Endoscopic Sutured Gastroplasty (ESG) Dietary Guidelines for Patients

Preparing for your Endoscopic Sleeve Gastroplasty Journey

This comprehensive guide provides dietary advice following your ESG procedure and has been meticulously crafted by Dr Murat Ustun bariatric team. Should you have any inquiries or concerns, please don’t hesitate to reach out us (contact details provided at the conclusion of this leaflet).

Procedure Overview:
Considering Endoscopic Sleeve Gastroplasty (ESG) for weight loss? If you're battling obesity, ESG might be a safe and effective solution. It shrinks your stomach to help you shed pounds and improve your health.

ESG is a minimally invasive procedure aimed at reducing stomach size by internally placing sutures and tightening them to fold the stomach inward (refer to diagram). Consequently, your stomach’s capacity for food decreases, leading to a quicker sensation of fullness after meals. Unlike traditional surgery, ESG leaves no visible scars on the skin, as it is entirely performed internally. This approach minimizes the risk of complications and results in a shorter hospital stay. Additionally, no stomach parts are removed during the procedure, which is conducted solely via endoscopy, resembling a gastroscopy. You would have received a separate informational leaflet regarding gastroscopy.

Understanding the Procedure:

Anesthesia: Expect to sleep comfortably under general anesthesia during the procedure.

The Team: Our skilled team, including an experienced bariatric surgeon and an interventional gastroenterologist, anesthesiologist, and nurses, will ensure your safety and well-being.

The Process: An endoscope enters your mouth and reaches your stomach. Sutures are placed to create a smaller stomach pouch, curbing food intake and promoting weight loss. The procedure usually takes around an hour.

Post-Procedure Care and Recovery:
Follow-Ups: Regular online check-ins with your healthcare team are vital for monitoring your progress and addressing any concerns.

Pain Management: Our physician team will provide medication and guidance to manage any discomfort you might experience after the procedure.

Diet: Embrace a new, structured diet. Expect to start with clear liquids, progressing to soft foods and eventually a normal diet, all under your doctor's guidance.

Activity: You can resume normal activities within a few days, but gradually increase your exercise routine, listening to your body's cues

Change Your Life after the ESG Procedure:

Initial Restrictions: Expect dietary limitations in the first few weeks, focusing on clear liquids and then progressing to soft foods.

Long-Term Habits: While specific restrictions ease after recovery, prioritizing healthy, nutritious foods is crucial for sustained success.

Embrace Your Transformation: Remember, ESG is just a tool. Lasting results require sustained commitment to healthy lifestyle changes. With the right preparation, mindset, and support, you can embark on a successful weight loss journey and improve your overall health.

Lifestyle modifications are important! Get ready to embrace healthy habits! Smoking cessation, managing stress, and incorporating regular exercise can boost your success.

Medical Clearance: Your doctor will perform tests and examinations to ensure your suitability for the procedure.

Tips for Success: Your doctor or a nutritionist can offer personalized advice on healthy eating habits, like:
*Eating slowly and chewing thoroughly
*Staying hydrated
*Stopping when you feel full
*Opting for smaller portions
*Choosing low-sugar, low-fat, and low-calorie foods

How to Adjust Your Diet Before the ESG Procedure:

Prior to ESG, patients should follow a high-protein, low-carbohydrate diet and ensure adequate fluid intake. Additionally, they should refrain from consuming food or liquids the night before the procedure.


If you haven’t done so already, the first step is to eliminate beverages containing added sugar, carbonation, and caffeine. This encompasses drinks like soda, sports beverages, lemonade, fruit juice, milk, coffee, tea, smoothies, and alcohol.

Since the ESG procedure transforms your stomach into a tube shape, fluid intake won’t be severely restricted. Therefore, it’s crucial to cut out these liquid calories if you want to optimize your weight loss objectives.

All beverages should contain 10 calories or fewer per 8-ounce serving. Once you’ve identified some sugar-free, non-carbonated options that you enjoy (such as water, Powerade Zero, Propel, Crystal Light, among others), aim for a minimum of 64 fluid ounces per day.

Begin practicing drinking these fluids between meals because following the ESG procedure, there won’t be adequate space to consume liquids and protein simultaneously.


The initial dietary adjustment involves emphasizing protein in your meals and snacks. Protein is the most satisfying macronutrient, which is why it’s recommended to prioritize protein consumption first.

The aim is to consume 60-90 grams or more of quality protein daily, as this amount is essential for maintaining lean body mass, crucial for optimal metabolism.

