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The Bariatric Food Pyramid


The key to long-term success with bariatric surgery is certainly life-long dietary modification.

While most guidelines focus on the immediate needs of patients undergoing bariatric surgery, long term nutrition continues to be an important issue, even in weight-stable patients.

As people with bariatric surgery tend to eat far fewer calories than before and (depending on the type of surgery) may be more prone to certain deficiencies, a “balanced” diet for them will look very different from that recommended for the general population.

This issue is now addressed in a paper by Violeta Moize from the University of Barcelona, Spain, just published in OBESITY SURGERY.

Based on the current knowledge of dietary strategies and behaviors associated with beneficial long-term nutritional outcomes in post-bariatric surgery patients, the researchers have developed a “bariatric food pyramid”, that can be used as a teaching tool and reminder to patients.

Given the nature of the operation and the physiological demands of this very special patient population, it is not surprising that there is a strong focus on high-quality protein, balanced with nutrient-dense complex carbohydrates and healthy sources of essential fatty acids.

Hopefully this tool will help both therapists and patients better understand nutrition recommendations for a healthy long-term post-op diet.

AMS
Station Touristique Duchesnay, Quebec

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Moizé VL, Pi-Sunyer X, Mochari H, & Vidal J (2010). Nutritional Pyramid for Post-gastric Bypass Patients. Obesity surgery, 20 (8), 1133-41 PMID: 20401543

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22 Comments

  1. Awesome paper which summarizes nicely nutrition principles for gastric bypass patients. It should be of use to both professionals and patients. Thanks Arya!

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  2. The chart is not very clear.
    1. The bottom part suggests supplements as a base. Why do people need to put these in there bodies when they could eat fruits and vegetables and others to ensure vitamin and mineral content?
    2.This second most important part talks about meats and dairy products again as thought they are more important than fresh fruits and vegetables.
    3.Here is the important section. It should be #1. The portion frequencies are all wrong also.
    Just an opinion. I never assume people understand something because I do. Unfortunately the medical field often does.
    Thanks for listening.
    What do you think Doc?
    Pierre
    Thee Quest For Perfect Health

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  3. @Pierre Trudel: the key to understanding this pyramid is that it is ONLY meant for post-bariatric surgery patients. Most of these patients need supplements because as a result of their surgery they are unable to eat enough fruit or vegetables to meet their daily nutritional needs. As they are only eating around 1400 KCal/day, they need to focus on meeting their protein needs first before eating “fillers” like carbs. Thus for post bariatric patients it is indeed more important to eat their daily meats and dairy products than fruit of vegetables. This is indeed the exact opposite of the normal food pyramid for non-surgical patients.

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  4. Dr. Sharma, I am trying desperately to avoid bariatric surgery. I am terrified of doing something irreversible to my body, I loathe the loose skin problem, and to be honest I might be able to sue my insurance company and force them to pay for the procedure, but I could never afford the plastic surgery necessary to finish the job of making me look like a human being. What would be your first impression of following the same diet as a bariatric patient without the surgery? Does the surgery somehow actually make this way of eating possible, where it would be impossible without the surgery?

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  5. @Speedwell: As noted earlier – this is NOT a diet for weight loss or for patients who have not had bariatric surgery! I cannot make individual recommendations on this site, but in general terms, this diet is neither recommended for weight loss nor will it likely be possible to maintain this diet without having had bariatric surgery. Surgery, by reducing the size of the stomach and/or changing absorption of nutrients allows patients to live by consuming only around 1400 calories a day forever. Most patients trying to eat so little without surgery will likely be hungry all the time and will therefore eventually fail.

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  6. Thanks Doc for making that clear to me.
    One question, would they not get the nutritional values if they ate fruits & vegetables juiced or as smoothies?
    Thanks for all your advice and I follow you everyday.
    I also tweet all your articles to my followers.
    Pierre Trudel
    Thee Quest For Perfect Health
    theequest.com

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  7. @Pierre Trudel: Due to the reduction in stomach size, patients may not be able to eat that many fruits and vegetables. Smoothies may cause dumping syndrome and lead to too many calories. As surgery may affect digestion – not all nutrients may be easily absorbed.

