Post procedure diet - bariatric surgery (puree)
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
Aim
Prevent gastrointestinal symptoms and complications by providing pureed diet for patients who have successfully transitioned past the bariatric fluid diets after bariatric surgery.
Characteristics
Foods are smooth and free of lumps and served moist or with a low-fat sauce or gravy, where possible. Foods should be high protein and low glycaemic index. High-fat and high-energy foods are to be avoided.
The meal plan is designed to limit the range of choice and restrict portion sizes to control the volume of food served.
- Three main meals will be served daily – with only three items provided at each meal. These include:
- for breakfast, a cereal, hot breakfast choice and drink
- for lunch and dinner, a hot main meal or soup, low-fat yoghurt and drink.
- Three mid-meals will be served daily, with only one item provided at each mid-meal. This includes either pureed fruit or low-fat yogurt or skim milk or a high-protein supplement.
- Water can be served in addition to these items.
- Hot main meals are restricted to half serves and should provide ≥10g protein per serve.
- Plated main meals will consist of a half serve of the hot main and up to two half serves of vegetables. This will equate to a maximum plate serve of 150g. The low-fat yoghurt and beverage will be allowed in addition.
Indications
Post-bariatric surgery, as clinically indicated or as per the surgeon’s recommendations, for example, suggested for weeks two to four, after an initial fluid post procedure bariatric diet.
Nutritional adequacy
This diet is low in all nutrients and should not be used as the sole source of nutritional support for extended period without supervision by a dietitian. Patients will require assessment and monitoring by a dietitian during the admission. Patients will require additional protein as well as vitamin and mineral supplementation. Chewable or liquid forms are preferable, if available.
Precautions
Not suitable for patients immediately following, or for a week, after bariatric surgery. This diet should be transitioned after successful tolerance of bariatric clear fluids and bariatric full fluids.
Paediatrics
Suitable for use in adolescents (≥15 years) when combined with an age-appropriate diet. However, it is noted that surgery can be considered at 14 years of age in exceptional circumstances.
Sample menu
| Meal | |
|---|---|
| Breakfast |
|
| Lunch |
|
| Dinner |
|
| Mid meals | 1 item per mid-meal
|
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | Small serves only of pureed meat, chicken, fish or legumes with a low-fat sauce or gravy to achieve a thick, moist texture Pureed choices to contain ≥10g protein per serve and ≤10g fat per serve | Foods cooked with cream-based sauces |
| Sauces, gravies | Smooth, low-fat sauces and gravies (≤1g fat per serve) | Cream-based sauces Any with seeds or lumps, e.g., onion, honey mustard or fresh tomato sauce |
| Starchy vegetables / pasta / rice | None | All |
| Vegetables | Small serves of pureed vegetables Small serves of smooth mashed vegetables, e.g., pumpkin | Standard vegetable serves sizes Coarsely mashed vegetables Pureed vegetables containing lumps or fibrous strands, skins or husks Raw vegetables |
| Soups | Smooth high-protein soups containing ≥5g protein per serve and ≤8g fat per serve | Cream-based soups Clear soups |
| Sandwiches | None | All |
| Salads, dressings | None | All |
| Breads, cereals | Smooth, lump-free breakfast cereal | All breads Cereals that do not soften easily, or with fruit or seeds, e.g., muesli |
| Spreads | None | All |
| Hot breakfast choices | Scrambled egg Pureed baked beans | All others |
| Fruit | Pureed canned or stewed fruit Smooth, ripe, mashed banana | All others, including pureed fruit with any visible lumps |
| Yoghurt | Smooth fat-free or low-fat yoghurt | All others |
| Desserts | None | All |
| Milk and cheese | Skim milk | Other milk |
| Beverages | Water Low-joule cordial Strained vegetable juices One 100-120mL serve of tea/ coffee per day (with or without skim milk) | All others including fruit juices, cordial and carbonated soft drinks |
| Biscuits | None | All |
| Miscellaneous | Commercial low-fat, high-protein supplements Low-joule ice blocks Pepper, sweetener Low-fat milk or protein powder may be added to drinks or soups to increase protein content | Sugar, cream Salt Confectionary and chewing gum |
References
- Academy of Nutrition and Dietetics (USA). Nutrition Care Manual. Cleveland: Academy of Nutrition and Dietetics. [cited September 2020]. Online subscription required.
- Allied Health Sciences Section Ad Hoc Nutrition Committee: Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS Allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis [Internet]. 2008 Sep-Oct [cited month year] 4:S73–108. DOI: 10.1016/j.soard.2008.03.002.
- Dietitians Association of Australia. Nutrition manual. 9th ed. Canberra: DAA; 2014. [cited April 2023 year].
- Shannon C, Gervasoni A, Williams T. The bariatric surgery patient – Nutrition considerations. Aust Fam Physician. 2013 August [cited April 2023] 42(8):547-52.