To achieve this protein intake goal, a suitable portion size is approximately the size of your palm of protein at each meal. If aiming to increase muscle mass, protein intake should be slightly higher.

Excellent protein sources include chicken, turkey, beef, pork loin, fish, seafood, tofu, eggs, plain or light Greek yogurt, and cottage cheese.

A helpful way to determine if your protein choice is of high quality is to ask yourself, “Could I raise this in my backyard or identify its source if I visited a farm?”

For instance, a hamburger patty originates from a cow, visible grazing on a farm, or salmon sourced from a stream. In contrast, items like hot dogs or bologna are not seen on farms, nor do fields produce protein cookies.

Hence, salmon or a hamburger patty are superior quality protein sources compared to hot dogs, bologna, or protein cookies.


Encouraging news: as you prioritize quality protein in your meals, you’ll naturally feel fuller quicker, making it easier to avoid starchy, processed, and empty-calorie foods. These include sweets (cakes, candies, cookies, pastries, etc.), bread/rice/pasta, breakfast cereal/oatmeal/grits, and snack foods like chips, crackers, pretzels, and popcorn. Despite their appeal, these foods are deficient in protein.

Opting for these foods post-ESG procedure, when stomach capacity is reduced, will limit space for adequate protein intake. Furthermore, the tubular shape of the stomach post-ESG surgery allows these foods to slide through too easily, potentially hindering weight loss if consumed regularly.

Therefore, in preparation for the ESG procedure, restrict daily carbohydrate intake to 120 grams or less, with the majority of carbs sourced from vegetables or fruits. (Hint: consistent consumption of dense, high-quality protein will naturally limit carbohydrate intake to around 120 grams per day.)

A practical method to monitor your protein and carbohydrate intake is by utilizing a food tracking app like Baritastic, which allows you to measure and log your food and beverage intake effortlessly.


As you begin monitoring your food intake, you’ll observe how your dietary choices contribute to (or detract from) your daily protein and carbohydrate targets. One effective strategy to support your goals is to create a deliberate eating schedule.

Aim for three well-balanced meals spaced approximately 4-5 hours apart, along with one planned snack each day. Strive to stick to eating four times a day and avoid skipping meals. The goal is to steer clear of grazing or mindless snacking habits, as frequent snacking can impede weight loss post-procedure.

The upside is that consuming protein-rich meals three times a day helps reduce hunger, diminishing the urge to snack excessively. Additionally, skipping meals should be avoided, as post-procedure, you’ll have limited food volume capacity at one time.

Therefore, careful planning of three meals and one snack is essential to ensure adequate protein intake for preserving lean body mass and sustaining metabolism.

While enjoying your protein-rich meals, practice mindful eating by chewing food thoroughly and limiting meal duration to 15-20 minutes. Consider setting a timer if necessary.

During mealtime, minimize distractions like watching TV, checking emails, or scrolling through social media. Eliminating distractions enhances awareness of fullness cues, which is crucial post-procedure.


Lastly, but equally important, initiate an exercise routine. Understandably, everyone leads busy lives. However, to optimize weight loss post-procedure, it’s imperative to allocate 30-60 minutes daily for moderate-vigorous exercise.

Begin by establishing a consistent exercise schedule that aligns with your lifestyle. For instance, if mornings aren’t your preference, plan to exercise after work by packing a gym bag.

Once you’ve dedicated consistent time, choose an activity that you genuinely enjoy and that suits your physical abilities. If walking causes discomfort, consider alternatives like a YouTube yoga session.

Remember, any form of movement is beneficial, so prioritize activities that challenge you and elevate your heart rate. To stay accountable, enlist a workout buddy to join you in your exercise regimen.

Start implementing these changes before the ESG procedure to familiarize yourself with the dietary and lifestyle adjustments crucial for long-term success. These modifications will aid you in achieving, and potentially surpassing, your weight loss goals with the ESG.

Post-ESG Food Reintroduction:

Following the procedure, it’s essential to progress through various stages of food reintroduction, gradually advancing from liquids to solid foods. This stepwise approach allows ample time for the stitches to heal properly, minimizing the risk of stitch loosening. For optimal weight loss outcomes, it’s advisable to restrict the consumption of the following foods:

 • High-calorie beverages such as alcoholic drinks, fruit juices or smoothies, full-fat milk or creamy beverages like hot chocolates, milky coffees, or milkshakes, and sugar-sweetened soft drinks or energy drinks.

 • Sugary or fatty treats including chocolate, ice-cream, cakes, candies, biscuits, and desserts.

