Support Programs
An integral part of your decision to have safe weight loss surgery is the commitment to follow-up. We want you to be successful; therefore, we have designed support groups for you to attend and resources to guide you through the entire weight loss surgery process.
The learning, sharing and support you receive from your peers is a great way to keep your weight loss motivation high. By participating in a safe weight loss surgery support group, you are more likely to reach your goals than if you tried alone.
Each support group features a speaker on a subject of interest to people who are anticipating or who have had safe weight loss surgery. A period of questions and discussion follows every featured speaker. All pre and post-operative weight loss surgery patients and their family members are welcome to join us.
Virtual support groups
- 1st Wednesday of the month – "Food for Thought" and open discussion with Bariatric & Metabolic Institute Nutrition and Psychology.
- 3rd Monday of the month- Topic with Q&A (see schedule below).
View January–November 2024 Virtual Support Group Schedule.
In-person support groups
Please note: All in-person support groups are currently on hold. Please call 216.445.2224 for more information.
- Main Campus Support Group.
- Avon Support Group.
- Twinsburg Support Group.
Patient Navigation | Welcome & Next Steps
Cleveland Clinic's Bariatric & Metabolic Institute patient navigators are hosting a weekly online meeting to answer our surgical patient’s questions about next steps. If you’re interested in joining please contact your care team for a link to attend. Meetings are held weekly on Tuesdays from Noon – 1 p.m.
Nutrition After Surgery
Your registered dietitian will provide you with dietary rules following your surgery. Here are some guidelines that can be helpful:
1. Protein is your new number one food. Always eat your lean protein food first to meet your minimum 60g of lean protein intake a day. Lean protein can be: 1 oz. of meat (chicken, turkey, fish, beef, or pork), 1 oz. of low-fat cheese, 2 Tbsp. peanut butter, 1 egg, ¼ cup of low-fat cottage cheese.
2. You should not skip meals. Eat at least three meals a day. Having 1-2 small high-protein snacks may be beneficial if you are going more than 4 hours in between your meals. Small, frequent meals will help to prevent you from filling your pouch up too fast and will keep your metabolism burning.
3. You should eat at your table. Use a plate or dish and sit down. Take 30 minutes to eat your meals. Avoid eating at the counter or cupboards, in front of the refrigerator, in other areas of the home, or in front of the TV or computer.
4. Make portion control a priority. Serve smaller portions. Cut up chicken in smaller pieces. Use a salad plate as your dinner plate or baby spoons to prevent overeating. Slow down with eating, chew foods thoroughly, and stop when you feel full. Keep serving dishes off the table.
5. Liquids need to continually consumed throughout the day. Drinking 6-8 cups of caffeine-free, calorie-free, and non-carbonated beverages a day is a must. You don't want to drink with your meals; stop drinking 30 minutes before your meal, eat, and then wait 30 minutes after your meal to drink again. This will prevent nausea and vomiting. Sip on fluids in between your meals.
6. Take your vitamin/mineral supplements daily. When your doctor gives you permission, take your multivitamin and calcium citrate supplements daily. Additional vitamin B12, vitamin D, and iron may be required.
7. Remember, this is a new way of life. Not just a diet. Try not to think of this weight loss surgery as a diet, but as a new way of life not only for you but also for your family and friends. These healthy habits are a lifestyle change for now and forever.
Nutrition
You will not be able to meet certain vitamin and mineral needs without supplementation. Vitamin and mineral deficiencies have been observed in patients after weight loss surgery. Iron, folate, vitamin B12, calcium, and zinc are most affected after gastric bypass surgery. If you are having gastric banding surgery you will not need to take all the above supplements. Gastric banding does not cause malabsorption of nutrients from your foods. A daily multi-vitamin and calcium supplement is usually sufficient.
All of the required vitamin supplements are listed below. They are available over the counter at your local pharmacy. If you have difficulty locating or tolerating any of the supplements, call your dietitian or surgeon for suggestions.
Mandatory Vitamin Supplements:
1. Multi-vitamin and Mineral
Dosage: 1-2 daily with meals
Type: 2 children’s chewable multi-vitamin OR 2 chewable or liquid adult multi-vitamin.
