Section 14: Dietary advice for Week 5 onwards – solid/textured food

Around this time, you will have an appointment with the dietitian who will discuss your progress and advise you on diet and activity. You may have noticed that you can eat as much, or nearly as much, as you could before your operation. Please don’t worry that your band isn’t working - this is because the band requires an average of 4-6 adjustments before its effects are fully apparent. 

Choosing the correct texture of foods 

It is important from week 5 onwards that you start to progress onto textured foods – this means foods that require chewing to break them down. You may recall that this was mentioned when we described how the band works. This is important to get the best results from your band.  

Follow these guidelines: 

1. Follow the 20/20/20/20 rule – no bigger than a 20p piece sized portion of food on your fork / spoon, chew for at least 20 seconds, have a 20 second rest after swallowing each mouthful of food before taking the next, and stop eating after 20 minutes. If there is anything left on your plate, throw it away or save it for another meal. As well as helping to ensure your food travels through the band without any problems,your portions will also be smaller than with the softer foods 

1. You will feel satisfied for longer.This is because it is thought that the number of times theoesophagus has to contract (i.e. the number of ‘squeezes’ that are needed) to get a mouthful of solid/textured food through the band is greater than with a mouthful of soft. This means that the nerve endings in the stomach wall receive more stimulation, which then sends messages to the brain to say that you are satisfied. 

1. For these reasons,liquids and soft foods should be avoided long term as they slide through the band too easilyand don’t stimulate the nerve endings as much, so you will likely feel less satisfied and can manage bigger portions 

Things to be wary of: 

1. Dishes where lots of sauce is used, as this will make the dish too soft. Good examples would be sauce on pasta and gravy on a roast dinner. You can overcome this by limiting the amount of sauce/gravy used to 1 tablespoon, and/or adding chunky vegetables, beans and/or lentils to the sauce to improve its texture. 

1. Soft ‘complete meals’ e.g. fish pie, shepherd’s pie, lasagne. Ideally avoid these meals, but if and when you do choose them, they should only fill ½ of the plate; fill the rest of the plate with crunchy steamed vegetables or salad. 

Try our swaps below to make better, textured food choices: 

Do I need to cook myself separate meals to the rest of the family? 

No! Your diet following a gastric band should still fit into your lifestyle and you shouldn’t have to cook separate meals for yourself. If you are having a family favourite like lasagne, spaghetti bolognese or cottage pie (all soft meals), then just add a portion of crunchy veg or salad on the side to “add the crunch”. With cottage pie, try reserving a bit of the meat sauce and cook yourself a jacket potato with the skin while the pie is cooking in the oven so you can avoid the mash. If you just love porridge on a cold winter’s morning, then add some chopped apple to the top. If you fancy a nice homemade soup then just have it with a little bread, roll or high fibre cracker or crispbread. 

What if I experience a heavy/tight feeling, pressure discomfort or pain in my chest and/or regurgitation when I eat? 

These symptoms are much more likely to occur when eating solid/textured food, but remember – these symptoms are not supposed to occur and are usually a sign 

that you are not following the ‘20/20/20/20 rule’. Another cause can be introducing a caution food too early (see below). There are a number of other possible causes, which are discussed in Risks of surgery, potential complications, side effects. 

If these symptoms occur too often (more than once or twice a week), they can increase the risk of developing complications such as pouch dilatation and band slippage (see Risks of surgery, potential complications, side effects). It’s important to remember that even a mild feeling of heaviness, pressure or tightness should still be avoided/limited - it is not only when it is uncomfortable or painful that it can cause problems. 

Caution foods 

There are some caution foods which may be more likely to cause discomfort/pressure/heaviness/tightness and/or regurgitation when eaten, particularly if introduced into your diet too early. Always take care when introducing foods back into your diet and take note of any discomfort.  

It is important to experiment with these foods to identify how your body will react. If a food causes problem, remove it from your diet and then re-trial it again after a few weeks. The ’20/20/20/20’ rule is especially important when eating these foods – remember that the most common cause of discomfort on eating and/or regurgitation 

is poor compliance with the ’20/20/20/20’ rule. 

The caution foods listed below should be the last attempted when progressing onto solid foods – try other foods first. They should also be avoided for a week or two after having fluid added to the band, to give you time to gradually adjust to any change in appetite and portion size, and to attempt other foods first. 

