After Obesity Surgery

The following programme contains scientific information. Our patients need to stay as much as possible within the programme to have a comfortable post-surgery experience, minimise risks, and lose weight healthily.

The information we share is not individual medical advice but general medical information. Surgery is the beginning of our journey towards health.

How to Lose Weight After Surgery?

Since we remove the part of your stomach that struggles to feel full, expanding to 80-85% smaller volume, you will start to feel full with much less food in the initial post-surgery period. Also, with the removal of the Fundus area, the secretion of the hunger hormone will decrease by 90%, significantly reducing your feeling of hunger and starting your weight loss. Initially, your stomach volume is 60 ml, reaching 240 ml (1 cup) by the 8th week.

Expected Changes in Body Weight;

In the first month after surgery, 20% of excess weight is expected to be lost, about 10% in the second month, and 5-10% from the third month onwards.

This expected weight loss is directly related to your adherence to the programme and your metabolic rate. Do not worry if your weight loss deviates from these rates.

For example; in a patient with an ideal weight of 75 according to body mass index and weighing 125 kg; an average loss of 10-12 kg in the first month, 5-7 kg in the second month, and 3-5 kg in the third month is expected. Even if there are pauses in losing weight during the period of adapting to your new lifestyle and depending on your metabolic rate, you will continue to actively lose weight in the first 12 months.

From the sixth month onwards, as you reach your ideal weight, significant weight gain is not expected as long as nutritional rules are followed and supported with exercise.

How to Achieve Healthy Weight Loss;

Adopting habits such as not skipping meals, chewing thoroughly, adequate nutrition, paying attention to solid-liquid separation, nourishing with protein-rich foods, and consuming sufficient fluids will ensure healthy weight loss and maintain weight loss permanently.

NUTRITION

Your tissues' early healing and adaptation will be achieved by adhering to the programme. It is important not to advance the periods included in the programme too early.

Each patient's nutrition regimen and compliance are different. Therefore, it is not correct for patients to take advice from other patients or give advice to others. It should not be forgotten that healthy weight loss and permanent weight loss are directly related to nutrition.

Including the nutrients your body needs in your nutrition plan is important. These include;

WATER: As water is the main building block of the body, a minimum of 1-1.5 litres should be consumed daily. Because water should be sipped, it is necessary to have a water bottle with you at all times after surgery.

Dark urine colour is a sign of not consuming enough water. Weakness, dizziness, headache, fatigue, fainting, etc., are primarily caused by dehydration due to insufficient fluid intake.

VITAMINS: The body generally obtains the vitamins it needs from outside sources.

Due to the different effects of these vitamins, their deficiencies can lead to various problems such as weakness, nausea, hair loss, fainting, feeling cold, forgetfulness, inability to concentrate, numbness, depression, vision problems, and sexual issues.

MINERALS: They play a role in the biological functions of many of our systems, such as nerves, digestion, and immunity. Deficiencies can occur in digestive system surgeries.

The main cause of hair loss is iron and zinc deficiency. Consuming foods rich in minerals in our meals will be beneficial.

PROTEIN: After these surgeries, it is necessary to nourish with different types of protein. Normally, the daily protein needed is about 70-100 grams.

NUTRITION PROGRAMME

From the day you are discharged, you have 4 main nutrition periods. The measurements are specified according to the cups found at home (240 ml), and do not forget to calculate your meals with the cup size at home.

FIRST PERIOD - LIQUID PERIOD (Days 1-14)

During this period, the size of your stomach is 60 ml (a quarter cup). The maximum amount of food you can consume at one time should be 60 ml. During this period, it is important to consume an average of 2-3 litres of liquid per day, half of which should have high nutritional content. The liquids you consume should be free of particles and able to pass through a straw or sieve. Large sips should not be taken, and at least 1-2 minutes should be waited between sips. Sips can be gradually increased as long as discomfort is not felt. Carbonated drinks should never be consumed. Very hot or very cold drinks should not be consumed. Cinnamon, cloves, turmeric, etc., can be added to water for flavour. The consumed liquids should be sugar-free, non-carbonated, and preferably rich in protein.