*Once on a regular diet can begin an over the counter prenatal vitamin OR 1 adult multivitamin (does not have to be chewable or liquid)
Function: Multi-vitamins will help ensure that you are getting enough of all the micronutrients that you need.
Interactions: None
2. Vitamin B12
Dosage: 1000 micrograms tablet or sublingual daily or 1000 micrograms monthly of injectable B12
Type: Any sublingual (dissolves under tongue), tablet, or monthly injection (prescribed by your surgeon)
Function: Helps with blood cell and nerve function, digestion and absorption of food, and protein synthesis. Deficiency may cause certain types of anemia.
Interactions: None
3. Iron
Dosage: 45-60 mg of elemental iron daily. Take with vitamin C.
Type: Any tablet of ferrous sulfate, gluconate, or fumarate that is equivalent to 27-28 mg
of elemental iron. Prenatal vitamins may already have enough iron in each tablet. Read the label first to see if additional supplementation is required.
Function: Vital to the formation of red blood cells that provide oxygen to the entire body.
Interactions: Take 1-2 hours before or after taking calcium. Do not take with milk, cheese, eggs, whole-grain breads and cereals. May cause diarrhea or constipation.
4. Calcium citrate with Vitamin D
Dosage: 1200-1500 mg daily. Calcium citrate is best absorbed in doses of 500-600 mg at a time. Take with meals.
Type: Tums® initially, once tolerating regular diet switch to Citracal® +D or any equivalent brand with calcium citrate. The citrate form of calcium is better absorbed since it doesn't require the acid from your stomach to be absorbed.
Function: Maintains bone strength; also helps heart pump correctly and repairs soft tissue.
Interactions: Caffeinated products, spinach, and whole grain products may decrease absorption. Take at least 1-2 hours before or after taking iron, since calcium will decrease iron absorption.
Exercise After Bariatric Surgery
Your physicians will likely want you to commit to an exercise plan before surgery. After surgery, you will be expected to exercise as part of the weight-loss process and for good reason. The Surgeon General’s report on physical activity and health states that exercise helps to:- Reduce the risk of dying prematurely from heart disease or other comorbidities.
- Reduce the risk of developing diabetes, high blood pressure, and colon cancer.
- Reduce blood pressure in people who already have high blood pressure.
- Build and maintain healthy bones, muscles and joints.
- Reduce feelings of depression and anxiety.
- Control weight.
Remember: The key to weight loss is using more calories than you take in!
Getting started with exercise:
Walking:
Walking is an easy way to get moving. Walking as exercise can be started before surgery and resumed once you've returned from the hospital. In fact, nurses at Cleveland Clinic will encourage you to get walking as soon as possible to help in the healing process. An exercise regimen featuring walking can be followed year round, outside when the weather is nice and at the gym or in a mall when the weather isn't so great.
Cleveland Clinic offers the following tips when you start walking to control your weight after bariatric surgery:
- Start by walking on a flat surface and gradually add hills or slopes, as you get stronger.
- Start with small distances and gradually increase the distance or amount of time you walk.
- Alternate your walking routes will help keep you from getting bored with your walking program.
- It may help to join a walking club or walk with a family member or friend to keep you motivated.
- Walk only where you feel safe.
- If you can, invest in a good pair of walking shoes.
- If you have not exercised in a long time, it might make you feel better to take a cell phone with you on your walks.
- You can use Google Maps to map out a route and check distances.
- Take a bottle of water with you on longer walks. Sip water at intervals, especially if you walk outside on hot days.
Aerobic Exercise:
Aerobic Exercise can also be a great way to help transform your life after your bariatric surgery. Before you start a program with aerobic exercise before or after your surgery, it is very important that you check with your doctor before you start any strenuous exercise program. Cleveland Clinic offers the following advice to patients interested in aerobic exercise:
- The best form of aerobic exercise is one that you will enjoy. It is difficult to stick with an exercise program you don't enjoy.
- A variety of aerobic activities can help you from becoming bored with your exercise program. Try doing different activities on different days.
- Swimming and water aerobics are a good form of exercise, especially if you have joint problems or joint pain.
- If you want to take an aerobic class, always start with a low impact class. Make sure the class is geared for beginners. Examples include swimming, seated exercise, biking (elliptical and recumbent), and rowing.
