Minimising Further Weight Loss Following Bariatric Surgery

You may be at a stage following bariatric surgery where you have reached a weight you are comfortable at, but you wish to prevent any further weight loss. You may have lost more weight than you wanted, and may be keen to re-gain some weight in a more controlled way. If so, it is important that you choose suitable foods to stay healthy.

Foods high in sugar and fat contain a lot of energy and can therefore help with weight gain. However, you should choose these wisely as some foods and drinks are more nutritious than others.

To gain weight you need to be eating and drinking more calories than you are using up. Due to surgery, it may be difficult to increase your portion sizes at meal times, therefore you will need to increase how often you eat and increase the calorie content of your meals. This booklet will give ideas on which foods and drinks to include, helping you either to slow down weight loss, maintain weight or to put on weight in a healthy way.

What can I do to help myself?

To help increase your calorie intake in a healthier way, you can try adding the following to your diet:

• Starchy foods are healthier than sugary foods. Try to eat plenty of bread, potatoes, rice, pasta and cereals instead of chocolate, sweets and cakes. Serve extra bread or crackers with meals. If you struggle with these foods, include small portions of them and you could discuss with your Dietitian suitable ways of cooking.

• Fat contains a lot of calories and can help with weight gain. There are different types of fat and having too much fat – especially saturated fat – can raise your blood cholesterol levels and increase your risk of coronary heart disease.

• Unsaturated fats are a healthier choice, in particular monounsaturated fats.  These can have a good effect on cholesterol levels so try to include foods high in these types of fat rather than saturated fat.

• Continue to follow the recommendations for a healthy balanced diet but eat as much as you feel comfortable with at meal times.

• Snack between meals and before bedtime. Healthy snacks ideas are provided later in the leaflet.

• Replace a drink or drinks of tea or coffee with nutritious drinks such as a glass of fortified whole milk, milky drinks, and fruit smoothies or fruit juice.

Remember if you are introducing any new food or drink into your diet, try this in small amounts and take your time.

Unsaturated fats (healthier choice)

Polyunsaturated

• Sunflower oil/margarine
• Corn oil/margarine
• Walnuts
• Pine nuts
• Oily fish.

Monounsaturated

• Olive oil and margarine
• Rapeseed oil
• Avocados
• Almonds
• Cashew nuts.

Saturated fats (limit these)

• Butter
• Pastries
• Chocolate
• Biscuits
• Cake
• Fatty cuts of meat
• Meat products e.g. sausages and pies.

What if I have a poor appetite?

You should try to:

• Eat little and often throughout the day. Attempt to eat something small every 2 to 3 hours. Try not to get out of the habit of eating.

• Eat whenever you feel hungry. On days when your appetite is good, try to eat more regularly.

• Eat your biggest meal earlier in the day when you have more energy. Your last meal of the day could be a simple sandwich or cereal with milk.

• Have your drink after meals rather than before or with meals. This may help if you feel full easily. Having drinks with your meals may be filling you up, which may stop you from finishing your meal or may make you vomit.

• Have nourishing drinks between meals such as milk, milky coffee, hot chocolate, milkshake, malted drinks (such as Horlicks or Ovaltine).

How can I make the food I eat higher in calories?

You can try by:

• Using fortified milk. Add 2 to 4 tablespoons of skimmed milk powder to 1 pint of whole milk and whisk well.  Use this milk in place of ordinary milk as a drink, in cooking, on cereals and in tea and coffee.

• Adding monounsaturated margarine, (for example, olive) to vegetables, potatoes and spread generously on toast/bread.

• Adding jam, honey, or dried fruit to cereal and desserts. (Be careful with high sugar foods such as jam or honey due to the risk of dumping syndrome).

Dumping syndrome is a set of symptoms that can be caused when food or drink high in sugar or starch moves suddenly into your small bowel.