Please note: not being able to tolerate one or all of these foods is NOT a sign that band is at the right level; they can just be more challenging to eat. Some people struggle with all these foods, whilst others will have no issues at all with them 

1. Bread & bread products

Do not try any of these foods until week 5 post-op, and follow the below staged approach when introducing these foods: 

• Try 1st: low fat crackers (e.g.Ryvita,Crackerbread, Finncrisp, Krisprolls) 
• Try 2nd: well toastedwholemealpitta bread 
• Try 3rd:wholemealwrap 
• Try 4th: Weight Watchers/Nimble/WarbutonsThins-type bread, toasted to begin with
• Try to avoid: soft doughy white bread

1. Rice

Do not try until week 5 post-op and ensure you have tried other types of carbohydrate first, e.g. potatoes with the skin on, pasta cooked so it retains some ‘bite’ (al dente), couscous, noodles. 

• Brown rice is better.
• Ensure you wash it thoroughly before and after cooking to prevent it becoming “sticky.”

1. Meat & vegetarian meat substitutes, particularly chicken breast, steak and porkchops.You may have already tried lean (ideally less than 5% fat) minced beef/pork/lamb/chicken/ turkey or minced Quorn in the soft food stage post-operatively. If not, try this first before attempting anything more solid. As mince has a tendency to be soft and ‘easy to eat’ when cooked, aim to include chunky vegetables, beans and/or lentils when making meals from these foods. 

Once you have started eating textured foods from week 5 onwards, start building in other meat products by following the below staged approach: 

• Try 1st: Stewing steak/casseroled/slow cooked meats
• Try 2nd: “Wafer thin” sliced sandwich meats (ideally less than 5% fat)
• Try 3rd: Chicken or turkey leg meat (no skin)
• Try 4th: Lean sausages (ideally less than 5% fat)
• Try 5th: Lean bacon or turkey bacon (fat cut off)
• Try 6th: Lean burgers
• Try 7th: Grilled/dry fried/barbequed/roasted chicken or turkey breast (no skin)
• Try last: Grilled/dry fried/barbequed/roasted beef/pork/lamb (trimmed of fat)

Other caution foods 

• Stringy vegetables/fruit such as green beans, sweetcorn and pineapple.
• Fruit with tough skin e.g. apples, pears, tomatoes or pith e.g. oranges, satsumas,

tangerines, clementines. You may find peeling is required 

• Nuts.
• Driedfruit 

Balanced meal plate – week 5 onwards (solid/textured food) 

Aim to use a small 6-inch plate for your meals. 

Each meal should consist of: 

• Vegetables/fruit - half the plate.  These are filling and low in calories so are a great option  
• Protein-based foods - a quarter of the plate 

• Carbohydrate-based foods - a quarter of the plate 

Vegetables, salad & fruit (½ of the plate) 

Follow up and general guidelines on life with a Band 

• All varieties – fresh, tinned, frozen
• Stir-fry
• Steamed or boiled (retaining a “crunch”)
• Limit to one avocado per week – avocado contains healthy omega 6 oils but due to this it is quite high in calories
• Remember that baked beans count, but only 1 portion per day
• Only have small portions of peas, broad beans and sweetcorn as they are relativelyhigherin calories compared with other vegetables due to their carbohydrate content 
• Opt for‘snack/fun size’ bananas 
• Limit fruit to 2-3 portions per day –a great choice for a healthy snack

Carbohydrate-based foods (¼ of the plate) 

Breakfast cereals 

• Branflakes*
• Minibix*
• No added sugar muesli
• Fruit andFibre*
• Special K*

• All Bran* 
• Low sugar granola 

*or supermarket equivalents 

Bread and bread products – remember these are caution foods. 

• Low fat crackers (e.g.Ryvita,crackerbread, Finncrisp, Krisprolls, oatcakes) 
• Pitta bread

• Wraps 

• Sandwich thins 
• Flatbreads 

• Bread/toast – you may find Weight Watchers / Nimble-style bread easier

Potato and potato products 

• Jacket potato (normal or sweet) (with skin)
• Boiled/new potatoes (with skin)
• Home-made potato wedges (try sweet potato for a change - it will also count as one of your 5-a-day!)

