Guest blog by: Lillian Craggs-Dino, DHA, RDN, LDN, CLT Embarking on a journey toward better health after metabolic and bariatric surgery requires a well-structured approach to diet and lifestyle. The foundation of this journey relies on a few key elements: prioritizing protein and fluids, taking daily vitamin and mineral supplements, and incorporating daily exercise. One of the most effective ways to support these habits is meal planning. By thoughtfully organizing your meals, you can align your diet with the phases of the bariatric journey, from liquids to solid foods, ensuring a smooth transition and sustainable weight loss. This blog will guide you through the essentials of meal planning after bariatric surgery, outlining the critical dietary stages and offering practical tips for each phase. The Importance of Meal Planning Meal planning is one of the easiest ways to ensure healthy eating habits and weight loss success. It involves organizing and thoughtfully deciding what to shop for, cook, and eat for a set number of days of the week.Successful meal planning involves understanding the different phases of the bariatric post-op diet and the appropriate foods for each stage. Understanding the Post-Op Diet Phases Common sense dictates that after any gastrointestinal surgery, the reintroduction of food must begin with liquids, followed by soft foods, and eventually transition slowly to regular and solid textures. The typical diet progression after bariatric surgery starts with clear liquids, then moves to full liquids, transitions to a pureed and soft diet plan, and finally, a diet with regular textures and some modifications. Refer to Table 1: Diet Progression After Bariatric Surgery, which describes the diet progression typically seen in bariatric nutrition protocols. Table 1: Diet Progression After Bariatric Surgery Clear Liquid Diet (CLD) A clear liquid diet consists of only liquids and foods that are clear liquids at room temperature.1 The CLD is nutritionally inadequate and should only be recommended for 1-2 days, typically starting immediately after surgery. The purpose of a CLD is that clear liquids are easy to digest and begin the hydration process. Appropriate beverages include water, broth, sugar-free gelatin, plain tea, decaf black coffee, sugar-free popsicles, and sugar-free sports drinks. Full Liquid Diet (FLD) The full liquid diet reintroduces protein shakes, milk, and nondairy liquids in addition to clear liquids to promote healing, provide protein nourishment, and continue hydration.* In this diet stage, patients continue to learn the sensations of their “tool” and new stomach. The goal is to reach 64 ounces of fluid intake per day, and the FLD typically lasts no more than 14 days post-op. It can also serve as a “safe zone” for patients experiencing vomiting, diarrhea, or food intolerance until challenges resolve. Tips for Success on the Liquid Diet Drink protein shake slowly, starting with 4-8 ounces over 30 minutes, and assess tolerance. Stop drinking when you feel full, even if it only takes five minutes. Experiment with different fluid temperatures (room temperature, warm, cold, or add ice) to see what feels most comfortable. Continue drinking clear liquids between shakes, waiting 30 minutes before and after a shake. Enhance flavor and avoid “protein shake burnout” by adding sugar-free flavorings, decaf coffee, sugar-free gelatin, sugar-free syrups, sugar-free extracts, and flavorful spices like cinnamon, cardamom, or pumpkin spice. Pureed Foods or Soft Diet The next phase of the bariatric diet typically involves a pureed or soft diet, aimed at increasing nutritional intake, especially protein, and continuing the weight loss journey. This phase is critical as patients learn the boundaries of their new stomach and discover food and other intolerances. Tips for Pureeing Food Cook proteins until soft or use canned versions. Chop cooked foods into smaller pieces. Place in a blender or food processor. Add about ¼ cup of liquid (such as water, broth, low-fat creamed soups, shakes, milk) or condiment (mayo, yogurt, cottage cheese, sour cream). Blend to a smooth texture with no lumps. Avoid multi-ingredients and consider using single-protein food items. Regular Diet With Some Modifications The goal for patients with metabolic and bariatric surgery is to resume a healthy diet composed of lean proteins, vegetables, fruits, and complex starches. Incorporating cultural foods, favorite foods, and variety is key to health and a successful relationship with the bariatric diet. The goal is to meet the minimum recommended protein intake of 60 grams daily. You can refer to Table 2: High Protein Foods for appropriate options to eat on a bariatric diet, while Table 3: Bariatric Meal Plan Example offers a week's worth of meal planning.It is also important to note that proper eating mechanics, such as eating slowly, chewing food thoroughly, and refraining from eating and drinking together, influence positive weight loss outcomes and food tolerance. Table 2: High Protein Food Choices Protein Food Grams of Protein Per Serving Large whole egg 6-7 Plain Greek yogurt, 8 ounces 12-23 Cottage cheese, low-fat, 8 ounce 12-14 Swiss cheese, low-fat, 1 ounce 8 Nonfat milk, 1 cup 7-11 Pork chop, boneless, lean, 3 ounces 26 Turkey breast, skinless, 3 ounces 24 Chicken breast, skinless, 3 ounces 24 Ground beef, 95% lean meat, 3 ounces 18 London broil red meat, 3 ounces 23 Yellowfin tuna, 3 ounces 25 Halibut, 3 ounces 23 Salmon, 3 ounces 23 Tilapia, 3 ounces 21 Sardines, 3 ounces 21 Navy beans, 1 cup 20 Lentils, ¼ cup 13 Canadian bacon, 3 ounces 15 Peanut butter, 2 Tablespoons 8 Tofu, 3 ounces 12 Edamame, ½ cup 8 Table 3: Bariatric Meal Plan Example Summary Navigating the dietary phases after metabolic and bariatric surgery successfully is key to achieving long-term health and weight loss goals. Prioritizing protein and fluids, adhering to a structured multivitamin supplement regimen, and incorporating daily exercise are foundational elements of this journey.Meal planning is also a powerful tool in recovery for engaging in a successful weight loss and health journey. It should be adjusted within the scope of the bariatric diet and tailored to the patient’s lifestyle, philosophy, and culture to support your new lifestyle. Reference 1. National Cancer Institute. 2024. Accessed from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/clear-liquid-diet. *These statements have not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your bariatric surgeon or another qualified healthcare provider with any questions in regard to a medical condition. A qualified healthcare professional can best assist you in deciding whether a dietary supplement is suitable based on your individual needs.