- Research has shown that increasing lifestyle activities can have the same effect on health and weight loss as a structured exercise program.
It's easy to work more exercise into your everyday life. Small choices made to benefit your health can add up quickly. Some examples include:
- Taking the stairs instead of the elevator.
- Parking at the far end of the parking lot and walking to the office or store.
- Mowing the lawn and raking leaves.
- Getting up from your desk to deliver a message instead of using E-mail.
- Walking to do errands instead of driving.
Strength Training:
Strength training may include the use of weight machines, "free" weights (hand-held weights), and resistance bands. Strength training is not recommended for the first three months after your surgery. As with all exercise programs, it is very important to check with your doctor before starting a strength-training program. Cleveland Clinic has three quick tips to help you in your strength-training:
- It is very important to use correct form when doing strength training. This will help to prevent injuries.
- When starting a strength-training program, it may be helpful to take a class or hire a personal trainer. The instructor or trainer will show you the correct way to use the equipment.
- Strength training workouts should always be preceded by a 10-15 minutes warm-up (such as walking, using the treadmill, riding an exercise bike). This will raise the core body temperature and ready the joints and muscles for the workout.
It is important to keep goals and motivations for working out. Cleveland Clinic recommends that patients exercise (after being cleared to do so by their doctor) for 30 minutes most days of the week. For patients just starting, it can be helpful to break down the 30 minutes into 3-10 minute sessions. Patients sometimes complain about having losing motivation or sight of their goals. Cleveland Clinic recommends trying to stay motivated by practicing the following tips:
- Begin your exercise program gradually and progress slowly over time.
- Vary workouts to alleviate boredom
- Develop specific, realistic and achievable goals
- Anticipate obstacles—have a back-up plan
- Keep your walking shoes or exercise clothes in the car.
Follow Up After Gastric Banding (LAGB)
You will be expected to follow up with your doctors at regular intervals after your laparoscopic adjustable gastric banding (LAGB) surgery . Below is the schedule Cleveland Clinic will ask you to adhere to:
| Time of Appointment | Type of Appointment |
|---|---|
| 1-2 weeks after surgery | Surgeon or Nurse post–op visit (10-14 days) |
| 4-6 weeks after surgery | Teaching and adjustment Surgeon Nutrition Psychology-Individual |
| 4 months after surgery | Teaching and adjustment Life After Surgery Group—Psychology Nutrition Labs |
| 6 months after surgery | Teaching and adjustment Nutrition Psychology Labs required |
| 8 months after surgery | Teaching and adjustment Nutrition Psychology Labs as needed |
| 10 months after surgery | Teaching and adjustment Nutrition Psychology Labs as needed |
| 12 months after surgery | Teaching and adjustment Nutrition Psychology Labs required |
| 15 months after surgery | Teaching and adjustment Nutrition Psychology |
| 18 months after surgery | Teaching and adjustment Nutrition Psychology Labs as needed |
| 21 months after surgery | Teaching and adjustment Nutrition Psychology |
| 24 months after surgery | Teaching and adjustment Nutrition Psychology Labs required |
| Annual (after 24 months) | Teaching and adjustment-3 visits per year Labs required one of the three Shared Medical Appointment Nutrition Psychology |
Follow Up After Gastric Bypass or Gastric Sleeve
You will be expected to follow up with your doctors at regular intervals after your gastric bypass or gastric sleeve surgery. Below is the schedule Cleveland Clinic will ask you to adhere to:
| Time of Appointment | Type of Appointment |
|---|---|
| 1 week after surgery | Surgeon or Nurse |
| 1 month after surgery | Surgeon Nutrition Psychology - Individual |
| 3 months after surgery | Shared Medical Appointment Life After Surgery Group—Psychology Nutrition Labs as needed |
| 6 months after surgery | Shared Medical Appointment Nutrition Psychology Labs Required |
| 9 months after surgery | Shared Medical Appointment Nutrition Psychology Labs as needed |
| 12 months after surgery | Shared Medical Appointment Nutrition Psychology Labs required |
| 18 months after surgery | Shared Medical Appointment Nutrition Psychology Labs as needed |
| Annual | Shared Medical Appointment Nutrition Psychology as needed Labs required |