 • Foods high in added fats and fat content such as butter, oils, cream, full-fat dairy products, fried foods, and fatty meats.

 • Savory snacks rich in fats like crisps, pastries, and nuts.

Diet Plan Following Endoscopic Sleeve Gastroplasty

Immediate Post-Surgery Phase:

Patients can begin consuming sugar-free clear liquids four hours after the surgery. Initially, focus on water and ice chips, but any transparent liquid with low sugar content is permissible.

This includes options like diet iced tea, low-calorie sports drinks (e.g., Propel Water), light soups (e.g., broth), sugar-free Popsicles, and sugar-free Jell-O.

There’s no restriction on the volume of clear liquids, but intake should be gradual. Extreme temperatures (hot or cold) may be less tolerable, so moderate temperatures are advised. Avoid gulping to minimize discomfort from swallowing air, which can lead to belching.


Stage 1: Liquid Diet (Weeks 1 and 2)

 • Begin with small sips and gradually increase intake as tolerated.

 • Incorporate high-protein liquids alongside other beverages, ensuring they complement rather than replace them.

Days 1-7 Post-Surgery:

Continue following the aforementioned guidelines. As the first week progresses, larger liquid volumes can be consumed. Hot or cold liquids may be better tolerated. Check labels and avoid liquids high in calories.

 • Allowed: 100% fruit juice (e.g., apple, grape, cranberry), clear broth (chicken, beef, vegetarian), sugar-free popsicles, sugar-free gelatin, water, ice chips, Crystal Light or Sugar-Free Kool-Aid, decaf teas, coffee, JourneyLite supplements (fruit drinks, gelatin, protein bouillon, hot beverages).

 • Avoid: Carbonated beverages, sugary drinks (sweet teas), citrus juices (e.g., orange, grapefruit, pineapple), tomato juices, juice drinks (e.g., Hawaiian punch).

High-Protein Liquids Include:

 • Milk with added milk powder (easily prepared at home).

 • Homemade smoothies with added milk powder, high-protein yogurt, or protein powder (store-bought varieties may contain excess sugar).

 • Smooth soups with added skimmed milk powder or unflavored protein powders (avoid instant cup-a-soups).

 • Commercial options like Meritene™ shakes, Complan™ shakes, meal replacement shakes, high-protein milkshakes, protein water, and protein powders (whey, soy, or pea).

Stage 2: Soft Diet (Weeks 3 and 4)

During this phase, focus on consuming foods that can be easily mashed with a fork or spoon. Aim for three small, soft meals per day, avoiding constant snacking. Pay attention to your body’s signals of satisfaction and stop eating when full.

If no complications arise, patients may transition to a soft, low-sugar, low-fat diet during weeks 2-4. This diet does not involve pureed foods but rather foods easily mashed with a fork. Avoid foods like chicken or bread that cannot be easily mashed.

Meals should be low in sugar (less than 4-5 grams per meal) and low in fat (less than 6 grams). Emphasize protein intake, targeting 12-20 grams per meal. Protein-rich soft foods include baked fish, tuna, lean ground beef, and legumes (e.g., beans, lentils).

 • Allowed: Protein shakes (e.g., Premier shakes, Atkins, Low Carb Slim Fast), yogurt (e.g., Carbmaster, Fit and Lite Greek High Protein), milk (skim, 1%, almond, soy - all unsweetened), V-8 juice, tomato juice, scrambled eggs, sugar-free pudding, cream soup (strained - e.g., cream of chicken, mushroom, broccoli), JourneyLite supplements (protein shakes, pudding, oatmeal, mashed potatoes, scrambled eggs, tomato soup).

 • Avoid: Foods with chunks or large pieces, sugary desserts (e.g., ice cream, regular pudding, cream pies), carbonated beverages.

Example Meal Plan for Stage 2:

Soft Diet
Breakfast Options:

 • Low-fat, high-protein yogurt paired with soft fruit

 • Softened Weetabix® or another cereal with milk supplemented with milk powder

 • Porridge or Ready Brek®

 • Soft-cooked egg (poached or scrambled) accompanied by tinned tomato

 • Homemade fruit smoothie blended with yogurt or milk

 • Protein or meal replacement shake

Main Meal Options (Two per day, for lunch and dinner):

 • Crackers or crispbreads topped with high-protein options such as tinned fish, cottage cheese, mashed egg, low-fat soft cheese, or hummus

