Bariatric Surgery Pre op Diet

When pursuing bariatric surgery, there are many thoughts that can circulate in your head, such as eating after surgery, exercising, and postoperative pain, but one of the biggest concerns is the dreaded pre-op diet. If you were to do a quick internet search on bariatric pre-op diets, you'd see no two are alike. One thing that cannot be stressed enough is that every surgeon and every clinic will have their own pre-op diet. It's important to follow their diet and guidelines, as this is what they have found to be best for their patients.

Length of Pre-Op Diet

Pre-op diets can range from a few days of a clear liquid diet, full liquids for a few weeks, participating in a program that requires several months of nutrition visits with weight checks, to even following a VLCD (800 calories a day or less).

Even though each diet looks different, one of the main purposes of each diet is to reduce the size of your liver. Having an enlarged and fatty liver has been shown to complicate bariatric surgeries, and it’s estimated that 75-100% of bariatric patients have nonalcoholic fatty liver disease^3,4. The reason for the additional complications is that an enlarged, fatty liver can obstruct access and increase risk of bleeding during surgery, due to friability of the liver tissue.

Reason for Pre-Op Diet

These restricted diets are necessary for more than just reducing liver size. A large-scale study showed gastric bypass patients that lost just 9.5% excess body weight (EBW) had a reduction in postoperative complications that included anastomotic leaks, deep infections, and minor wound complications.¹ Pre-op weight loss has been shown to improve weight loss and liver function at 6-months post-op4 and can even help reduce surgery time.¹

Changes Surrounding Pre-Op Diet

The benefits of following the restricted diet your surgeon and dietitian puts you on outweigh the cons. However, you should be aware these restrictions can make it difficult to meet all your nutrition needs through your diet. Therefore, it’s recommended during this time that you also start a multivitamin and mineral supplement². Having a visit with a registered dietitian before your procedure can help improve and correct any nutrition deficiencies prior to surgery; it’s also helpful to answer your questions about your pre-op diet.

A few other changes that might also be introduced on your pre-op diet are switching to decaffeinated beverages, cessation / quitting of smoking and alcoholic beverages, stopping birth control, and avoiding NSAID's. You can even include lifestyle changes, such as focusing on small sips of non-sugary beverages throughout the day. Your surgeon and bariatric team will discuss all these changes with you prior to starting them. Remember, they’re there for a reason, so follow their instructions closely. 

References:

1. Dagan, Shiri Sherf, et al. “Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice.” Advances in Nutrition: An International Review Journal, vol. 8, no. 2, 2017, pp. 382–394., doi:10.3945/an.116.014258.
2. Parrott, Julie M., et al. “The Optimal Nutritional Programme for Bariatric and Metabolic Surgery.” Current Obesity Reports, 2020, doi:10.1007/s13679-020-00384-z.
3. Wissen, J. Van, et al. “Preoperative Methods to Reduce Liver Volume in Bariatric Surgery: a Systematic Review.” Obesity Surgery, vol. 26, no. 2, 2015, pp. 251–256., doi:10.1007/s11695-015-1769-5.
4. Wolf, Risa M., et al. “Impact of a Preoperative Low-Calorie Diet on Liver Histology in Patients with Fatty Liver Disease Undergoing Bariatric Surgery.” Surgery for Obesity and Related Diseases, vol. 15, no. 10, 2019, pp. 1766–1772., doi:10.1016/j.soard.2019.08.013.

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