SOLUTIONS TO PROBLEMS YOU MAY ENCOUNTER DURING THE FIRST PERIOD

If you feel pain or vomiting, take a 10-15 minute break and reduce the sips. Do not forget that you have undergone major surgery and need to nourish rich in protein. If you feel a gnawing sensation in your stomach, you can consume one of the recommended drinks. If you get bored of liquid intake and tired of consuming frequently, you can try particle-free foods like smoothies.

RECOMMENDED FOODS FOR THE FIRST PERIOD

RICH IN PROTEIN	RICH IN VITAMINS AND MINERALS	CAN BE CONSUMED IN SMALL AMOUNTS
Meat, chicken, and bone broths	Herbal teas	Sugar-free tea
Particle-free, gas-free soups	Coconut water	Sugar-free jelly
Lactose-free, fat-free milk	Freshly squeezed seasonal fruit juices
Lactose-free, fat-free milk	Strained tomato juice
Soy milk	Strained vegetable juices
Watery kefir	Smoothie types

EXAMPLE NUTRITION PLAN;

Morning Hours (08:00-10:30)

Lactose-free milk mixed with freshly squeezed sugar-free fruit juice (Half a cup-120 ml) Herbal tea, fruit juice (Half a cup-120 ml) 1 cup WATER (240 cc)

Midday Hours (10:30-16:30)

Meat, chicken, bone broth (one of these) or soup (Half a cup-120 ml) Freshly squeezed or 100% natural fruit juice (Half a cup-120 ml) Sugar-free fruit jelly (Half a cup-120 ml) Kefir (Half a cup-120 ml) 1 cup WATER (240 cc)

Evening Hours (16:30-22:30)

Meat, chicken, bone broth (one of these) or soup (Half a cup-120 ml) Coconut water (Quarter cup 60 ml) or fruit juice (Half a cup-120 ml) Tomato or vegetable juice (Half a cup-120 ml) Sugar-free tea or herbal tea (Half a cup-120 ml) 1 cup WATER (240 cc)

This programme can be modified as per your request with equivalent foods from the above list. The specified amounts should not be consumed at once but according to the rules mentioned in the descriptions.

SECOND PERIOD – PUREE PERIOD (Days 15-28)

During this period, the volume of your stomach is 120 ml (about half a cup). Each meal should not exceed 120 ml. The foods to be consumed must be thoroughly blended to a yoghurt consistency and should not be chunky. Foods should be consumed slowly, in small bites, chewed well in the mouth, and not swallowed abruptly over at least 30 minutes. 5-6 meals should be consumed per day, and at least 1 hour should be left between each meal. Liquid intake should be stopped 30 minutes before eating and should not be consumed with meals. Liquid intake should resume 30 minutes after finishing the meal. The meal should be stopped as soon as a feeling of fullness occurs. When starting a new food, begin slowly and increase the amount if no problems are experienced. If you experience pain or similar discomfort, you are not yet ready to consume that food. Care should be taken to ensure that meals are spice-free if you struggle with consuming spices. As much as possible, attention should be paid to consuming nutritionally diverse foods. For example, if you consume meat at noon, try to consume fish or chicken in the evening. From the 15th day, you can try consuming tuna.

SOLUTIONS TO PROBLEMS YOU MAY ENCOUNTER IN THE SECOND PERIOD

If you feel any pain or nausea, the meal should be stopped, and nothing solid or liquid should be consumed for at least 30 minutes. If a feeling of excessive fullness occurs after eating, you should eat more slowly, and the amount eaten should be reduced.