 • Cheese omelette made with 1 to 2 eggs

 • Soft pasta dishes like lasagne, ravioli, or spaghetti bolognese

 • Shepherd’s or cottage pie

 • Fish in sauce or fish pie served with soft-cooked vegetables

 • Tuna pasta bake featuring soft-cooked pasta

 • Meat/chicken stew with vegetables and boiled/mashed potato/cassava/plantain

 • Mince in gravy with vegetables and boiled/mashed potato

 • Baked beans with boiled/mashed potato

 • Chunky, high-protein soups such as minestrone, pea and ham, or Tuscan bean

 • Lentil dhal

 • Meat/chicken and vegetable curry (avoid rice or bread for now)

 • Cauliflower cheese or macaroni cheese

Choose one option from each group to create balanced and satisfying meals during the soft diet stage. Adjust portions according to your appetite and dietary needs.

Stage 3: Soft Solid Food

This stage lasts for the fifth and sixth weeks after your surgery. You can eat foods that are soft and solid, but not hard, crunchy, or sticky. Follow these guidelines to eat safely and comfortably:

  • Eat slowly and in small amounts. Your bites should be no larger than a dime. Stop eating when you feel comfortably full.
  • Take one bite at a time, put your utensil down, chew well, and swallow. Wait for 10 to 15 seconds before taking another bite.
  • When you feel full, stop eating and wait for your next meal. If you overeat, you may feel pain or nausea.
  • Avoid distractions while eating, such as watching TV, using your computer, talking on the phone, or reading.
  • Use a small plate to make your food look more appealing. Your appetite will increase gradually, but you should never eat as much as you did before your surgery.
  • Chew your food until it is smooth and pureed. This may take 15 to 25 timesof chewing per bite.
  • Do not spend more than 20 minutes eating at one time.
  • Eat high-protein foods most of the time. Eat every three hours.
  • Avoid foods and drinks that are high in fat. Also avoid cooking methods that add a lot of fat, such as frying, deep-frying, or sautéing.
  • Do not drink fluids for 30 minutes after eating. Also, stop drinking fluids 15 minutes before eating.
  • Drink at least six cups (48 ounces) of fluids per day. You should be able to drink about one cup (8 ounces) of fluids at a time. Drink fluids that are low in calories or calorie-free, such as water, sugar-free drinks, coffee, or tea. You should get your calories from food, not from drinks.
  • Do not drink any carbonated beverages, such as soda, sparkling water, or beer.
  • Stay away from foods and drinks that have too much added sugar. Do not drink juice or eat dried fruit.
  • You can stop drinking your protein drink when you can get 60 to 80 gramsof protein from food alone.
  • Make sure your food is moist and easy to swallow. If a bite of food is too dry and gets stuck in your throat, causing discomfort, get up and walk around for a few minutes. If the food does not go down or come up, drink some water to help it move. This will relieve your discomfort.
  • When you try a new food for the first time after surgery, always try it at home first.

These are some examples of soft solid foods that you can eat. You should prioritize the food groups that provide you with enough protein:

Milk Group (High Protein): Non-fat, fat-free, lite, or light yogurt, either plain or flavored

Protein Group (High Protein): Fin fish, lobster, shrimp, scallops, crab, soft cooked eggs and egg substitutes (no hard-boiled eggs yet), beans (legumes), cheese with 3 grams of fat or less per serving, tofu, miso paste, tempeh, ground lean meat, ground chicken or turkey breast (hamburger, meatball, meatloaf, or chili)

Vegetable Group: Soft cooked artichoke (leaf tips and bottom), beets, cabbage, carrots, onion, mushrooms, sauerkraut, turnips, and skinless eggplant, summer squash, tomato, and zucchini

Fruit Group: Canned fruit packed in water or natural juice, unsweetened applesauce, banana, kiwi, melon, papaya, mango, raspberries, strawberries, and peeled apricot, nectarine, peach, or plum

Starch Group: Oatmeal, cream of wheat or rice, farina, or grits, all without any lumps, soups that contain fish, ground turkey or chicken breast, pureed or ground lean meat, or soft cooked vegetables, low-fat cream soups, toasted bread, bread sticks, crackers, melba toast, matzoth, rice cakes, corn, peas, lima beans, plantains, potatoes, yams, winter squash, yucca, unsweetened corn, wheat, or oat bran flakes, and Special K

Fat Group: Avocado, butter, cream cheese, margarine, mayonnaise, Miracle Whip, oils, olives, creamy peanut butter, salad dressing, sour cream, tahini paste

Gradually transition to a regular diet comprising all textures, but in smaller portions and with an emphasis on low-fat and low-sugar options.