• Less than 5% fat oven chips 
• Potato waffle 

Pasta and grains 

• Small pasta shapes, ideallywholemeal– you may find these easier than spaghetti/linguine 
• Noodles (egg or rice-based)
• Couscous

• Bulgur wheat/buckwheat 
• Rice - remember this is a caution food.  Wholegrain is better. Ensure you wash it thoroughly before and after cooking to prevent it becoming “sticky” 

Protein-based foods (¼ of the plate) 

Cheese  

• Reduced fat cottage cheese 
• “Light” cheese triangles/cheese spread 

• Reduced fat Feta-style cheese 
• “Light” / Babybel-style cheese 
• Reduced fat cheddar 

Eggs – omelette, boiled, scrambled, poached or dry fried 

Meats and low fat/lean meat products – remember these are caution foods. 

• Lean (ideally less than 5% fat) minced beef/pork/lamb/ chicken/turkey - as mince has a tendency to be soft and ‘easy to eat’ when cooked, aim to include chunky vegetables, beans and/or lentils when making meals from these foods.
• Stewing steak/casseroled/slow cooked meats
• “Wafer thin” sliced sandwich meats (ideally less than 5% fat)
• Skinless chicken thighs
• Lean sausages (ideally less than 5% fat)
• Lean bacon (fat cut off)
• Skinless chicken/turkey breast
• Grilled/dry fried/barbequed beef/pork/lamb

Fish and seafood 

• Fresh or tinned white fish (poached, grilled, steamed, baked)
• Fresh or tinned oily fish (poached, grilled, steamed, baked) e.g. sardines, mackerel, pilchards, fresh tuna, salmon, kippers.  Aim for 2 portions per week, as they provide essential ‘Omega 3’ oils. If you don’t like oily fish, consider taking a flaxseed oil supplement instead.
• Fresh or tinned shellfish e.g. prawns, mussels, clams, oysters, lobster

Vegetarian/vegan substitutes 

• Quorn fillets and pieces (vegan versions also available) 
• Quorn sausages and mince (no vegan versions available) 
• Soya products 

• Tofu 
• Tempeh 
• Non-dairy cheese 
• Fishless “tuna” 

Beans, pulses and lentils 

• All varieties (baked beans, chick peas, kidney beans,mixed beans)
• Products made with these foods e.g. falafel,houmous.

Milk and yoghurts (dairy or soya) 

Try to include some milk (or yoghurts) in your daily diet for your essential calcium 

See Follow up and general guidelines on life with a Band for more information. 

Drinks 

See Follow up and general guidelines on life with a Band  

Meal ideas for week 5 onwards 

All amounts are given as a guide only. You may require less or more than stated, as the band’s assistance in controlling portion size and appetite varies between people. 

Breakfast 

Eat as soon as you feel able in the morning – this may be a couple of hours after you wake. It could be that this ends up being a “brunch”, which isn’t necessarily a problem. It is important to eat as soon as you start to feel a little hungry, though - this will mean you are less likely to rush, reducing the risk of experiencing discomfort when eating. It will also help to ‘kick start’ your metabolism, thereby promoting use of stored fat as energy. 

Breakfast ideas include: 

• Any non-sugary crunchy cereal (e.g. bran flakes, Shredded Wheat or supermarket equivalent, malted wheat cereal e.g.Shreddies) and a splash of skimmed/1% fat/semi-skimmed milk (or lactose-free equivalents) or calcium-enriched soya milk or low-fat yoghurt/soya/lactose-free yoghurt + sweetener/fruit if required

• Fruit + high protein yoghurt (e.g. Arla, Skyr, 0% fat authentic Greek yoghurt) + 1tbsp toasted oats or low sugar granola 

• 1-2 poached/dry-fried/boiled/scrambled eggs or ½ tin beans or ½tin pilchards/

sardines/ mackerel and 1 slice toast* + light spread 

• Toasted bagel thin* with reduced fat cream cheese and (if you like it) yeast extract 
• Porridge, but only if made thick with some added raw chopped fruit e.g. apple, pear (thin porridge will be too soft and so not stimulate the nerve endings around the band very well) 

Avoid: 

Soft breakfast cereals e.g. Weetabix, rice krispies, corn flakes - these all turn soft very quickly after milk is added 

Smoothies (better to have some fruit) 

Meal-replacement or protein shakes 

*Remember, bread products are caution foods so you may wish to choose to have 2 low fat, high fibre crackers instead (e.g. Ryvita, Crackerbread, Krisprolls, Finncrisp, oatcakes) 

