Post-Op Instructions

Dietary plan after the Orbera^™ intragastric balloon placement

During the first week after placement, you may feel gastric discomfort. Your doctor may prescribe you with oral medication to help you with your symptoms. Reduce your chances of complications by following your doctor’s instructions carefully. Complications may include nausea, vomiting, gastric perforation, bowel obstruction, and premature balloon deflation.

Clear Liquid Diet: 24 — 48 Hours

Let your stomach rest and adjust to the gastric balloon. Follow your doctor's instructions and stay hydrated throughout the day. For the first two to three days, you are recommended to drink clear liquids only. When your stomach adjusts to the balloon, you can intake more varieties of liquids. Some examples of clear liquids are water, ice chips, sugar-free popsicles, crystal light, and strained clear broth (i.e. chicken, beef, and vegetables stock).

• Drink 64 oz. (about 8 cups) of fluid, including water
• Follow your doctor's instructions
• Take vitamins and supplements as directed
• Focus on low calorie beverages such as water, nonfat milk, no-calorie flavored water, no-sugar added apple juice
• Avoid sodas and alcoholic beverages
• Avoid caffeinated coffee and caffeinated tea as it may lead to dehydration.
• Schedule a follow up visit with your doctor

EXAMPLES OF A CLEAR LIQUID DIET

• Water: Bottled, tap, spring, no-calorie vitamin-enrich water
• Light Tea
• Sugar-free Jello
• Clear chicken, beef, and vegetable stock

Full Liquid Diet: Day 2-7

At this point your body is adjusting to the balloon and after about two days you will be able to enjoy full liquids. Examples of full liquids include protein shakes and strained soup. Remember to take small sips and drink liquids slowly. Wait about one to two minutes between sips. Some individuals may have to wait as long as 10 minutes between drinks. It is important to have at least 8 cups of liquid intake per day to stay hydrated. If you are taking medications, please contact your medical staff to see they may have liquid or other alternatives. Clear liquids are also acceptable in this stage.

Follow your doctor's instructions and stay hydrated throughout the day. For the first three days, you are recommended to drink clear liquids only. When your stomach adjusts to the balloon, you can intake more varieties of liquids. Some examples of clear liquids are water, ice chips, sugar-free popsicles, crystal light, and strained clear broth (i.e. chicken, beef, and vegetables stock).

• Take your time between sips
• ake smaller sips to help your stomach adjust
• Fluid intake should not be less than 8 cups per day
• Meal replacement shakes can help meet your calorie intake (Contact your dietician or staff for more information)

EXAMPLES OF A FULL LIQUID DIET

• Everything in the Clear Liquid Diet Above
• Nonfat/Skim milk
• Low-calorie soy milk
• Weak coffee
• Vegetable soup without the chunks such as tomato, cauliflower, and pumpkin soup(strained)
• Low-Fat Yogurt
• Sugar-free popsicle
• Protein shake

Pureed Food: Week 2

During the transition from full liquid diet to a pureed food diet it is important to listen to your body to see if you will be able to tolerate puree foods comfortably. In about a week, you will be able to transition to the next consistency, which are soft foods. Make sure to only continue if you are able to tolerate foods in the previous step comfortably. It is not a race to get to the next step, take your time until you are comfortable to reach the next consistency stage. Remember to stop eating if you feel discomfort or pressure.

• How to make a simple puree:
• Step 1: Cut food in to small pieces and place in to a food processor or blender
• Step 2: Add liquid (such as water, low fat chicken broth or apple juice) to cover the blades
• Step 3: Blend until smooth apple sauce like consistency
• Step 4: Strain out any pieces of food, seeds or lumps
• Step 5: Add spices to flavor the puree. Avoid hot spices such as hot sauce, cayenne, and jalapeno peppers)

EXAMPLES OF PUREED FOOD

• Cottage Cheese
• Pureed Soup
• Pureed Fruit
• Pureed Vegetables
• Baby Food
• Protein Smoothies

Soft Food: Week 3

In this stage, the transition is from puree to soft foods, is designed to prepare you to return to solid foods. Select soft foods that are low in calories, fats and carbs. Always listen to your body to see how well you are adapting to the current transition. Notice any feeling of discomfort, fullness or pressure. These may be signs to slow down or to stop eating completely.