Strive to balance your meals according to the recommended plate proportions, with half being protein, a quarter vegetables or fruit, and a quarter carbohydrate. Incorporate high-protein choices and incorporate soft vegetables and carbohydrates in moderation.

**IMPORTANT: Use only low fat or light products, or limit the quantity of full fat ones. Avoid sugar in natural PB. 

**IMPORTANT: Do not eat beef (except ground), rice or pasta for 3 months after your surgery.


Breakfast (7am)

1-2 eggs, scrambled.  7-14 grams of protein

Snack (10am):

4-5.3 ounces of Greek yogurt.  9-15 grams of protein

Lunch (1pm):

1-4 ounces (1⁄8 - 1⁄2 Cup) of Wendy’s chili.  2 -7.5 grams of protein

Snack (4pm):

1⁄2 cup of Skim Plus milk 5.5 grams of protein mixed with 1⁄2 scoop of Whey protein powder

12.5 grams of protein

Dinner (7pm):

1-2 ounces of baked sole fillet 7-14 grams of protein

Snack (10pm):

1⁄2 cup of Skim Plus milk 5.5 grams of protein mixed with 1⁄2 scoop of Whey protein powder 12.5 grams of protein Total Protein: 61-86.5 grams.

Following the fourth week, patients can transition to a solid, low-sugar, low-fat diet. This includes all solid foods meeting the low-sugar and low-fat criteria. Aim for three meals a day, each containing approximately 4-5 grams of carbohydrates, 6 grams of fat, and 12-20 grams of protein. Food should be chewed thoroughly but not to the point of puree. Eating slowly helps prevent vomiting due to restriction.


START: From the 6th or 7th week after the surgery.

DURATION: Indefinite.  

FOOD: Normal solid food

How To Eat Normal Solid Foods?

 1) Continue to follow all the advice for soft solid foods

2) Avoid red meat (mainly beef), soft or fresh bread, white rice, pasta and fibrous - stringy vegetables like asparagus, broccoli stalks, leeks, celery, string beans, sugar snap peas, snow peas, Chinese pea pods etc. As they may cause discomfort or blockage, even if you chew them well! You can make them easier to digest by removing the strings from celery, string beans, and the pea pods. Only eat the broccoli florets, not the stalks.

3) Some fruits and vegetables have skins thar are hard to break down after this surgery (for example the skin on apples, pears, nectarines, zucchini and eggplant)

You may need to peel these foods for a few months until your chewing improves.

4) Make sure all food is cut into pieces smaller than a dime before you eat it.

5) Do not eat more than 3⁄4 of a cup of food at a time to keep your stomach small.

Your meal should consist of no more than 1⁄4 cup of vegetables and no more than 3 ounces of fish or 2 ounces of poultry or 2 ounces of meat. You can replace the 1⁄4 cup of vegetables with 1⁄2 cup of salad. You can also reduce the amount of meat, fish or poultry and increase the amount of vegetables if you are meeting the minimum of 60g of protein per day.


Breakfast (7am)

1 hard-boiled egg 7 grams protein

1⁄2 slice whole wheat bread, toasted 1 tsp butter 1.5 grams protein

Snack (10 am)

8-14 ounces high protein drink 25 grams protein

Lunch (1pm)

1-2 ounce(s) chicken breast 7 -14 grams protein 1⁄4 cup cooked green beans 1 gram protein

Snack (4 pm)

1 ounce low-fat Swiss cheese 1⁄2 cup strawberries  7 grams protein

Dinner (7:30 pm)

1-3 ounce(s) baked fish 1⁄2 cup chopped salad 7-21 grams protein

Snack (10:00 pm)

5.3 ounces Total 0% Greek Yogurt 15 grams protein

Total Protein: 70.5g-90.5g


As you increase your food intake, you might be tempted to eat foods that are high in fat. Please avoid this temptation as it will hinder or even undo your weight loss. Remember these tips as you choose your foods:

-All fried foods have a lot of fat, whether they are vegetables (like fried zucchini, fries, hash browns, fried plantains, or onion rings), poultry (like fried chicken, chicken nuggets, or buffalo wings), beans (like refried beans) or snacks (like Cheetos®, Doritos®, Fritos®, or potato chips). Other fried foods to avoid are grilled cheese sandwiches, egg rolls, French toast, chow mein noodles, croutons, and hard taco shells.