RECOMMENDED FOODS FOR THE SECOND PERIOD

RICH IN PROTEIN	RICH IN VITAMINS AND MINERALS	CAN BE CONSUMED IN SMALL AMOUNTS
Milk, yoghurt, kefir	Boiled potatoes	Sugar-free dairy desserts
Cheese varieties***	Sugar-free prepared purees	Diabetic hazelnut, peanut butter
Vegetable dishes***	Fruit purees (Peeled and non-acidic)	Biscuits, crackers
Soup varieties***	Olive, avocado paste	Honey
Soft-boiled egg	Broccoli, carrot, spinach, celery, artichoke
All foods from the first period	All foods from the first period	All foods from the first period

NOTE: *** Foods marked with asterisks should not be consumed without being blended.

EXAMPLE NUTRITION PLAN

Morning Hours (08:00-11:00)

Soft-boiled egg White cheese, olive paste Blended seasonal fruits (except acidic ones like orange) WATER 300 ml (1.2 cups)

Midday Hours (11:00-18:00)

Vegetable soup prepared with meat or chicken broth (vegetables blended) Yoghurt Blended seasonal fruits (except acidic ones like orange) WATER 300 ml (1.2 cups)

Evening Hours (18:00-24:00)

Potato puree enriched with meat broth or blended protein-rich other foods (From the 3rd week, blended fish) Banana or blended other seasonal fruits, Sugar-free pudding, custard (one of these only) WATER 300 ml (1.2 cups)

THIRD PERIOD – Soft Solid Food Period (Weeks 5-6)

During this period, the volume of your stomach is about 140 ml. Each meal should not exceed 140 ml. As each person's food tolerance differs during this period, a different food should be tried every day. The consistency of the foods should be such that they can be consumed with a fork. 3-4 meals should be consumed per day, and at least 3 hours should be left between meals. If meals are not completed, there is no need to wait 3 hours. Liquid intake should be stopped 30 minutes before eating and should not be consumed with meals. Liquid intake should resume 30 minutes after finishing the meal. Foods should be chewed thoroughly and consumed in small bites. The meal should be stopped as soon as a feeling of fullness occurs. When transitioning to a new food, start eating very slowly and continue if no problems are experienced. If you experience pain or similar issues, you are not yet ready to consume that food. To develop a dietary habit, 3 main meals per day and 1-2 pieces of fruit should be consumed between meals, even if you do not feel hungry, chewing well. Raw vegetables and fruits should be avoided during this period. Meals should not be skipped, and the number of snacks should not be increased.

SOLUTIONS TO PROBLEMS YOU MAY ENCOUNTER IN THE THIRD PERIOD

If issues such as indigestion, heaviness, and intense pain occur, you should revert to the second period's nutrition and continue as in the second period. Once ready, you can start the third period again.

RECOMMENDED FOODS FOR THE THIRD PERIOD

RICH IN PROTEIN (Must be chopped/minced)	RICH IN VITAMINS AND MINERALS (Must be chopped/minced)	CAN BE CONSUMED IN SMALL AMOUNTS (Must be sliced)
Fish (Grilled, steamed)	Nuts (walnuts, hazelnuts, etc.)	Toasted bread
Meatballs (Grilled, baked)	Seasonal fruits	Fat-free cereal with skim milk
Chicken (Fat-free, minced)	Cooked Vegetables (Zucchini, green beans)
Well-cooked egg	Salad
All foods from the first and second periods	All foods from the first and second periods	All foods from the first and second periods

EXAMPLE NUTRITION PLAN

Morning Hours (08:00-11:00)

Skim milk or tea (Half a cup-120 ml) Well-cooked egg, (not fried) A slice of white cheese, WATER 300 ml (1.2 cups)

Midday Hours (11:00-18:00)

Minced vegetable dish or fish, Banana or broken down other seasonal fruits, A small amount of nuts (chewed well) Diluted buttermilk or kefir (Half a cup-120 ml) WATER 300 ml (1.2 cups)

Evening Hours (18:00-24:00)