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  8. Hello DR. Sharma. Your discussion with Pierre Trudel sparked some interest on my behalf. I know that some bariatric surgeons in the USA recommend a raw whole food concentrate in a powdered form post and pre surgery in order to build and maintain the immune system. It is a powdered concentrate allowing for quick digestion and room for the desired protein as you indicated. Being that it is powdered fruits, vegetables, grains, grapes and berries, the recipients receive the essence of 7 to 8 servings every day, it requires very little room for digestion and is quickly absorbed into the blood stream. This concentrate also delivers phytonutrients that combat inflammation and oxidative stress; it is virtually free of sugar and salt, suitable for those people that have diabetes, high blood pressure and high cholesterol. My e-mail is biluba@netscape.ca if one wishes more discussion???

    Bill Moe

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  9. Dear doctor: Could you please send me an enlarged photo of the new pyrmaid so that I could study it better. The bottom line has physical activity and this can prove a problem for a person like me because I have OA in one foot and need surgury to pin that and reduce inflemation. The other information looks like it will help with my pre-surgery weight-management–Thank you for timely informative and encouraging updates–one of your future patient: I hope

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  10. If everyone ate closer to this pyramid, they wouldn’t need the surgery in the first place.

    The good thing is that it’s fairly low carb, but unfortunately, still fat-phobic. *sigh*

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  11. Hi.Dear .I want to know how much time we have to use this pyramid after surgery?
    when we can start usual pyramid?
    Thank you so much
    Asal

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  12. The changes to your intestines after surgery are permanent. This means that this pyramid is how patients have to eat after surgery forever.

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  13. Would this pyramid be the same for someone who has had gastric sleeve surgery? What is the best diet for someone who has had it done?

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  14. “Would this pyramid be the same for someone who has had gastric sleeve surgery? What is the best diet for someone who has had it done?”

    Part of the logic behind this pyramid is that all people with any kind of bariatric surgery tend to consume fewer calories than before (after all that was the whole point of the surgery).

    Eating fewer calories also means you have to be extremely careful to make sure that you still get all your essential nutrients in your diet – squeezing these into fewer calories is the challenge.

    Therefore this pyramid puts protein and supplements, etc at the bottom and the more or less “empty” calories at the top.

    From that perspective, this pyramid would apply to anyone who is drastically reducing caloric intake – with or without surgery.

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  15. I have a question about fat intake. If I had 3 tsp of olive oil is that my fruit/vegetable servings for the day. Also, how much fat is recommended on this plan. Thank you doctor!

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  16. ” If I had 3 tsp of olive oil is that my fruit/vegetable servings for the day. ”

    Interesting thought but I doubt that dietitians would count olive oil (or any other kind of vegetable oil) as a serving of veggies.

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  17. Dr Sharma, how does this relate to the new ‘plate’ that is out now? Any change??

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  18. I am a dietitian who works with bariatric patients and I really like this pyramid. People do seem confused about it applying to the general population when in fact it applies to those who have had surgery that PERMANENTLY alters their physical anatomy. I would like a full size poster. Is there one available?

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  19. Dear Dr.Sharma,
    i´am a dietitan and diabetes nurse and life in Hamburg/Germany. I works with bariartic patient and i like your nutrition pyramide.
    I would like a full size poster or a pdf-datei? is there on available?

    Kind regards
    Helga

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  20. Where can I get a larger version of this as poster size to keep on my refrigerator? When I blow up this one it is blurry. I love this, live by it, and need it in my face everyday! Thank you.

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  21. Did a larger version of the chart come out? I would be willing to pay for the chart as it’s a very valuable tool! Thanks so much for your work. I had bariatric surgery Jan 16 and have lost 74 # as of today. No problems whatsoever, but I always am looking at supplements to complete a healthy day and healthy life.

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  22. What frustrates me is the cost of this surgery. It sucks really

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