PRE-OPERATION BARIATRIC SURGERY DIET

WEIGHT LOSS BEFORE SURGERY • Allows for a safer and easier surgical procedure • Reduces time spent in the operating room • Promotes faster recovery following surgery • Reduces the risk of complications • Helps maintain normal blood glucose (sugar) levels, which is important for normal healing • Helps you better understand eating and behavioral changes needed for successful weight loss after bariatric surgery • Leads to the best possible overall weight loss • Helps prevent indulging in inappropriate “last chance” eating behaviors and weight gain prior to surgery

Every pound you lose prior to surgery significantly improves the safety of your surgery!

TWO-WEEK PRE-OP MEAL PLAN • This meal plan should be followed for 2 weeks prior to your operation. • The meal plan consists of 4 meal replacements and one solid food meal per day (except for the day before surgery). • You may eat your solid food meal at any time of the day. • On the day before your operation, eliminate the solid meal and consume all liquids (5 shakes instead of 4). • Spread out your meal replacement shakes and one solid food meal evenly throughout the day. • Have your meal or a shake every 3-4 hours. • Take 1 multivitamin daily. Before surgery, any multivitamin is appropriate. After surgery, you will need to follow specific vitamin recommendations that will be provided to you. • Drink 64 oz. (8 cups) of calorie-free/very low calorie (less than 5 calories per serving) sugar-free fluids daily. • Avoid caloric beverages including alcohol, juice (even 100% fruit juice), regular soda, Gatorade, and sweet tea. • Approved beverages include but are not limited to water, broth, decaf coffee, decaf tea, unsweetened decaf iced tea, Propel Zero, and Crystal Light packets. • Do not add fruit or milk to any of the meal replacements. • If you are using powdered shake mix, you should use water to mix your shakes (not milk or juice).

PRE-OPERATIVE MEAL PLAN Meal 1 Meal Replacement Shake Meal 2 Meal Replacement Shake Meal 3 Meal Replacement Shake Meal 4 Meal Replacement Shake Meal 5 Food Meal: lean protein with non-starchy vegetables • 1 serving lean protein (110-160 calories) (3-4 ounces lean meat) • 2 servings of non-starchy vegetables (50 calories) *see page 3

BARIATRIC SURGERY PRE-OPERATION BARIATRIC SURGERY DIET

MEAL REPLACEMENT OPTIONS

PRODUCT AVAILABLE LOCATIONS OPTIFAST UAB Weight Loss Medicine Clinic (UAB Hospital-Highlands) Premier Protein Wal-Mart, Costco, Target, Walgreens, etc. For exact locations, visit PremierProtein.com Muscle Milk (11 fluid oz.) CVS, Sam’s Clubs, Costco, Walgreens, Target (Ready-to-Drink) *Not Muscle Milk Pro* For exact locations it is best to call your local store. Bariatric Advantage High-Protein Meal Replacement Only available online at: https://www1.bariatricadvantage.com/catalog/us-en/5/Meal_ Replacements UNJURY (use 1.5 scoops per serving) Only available online at: http://www.unjury.com/ (Powder) Nectar (as part of bariatric bundle in use with OPTIFAST) UAB Weight Loss Medicine Clinic (UAB Hospital-Highlands)

NUTRITION GUIDELINES FOR CHOOSING A PROTEIN SHAKE FOR PRE-OP DIET If you would like to use a protein shake that is not on the approved list above, you must make sure that it meets ALL of the following criteria for calories, protein, fat, AND sugar in order to be an approved choice. If a protein shake is too high or low in any of the following categories, it is NOT appropriate for the pre-op diet.

CALORIES Less than 200 calories PROTEIN At least 15 grams FAT Less than 5 grams SUGAR Less than 5 grams

BARIATRIC SURGERY PRE-OPERATION BARIATRIC SURGERY DIET

FOOD MEAL OPTIONS FOOD MEAL OPTIONS

VEGETABLE PROTEIN

Per Serving: 25 calories, 5 g carbs, 2 g protein Per Serving: 110-160 calories, 14-21 g protein, 0-6 g fat

