NUTRITION
At the intragastric balloon, the success doesn’t depend solely on the procedure. The nutritional support is essential to obtain satisfactory results, aiming a healthy weight loss. There are important nutritional actors that must be clear so that there’s not a higher accession from the patient. The dietotherapies accession will depend from the abilities of the nutritionist professional to adjust the recommendations to the patient’s lifestyle and individual preferences.
GOALS
The aim of the nutritional accompaniment during the pre-procedure period is the increase of the potential success and aims to promote the initial weight loss, reinforce the patient’s perception that the weight loss is possible when the energetic balance becomes negative, identify errors and eating disorders, promote real expectations of weight loss, prepare the patient for feed and to verify the patient’s potential for the procedure’s success. A good comprehension about the alterations of the capacity, gastric function and dietetics restrictions is decisive to achieve a great result after the procedure. The plan of the gradual introduction of food must be performed with resources that ensure the comprehension about the gastric capacity, potential physiological discomforts and consequences that may occur if the protocol isn’t followed. The individual’s responsibility at the self-care is emphasized during this stage.
The elaboration of the proposed protocol initially considered the guidelines about the evolution of the consistencies reported in literature, but, during the daily contact with the patient, it was verified the need to make some adaptations in what concerns the time needed of contact during the pre-operatory, enough to perform an effective work, and, in what concerns the evolution of consistencies, in a way to provide a higher comfort for the patient. Only after the nutritional evaluation it can be stated if there is or not a balloon indication for the patient. It’s important to emphasize that all professionals from the team (endoscopist, anesthetist, nutritionist, psychology and a physical educator), reunite to discuss cases and the patient’s release for the procedure.
To make a lasting and effective success around the procedure, the dietary behavior of these patients must be gradually monitored, in a way that occurs a weight loss and the depletion of vitamins, minerals and proteins be avoided.
The nutritionist must guide the progressive evolution of foods according to their compositions and consistencies, helping with the meal planning and to be alert to possible disabilities.
Before the definition of the Orbera’s placement, the patient must obligatorily schedule an appointment with the nutritionist; this way, the procedure can be performed with safety for the team and patients.
1st APPOINTMENT
- Nutritional anamneses;
- Anthropometric evaluation;
- Delivery of the statement of responsibility;
- Liquid diet for 24hrs before the procedure;
- 12hrs of fasting before the procedure.
RESTRICTED LIQUID DIET (72 hrs): Diet to adapt the balloon and to avoid dehydration, must be fractionated in small volumes, several times of the day, according to the acceptance. It might be consumed: water, coconut water, jelly, fruit popsicle and teas.
COMPLETE LIQUID DIET (12 days): Introduction of liquid and low-caloric foods; all of them must be blended and strained. It might be consumed: fruit, yogurts, fruit juices, blended and strained soups.
2nd APPOINTMENT – 15 days after the procedure
CREAMY DIET (15 days): Introduction of creamy foods, always in small portions, respecting the time fractioning. It might be consumed: vegetable puree, fruit meal, white cheese and hardboiled egg.
In this appointment, the patient must be guided to the next step of creamy diet, must be careful to not introduce carbohydrates in excess and to raise awareness for the practice of physical activates.
3rd APPOINTMENT – 30 days after the procedure
PASTY DIET (15 days): Introduction of creamy foods, always in small portions, respecting the time fractioning. It might be consumed: fish fillet, minced meat, shredded chicken and cooked vegetables.
4th APPOINTMENT – 45 days after the procedure
SOFT DIET (45 days):Introduction of creamy foods, always in small portions, respecting the time fractioning. It might be consumed: whole grains, thins meat, cooked vegetables and fruits.
5th APPOINTMENT – 90 days after the procedure
GENERAL DIET (45 days):Introduction of all foods, always in small portions, respecting the time fractioning. It might be consumed legumes and raw leaves.
6th APPOINTMENT – 135 days after the procedure
DIET SPECIFICALLY MADE FOR THE PATIENT. IT MUST BE PRIORITIZED FOOD PREFERENCES, LIFE HABITS, FOOD PROFILE, LONG TERM OBJECTIVES, PHYSICAL ACTIVITIES.
7th APPOINTMENT – 165 days after the procedure
LIQUID DITE (72 hrs):This diet is essential for the cleanliness of food residues within the balloon. Must be strictly followed to ensure the patient’s safety.
The patient must consume light or zero refrigerants to help the balloon’s cleanliness.
Absolute fasting of 12hs or according to the medical guidance.
8th APPOINTMENT – 180 days after the procedure
The next diets must be elaborated according with the patient’s goals, in a individualized way, respecting the individual preferences, physical activities and life habits.
The weight loss is intense, especially during the first two weeks after the procedure. The slimming accelerated rhythm is observed until the third month and then it begins to slow down. This is a natural procedure of physiological adaptation that makes the body spend less daily energy to avoid that the weight loss is fast and permanent, and may result in malnutrition.
The best way to improve the weight loss rhythm during this stage is the regular physical activity. The exercises make the body spend more energy, which helps in the weight loss, besides bringing a well-being and relaxed feeling.
Medical assistance must be reached to evaluate the proper moment to initiate the exercises and a physical educator to choose the best kind of activity to be performed.
The nutritional follow-up will be essential to the dietary re-education, aiming the acquisition of good dietary habits to promote an excellent quality of life.
BIBLIOGRAPHIC REFERENCES
- Bonazzi CL., Valença MCT., Bononi TCS., Navarro F. A intervenção nutricional no pré e pós operatório da cirurgia bariátrica. São Paulo: Revista Brasileira de Obesidade, Nutrição e Emagrecimento; 2007.;10p.
- Ybarra J., Hernández JS., Pérez A. Hypovitaminosis D and Morbid Obesity. Barcelona: Nursing Clinics of North America; 2007; 9p.
- Cruz MRR., Morimoto IMI.Intervenção nutricional no tratamento cirúrgico da obesidade mórbida:resultados de um protocolo diferenciado. São Paulo: Revista Nutrição; 2004; 10p.
- Silva APMF, Furtado RPC, Barros AR, André JCS, Fagundes CT. Acompanhamento nutricional em cirurgia bariátrica- Experiência do Hospital Naval Marcílio Dias. Rio de Janeiro: Arquivo Brasileiro de Medicina Naval;2005; 07p.
- Faria SL, Lopes T, Vieira M, Kelly EO, Faria OP. Sugestão do Uso da Pirâmide Alimentar em cirurgia bariátrica. São Paulo: Nutrição em Pauta; 2008; 7p.
- Faria SL, Kelly EO, Faria OP. Acompanhamento Nutricional Pós Cirurgia Bariátrica. São Paulo: Nutrição em Pauta; 2008; 4p.
Bye Maria Angélica Monteiro Grecco
Nutricionist/ Personal Diet – CRN 26241
Expert in Clinical Nutrition.
Espert in Enteral and Parenteral Nutrition.
Member of the Brazilian Society of Bariatric and Metabolic Surgery