-Use low fat cooking methods instead of frying, bake, broil, roast, grill, poach, steam, or boil your meat, poultry, or fish.
Use a non-stick pan and/or a cooking spray (like PAM®) when cooking on the stove. If you need to use oil, use as little as you can (1 tsp should be enough). Do not use these fats in your cooking: bacon grease, fatback (or salt pork), shortening (like Crisco®), lard, or beef tallow.

-Avoid high fat meats/poultry such as spareribs, sausages, oxtails, chicken/turkey wings, chopped chicken livers, ground pork, regular ground beef, luncheon meats that have 5 grams or more of fat per ounce (like bologna, pimento loaf, salami), hot dogs (beef, turkey, or chicken), bacon (unless you count it as a fat serving: 1 slice = 1 fat serving).

Use ground turkey or chicken breast instead of regular ground turkey or chicken.Use ground sirloin or beef that is 91% to 99% lean instead of regular ground beef/chuck.

The best choices for luncheon meats are: turkey/chicken breast, roast beef, any of the hams, or Healthy Choice® luncheon meats.
Chicken or turkey hot dogs are almost as fatty as regular beef hot dogs. Choose low fat beef hot dogs instead.
Canadian bacon has much less fat than regular bacon. It is a better choice.

-Take off the skin from poultry as most of the fat in poultry is in or near the skin.

-Cut off all visible fat from meat.

-Keep using fat free, 1%, Skim Plus®or Smart Balance® milk and light or fat free yogurt.

-Only eat cheeses that have 3 grams of fat or less per ounce. When you eat out, you can assume that the cheese on your food is full fat cheese. Either skip it or eat less of it.

-Olives count as a fat: 8 large black/green olives = 1 fat serving 10 small black or green, stuffed olives = 1 fat serving. ) Nuts count as a fat and they might be hard for you to digest, so be careful!! 4 halves of pecans, walnuts = 1 fat serving 10 whole peanuts or pistachios = 1 fat serving 6 almonds or cashews = 1 fat serving 1 TBSP sesame, pumpkin, or sunflower seeds = 1 fat serving 2 tsp peanut butter = 1 fat serving J)

Foods made with mayonnaise such as egg, tuna, chicken, macaroni and potato salads, and cole slaw are high in fat, mostly because of the full fat mayo that is used to make them. One teaspoon of mayo has 45 calories and 5g of fat. You get much more mayo than one teaspoon in one serving of these foods. Either stay away from these items when you eat out or make them at home using low fat or fat free mayonnaise [Hellmann’s® Light (flavored varieties are OK) or Reduced Fat Mayonnaise products are good options]. Tartar sauce is made from mayonnaise, so it is high in fat. Make your own tartar sauce using low fat or fat free mayonnaise. You can find good recipes online.

-Opt for water-packed tuna instead of oil-packed tuna. This way, you can cut down on 10 calories and 2 grams of fat for every ounce. Store-bought tuna salad is also high in fat because it uses oil-packed tuna and high fat mayo. 

Likewise, you can save around 30 calories and 3g of fat per ounce by choosing sardines without skin and bones that are packed in water rather than oil. 

-The salad dressings that come with your order are usually loaded with fat. Request low fat or fat free dressings and have them “on the side” (in a separate bowl from your salad). Drizzle salad dressing lightly over your salad or dip your fork into the dressing first, then pick up your lettuce leaves. 

These methods will reduce the fat intake from an otherwise healthy food. 45 calories and 5 grams of fat: 1 TBSP regular salad dressing 2 TBSP’s low fat salad dressing Less than 20 calories with no fat: 1 TBSP fat free salad dressing 2 TBSP’s fat free Italian salad dressing 

-“Light” olive oil refers to its mild flavor. It has the same amount of fat and calories as regular olive oil. 

-Other foods that are rich in fat include: cream soups (made with heavy cream and butter), granola (cooked in oil), mashed potatoes (usually made with regular milk and butter), regular popcorn (cooked in oil), crackers filled with cheese or peanut butter, avocado (a good fat but 1⁄8 of one = 45 calories and 5g fat), sauces such as alfredo, béarnaise, hollandaise, white clam and pesto (made with cream, mayonnaise, butter and/or oil), “light” tomato sauce (has cream added to make it pale in color), coconut (meat, cream and milk), hummus (made with olive oil and tahini paste, both good fats) and croissants (made with a lot of butter). 

-You can use herbs and spices to flavor your foods. Avoid eating too much of hot, spicy foods like hot pepper sauce, jalapeno peppers, red pepper flakes, etc. These may produce excess stomach acid, leading to an ulcer in your stomach pouch. 

