Post procedure diet - bariatric surgery (soft)
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 a soft foods diet for patients who have successfully transitioned past the bariatric puree diet around four weeks after bariatric surgery.
Characteristics
Foods may be naturally softer or cooked to alter texture. Food should be moist, easily crumbled or served with a low-fat sauce or gravy to increase moisture content. Foods should be high protein and low glycaemic index. High-fat and high-energy foods are to be avoided. The texture of this diet is consistent with the soft-dental / easy-to-chew diet.
The meal plan is designed to limit 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 soft fruit or low-fat yogurt or skim milk or a high protein supplement.
- Water can be served in addition to the above 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, one half serve of vegetables and one half serve of starchy vegetable or pasta. This will equate to a maximum plate serve of 155g. The low-fat yoghurt and beverage will be allowed in addition.
Indications
Post-bariatric surgery, as clinically indicated or as per surgeon’s recommendations, for example, suggested for weeks four to eight, after tolerating the post-procedure diet - bariatric surgery (puree).
Nutritional adequacy
This diet is low in all nutrients and should not be used as the sole source of nutritional support for an extended period without supervision by a dietitian. Patients will require assessment and monitoring by a dietitian during the admission. Patients will require vitamin and mineral supplementation. Chewable or liquid forms are preferable, if available.
Precautions
Not suitable for patients immediately following, or for weeks one to three, after bariatric surgery. This diet should be transitioned after successful tolerance of bariatric clear fluids, bariatric full fluids and bariatric puree diet.
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 |
Soft meat/fish/chicken with gravy/sauce (75g small serve) and soft vegetable (35g small serve) and soft starch option (45g small serve) or soup (180ml serve) |
| Dinner |
|
| Mid meals | 1 item per mid-meal
|
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | Soft dishes, e.g., casseroles, crepes Tender sliced meats Well-cooked legumes, e.g., baked beans Soft falafel Soft rissoles Fish soft enough to break into pieces with a fork or spoon, e.g., poached, soft fish, fish cakes All dishes to be served with a low-fat sauce or gravy Soft choices to contain ≥10g protein per serve and ≤10g fat per serve | Fried foods Fatty meats, e.g., sausages, bacon Meat that is tough, stringy or has rind or gristle Dishes with pastry or a hard base, e.g., pizza, quiche, pie Dishes with crisp topping 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 | Mashed potato Soft pasta | Other potato Rice Noodles Pasta / vegetable bakes with crisp or crunchy tops |
| Vegetables | Small serves of soft / mashed vegetables | Standard vegetable serves sizes Hard raw, crisp or crunchy vegetables, e.g., some stir fry |
| Soups | 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 | Rolled oats, semolina Cereals without nuts, seeds or grains Unprocessed bran | All bread All other cereals |
| Spreads | None | All |
| Hot breakfast choices | Scrambled egg, poached egg, or baked beans | All others |
| Fruit | Canned or stewed fruit Soft fresh fruit, e.g., bananas, pawpaw, oranges, mandarins Soaked prunes (no seed) Grapes | Other hard or unripe fresh fruit, e.g., apple Dried fruit |
| Yoghurt | Fat-free or low-fat yoghurt with soft fruit pieces | All others including those with dried fruit or hard nuts or seeds |
| Desserts | None | All |
| Milk and cheese | Skim milk | Other milk All cheeses |
| Beverages | Water Low-joule cordial Strained vegetable juices Tea and coffee | All others including fruit juices, cordial and carbonated soft drinks |
| Biscuits | None | All |
| Miscellaneous | Commercial low-fat, high-protein supplements Pepper, sweetener Milk powder 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.