Expert Q&A: The 10 Most Commonly Asked Bariatric Questions

Article By: Rachel Ignomirello, MS, RDN, CSOWM, LDN

Rachel Ignomirello is a Bariatric Dietitian and Board-Certified Specialist in Obesity and Weight Management.

As a bariatric dietitian, I answer questions all day, every day in consults, clinic, classes, and support groups. Questions and curiosity are a natural part of becoming a bariatric patient — it means you are learning! Here are some of the questions I get asked the most.

1) What is dumping syndrome? Dumping syndrome is “rapid gastric emptying.” Concentrated sweets (sugar/desserts), concentrated fats (greasy/oily foods), and/or drinking while eating can trigger dumping syndrome. The food from the small stomach pouch “dumps” into the small intestine, triggering a fluid shift to the bowel. Patients often experience dizziness, cramping, rapid heart rate, sweating, and/or diarrhea. Dumping syndrome is more likely to happen with a malabsorptive type of surgery like the gastric bypass. The best way to avoid dumping is to follow your nutrition guidelines.

2) Do I really need to quit soda and coffee? Carbonated, fizzy drinks introduce a lot of air/gas into the small stomach pouch. This air creates discomfort, bloating, and excess gas. After surgery, patients find soda too uncomfortable to tolerate. Plus, soda is one of the biggest sources of sugar in the American diet. On the other hand, coffee often can be incorporated into the postoperative diet. However, the caffeine part of coffee should be determined by your bariatric program. Most programs limit caffeine after surgery because it can irritate the stomach lining. I think patients should also be mindful of how they prepare their coffees. Try replacing added sugar and high-fat cream with a sugar substitute, low-fat milk, or a protein shake instead.

3) What vitamins can I take after surgery? Vitamin supplementation is a critical part of lifelong health to prevent serious deficiencies. Bariatric-specific vitamins should be taken because they are made with higher levels of key nutrients such as iron, vitamin B12, thiamine, vitamin D, calcium, etc. Regular, over-the-counter supplements will generally not meet patients' needs. Talk with your program about which supplements are right for you. Postoperative lab work will help monitor your levels of vitamins and minerals.

4) Will I go bald after surgery? I’ve never seen a patient “go bald” and permanently lose their hair after surgery. However, hair shedding can be normal in the first 3-6 postoperative months. This shedding is temporary due to the stress of surgery and rapid weight loss. As long as you are meeting protein goals and taking bariatric vitamins, hair will grow back strong.

5) How big are my portions after surgery? Considering the fact that the postoperative stomach size is generally equivalent to either a large egg or small banana, portions are small. Early on, portions may only be 1-2 ounces or a couple of tablespoons! Long-term, most bariatric patients can comfortably consume 4-8 ounces of food per meal. Mindful, slow eating will help patients realize fullness signals to stop eating. I always encourage dime-size bites and good chewing to help with better digestion.

6) Do I have to give up eating out? The majority of food consumed should be prepared at home. Food eaten away from home tends to be higher in calories, fat, sugar, and salt. However, patients can still enjoy the occasional meal eaten out in the long run. Depending on the restaurant, you may be able to find grilled proteins and steamed vegetables. I also encourage patients to always split the meal or take at least half home in a to-go box.

7) Are there any foods I should avoid? Right after surgery, patients should always follow their bariatric program's dietary guidelines. If a food is not listed or allowed in a given stage, it should be avoided for safety and GI comfort. There are foods that are notoriously tough for patients to tolerate and are often avoided for a while in the diet progression. These can include tough meats, nuts, seeds, popcorn, stringy/fibrous vegetables, and even certain bread products. Long-term, the bariatric diet should be high in protein while being low in fat and sugar. Foods high in sugar and fat are often calorie-dense and may increase the risk of dumping syndrome. Desserts, fried foods, and refined carbohydrates (i.e. white bread and crackers) should be replaced with lower calorie, more nutritious options.

8) How many calories do I need? How much protein and fluid do I need? Calorie goals will vary from person to person. It depends on how far out from surgery you are, your activity level, your age, and your long-term goals. Generally speaking, most patients need at least 60-80 grams of protein and at least 64 ounces of fluid per day. Again, this can vary from person to person. Your program dietitian can provide individualized nutrition needs.

9) How long does the diet last? For most bariatric programs, the diet progression lasts anywhere from 3 months to a full year. The postoperative diet is key for safe weight loss and healing and to lower complications like nausea, vomiting, plugging, or obstruction. Many patients notice more “normal” eating patterns after the first year. At that time, I like to encourage the bariatric plate method of eating for smart portions and order of eating.

10) How will I survive the liquid diet? The liquid diet stages are often the hardest for patients. Some programs do two weeks of liquids both before and after surgery. Prior to surgery, a liquid diet can used as a “liver reduction” diet to decrease surgical complications. After surgery, liquid diets are used to promote healing of the new GI tract. What helps during these times is remembering the importance of the diet (health and safety), remembering your “why” for surgery (quality of life, for example), having lots of variety in allowed choices, and surrounding yourself with support instead of temptation.

BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.