisps

l Drinks high in fat and sugar e.g. milk shakes, full fat milk, ordinary fizzy drinks and squashes


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ConstipationDue to the changes in diet and fluid intake it is common to experience constipation.

It is important that you do not strain when opening your bowels.

If you are constipated, first ensure that you are having a minimum of 2 litres of fluid every day.

Make sure that your intake of fruit and vegetables is as described in this booklet.

This should ensure adequate fibre and fluid intake.

If you still remain constipated discuss this with the specialist nurse or your GP for advice.

You may require medications to help such as lactulose, fybogel, movicol or senna.

Sugars

Fat

per 100g

5g or less

3g or less

Food labelsWhat is classed as ‘low fat’?What is classed as ‘low sugar’? Look at ‘per 100g’ on the food label, and use the guide below to identify whether a food is low in fat or sugar. Try to choose ‘Low’ fat / sugar foods as often as you can.

Remember, your stomach pouch is very small and can fill up very easily. Vomiting is a sign that you are filling your pouch too much, or too quickly. If you do not change your eating habits, this can result in stretching your pouch, which may cause your weight loss to be less successful.

Usually, vomiting can be avoided by improving your eating habits. This is why working on your eating habits (outlined on page 17) is so important.

But if your nausea or vomiting does not improve even after following the eating habit guidelines for a few days, please contact a member of our team (see section at the end of this booklet for contact details) or your GP for further advice.

Nausea and VomitingIf you feel sick, or are sick, this may be caused by:

l Eating too much

l Eating too fast

l Gulping instead of sipping drinks

l Drinking too soon before, with or after meals


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The Liver Reducing Diet The liver is the largest organ in the body and sits across the upper part of your digestive system (see the diagram below).

Following this diet will reduce the size of your liver making the surgery easier and less likely to have complications.

It is recommended that a very restricted diet; one that is low in fat, sugars and starch, be followed for TWO WEEKS or longer prior to surgery.

By following this eating plan the energy supply in your liver is used up, causing it to shrink.

This eating plan is only recommended prior to surgery and it is NOT TO BE FOLLOWED AFTER THE OPERATION. It is possible that you will lose a lot of weight on this diet, but it will mainly be water loss.

Please ensure that you have plenty to drink throughout the day; it will not prevent you from losing weight.

Use the following tables to help you to choose the right amount of each food.

Diaphragm

Large Intestine

StomachLiver

You can have any 3 servings from this list per day.

Porridge oats or sugar free muesli

Bread

CrispbreadCracker

Oatcake

Breakfast cereal

Pasta or Noodles

Rice

Cous Cous, pearl barley, quinoa

Pitta, Chapatti, Wrap

Baked or boiled Potato (with skin)

1 Serving is Equal to:Starchy Foods1 heaped tablespoon (uncooked)

1 medium slice OR ½ roll

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1

3 level tablespoons OR1 wheat / oat biscuit

2 tablespoons cooked1 tablespoon uncooked2 tablespoons cooked1 tablespoon uncooked2 tablespoons cooked1 tablespoon uncooked

½ large OR 1 medium

1 small potato ½ large potato 2 egg size potato


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Chicken / Turkey

Butter or Margarine

White fish

Cooking Oil

Beef / pork / lamb

Low fat spread

Oily fish

Mayonnaise, salad cream, oil based dressing

Eggs

Thickened Gravy

Beans, Pulses, Lentils

Lean bacon

Reduced fat / Light Mayonnaise, salad cream, oil based dressing

Cooked meat slices

Unthicken Gravy

Tofu, quorn, soya

1 Serving is Equal to:


Protein Foods

Foods High in Fat

50g (2oz) cooked OR 100g (4oz) raw

1 teaspoon

125g (5oz) cooked

1 teaspoon


2 teaspoons


1 teaspoon

2 medium eggs

1 tablespoon

4 heaped tablespoons cooked

2 grilled rashers (remove visible fat)

2 teaspoons

2 medium slices OR 4 wafer thin slices

4 tablespoons

100g (4oz)



Banana

Milk (semi-skimmed or skimmed)

Please avoid dried fruit and fruit juice as they contain a lot of sugar.

Medium fruit e.g. apple, pear, orange

Diet Yoghurt

Large fruit e.g. melon, pineapple

Soya Milk

Small fruit e.g. plums, Satsuma

Cottage Cheese (low fat)

Berries e.g. strawberries

Low Fat Cheese

Grapes / Cherries

Cream Cheese (low fat)

Tinned/stewed fruit (unsweetened)



Fruit

Dairy Products

1 small

200ml OR 1/3 pint

1 fruit

1 small pot (125-150g)

1 slice

200ml OR 1/3 pint

2 fruits

2 tablespoons

1 large handful

Matchbox sized piece

Approximately 14

1 tablespoon

3 tablespoons


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Alongside this, you can have an unlimited amount of most vegetables and salad so fill yourself up with these.

They should cover over half of your plate. Avoid adding fat when cooking/at the table.

