Obesity surgery (i.e. bariatric surgery) has different procedures on display. All of them are expected to improve the nutritional behaviour of the patients after surgery. First, bariatric operations have their own consequences that make initial eating difficult - which can last for a few weeks or months depending on the type of operation ; second, the surgery is not a miraculous tool, and gives the patient an opportunity to change deeply his former habits and learn how to eat properly.
Immediate advice after gastroplasty are detailed in the corresponding chapter. Here are some advice that can be given a while after operation, when the patient is likely to cope with it according to his own pace. These advices have been designed for a stapled gastroplasty or a lap-band operation, but one can adapt them for each kind of operation.

General advice or golden rules of eating and exercise:

Eat three small meals per day:
The upper stomach is made to hold about the amount of food you can fit into half a glass. If you try to take more than on a single occasion, it is likely that you will feel sick and vomit. You must therefore learn just how much your stomach can accept at any one time and not ever go beyond that.

Eat only good solid food:
You can’t eat very much and therefore you must eat the right foods and not waste your capacity on nutritionally poor food. It is important that the food you take is solid food. The operation does not work for liquid calories. They simply run through without any particular resistance and no feeling of fullness will be obtained.
As far as possible then the foods should be as solid and as dry as possible, and liquid calories, regardless of how healthy they may seem to be should be avoided. Eat apples and oranges, do not drink apple juice and orange juice.

Eat slowly, sense fullness and then stop:
When the stomach is full, signals will tell you that you have had enough. Try to make each meal as long as possible, always be trying to sense that the stomach is approaching fullness, and then stop regardless of whether there is food on the plate or not.

There must be no eating between meals:
Once the meal is finished it is essential that you take no further food until the next meal time/ One of the greatest cause of failure is the taking of snacks between meals.

Take no liquid with the meal:
If you take liquids with your meal the benefits of the procedure will be weakened. They should be avoided for about two hours after the meal.

All liquids must be of zero calorie content:
Any calorie containing liquids simply flow past the restriction of the band and will be able to maintain your weight in spite of all your other best efforts. You should only drink water, mineral water, tea or coffee (preferably without milk or sugar) and low calorie soft drink.

Exercise for at least 30 minutes each day:
This is at least as important as all the other rules. Not only must you take in less calories but you must use more and the exercise will improve your general health as well. Initially while you are morbidly obese this is difficult, but as your weight decreases it becomes easier as you become fitter and healthier, and you will get greater enjoyment from it.

Make it a habit to walk instead of using the car. Become active in the garden and do things yourself instead of using machines. Put together at least 30 minutes of moderate intensity physical activity on most and preferably all days. Start off with exercises such as walking and swimming and progress to more vigorous walking or even jogging, aerobics and bike riding. As your weight comes down your exercise capacity will increase and your general activities during the day will increase.

Your exercise programme should be designed to generate a significant aerobic demand. You should be puffing and if you check your pulse it should be up around 120-140 beats per minute. Generally this can be best achieved by outdoor exercises or by aerobics classes at the gym. Exercise devices in the home are often not as effective and it is not so easy to continue pushing yourself over an extended period of time.

Your food guide:

Foods that are high in protein and foods that are high in complex carbohydrates are best. Foods that are high in fats or in simple sugars are worst. As far as possible restrict your range to the good foods. This will include vegetables, fruits, meats, eggs, cereals, breads and cereals and dairy products range.
Remember also that gastroplasty only works with solid food and therefore even within the good food groups you have to avoid the liquid forms of these foods. Eat vegetables rather than vegetable soup and eat an apple rather than drinking apple juice. Try to select the foods listed under the following food groups each day.

Fruit and Vegetables:
Aim for 2-3 types of vegetables; 1-2 pieces of fruit - fresh, stewed or canned (with no added sugar) every day.
Initially you may have to remove the skin from fruits and vegetables and choose mashed or softly cooked vegetables and cooked or tinned fruit.
Ensure that you have some of a dark green or orange vegetable daily, but make sure that it is well cooked, soft and mushy.

Breads and cereals:
Aim for one small bowl of cereal; 1-2 slices of bread a day.
Use wholegrain, wholemeal or rye breads.
Remember to thinly scrape on the low calorie spread.
Chose wholemeal breakfast cereals, e.g. Weetabix, rolled oats.

Meat, fish, poultry, eggs:
Aim for 30-45 gms of meat, fish or poultry, or an egg each day.
Remember to always: remove all visible fat from meat, remove skin from poultry, use low fat cooking methods such as grilling, steaming, microwaving or boiling (avoid frying). Use lean mince and soft meats initially. Avoid sauces and gravies.

Dairy products:
Theoretically, milk and yoghurt are liquid forms of calories ans should be avoided. However, these foods are an essential part of a healthy diet for the calcium they provide. For this reason these foods are permitted in restricted quantities.
A maximum of 500 mls of low fat milk or yoghurt is permitted.
This includes use on cereal, in tea and coffee and in cooking.
A maximum of 30 grams of cheese is permitted.

Fats:
Limit your intake to 3-4 teaspoons of margarine, oil each day.
Low fat salad dressings and mayonnaise is allowable in moderation.

Fluids:
Drink as much zero calorie fluid as you wish each day.
Suitable fluids are: Tea and Coffee, Plain water, Low calorie cordials, Clear Soup, Mineral Water, Low calorie soft drinks.

Foods to be avoided:
Foods such as sugar and those foods and beverages containing large amounts of sugar, e.g. soft drinks, cordials, rich cakes and biscuits, jam, honey, contain very little food value.
Other concentrated sources of energy are high fat foods such as chocolate, chips, pies and pastries. These foods should also be avoided. Alcoholic beverages, including beer, wine, spirits, diet beer, liqueurs, port, sherry, cocktails, champagne and diabetic wine contribute a concentrated source of energy to the diet but with no other nutritional benefit, therefore we recommend that in general you avoid these beverages.