The Bariatric Diet
Blog series: Popular diets and weight loss surgery
Let’s review the Bariatric Diet before we compare it to other popular diets!
Before we move forward in this series and discuss keto, intermittent fasting, WW and the many other diets I’ve been asked about we need to start here.
Let’s start with what the bariatric diet “basics” are as well as why some of the recommendations differ program to program. This will help as we move forward so we can compare whichever diet we are discussing against the primarily goals and objectives of the bariatric lifestyle.
What is the history or backstory of the bariatric diet?
Each diet I discuss will cover the background of the diet. Whenever I hear about a new diet trending in popularity, I like to know where it come from. Who created this diet? What is it founded upon? Is there some history to know about? Let’s ask these questions about the bariatric diet.
Gastric Bypass was developed in the 1960s and the Gastric Sleeve was first performed in 1990 (source). The ASMBS (American Society for Metabolic and Bariatric Surgery) was established in 1983. ASMBS is who provides the “Center of Excellence” accreditation to bariatric centers. They provide a lot of guidelines for bariatric providers.
When it comes to bariatric diet recommendations, there are a few professional groups focused on research and providing best practice guidelines. Dietitians may utilize these professional groups and research based guidelines, colleagues and of course data from their own experience. Examples of professional groups include the ASMBS and the AND (Academy of Nutrition and Dietetics).
Recommendations of the bariatric diet
For each diet in the series, we will go through what it is that is being recommended.
The bariatric diet (like many diets) will have different approaches. Main themes will be the same, but some details may change from one program to the next.
Which of course begs the question, why?
Why are there differences in bariatric eating recommendations?
Dietitians have extensive training in nutrition and complex chronic diseases. Between their education and the resources I mentioned previously (professional organizations, research, colleagues, experience) this allows them to take the information and translate it into a patients daily life based on their goals and their barriers.
The ASMBS may provide best practice guidelines but will allow room for clinical judgement for the provider.
This allows dietitians and providers to work with patients to create an individualized plan and that means each program will have a different approach.
Nutrition counseling is as dynamic and individualized as mental health counseling. It would be weird if all counselors had the same exact recommendations for all patients with anxiety. They may have a certain approach but will certainly be unique to their client.
The main components of the bariatric diet
While programs will differ, there are main components of a bariatric lifestyle you’ll hear about consistently:
Focusing on protein at all meals
Avoiding simple carbohydrates, concentrated sweets, sweetened beverages
Avoid drinking with meals
Take small bites, chew well, eat slowly
Some things you might hear differently:
Count your grams of protein vs don’t
Count your calories vs don’t
How long to wait before drinking after a meal
If or when to add complex carbohydrates to your protein and vegetables
My approach to the bariatric diet
Now that we have covered why some programs will differ (clinical judgement) and what some of the main components of the bariatric diet include, I want to touch some on my particular approach to bariatric eating.
The 2:1 protein method (my preference)
My personal approach to eating after bariatric surgery is to focus on quality over quantity. This means instead of counting calories or grams, focus on what the food is and listen to your body’s natural cues.
For the majority of post-op patients, I advise three meals a day at consistent times day to day and focusing on hydrating fluids in between those meals.
At meal times, I use the “2:1 protein method” as a way to approach eating with a simple ratio instead of weighing and counting food. Eat two bites of protein to one bite of vegetables (2:1) and pause in between each bite to see if you are comfortable or need another bite.
This approach also grows with patients as they get further out from surgery so the approach doesn’t change even if it’s been a decade since the operation.
Certainly if patients are further out of surgery and having hunger for a snack, a protein based snack is just fine especially if water goals are met. Here is a link to my “Am I Really Hungry” flow chart that has patients asks a series of questions if they are hungry in between meals. It helps identify if it’s true hunger or if it’s more related to the emotional side of eating.
For more information on my particular approach, I have a video course for Gastric Bypass and Gastric Sleeve patients. (The course for DS patients is not available yet but primarily the approach is the same.)
Next up we are going to talk more about macros. This question came up quite a bit when I asked what diets post-ops wanted to know about. This will be a good way to get us started before we move into keto or other diets that use macros as the foundation of their eating style.