Broken down meat, chicken, fish, or other protein-rich food varieties prepared in a broken down form, A small amount of nuts (chewed well) Herbal teas WATER 300 ml (1.2 cups)

FOURTH PERIOD – Normal Foods (Weeks 6-8 and afterwards)

EXAMPLE NUTRITION PLAN

Morning Hours (08:00-11:00)

Low-fat milk, low-fat cheese, egg Fruit juice closer to noon Calorie-free liquids (tea, water, herbal teas)

Midday Hours (11:00-18:00)

Low-calorie foods are rich in protein, vitamins, and minerals (Lean meat, fish, chicken, legumes, vegetable dishes) Stay away from ready meals and fatty foods. Seasonal fruits, 3 hours after the main meal, a light snack such as soup, buttermilk, yoghurt, muesli, nuts, fresh fruit, Calorie-free liquids (tea, water, herbal teas)

Evening Hours (18:00-24:00)

Low-calorie foods are rich in protein, vitamins, and minerals (Lean meat, fish, chicken, legumes, vegetable dishes) Stay away from ready meals and fatty foods. Seasonal fruits, 3 hours after the main meal, a light snack such as soup, buttermilk, yoghurt, muesli, nuts, fresh fruit, Low-calorie light desserts, Calorie-free liquids (tea, water, herbal teas)

WHAT SHOULD BE DONE FOR IDEAL AND PERMANENT WEIGHT LOSS?

Consuming 1000 kcal in the first year is not a problem. A protein-based diet leads to the breakdown of fats and healthy weight loss. A protein-based diet is important for permanent weight loss, bone, hair, nails, hormonal regulation, enzymatic activity, and the immune system. After the first year, you can consume up to 1200-1300 kcal of food by following recommendations.

Eat regularly and balanced;

It is important to nourish primarily with fresh and natural foods that are protein-based and have diverse nutritional content, focusing on vegetables and fruits.

Make a solid-liquid separation and consume enough fluids;

It is important to consume your drinks 30 minutes before or after meals. The desire to drink water immediately after meals will gradually disappear. At least 1.5 litres of fluid should be consumed daily.

Do not skip meals;

In the first month, you should organise your meals to include 3 main meals and 2 snacks per day. It is very important not to skip meals and not to stay hungry for long periods. From the second month onwards, you should transition to a maximum of 4 meals.

Take time for eating;

Even if you eat less, spend at least 30 minutes on your meal. It is important to take small bites, leave time between bites, and chew thoroughly before swallowing.

Do not force yourself;

When you feel very hungry, remember that the capacity of your stomach is small. Taking small portions and stopping when you feel full will prevent you from gaining weight.

Adopt healthy eating as a habit;

You should motivate yourself to continue healthy eating not just as a temporary phase but as a lifelong practice. It is important to explore healthy foods that you love and can easily access.

WHAT TO AVOID

SMOKING;

Smoking should be strictly avoided as it can affect the healing period of your wounds after surgery. Smoking can increase the rates of complications such as leakage, bleeding, and prolong your recovery process. Respiratory problems, vomiting, pain, nausea, loss of appetite, hunger, gnawing, embolism, ulcers, and other risks may increase in post-surgery smokers.

CARBONATED DRINKS

The gas dissolved in the stomach can cause stretching and pain by straining the reduced stomach. Carbonated drinks can cause leaks in the early days. Carbonated drinks should be avoided for life.

ALCOHOL

Alcohol consumption should be avoided during the first 12 months of recovery. Alcohol causes dehydration in the body. Also, due to its high calorie and low nutrient content, it should not be consumed during the 12 months when eating and drinking are restricted. Even after 12 months, it is recommended to consume it in very small amounts.

CAFFEINATED FOODS

These foods should not be consumed post-operation due to their diuretic and fluid loss effects and the potential to cause palpitations. After 6 months, they can be consumed in small amounts.