EAT MORE OFTEN SERVING SIZE EAT MORE OFTEN SERVING SIZE Artichoke 1 medium Beans, lentils ¾ cup cooked Asparagus ½ cup Edamame ¾ cup Bean sprouts 1 cup Egg whites 4 large Beets ½ cup or 1 medium Egg substitute, plain ¾ cup Broccoli 1 cup raw or ½ cup cooked Egg 2 whole Brussels sprouts ½ cup Fish, fresh or frozen 3 ounces Cabbage 1 cup raw or ½ cup cooked Fish, canned Carrots 1 cup raw or ½ cup cooked Salmon 2 ounces Cauliflower 1 cup raw or ½ cup cooked Sardines 4 medium Celery 6 sticks Tuna, in water 3 ounces Cucumber 1 Tuna, in oil 2 ounces Eggplant ½ cup Shellfish Greens, Collards, Turnips, Clams 15 Mustard, Kale ½ cup cooked Crab, lobster, scallops 3 ounces Green beans ½ cup Oysters 12 medium Leeks ½ cup Shrimp 15 medium Mushrooms 1 cup Game, wild, no skin 3 ounces Okra 6 pods or ½ cup cooked Pheasant, venison, rabbit 3 ounces Onions ½ cup Poultry (no skin) Pepper, bell 1 cup raw or ½ cup cooked Chicken, turkey, white meat 3 ounces Radishes 10 Cornish hen 3 ounces Rutabagas ½ cup cooked Chicken, turkey, dark meat 2 ounces Salad greens/lettuce 1 cup raw Duck or goose 2 ounces Scallions ½ cup Ground turkey breast 3 ounces Spinach 1 cup raw or ½ cup cooked Tofu ½ cup Squash Spaghetti squash ½ cup cooked EAT LESS OFTEN SERVING SIZE Yellow/Summer squash ¾ cup cooked Beef, lean cuts trimmed of fat - Tomatoes 1 small round, sirloin, flank, tenderloin, Water chestnuts ½ cup 93%-97% lean 2 ounces Zucchini ¾ cup cooked Deli meat, all natural 3 ounces Lamb, roast, chop, leg 2 ounces EAT LESS OFTEN SERVING SIZE Pork, lean - tenderloin, Spaghetti sauce ½ cup center cut chop, Tomato juice, 100% juice ½ cup Canadian bacon, ham 2 ounces Vegetable juice, 100% juice ½ cup Veal, chop, roast 2 ounces

BARIATRIC SURGERY PRE-OPERATION BARIATRIC SURGERY DIET

RECIPE IDEAS CROCKPOT SALSA CHICKEN Serving Size: ¾ cup | Makes about 6 servings • Place the 3 boneless skinless chicken breasts in the crockpot and cover with 1 jar of salsa • Cover and cook on high for 4 hours or low for 6-8 hours • Shred the chicken in the slow cooker and toss with remaining salsa and juices

EASY FAJITA VEGETABLES Serving Size: 1 cup cooked | Makes 2 servings • Chop up 1 cup red bell pepper, 1 cup green bell pepper, 1 cup portabella mushroom, 1 cup yellow onion and place in a skillet with ½ cup water • Next season with 4t chili powder, 2t paprika, 1t onion powder, 1t garlic powder, ½t cayenne pepper, 1t cumin or use your own low-sodium taco seasoning • Cook at medium heat for 10 minutes or until tender

BROILED SALMON WITH ROSEMARY Serving Size: 4 oz • Rinse the 4 oz salmon filet under cool water and pat dry with paper towel • Place fillet on non-stick baking dish • Combine ½t lemon juice, ½t rosemary, ½ clove garlic, and salt/pepper • Brush mixture on to the fish • Bake at 450 degrees for 12-15 minutes or until salmon is cooked through

TOMATO, ONION, AND CUCUMBER SALAD Serving Size: 2 cups • Cut up ¾ cup cucumber, ¾ cup tomato, ½ cup onions • Marinate with ¼ cup red wine vinegar

BALSAMIC DIJON CHICKEN BREAST Serving Size: 4 oz | Makes 2 servings • Cut the 8oz boneless skinless chicken breast in half • Mix 1T balsamic vinegar, ½T Dijon mustard, and ½t dried parsley flakes in a small bowl • Place the chicken in a Ziploc bag, pour in the marinade • Let it marinate for at least 10 minutes or overnight • Bake at 425 degrees for 15 minutes or until chicken is cooked through

EASY GREEN BEANS Serving Size: 1 cup | Makes 4 servings • Add 1 small chopped onion into a non-stick medium size pan • Sauté over medium for about 3 minutes • Next add 1 cup low sodium chicken broth and bring to a boil • Add 1 lb of trimmed green beans • Cover pan and simmer for 8 minutes, or until tender

BARIATRIC SURGERY PRE-OPERATION BARIATRIC SURGERY DIET

CHECKLIST TO COMPLETE BEFORE YOUR OPERATION APPOINTMENTS: • Make a follow-up appointment with your PCP/endocrinologist for a date within 2 weeks following your operation, as your medications likely will need to be adjusted (especially if you have HTN or DM). • Schedule a follow-up with your surgeon.

NUTRITION: • Purchase all necessary vitamin/mineral supplements. • Stock your home with approved fluids. • Stock your home with Phase 2 items you will use as meals. • Purchase a food scale and/or measuring cups. • Decide if you plan to use paper and pencil or a smartphone app for food journaling. • Download the app or get a notebook. • Fill out the “important dates” section of your handout, so that you know when to advance your diet.

MY IMPORTANT DATES Date of operation Start pre-operative diet (2 weeks before operation) Date of 5 meal replacements (1 day before operation) Start Phase 2 (date of discharge from hospital) Start Phase 3 (2 weeks post-op to 3 months post-op) Start Phase 4 (3+ months post-op)

Phase 1: Clear Liquid (Only while in the hospital) Phase 2: Full Liquid (Day 2-14 post-op) Phase 3: Pureed/Soft (Day 14-3 months post-op) Phase 4: Regular Texture (3+ months post-op)

IMPORTANT CONTACT INFORMATION FOR NUTRITION QUESTIONS: Patient Portal: Weight Loss Medicine Dietitian (best way to contact a dietitian) Weight Loss Medicine Clinic Phone: 205.934.7053

BARIATRIC SURGERY