You should avoid the following vegetables for now as they contain too much starch;

l Beetroot

l Parsnip

l Peas

l Sweetcorn

l Squash

A typical day might look like this:

Sample meal plan:Breakfast: l 3 tablespoons of low sugar cereal e.g.

porridge OR l 1 slice of toast with a scraping of low

fat spread

Mid-morning: 1 Portion of fruit

Lunch: l Unlimited non starchy vegetables or

salad l 1 slice of toast with a scraping of low

fat spread l a small portion (2oz or 56g) of lean

meat, fish or cheese

Mid-afternoon: 1 Portion of fruit

Evening meal: l Unlimited non starchy vegetables or

salad l 2 egg sized potatoes or 1/2 a jacket

potato l A small portion (2oz or 56g) of lean meat,

fish, cheese, tofu or quorn based dish

Supper: 1 low fat, low sugar yoghurt

During the day: 1/3 pint milk (for cereal and in cups of tea/coffee)Suitable drinks include: l Tea l Fruit teas l Coffee l Oxo / Marmite / Bovril l Horlicks / Ovaltine (light

options) x1 per dayl Low fat hot chocolate x1

per dayl Water l Sugar free flavoured water l Low sugar cordial l Diet drinks

Tips for success with the liver reducing diet l Use smaller plates, bowls,

knives and forks than you usually do. This will help you to control your portion size

l Aim for half a plate of vegetables or salad at mealtimes; this will fill you without giving you too many calories

l Eat slowly and aim to make your meal last 20 minutes. Chew you food well and put your knife and fork down between mouthfuls

l Include plenty of drinks. This can help to fill you up and reduce your appetite

l Choose wholemeal cereal, bread, pasta and rice. It will fill you up for longer

l You should now be eating less than you did before, so you will want to make the most of it. Eat without distractions and enjoy each bite


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I am on medication to control my diabetes, will it need to be adjusted?It is likely that you will need change the amount of medication you have whilst following the eating plan. Make sure that you seek advice from your Diabetes Care Team before you start so that you are ready to make the right changes. If you have a blood glucose testing device, check your blood sugars regularly. If you have diabetes but are not on medication, make sure you continue to have starchy foods at every meal as outlined in this plan.

Frequently asked questions

When will I know when to start the diet?You will be given a date for surgery about 4-6 weeks before the operation. Start the eating plan 2 WEEKS before the date of your surgery.

Are there any side effects to following the diet?Most people follow the eating plan very well without any problems. You may feel hungrier or possibly lacking in energy. However, these feelings mean you are not giving the body with the energy it needs, which ends up with you losing weight. If you are still concerned you can contact the dietitians for more help. If you have diabetes, see the next question.

Where can I get further information and support? For further help you can access relevant websites, phone, email or write to us (see page 29 or go to our drop in sessions at the Hospital.

The drop-in sessions are run by the dietetic team every Friday afternoon from 12.30-3pm in the Diabetes Centre (Ground floor of the purple zone off the main corridor) at Salford Royal. If you want to see one of us please contact us before coming.

What if my liver does not reduce in size?In the few cases where the liver has not reduced in size it is usually due to the person not following the eating plan fully. Unfortunately, if this happens the surgery may have to be cancelled. Remember that this does not happen very often if you follow the dietary advice.

Becoming pregnant after surgeryObesity can cause infertility, but following weight loss surgery ovulation and periods can recommence. Pregnancy is safe after surgery, reduces the risk of miscarriage, high blood pressure and diabetes.

However patients are advised not to get pregnant for the first 12 months after surgery, to allow the weight loss to slow down and establish a regular eating pattern. If you were to get pregnant it is advised that you should your dietician and G.P to ensure that you are having all the nutrients you and your baby require. Once you become pregnant you are advised seek medical advice on the medications you are taking to ensure they are suitable for pregnancy.

There is no reason why you should not have a normal delivery and be able to breast feed after surgery.


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Useful websites:British Obesity Surgery Patient Association (BOSPA)

British Obesity and Metabolic Surgery Society (BOSS)

Weight Loss Surgery Information and Support (WLSinfo)

Drinkaware - alcohol advice

Salford Royal Bariatric Service

Weight Loss Resources UK

08456 020 446

02073 044 786

0151 222 4737

020 7766 9900

01733 345 592

www.bospauk.org

www.bomss.org.uk

www.wlsinfo.org.uk

www.drinkaware.co.uk

http://www.srft.nhs.uk/bariatric/

www.weightlossresources.co.uk

Further information:You can contact our team at Salford Royal NHS Foundation Trust. If you have any questions, please do not hesitate to contact us:

Specialist Bariatric Dietitians

Specialist Upper GI / Bariatric Nurses

0161 206 1223

0161 206 5062Weight Management DietitiansDepartment of Nutrition and DieteticsSalford Royal NHS Foundation TrustStott LaneSalford, M6 8HD

[email protected]

Notes

For further information on this leaflet, its references and sources used, please contact 0161 206 5062

Salford Royal operates a smoke-free policy.

For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779

Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD

Telephone 0161 789 7373www.srft.nhs.uk

www.srft.nhs.uk/for-members

If you would like to become a Foundation Trust Member please visit:

If you have any suggestions as to how this document could be improved in the future then please visit:

http://www.srft.nhs.uk/for-patients

Under the Human Tissue Act 2004, consent will not be required from living patients from whom tissue has been taken for diagnosis or testing to use any left over tissue for the following purposes: clinical audit, education or training relating to human health, performance assessment, public health monitoring and quality assurance.

If you object to your tissue being used for any of the above purposes, please inform a member of staff immediately.

Copies of this information are available in other languages and formats upon request.

In accordance with the Equality Act we will make ‘reasonable adjustments’ to enable individuals with disabilities, to access this treatment / service.

If you need this interpreting please telephone

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Salford Royal NHS Foundation Trust

All Rights Reserved 2014

This document MUST NOT be photocopied

Information Leaflet Control Policy:

Unique Identifier: SURG37(14)

Review Date: August 2016

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