There’s lots of information online around what and how much you should eat after bariatric surgery. Many patients come across this while researching surgical options, and it is often very confusing. One of the questions we get asked most often is: how many calories should I be having each day after my surgery?

Unfortunately the answer to this question is not clear-cut. At present we do not have a validated predictive equation for estimating calorie requirements for patients after bariatric surgery. Therefore any calorie targets that you have read about online are not based on robust scientific evidence. Furthermore, your calorie intake will change as the months go by after surgery. Your portion sizes will begin to increase which is what we expect and want to happen.

When we look at each patient’s food intake after surgery we are more focused on the qualitative as opposed to the quantitative. We want to know how you are doing identifying your new hunger and satiety cues, what types of food you are choosing, in what settings you are eating your meals, social occasions or eating out, and any challenges you may have. We are far less interested in the number of calories.

Below we will discuss some of the reasons why calories counting is not useful after surgery, and what you can monitor yourself instead!

A shift away from the ‘dieting mentality’
Many patients have understandably developed a strong habit of counting calories after many, many years of dieting. After your surgery, we will focus on changing this mentality and setting up healthy eating habits and thoughts around food. It is this that is going to set you up for long-term success and help to prevent relapses. Counting calories will not, but it will cause you much more stress and anxiety!

Bariatric surgery is not a diet – it is a life-long change
As you all already know, bariatric surgery is not a short-term solution, it is a long-term solution that will be a part of your life for the rest of your life. Therefore, the focus is on life-long positive habits. At the end of the day counting calories is just another fad diet. No one wants to keep tabs on the calories in each of their meals for the rest of their life, and nor do we want you to! Thus this is not sustainable and lifelong.  

Food Quality:

Bariatric surgery reduces the amount of food you are physically able to eat, however it has no affect on the nutritional quality of the food you eat. Calorie counting does not help us here either, as the lowest calorie choices are not always the most nutritious. See the example below:

If you were choosing a drink based on just calories you would choose the soft drink right? However, it is critical to consider where these calories are coming from. The calories in the soft drink are coming solely from refined carbohydrate or sugar. The calories in the milk however are coming from a combination of carbohydrate (lactose), a small amount of fats, and most importantly PROTEIN! We already know how critical protein is to your post-surgery diet. Not only that, the milk also contains many other nutrients such as calcium and phosphorous essential for bone health. I’m sure you can guess which one we would recommend! That’s right the reduced fat milk! Even though it is higher in calories it is much more nutritious. A classic example of quality over quantity!

Eating after bariatric surgery is much more about quality over quantity, simply because your quantity is restricted so we need to make sure the quality is high!

What should I focus on with my diet after surgery?

• Regular meals.
• Listen to your hunger and satiety cues and eating accordingly.
• Focus on protein and low starch vegetables at meal times and then fruit, dairy as snacks if you have the appetite.
• Keep carbohydrates to a minimum and choose low GI, wholegrain options when you do have them i.e. brown basmati rice instead of white rice.
• Keep hydrated and remember to drink.
• Take your daily supplements.
• Exercise as appropriate for you.
• Keep up regular contact with us! That is why we are here, so you do not have to figure things out on your own!
• And remember always quality over quantity!

We understand that many patients are concerned about the small portions of food they are eating immediately after surgery, and start counting calories to keep tabs on their nutrition. These small portions are only short term and this is one of the reasons we do your pre-surgery bloods so we can begin to correct any nutritional deficiencies prior to surgery. Keeping up your supplements during this time is also critical to achieve adequate nutrition. This is also why we keep in such close contact during the first few months so we can make sure you are choosing the right types of foods. If you have any concerns about this please do not hesitate to have a chat to us about it, because it is a very common concern!

References:

• Shannon, C, Gervasoni A, Williams T. The Bariatric Surgery Patient: Nutrition Considerations. Australian Family Physician, Vol 42, No 8, p547-551.
• Food Standards Australia and New Zealand (2014). AUSNUT 2011-13 – Australian Food Composition Database. Canberra: FSANZ