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Pre Op Plan Post Op Bariatric Edition

Should I follow my Pre-Op Bariatric Plan to get the scale moving again?
I hope your days are getting a bit longer with a bit more sunny bits and that your temperatures are getting warmer. It is almost mid-March. I woke up last Sunday feeling fantabulous! I could not understand for the life of me HOW the HECK did I manage to sleep in until 10.30 am?? I stretched out, got myself a coffee and started to make “Sunday plans” in my head. 
It took me over an hour to figure out that the time had changed and that I missed it. I hate it when that happens. I truly thought that I was channeling my inner teenager and that I managed to sleep in super late HA. Not so. The clocks jumped forward an hour at midnight. 
I remember back a few years ago when the bariatric pre-op diet was a diet of liquids. How horrible! All of my clients buckled up and did their liquid diet like champions but, I think that underneath they were suffering. I can’t imagine how hard it must have been or how motivated they were to do a 2 week liquid fast. 
I doled out pre-op diets of 7 to 21 days. It was my job and I was doing my best to help my clients shrink their livers and get mentally and physically prepped for what was to come post-surgery. This was the famous pre-op diet from years ago: 
  • 3 protein shakes
  • V8 juice (one serving)
  • Broth (unlimited)
  • Sugar free popsicles (1)
  • Sugar free pudding (1)
  • Sugar free jello (1)
  • Low fat yogurt (1 serving)
  • Low fat cottage cheese (1 serving)
  • Tons of sugar-free beverages
Of course, my clients lost weight. Of course, they were miserable. Of course, this diet was unhealthy and hard to follow. Their motivation was their upcoming surgery and the fear that their livers would not be cleansed enough to have surgery performed.
I am writing this today because I still get a lot of past clients that ask me for a copy of their pre-op diet. They intend to follow it again to kick-start weight loss in their bariatric journey. They have had a regain or a stall and they feel stuck and they remember how the pre-op diet that they followed worked the first time, so it has to work a 2nd time.
Today I explain to them that this is NOT the best way to kick-start weight loss. Sure, weight loss will happen but it is so difficult to stay on this liquid plan that they are sure to fall off after only a day or two. The reason it worked the first time was due to their deep-fear of their upcoming surgery and the thought that it was a dangerous surgery if the liver was not cleansed before surgery. 
FEAR is a huge motivating factor.  
Nutritional science has made many advancements today. It has come leaps and bounds.  We now know that the best way to shrink the liver is not through a liquid diet. We now know that the best way to get the liver prepped for surgery is through a diet of real food. The pre-op diet is now designed to remove all the sugar, refined/ processed carbohydrates, and alcohol out of the diet. This is how the liver gets to take a break and shrink.
The latest liver-shrinking bariatric diet that I give to my clients is a plan that is low in dietary carbohydrate and fat that will encourage the body to use up glycogen (a sugar that is stored in the liver and muscles for energy) and fat stores to help minimize the size of the liver.
The latest, updated pre-op diet looks like this:
  • 3 shakes a day / high in protein
  • 3 servings of cottage cheese or yogurt
  • One meal a day which consists of one serving of protein and two low carb veggies
  • Unlimited broth
  • Unlimited sugar-free beverages
These are the basic guidelines and when I discuss one-on-one with each client during their pre-op nutrition call, I tailor the pre-op diet to suit them. 
For example, if they are vegan, I make their diet vegan-friendly. If they are vegetarian, we find a way to complete the pre-op diet which is in line with their nutritional beliefs. If they have food sensitivities or intolerances, I work out a plan where they are shrinking their livers without the offending foods included. If they hate specific options, I switch them out.
ALL of my clients lose weight on their pre-op diet. ALL of my clients have their surgery performed because their livers are small and pink and pliable. I have never had a client refused surgery due to their engorged liver. It’s my job to prep-livers and I do a darn good job of it. My clients will tell you how much weight they have lost during their pre-op stage. 
Now, this weight loss during the pre-op stage also has a lot to do with the fact that they are coming from a very poor diet that is based around refined and processed foods, fast foods and convenience foods or junk food and they are committing to a diet of real food. Of course, the scale is going to move very quickly and they will have a quick weight loss.
Today when my clients reach out and want me to share a diet plan that works to get them past a stall or to get back on track after a regain, you know what I do? I put them on a “real food” diet for a few days. I just pull out refined and processed foods (carbohydrates like bread, pasta, rice, tortillas, crackers, chips, juice, fruit, candy, chocolate bars, bakery goods, etc.) ….
And I give them a plan that consists of protein and vegetables. I skip the protein shake and give them two boiled eggs. I skip the protein shake and give them a chicken salad. I skip the protein shake and give them a small steak with green beans. 
A protein shake goes straight through the bariatric pouch. It doesn’t fill the pouch as the pouch is supposed to be used. A protein shake makes me feel ravenous only an hour after I drink it. How is that going to help me to lose weight? Why not snack on a chicken breast? Now that would fill the pouch, put it on “lock-down” and prevent grazing all day long.
I have never had a client gain weight or have a weight-loss stall while eating chicken breast and broccoli. The stalls or regains always happen to my clients who are guzzling down protein shakes and eating up those protein bars and snacks. As soon as we get those out of the diet and switch over to “real food/ chicken breasts for example”, weight loss starts up again.
Could it be that the shakes are making my clients hungrier than ever? I think so. They end up over-consuming calories because they are drinking a large part of their calories each day. Now, these shakes are only a tool. They are a tool that I use to get ready for surgery and a tool that I use immediately post-op and up to 6 weeks after surgery. The sooner we can switch to real food, the better the results will be. 
Yes, it will always be “real food for the win”.
If you feel stuck in your weight loss journey, reach out to me. Together we can make the changes that will get you past your stall and back on the Losers-Bench once again.

About the Author: Sheri Burke is a Registered Holistic Nutritionist and Bariatric Surgery Coordinator at International Patient Facilitators in Tijuana and Cancun, Mexico. She has worked with bariatric surgery clients for over 10 years and especially enjoys providing nutritional guidance to pre and post bariatric clients.  In her free time, she enjoys spending time with her husband and two teens and cooking up a nutritional storm in the kitchen.

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