Other seasonings and condiments that are okay to use with foods are: Flavoring extracts Garlic Ketchup Lemon juice Pimentos Lime juice Soy sauce* Mustard* Salsa Vinegar Worcestershire Sauce* *High in sodium 

-Limit yourself to one starch serving per day for the next month. 

-Different people have different food intolerances. You will discover which foods are agreeable and which ones are not by experimenting. 

-Sometimes a food that is fine one day is not fine the next day. This is normal. Don’t forget to include a variety of foods in your diet and keep trying.

Following these dietary guidelines diligently will support your recovery and optimize the benefits of your ESG procedure. For further assistance or clarification, do not hesitate to contact our nutrition and dietetics department.

As you progress to the regular diet stage, it’s crucial to shift your focus towards sustaining a long-term healthy eating pattern. Remember, your goal isn’t merely to consume small portions to reduce calorie intake and shed pounds but also to adopt a balanced and nutritious eating plan.

 -Aim to have three balanced meals each day. Avoid skipping meals, as prolonged periods without eating can actually hinder weight loss.

 -Mindful Eating: Take your time to eat slowly and stop when you feel satisfied. Rushing through meals can lead to overeating, as there’s a delay between eating and your brain signaling fullness. Chewing food thoroughly is essential for proper digestion.

 -Prioritize Protein, Vegetables, and Carbohydrates: Consume your meals in the order of protein, vegetables, and carbohydrates. Begin with protein, as it’s the most satiating component. If you feel full before finishing your meal, prioritize protein over carbohydrates.

 -Embrace Solid, Balanced Foods: Opt for solid foods like lean meat or fish paired with vegetables, as they provide prolonged satisfaction and help in portion control. Follow a diet aligned with healthy eating guidelines, emphasizing low-fat and low-sugar options while incorporating lean protein and fiber-rich foods.

 -Portion Control: Limit your meal sizes to those of a ‘side plate’ or ‘tea plate.’ Using smaller plates can aid in portion control over the long term. Refer to the small dinner plate diagram for guidance.

 -Beware of Unplanned Snacking: Avoid developing a habit of constant grazing throughout the day. Stick to structured meals to maintain consistency in your eating pattern.

 -Opt for Low-Calorie Beverages: Choose non-carbonated, low-calorie drinks to avoid unnecessary calorie intake. Liquids pass through the stomach quickly, and high-calorie beverages can contribute to excess calorie consumption without providing satiety.

Limit intake of high-calorie drinks such as alcohol, fruit juices, smoothies, sweetened squash/cordial, non-diet soft drinks, sports drinks, and milk-based drinks, excluding low-fat milk in moderate amounts. Steer clear of fizzy drinks, as they can cause discomfort and potentially stretch the stomach.

Cooking Suggestions:

• Prior to cooking, ensure to trim off all visible fat and skin from meat or chicken.

 • Utilize low-fat cooking methods like grilling, baking (consider wrapping in foil to retain moisture), steaming, or boiling.

 • Limit the use of oil or butter when preparing vegetables or salads. Instead, enhance flavor with seasonings or a modest amount of low-calorie dressing or vinegar.

 • When oil is necessary to prevent sticking, opt for spray oil.

 • Enhance dishes with flavor using herbs, spices, seasonings, lemon juice, ginger, onions, and garlic.

Avoid adding oil or butter to your carbohydrates; opt for simplicity.
 • Opt for high-fiber carbohydrate choices whenever feasible, as they promote longer-lasting fullness and aid in preventing constipation. Consider options such as wholegrain bread, pasta, rice, crackers, and leave the skins on potatoes.

Multivitamins and Minerals  After ESG

Following your procedure, it’s improbable that you’ll obtain all the essential vitamins and minerals solely from food. Hence, it’s crucial to incorporate a multivitamin and mineral supplement into your routine:

 • Multivitamin and Mineral (A-Z) Options:

 • Forceval™ (available by prescription) – Take 1 capsule daily

 • Over-the-counter alternatives (1 tablet daily) such as Sanatogen A-Z™, Centrum A-Z™, Tesco A-Z™, Lloyds A-Z™

 • Vitamin D 2000IU: Take 1 tablet daily

 • If you have a pre-existing deficiency (e.g., iron), continue any prescribed supplements.

Long-Term Nutritional Monitoring

Regular blood tests are essential to monitor for nutritional deficiencies (insufficient levels in your body). It’s recommended to undergo blood tests at 6 and 12 months during the first year post-procedure, followed by annual testing thereafter.