EXERCISE AND SPORTS

Exercise and sports are very important for a healthy life and permanent weight loss. Starting sports simultaneously with weight loss after bariatric surgery is important to minimise or prevent sagging.

Adjusting metabolism and body balance, balancing breathing, active and balanced nutrition, and increasing mobility are achieved through exercise.

You can start walking for 30 minutes a day immediately after being discharged. Initially, start with low intensity and gradually increase the duration. Initially, aim for 200 minutes per week, and in the long term, aim for 400 minutes of exercise per week. Resistance exercise can slowly be added after 1 month to prevent muscle loss and increase fat breakdown.

• No strenuous exercise should be done in the first 4 weeks.
• No lifting over 7 kilos should be done in the first 6 weeks.
• No abdominal exercises should be done in the first 12 weeks.

WALKING

Make time for walking wherever you are. Increase your walking duration day by day from the day you are discharged.

SWIMMING

You can start swimming once the surgical incision sites have healed. You can swim from the 1st month.

BICYCLING

You can cycle at a gentle pace from the first month, along with adequate fluid intake.

SPORTS

The exercises you do in the gym should not be aimed at weight loss but at increasing muscle mass and flexibility. Amino acid-protein supplements should not be taken.

Basic weight exercises can be done. You should get a pair of dumbbells and do exercises without lifting more than 7 kg for the first 6 weeks.

PILATES and ZUMBA

It will help shape your body, gain an aesthetic posture, relax psychologically, and burn calories. It can be started from the 2nd month.

BATHING and CARE OF LAPAROSCOPY INCISIONS

When you are discharged from the hospital, your surgical incisions will be covered with a waterproof dressing material. You can take a bath with this dressing. If the dressing is not soiled with blood or discharge, it should be changed every 3 days.

If there is swelling, redness, bleeding, or discharge at the incision sites, your dressings need to be changed daily. If these complaints continue, you should contact your doctor.

Creams (contractubex), St. John's wort, aloe vera, and baby oil can be applied and massaged on the surgical scars.

WORK LIFE

If you feel well, you can return to desk jobs after 7 days. Those in physically less demanding jobs can return after 14 days, and those in physically demanding jobs can return after 30 days.

TRAVEL and DRIVING

Do not drive for a week after being discharged. Avoid long trips in the first weeks unless necessary. If you must travel, take short walks in the aisle of the plane or bus every hour.

PREGNANCY and SEXUAL LIFE

You can resume your sexual life after 15 days.

Significant improvements in fertility and the quality of sexual life are observed with weight loss after surgery. This is due to the positive effects of post-surgery obesity recovery, mobility, hormonal balance, and increased motivation.

Remember that the health of the baby depends on the parents being healthy. It is beneficial for you and your baby's health to wait 18 months after surgery before getting pregnant.

FASTING

People who have undergone obesity surgery should avoid long periods of fasting after surgery. Problems such as increased acid levels, bile reflux into the stomach, stomach enlargement due to overeating, and not being able to get the necessary vitamins and minerals after surgery can arise. It is recommended not to fast until 24 months after surgery.

SLEEPING-LYING POSITION

For 15 days after surgery, you should not lie on your abdomen. It is recommended to lie on your back or side.

PROBLEMS YOU MAY ENCOUNTER and SOLUTIONS

VOMITING

Vomiting most commonly occurs due to eating too quickly and more than the stomach can handle. Causes of vomiting include:

Eating too much, Eating too quickly, Not chewing food sufficiently, Consuming liquids with foods.

After asking yourself these questions, you should be sure you are not doing any of the listed activities. If vomiting continues throughout the day, stop consuming solid and thick foods and try only clear liquids for 6-12 hours. If vomiting persists for 24 hours, please contact us.

DEHYDRATION (Decrease in the body's fluid-water ratio)

If you cannot consume enough liquids, dehydration can occur. Symptoms include weakness, dark-coloured urine, nausea, dizziness, coated tongue, fainting, sleepiness, back pain, etc. If you experience these symptoms and cannot consume enough liquids, you may need to go to a hospital for IV fluid therapy. In such a case, please contact us.