Lunch ideas include 

• 2-3 low fat, highfibre* crackers/crispbreads (e.g.Ryvita, Krisprolls, Finncrisp) (+ 2tsp. reduced/low fat cheese spread/soft cheese or ½ tin of fish (e.g. tuna, salmon) (in mineral water/brine, not oil) or 1 serving of smoked mackerel pate (see recipe below) or 1tbsp. Reduced fat shop-bought or home-made houmous or 1tbsp. spicy bean pate and 2 inches cucumber or 7 cherry tomatoes or 1 carrot or 1-2 sticks celery 

*avoid regular crackers - although often low in calories, they are very often high in fat and low in fibre, which means they require very little chewing break down too quickly, so the nerve endings won’t receive as much stimulation.  Aim for crackers containing less than 3g of fat per 100g. 

• 30g low fat mozzarella/45g cottage cheese/1-2 eggs/30g wafer-thin chicken/

ham/turkey + lettuce, tomatoes, peppers, cucumber + 1-2 egg-sized boiled 

potatoes/120g cooked (50g dried) pasta or couscous/2-3 low fat, high fibre crackers/crispbreads + mixed salad (try: lettuce, rocket, tomato, cucumber, celery, gherkins, jalapenos, beetroot, spring onion, finely sliced red onion, radishes, quartered grapes, sliced apple, grated carrot, shredded red or white cabbage). Try a low fat dressing. 

• Oven-baked jacket potato (white or sweet) with the skin + filling (e.g. 30g reduced fat cheese + ½ tin beans or ½ tin tuna + 1tsp. extra light mayonnaise + chopped gherkins or 30g reduced fat feta cheese + beetroot & mint or reduced fat mozzarella, cherry tomatoes & basil) and half a plate of salad. 

• Pasta salad (why not make a batch for the week on a Sunday?) – 50g dried (120g cooked)wholemealpasta + chunky diced raw peppers, red onion, cucumber and gherkin + 1tbsp of a home-made tomato sauce or extra light mayonnaise and half a tin of tuna / half a diced chicken breast / half a tin of mixed beans 

• Toasted wholemeal sandwich thin with a small tin of baked beans 

• Medium wholemeal toasted pitta bread with sliced chicken/ham or half a tin of tuna with salad 

Evening meal ideas include 

• 1 palm-sized fish cake (made with cod, smoked haddock, seasoning, spring onion, 

mashed potato (white or sweet), lime zest and chilli if desired) + half a plate of crunchy al dente vegetables or mixed salad 

• ½ grilled tuna steak or 1 salmon fillet + 2-3 small new potatoes + 1-2 portions veg
• Stir-fry: 50g Quorn/soya meat/king prawns/finely diced chicken + peppers,courgettes,spring onions, mushrooms + 1tsp reduced sugar sweet chilli sauce + 1tsp reduced salt soy sauce + 50g dried (120g cooked) egg or rice noodles (ideally wholemeal) 
• 2 tbsp. cooked couscous + roasted vegetables (peppers,aubergine,courgette, red onion, cherry tomatoes, mushrooms) + 30g reduced fat Greek-style salad cheese 
• 60-70g less than 5% beef/pork/turkey mince or Quorn mince made into a burger (with onion, seasoning + 1-2tsp. milk) + 6-10 potato wedges (make your own by chopping a baking potato or sweet potato into wedges and tossing in 1tsp. olive oil, 1tsp. ground cumin, 1tsp. ground coriander, 1tsp. cayenne pepper and baking at 220ºC for 30 minutes or until crisp) (no burger bun) + mixed salad
• 2tbsp. cooked bulgur wheat + 2tbsp. mixed beans + mixed salad
• 60-70g mixed beans made into a burger (mashed together with onion,chilli, garlic,

seasoning + 1-2tsp. milk or beaten egg to bind) + 6-10 potato wedges (no burger bun) + salad 

• Halibut & green bean salad 
• 2-egg Spanish-styleomelettewith finely sliced potatoes, peppers, tomato and mushrooms 
• 1 lean sausage/vegetarian sausage* + 2 egg-sized new potatoes + 1-2tbsp. green beans
• Spaghetti Bolognese made with extra lean minced beef (1 x 500g pack should make

10+ portions), coarsely diced carrot, peppers, courgettes & onion (sauce to fill a quarter of the plate) + 120g cooked (50g dried) pasta (to fill another quarter of the plate) + half a plate of steamed al dente crunchy vegetables or salad 

• Chicken or Quorn fajitas 

Snacks 

Once your band has the right amount of fluid for you (remember this takes 4-6 adjustments on average), you shouldn’t feel physically hungry again until 4-5 hours after a meal. However, if you find you are going longer than this between meals, it is important you have a snack, or you may find it difficult to eat your next meal (see Common problems).  