Considerations for Eating After Endoscopic Sleeve Gastroplasty:

Remember that ESG converts the stomach from a larger sac to a narrow tube. While less restrictive than other procedures, such as gastric bypass or adjustable gastric banding, the stomach’s storage capacity is significantly reduced.

Eating too much or too quickly can cause discomfort or vomiting. Patients should eat slowly and stop when feeling full. Liquids pass through the system without restriction and can contribute excess calories, so calorie-dense liquids like juices, milk, and protein shakes should be avoided.

Opt for no-calorie or low-calorie liquids such as water, artificially sweetened beverages, and skim or 1% milk. Protein supplementation should be in powder form and added to solid food. Adhering to these guidelines maximizes the effectiveness of the gastric sleeve procedure and promotes optimal weight loss.

*Individual results may vary based on factors such as surgery type and adherence to the aftercare program. As with any medical procedure, there are risks and potential complications. Testimonials are not indicative of typical results and are voluntarily provided by patients.

Nausea and vomiting are common during the initial week post-surgery. Medications prescribed to manage these symptoms include:

 • Prilosec (omeprazole): Take one tablet daily to reduce acid.

 • Zofran (ondansetron): Dissolve one tablet under the tongue every 6 hours for nausea.

 • Phenergan (promethazine): Take 1-2 tablets by mouth every 4-6 hours for nausea.

 • Levsin (hyoscyamine): Dissolve one to two tablets under the tongue every 4 hours as needed for spasm or cramping.

If vomiting persists despite medication use, contact your healthcare provider for further guidance.

In Summary Helpful Tips:

 • Plan 3 meals and 2 snacks.

 • Maintain good posture during meals and while drinking fluids to aid tolerance.

 • Stop eating when full (Hiccup sensation indicates fullness; one additional bite may be too much).

 • Avoid drinking 30 minutes before and after meals.

 • Refrain from eating 3 hours before bedtime.

 • Use anti-nausea medications as prescribed.

Once you feel well enough (typically 3-7 days post-surgery), begin an exercise program without restrictions. Aim for 10,000 steps per day using an activity tracker like a FitBit to enhance weight loss.

How to deal with common issues?

Constipation: If you have constipation, you can try these remedies:

Take two tablespoons of Milk of Magnesia twice a day, or use a Dulcolax suppository or a Fleets® enema.

Drink at least 48 ounces of fluids every day.
Eat more foods that are rich in fiber, such as beans, vegetables, fruits, and high-fiber cereals.

Walk regularly.

Use a daily stool softener (like Colace) or a fiber supplement (like LiquaFiber, Benefiber, sugar-free Metamucil®, or sugar-free Citrucel®).

Gas: If you have gas, you can try these solutions:

Take Gas-X tablets that are available over the counter.
Use liquid bean-O® if certain foods give you gas (such as beans).
Walk regularly.
Eat and drink slowly and avoid skipping meals.

Vomiting: If you have vomiting, you can try these tips:

Make sure your bites are no larger than a dime.
Eat slowly and chew well. Put your spoon down after each bite and wait for 15 seconds before taking another one.

Avoid foods that are too dry, such as overcooked chicken breast or fish. Do not drink during your meal and wait for 30 minutes after eating before drinking again.

If you keep vomiting every time you eat, stop eating and drinking for four hours and then have clear liquids for one day before trying solid food again. If vomiting continues, contact your gastroenterologist’s/surgeon’s office. If you also have abdominal pain, go to an emergency room.


For managing regurgitation:

 • Steer clear of carbonated beverages, cabbage, leeks, onions, cucumbers, peppers, and garlic.
 • Avoid heavily seasoned or spicy foods.
 • Eat slowly in a relaxed setting, refraining from talking while eating.
 • Avoid chewing gum.

How to exercise 

Hopefully, you have been enjoying your walking program and doing well with it. Make sure you do cardio-vascular exercise that raises your heart rate for at least 30 minutes every day. It is also important to include resistance exercises in your exercise routine (get approval from your nurse practitioner or surgeon first).

However, you will need the guidance of a trained professional for this. The most successful patients are those who change their body composition. They reduce their fat mass (by doing aerobic exercises like walking, running, treadmill, bike, rowing, elliptical, etc.) and increase their muscle mass (by doing resistance exercises like weights, machines in the gym, exercise bands, Pilates, etc.).

Regular meetings with your support team for nutritional training and progress monitoring are essential for successful lifestyle changes. The target weight loss during the first 6 months is 25-50 pounds, with higher-BMI patients aiming for the higher end and lower-BMI patients aiming for the lower end. However, weight loss outcomes may vary based on individual adherence to the program.