Diet stages of laparoscopic adjustable gastric band

LAGB diet stage*	Begin	Fluids/food	Guidelines
Stage I
	Postoperative days 1 and 2	LAGB clear liquids: Non-carbonated; no calories No sugar; no caffeine	Postoperative LAGB day 1, patients may begin sips of water, ice chips, and no sugar liquids; avoid carbonation
Stage II
Begin supplementation: Chewable multivitamin with minerals x 2/day Chewable or liquid Calcium citrate with vitamin D	Postoperative days 2-3 (discharge diet)	LAGB clear liquids: Variety of no-sugar liquids or artificially sweetened liquids Plus LAGB full liquids: No more than 3 g fat per serving protein-rich liquids	Patients should consume a minimum of 48-64 ounces of total fluids per day, 24-32 ounces or more ounces LAGB clear liquids, plus 24-32 ounces of any combination of full liquids:
			1% or skim milk mixed with:
			Whey or soy protein powder if lactose intolerant
			Lactaid milk or soy milk mix with soy protein powder
			Light yogurt, blended
			Plain yogurt
Stage III
Week I	Postoperative days 10-14*	Increase LAGB clear liquids (total liquids 48-64 plus ounces per day) and replace full liquids with soft, moist, diced, ground, or pureed protein sources as tolerated - as evidenced by the absence of excessive fullness or bloating, nausea, or vomiting. Stage III week 1: Eggs, ground meats, poultry, soft, moist fish, added gravy, bouillon, light mayo to moisten, cooked bean, hearty bean soups, cottage cheese, low fat cheese, yogurt	NOTE: Patients should be reassured that hunger is common and normal after LAGB
			Protein food (moist, ground) choices are encouraged for 3-6 small meals per day, to help with satiety, since hunger is common within a week or so of LAGB
			Mindful, slow eating is essential
			Encourage patients not to drink with meals and to wait ∼30 minutes after each meal before resuming fluids
Week 2	4 weeks postoperatively	Advance diet as tolerated. Tofu is a good choice as it is soft. Dense, chewy foods such as tough meats and doughy breads should be avoided as they may cause obstruction. Avoid high-calorie soft foods such as ice cream.	Adequate hydration is essential and a priority for all patients during the rapid weight loss phase. Protein at every meal and snack, especially if increased hunger noted prior to initial fill or adjustment. Very well-cooked vegetables may also help to increase satiety.
Week 3	5 weeks postoperatively	Continue to consume protein with some fruit or vegetable at each meal.
Stage IV
Vitamin and mineral supplementation daily^¶	As hunger increases and more food is tolerated	Healthy solid food diet.	Healthy, balanced diet consisting of adequate protein, fruits, vegetables, and whole grains; calorie needs based on height, weight, age.
Post-LAGB fill/adjustment
	∼6 weeks postoperatively for LAGB, and possibly every 6 weeks until satiety reached	Full liquids x 2 days post-fill; advance to Stage III, week 1 guidelines above, as tolerated. = x 4-5 days, then advance as above.	Same as Stage II liquids above x 48 hours (and/or as otherwise advised by surgeon). NOTE: When diet advanced to soft solids, special attention to mindful eating and chewing until liquid is key, since more restriction may increase risk for food getting stuck above stoma of band if not properly chewed (eg, if not chewed until liquid).

LAGB: laparoscopic adjustable gastric band.
* There is no standardization of diet stages; there are a wide variety of diet protocols varying from how long patients stay on each stage and what types of fluids/foods are recommended.
¶ Nutritional labs should be drawn at 2, 6, 12 months and yearly indefinitely; bone density test at baseline and every 2 years.

Table provided with permission: Sue Cummings, MS, RD, LDN; MGH Weight Center, Boston, MA.

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Diet stages of laparoscopic adjustable gastric band