Episode 20

Mediterranean Diet After Weight Loss Surgery

Published on: 20th September, 2022

Mediterranean Diet after weight loss surgery

Success after weight loss surgery doesn't end with an operation. It just gets started.

The most recalcitrant people to diets are those who undergo weight loss surgery. Weight loss surgery patients were on multiple diets prior to surgical intervention.  The Mediterranean Diet is the best post-operative diet one can have.

Weight Loss and the Mediterranean Diet

The Med Diet is favorable for health. Multiple studies have shown decreased risk of cardiovascular disease, cancer, and autoimmune disease. What about weight loss? Systematic reviews have shown the Med Diet is equal or superior to other diets for weight loss. However, we found no post-operative program to adopt the Med Diet after weight loss surgery.

Preoperative Med Diet

We began coaching patients with the Med Diet before surgery. Many insurance companies require a preoperative, physician-supervised diet. In 2010, we began to use the Mediterranean Diet as a template for our patients using the 9-point scale.  Contrary to weight loss plans, our emphasis was learning the Med Diet.

Weight Loss Surgery Protocol Liquid Phase

The immediate post-operative diet emphasized soups and smoothies rich in legumes, vegetables, and fruits. Modular, unflavored protein supplements (whey or pea-based) were used to augment the protein content during this time, as were standard chewable vitamins.  Thus, the beginning of the post-operative plan was already a rich Mediterranean-style diet.

Early Solid Food Phase

Legumes and fish were emphasized during the early solid food phase, which were universally easy to digest. One of the favorite Mediterranean-style foods were tacos.  Contrary to popular belief, the Med Diet is not foods commonly eaten in the Mediterranean. Instead, it consists of foods rich in whole grains (corn tacos), fruits (homemade salsa), legumes (lentils), some dairy products (cheese), and fish.

We noted lettuce was problematic for some in the early phase, but spinach was easy to digest. Thus salads were based upon spinach rather than lettuce.

Later Solid Food Phase

As the stomach continued to heal, we stressed the increase in food with multiple fiber types.  We de-emphasized red meats, cautioned against excess alcohol, and worked on olive oil as the primary source for fats.

Follow up

Cooking classes were a constant feature of our support group, often bringing in guest chefs from the area and the Food Network. We emphasized the importance of patients learning to cook.  Many of our patients believed that cooking was the most important aspect of their postoperative care. We found that those who learned to cook their meals had better weight loss than those who did not.

Validated Food Frequency Questionnaires (FFQ) were used to follow a group of patients. The FFQ were validated using dietary logs during follow-up with patients.

Getting in that quantity of food

Stomach capacity after weight loss surgery is limited. How, then, does one get in the required amount of food? It is not difficult.

All food is measured pre-cooked. Take broccoli. If you take nine ounces of broccoli and bake it, you end up with a small amount of volume but still have the one Mediterranean Diet point.

The increase of vegetables in the diet is one way to reduce inflammation.

Food increases over time

Food volume increases over time with both the Gastric Sleeve, Lap-Band, and RNY gastric bypass. The answer is not to eat less or take more protein shakes. The answer is to eat better. To have a balanced diet.

Putting someone on yet another low-carb plan does not provide a healthy long-term solution. 

Protein Deficiency

Since meat is not emphasized in the Mediterranean Diet, some patients were concerned about protein intake. Lab tests did not show any patient with protein deficiency.

The Study

Over 220 patients agreed to long-term follow-up with FFQ, but we obtained consistent data on 134 patients after surgery, with a minimum seven-year follow-up.

The FFQ were converted to the nine-point Med Diet, and the results were analyzed.

Of the 134 patients, there were 65 which had scores of 5-9 Mediterranean Diet points. They showed an absolute reduction of weight of 54% total weight loss. Those patients who scored 0-3 points had a total weight loss of 32%.

What About Poor Adherence to Med Diet

Of the patients studied, 74 had the Lap-Band, 50 had the Vertical Sleeve Gastrectomy, and ten had the RNY gastric bypass. There was no weight loss difference regarding the type of weight loss surgery.


Those patients who did not do well with weight loss all had >50 grams of alcohol per day. In contrast, those who did well reported less than 50 grams of alcohol per day.

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About the Podcast

Fork U with Dr. Terry Simpson
Learn more about what you put in your mouth.
Fork U(niversity)
Not everything you put in your mouth is good for you.

There’s a lot of medical information thrown around out there. How are you to know what information you can trust, and what’s just plain old quackery? You can’t rely on your own “google fu”. You can’t count on quality medical advice from Facebook. You need a doctor in your corner.

On each episode of Your Doctor’s Orders, Dr. Terry Simpson will cut through the clutter and noise that always seems to follow the latest medical news. He has the unique perspective of a surgeon who has spent years doing molecular virology research and as a skeptic with academic credentials. He’ll help you develop the critical thinking skills so you can recognize evidence-based medicine, busting myths along the way.

The most common medical myths are often disguised as seemingly harmless “food as medicine”. By offering their own brand of medicine via foods, These hucksters are trying to practice medicine without a license. And though they’ll claim “nutrition is not taught in medical schools”, it turns out that’s a myth too. In fact, there’s an entire medical subspecialty called Culinary Medicine, and Dr. Simpson is certified as a Culinary Medicine Specialist.

Where today's nutritional advice is the realm of hucksters, Dr. Simpson is taking it back to the realm of science.

About your host

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Terry Simpson

Dr. Terry Simpson received his undergraduate, graduate, and medical degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. Until he found he liked people more than petri dishes. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2018 and 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.”