DUMPING SYNDROME

It is very rare after sleeve gastrectomy. It can occur due to consuming large amounts of foods high in simple carbohydrates, such as sugary foods, ice cream, syrupy desserts, rice, pasta, and potatoes. Symptoms include a feeling of fullness, cramps, nausea, and diarrhoea in the abdominal region. Sometimes dizziness, warmth in the body, weakness, or fainting can be observed. Sweating, and increased heart rate are among the symptoms.

Limiting foods containing simple carbohydrates consuming more protein and not drinking liquids with meals can reduce symptoms.

NAUSEA

It is often due to eating more than your stomach can handle, sensitivity to food odours, painkillers, not eating, and low fluid intake. If nausea persists for more than 24 hours, please contact us.

CONSTIPATION

One of the biggest problems brought by insufficient water intake is constipation. If you encounter this problem, you should first increase your fluid intake. Drinking a warm glass of water on an empty stomach in the morning and increasing fibrous products will help you deal with constipation.

It may be difficult to increase the consumption of fibrous foods in the first weeks, so probiotic-rich yoghurt and kefir can be consumed. Probiotic medication can be used. Being physically active is also important in dealing with constipation. If there is no improvement with these methods, Duphalac syrup can be used morning and evening.

DIARRHOEA

If defecation occurs more than 3 times a day, lactose-containing foods like milk should be limited. Make sure you are eating slowly and chewing well. Limit the intake of fat and spices. It is important not to drink liquids with meals. Liquids taken with meals can cause the food to pass through the stomach tube faster, leading to diarrhoea, nausea, and vomiting. Develop the habit of reading labels and remove foods containing sugar alcohol from your diet. They are listed on labels as sorbit-OL, mannit-OL, etc.

For diarrhoea, you can take probiotic support. If diarrhoea lasts more than 2 days, please contact us.

STICKY LIQUID IN THE MOUTH

The main cause is the reflux of stomach acid and mucus necessary for digestion back into the oesophagus. This problem usually resolves on its own within 3 months. Sleeping with the head elevated, not eating late at night is recommended.

FOOD STUCK

This problem may occur if a solid food is swallowed too quickly or without sufficient chewing. Vomiting may occur. Drinking water on top of it can aggravate the problem. In this case, the thing to do is to wait. Vomiting or gagging in the early stages of surgery can cause separation at the staple (stapler) line due to excessive pressure and lead to late leaks.

HIGH FEVER

Please contact us if you have a fever exceeding 38 degrees after being discharged.

PAIN

Mild to moderate pain is normal after surgical operation. If your pain intensifies despite taking the painkiller (Felden Flash) given to you, please contact us.

DIZZINESS or HEADACHE

Make sure you are consuming enough fluids, not skipping meals, and getting enough nutrients. Measure your blood pressure and add a little salt to your food if you have low blood pressure. If your complaints continue, please contact us.

FATIGUE, WEAKNESS

Pay attention to consuming enough fluids and getting a full night's sleep. Protein-based nutrition and activity are important for alleviating fatigue and weakness.

STOMACH ACID

Consumption of spicy, tomato-based foods, very hot and cold foods can cause this.

LEG CRAMPS

The main cause is a diet poor in Magnesium and Potassium. Insufficient fluid intake can also cause leg cramps. Increase the consumption of kefir, yoghurt and take a multivitamin supplement.

TEMPORARY HAIR LOSS

It can occur at any time between 3-9 months after surgery. Knowing that hair loss is temporary and that your hair will return to normal once the weight loss period is completed is important. In case of hair loss, it is necessary to check iron, zinc, B12 levels and use medication according to your doctor's advice if deficiencies are found.

REACTIVE HYPOGLYCEMIA (Sudden drop in blood sugar)