In the earlier stages post-surgery when the band is not yet tight enough, you may find you are hungry sooner than 4-5 hours after meals and so need a snack. 

Ideally, try to go for one of the following healthy options - they’ll give you fibre, vitamins and minerals, as well as being a low calorie choice: 

• A portion of fruit e.g. 1 ‘fun size’ banana or ½ a normal sized banana, 10 strawberries, 1 apple/peach/nectarine, 2 satsumas/kiwis, 3 plums 
• 1 raw carrot/½ pepper/1-2 sticks celery/1-2 inches cucumber & 1 tbsp. reduced fat hummus/smoked mackerel pate/bean pate  

• 5-6 olives

• 1 tablespoon sesame seeds 
• 3 Brazil nuts / 4 walnuts / 5 almonds 
• A handful of plain (not salted/sweet) popcorn - this is easy to make yourself 
• 1 or 2 high fibre, low fat crackers/crispbreads with a scrape of reduced fat soft cheese, reduced fat or homemade houmous or spicy bean pate 

If you really don’t fancy one of the above options, try to still go for something containing under 100 calories - examples include: 

• Certain cereal bars e.g. Alpen Light, Special K,RyvitaGoodness 
• Packet of crisps/baked snacks e.g. Snack-a-Jacks,RyvitaMinis, Quavers, Squares, Wotsits, Skips, French Fries. Tip: Often packets bought individually will be higher in calorie than those from multipacks, so do check the label 

• 2 rich tea biscuits or 1 plain digestive or oat biscuit 

Some chocolate mousse pots (check the label), low fat yoghurt/fromage frais and sugar-free jelly are all low calorie choices, but they lack texture so are best kept to when you just fancy something sweet but recognise that you aren’t physically hungry. Try freezing yoghurts for a longer-lasting snack. 

Sample Meal Plan One 

Breakfast: Poached egg on a small slice of granary bread, toasted – sprinkle a little freshly chopped chives over for extra flavour 

Mid-morning (if hungry): A sliced Kiwi fruit 

Lunch: Toasted wholemeal pitta bread filled with small can of tuna, finely chopped spring onion, shredded lettuce, a drizzle of lemon juice and black pepper  

Mid-afternoon (if hungry): A handful of fresh strawberries or raspberries 

Evening Meal: A small swordfish or tuna steak cooked in spray oil and served on a bed of wholegrain rice with a fresh green salad on the side 

Sample Meal Plan Two - Vegetarian 

Breakfast: Low sugar granola with low fat natural yoghurt and a handful of fresh berries on the top 

Mid-morning (if hungry): Half a carrot, cut into sticks 

Lunch: reduced fat cheese salad - try finely chopped peppers, red onion, tomatoes, cucumber and flat leaf parsley – serve with an oil free dressing if desired and a couple of high fibre, low fat crackers/crispbreads for carbohydrate 

Mid-afternoon (if hungry): Small, fresh fruit salad 

Evening meal: Quorn stir fry – chop the Quorn into chunks, and add your favourite chopped veg. Add garlic, ginger, chilli and soy sauce (ideally reduced salt) for extra flavour and serve on a bed of rice (ideally wholegrain) 

Sample Meal Plan Three – Vegan 

Breakfast: branflakes with calcium-enriched non-dairy milk and a handful of fresh berries 

Mid-morning (if hungry): ½ carrot or ½ pepper cut in to sticks 

Lunch: small jacket potato with non-dairy cheese and a side salad of your choice 

Mid-afternoon (if hungry): 2 crispbreads topped with sliced beetroot 

Evening meal: Oven baked tempeh with steamed broccoli on a bed of brown rice  

Textured diet – check list  

• Follow the 20/20/20/20 rule 
• Foods should be solid and chewable 
• Avoid meal replacement drinks and soft sloppy foods 
• Have regular, small, balanced meals 

• Exercise regularly 
• Swap to a solid tablet multivitamin & mineral supplement once managing a normal, textured diet