• Use 20/20 rule: Chew food at least 20 times + a meal should take about 20 minutes to finish
• Eat Slowly
• Slow down or Stop eating if discomfort occurs
• Only progress to the next stage if you are comfortable with the current consistency stage

EXAMPLES OF SOFT FOOD

• Soft veggies (over cooked)
• Oatmeal
• Tofu
• Hummus
• Boiled Eggs
• Canned Chicken, Tuna, or Salmon

Solid Food: Week 4

The fourth week is the final dietary transition, which introduces solid foods in to the diet. This is the consistency of food that you will be able to eat from this point forward. The gastric balloon is designed to be a tool to re-train your appetite to help you with your weightless goals. Contact your dietician or clinical staff member if you have any problems, questions or concerns regarding diet and food intake.

• Introduce one solid food at a time and see how it makes you feel. Start with cooked foods before going to raw or hard foods
• Limit starches such as rice, bread and pasta as these foods can cause bad breath by sticking to the balloon
• Drink a glass of water 30 minutes before every meal
• Drink two glasses of water 30 minutes after each meal to rinse the balloon
• Refrain from drinking water during the meal
• Take a multivitamin as directed by your medical practice
• Avoid fried foods, instead bake, boil, barbecue or broil foods
• Limit use of oil, butter, cream, sugar, mayonnaise, jelly, jam, and margarine as they may be high in fat or sugar content.

EXAMPLES OF SOFT FOOD

• Fresh apples
• Fresh cucumbers
• Lean beef steak
• Grilled chicken breast
• Grilled salmon
• Steamed tilapia or halibut
• Salad with light vinaigrette
• Mini turkey meatballs
• Soft or hard boiled egg
• Spinach Frittata
• Cooked Carrots
• Chicken Sandwich
• Boiled Shrimp

Sample Food Guidelines For Orbera

FOOD TYPES	WHAT IS ALLOWED TO EAT/DRINK	WHAT TO AVOID
Beverages	Water No calorie flavored water Decaffeinated teas & coffes Vitamin enriched water(sugar free) No sugar added coconut water	Sodas Sugary beverages Sweetened juices Caffeinated beverages Alcoholic beverages
Dairy Products	Non fat milk Non fat yogurt Non fat dry milk powder Low-fat cheese	Whole milk Sweetened & flavored milk High-calorie yogurt Full cream Whole milk cheese
Meat, Fish, Poultry, Eggs, & Legumes	High protein & lean meats, fish & poultry Steamed, grilled, or baked chicken/turkey Steamed, grilled, or baked fish Steamed, grilled, or baked steak Whole eggs, egg whites and egg substitutes Beans, peas, and lentils	Fried foods Hot dogs High-fat ground meats High- fat Processed foods High-calorie fast foods
Fruits And Vegetables	All fruits are acceptable. However, limit the calorie intake on high-fat fruit such as avocado. All vegetables are acceptable. However, limit the calorie intake on starchy vegetables such as potatoes, yams, and corns
Grains And Starches	White rice, wild rice, red rice Sprouted grains Whole wheat bread Quinoa Light soup or with nonfat creamer	French fries Croissants Popcorns High- fat soup
Fats	Low-fat or nonfat margarine Light cooking spray Low-fat mayonnaise Low-fat salad vinaigrettes	High saturated fats
Sweets And Deserts	Sugar free popsicles Low-calorie/mini pies and cakes Sugar-free pudding Sugar substitutes (i.e. stevia/Splenda)	Candy, caramel Ice cream High sugar and fat baking goods High sodium snacks

Dietary plan prior to the removal of Orbera^™ intragastric balloon

Follow your doctor's instructions and meet the support team on a regular basis. After about 6 months, your doctor will perform a removal of the gastric balloon. You may be instructed to consume only fluids for 24 hours before the removal procedure.