Eating after having gastric sleeve surgery has special considerations that must be accounted for to ensure the patient continues losing weight and maintains weight loss while being healthy. This article discusses what a healthy post-op meal plan includes and gastric sleeve meal size and portion size recommendations based on how long it has been since the patient had surgery. 

What Is Weight Loss Surgery?

Weight loss surgery physically alters the stomach size, reducing the amount of food it can hold. A popular option for weight loss surgery is the gastric sleeve, which reduces the stomach size by about 80%. 

The reduction in stomach size means the amount of food the patient can eat is drastically smaller, which results in weight loss.

Why Is It Important to Monitor Portion Sizes After Gastric Sleeve Surgery?

While it may seem that weight loss is automatic after gastric sleeve surgery, it is essential to remember that the stomach is elastic. Therefore, if someone has weight loss surgery and doesn’t maintain portion control with their meals, the stomach can stretch and hold more food, resulting in slower or reduced weight loss or even regaining weight.

What Should a Post-Gastric Sleeve Diet Include, and Is It a Very Low-Calorie Diet?

After having gastric sleeve surgery, the patient’s diet should eventually include all of the items in a balanced meal plan, although it will have fewer calories to encourage weight loss. Initially, the patient will be on a high-protein, very low-calorie diet. Over time, as the stomach heals, calories and variety will increase. Below, we’ll discuss why portion control is critical for post-op gastric sleeve surgery patients. 

Eating on smaller plates is helpful for some patients. Putting mini-meals on bread plates or saucers makes the portions look larger than if placed on a regular-sized dinner plate.

Some foods and beverages should be avoided, like sugar-sweetened and carbonated beverages. Carbonated drinks should also be avoided because carbonation takes up stomach space, reducing the amount of high-quality, whole foods that can be eaten. Foods and beverages that are high in sugar should be limited so that the foods critical to establishing and maintaining health can be included in the patient’s mini-meals. 

Patients should also eat slowly to learn to listen to their body’s fullness cues. Post-op fullness cues usually include pressure in the chest, burping, sighing, hiccup, runny nose, or sneezing.

Below are the four keys for building a post-op patient’s meals.

Key 1: Prioritize Protein Intake

Protein is the priority to ensure the patient’s body can recover from surgery and maintain lean muscle mass.  A meal protein portion should be 15 to 30 grams or 2 to 4 ounces of high-protein food. 

Protein shakes can be used to increase protein intake if needed. The dietitian should be consulted for appropriate shake selection, serving size, and thickness determination. The consistency of the liquids will determine how much can comfortably be consumed. Thicker liquids, like a thick protein shake may cause increased fullness and reduce the patient’s daily caloric and protein intake. 

Key 2: Fiber Filled Veggies

Fiber helps the patient’s digestive system work properly and keeps the microbiome healthy. At six months post-op, increased fiber is usually included in the patient’s meal plan. Eating high-fiber vegetables and starches should be cleared with the doctor or registered dietitian before including them in the diet plan.

Key 3: Carbohydrates

Carbohydrates provide energy, so it is important to include them in the post-op meal plan. Fruits and vegetables are optimal choices. Generally, 1/4 cup of vegetables can be included in the patient’s meal plan at six months post-op.

Fruit juices are typically not recommended because they are concentrated sources of sugar and calories that pass through the stomach quickly. Other sugar-sweetened beverages like sodas and carbonated beverages are also not recommended.

Key 4: Healthy Fats 

Fats are essential to assist with the absorption of fat-soluble vitamins, and they are required for the body to make hormones. In general, post-op bariatric surgery meals should be low-fat. Most fat should be included in the preparation of foods – like olive oil used for cooking.  Small amounts can increase the flavor of foods, like a small dab of guacamole or sour cream or a small piece of avocado.

What Should Your Daily Calorie Intake Be?

The number of calories a patient eats varies depending on how far after surgery it has been. Those who are immediately post-op may eat only a couple of hundred calories daily. This is one reason weight loss is fast immediately after surgery.

As the patient starts eating more solid foods, their intake increases to 300 to 600 calories each day. Once the patient reaches the six-month post-op milestone, calorie intake will increase to approximately 1,000 calories daily. Then, the calorie goal will increase to 1,200 calories daily over the next few months.

While 1,200 calories are still on the lower end of normal, that is an appropriate amount to provide proper nutrition while achieving and maintaining weight loss for most individuals.

What Are Normal Portions After Gastric Sleeve?

After surgery, eating smaller portions is easy because it takes less food to feel full. Understanding portion sizes helps you achieve your weight loss goals and maintain them in the future.

The amount of food the stomach can handle depends on:

• Type of food
• Hunger level
• Speed of eating
• How long it has been since surgery
• Combinations of food in the meal or snack

There are two ways to measure portions or measure food. The first is by volume, usually in cups or portions like 1/4 cup or 1/2 cup. 

The second way is to use a food scale and measure the weight of the food. When food is weighed, the portion is provided in ounces or grams.

While the amounts provided below are typical portion sizes, each person is different. They should work with their doctor and registered dietitian to ensure that they eat enough protein and eat a balanced diet, even if that means using supplements like protein shakes.

Portion Size the First Few Months After Gastric Sleeve

Immediately after surgery, the patient should follow the meal plan provided by the surgeon. Usually, this involves starting with a liquid diet, moving to pureed or soft foods, and then advancing to solid foods. During this time, the patient eats very small portions ranging from one tablespoon to 1/4 to 1/2 cup.

After the transition to solid foods has been made and the patient has been cleared to liberalize their diet, portion sizes will still be quite small: 1/4 to 1/2 cup per meal or two to four ounces of food if food is weighed. While these portion sizes are tiny compared to pre-surgery portions, that amount is appropriate for the patient’s new stomach size.

Portion Size 6 Months After Gastric Sleeve Surgery

Six months after surgery, food portions increase slightly. Most patients can consistently eat 1/2 cup or four to six ounces of food.  The patient should focus on protein-rich foods and begin including high-fiber starches like beans, sweet potatoes, vegetables, and fruits.

Portion Size 1 Year After Gastric Sleeve Surgery

One year post-op, the patient’s portion sizes increase to what they will remain for the long term – usually 1 to 1 1/2 cups or 8 to 12 oz of food. Remember, this general guideline may vary for different gastric sleeve patients. 

The patient will focus on eating adequate protein and including fiber, vegetables, and fruit in their meals. Portion sizes remain critical to keep the stomach from stretching and weight gain from occurring.

Conclusion

While a post-op gastric sleeve or bariatric surgery meal planning may feel daunting, it is doable and easy to follow once the patient understands what foods to include, how much, and what to avoid. Measuring portion sizes while listening to fullness signals will help the patient lose weight while staying healthy. The further the patient is from surgery, the more food and variety they can include in their mini-meals.

If you want help with your post-gastric sleeve or gastric bypass surgery meal planning, contact us at