This causes water to move into your small bowel to help break down the food. This can occur within 30 minutes of eating / drinking, and symptoms include abdominal bloating, cramps and pain, sweating, nausea and vomiting, heart palpitations, dizziness / fainting and diarrhoea.

‘Late’ dumping syndrome can occur 1 to 3 hours after a meal. This is where your body releases a surge of insulin in response to this overload of sugar / starch, causing your blood sugar level to drop too low. This can lead to heart palpitations, sweating, fainting, fatigue, confusion, hunger and tremors. Some examples of foods that may lead to dumping syndrome include chocolate, sweets, sweet puddings/desserts, full-sugar drinks, cakes and sweet biscuits.

• Using monounsaturated fat oils, (for example, olive, rapeseed) for frying and add extra in cooking (e.g. in stir-fries, curries, mince).

• Adding reduced fat cheese to potatoes, soups, vegetables, pasta, and omelettes.

• Using low fat plain yoghurt instead of cream, (for example, in soups and sauces).

• Adding skimmed milk powder to sauces, soups and desserts.

• Adding unsalted ground nuts (for example, almonds, cashews, hazelnuts) and ground linseeds to meals and drinks, such as soups, cereals, yogurts and smoothies.

Meal ideas

Breakfast

• Wholegrain breakfast cereal or porridge with fortified whole milk. Add fruit (e.g. dried raisins, banana), nuts (e.g. walnuts, almonds) and seeds (e.g. linseed, pumpkin) to add more calories.

• Toast, crumpets or teacakes with olive or sunflower spread, jam or marmalade, honey, low fat cheese spread.

• Beans/tomatoes on toast. Lean bacon can be included occasionally. Melt low fat cheese on top.

• Boiled/scrambled/poached egg on toast. Fortified milk can be added to the scrambled egg.

• Kippers with toast.

• Low fat yoghurt/fromage frais with fruit and/or muesli.

Light meal options

• Soup (homemade or tinned). Serve with bread or crackers.

• Beans or egg (scrambled, poached or boiled) on toast.

• Sardines, pilchards or mackerel on toast.

• Wholemeal/granary sandwich with filling: tuna/egg with low fat mayonnaise/salad cream, lean ham or chicken salad, reduced-fat cheese and pickle or tinned salmon.

• Small jacket potato with any of the following fillings: tuna with low fat mayonnaise, beans and / or cheese, cottage cheese, and vegetable chilli or chilli made with lean mince.

• Omelette (e.g. ham and tomato). Serve with bread.

• Crackers with hummus or natural nut butter.

Main meal options

• Shepherd’s pie, made with lean mince served with vegetables.

• Lean beef, chicken, or meat alternative casserole with added potatoes and vegetables.

• Spaghetti bolognese, made with lean mince.

• Pasta with lean bacon/tuna/chicken, vegetables and tomato based sauce topped with reduced fat cheese.

• Reduced fat ready meal served with bread and extra vegetables.

• Chicken/beef curry/lentil dahl with rice or chapattis.

Desserts

• Low fat custard with plain sponge.

• Low fat yoghurt/fromage frais with fruit.

• Jelly and fruit with reduced fat ice-cream.

• Sorbet.

Many processed foods are high in salt, therefore you should try to limit processed options and choose low salt varieties of all foods where possible.

As with all foods, if trying them for the first time after your surgery, you should have them in small amounts and eat slowly so that you can test your tolerance.

Further information is available from:

Please contact your GP or healthcare professional for more information.

Information used in the development of this leaflet:

• National Institute for Health and Care Excellence (2017) Nutrition support in Adults: oral nutritional support, enteral tube feeding and parenteral nutrition NICE guideline (CG32).

Contact numbers

If you need further help or dietary advice please contact the dietitians via:

Specialist Services Admin Hub

Telephone: 01429 522471

Opening hours: 8:30am to 4:30pm (Monday to Friday excluding Bank Holidays)

Specialist Bariatric Nurse

If your call is not answered, you have the option to leave a voicemail message.

Telephone: 01642 624601

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