Meeting with the dietitian?
Describe the dietitian’s role in treating the weight loss surgery patient.
- The dietitian’s role is to educate patients on the appropriate dietary and lifestyle changes before and after surgery to promote and sustain weight loss. The dietitian also provides support and guidance throughout the weight loss process.
What is the goal of the dietitian when caring for the weight loss surgery patient?
- The goal of the dietitian is to provide the patients with the necessary tools and evidence-based knowledge to promote weight loss, healthy lifestyle changes, and positive health outcomes. These tools may include handouts, recipes, interactive discussions and support throughout the weight loss process.
What are some things you look for when first sitting down with a patient?
- First, I review the weight history, diet history, current exercise routine, and any future plans for exercise the patient may have. Together, we then discuss weight and health goals and the means in which the patient may achieve these goals. We focus on 2 – 3 goals each visit to promote self-efficacy and sustainably.
What can I expect from my first appointment with a dietitian?
- The patient will complete a brief questionnaire describing what the patient had to eat in the past 24 hours, current food/eating habits and attitudes, a brief weight history, and current exercise routine. Through this questionnaire, the patient and I discuss goals and barriers he/she may have. Then, we discuss current and future dietary changes in preparation for surgery. Additional educations such as behavior modifications and supplementation are provided to further prepare and equip the patient with the knowledge and tools for success.
What are some of the diet or behavior changes that patients should expect?
- To promote weight loss and lifestyle change, patient should follow a low fat, high protein diet. Additionally, patients should also exclude any caffeinated or carbonated beverages.
- Changes in behavior involving food are equally as important as diet changes. Some of the behavior changes patients are encouraged to implement prior to surgery are eating protein first, utilizing smaller plates and utensils, chewing food at least 20 times before swallowing, waiting 30 minutes between meals and beverages, planning meals, and tracking food intake.
Do you have any tips or guidelines for eating and preparing meals?
- Preparing meals by means of steaming, baking or grilling is greatly encouraged to promote weight loss. If time is limited, preparing meals in a crock pot is a good way to cook meals for a busy lifestyle. Including protein in each meal, smaller portions of lower fat foods and incorporating a variety of vegetables adds balance to your diet and promotes the feeling of fullness. Enjoy your meal by practicing mindful eating techniques such as chewing at least 20 times and putting your fork down in between bites. Drinking at least 64 oz. for water throughout the day while avoiding caffeinated and carbonated drinks promotes hydration and further prepares patients for after surgery.
What diet changes should patients expect leading up to surgery and after surgery?
- In the two weeks before surgery, patients should start a meal plan of 800 – 1000 calories per day to facilitate the breakdown of fat without causing muscle loss. Protein supplements are important to ensure the patient is still getting adequate protein.
- The day before surgery, day of surgery, and the day after surgery, the patient will follow a clear liquid diet.
- Once cleared, the diet should then progress to full liquids, pureed, soft foods, and then regular diet. The patient will follow a diet progression outlined by the dietitian in the previous nutrition educations.
What is the difference between a clear liquid diet and a full liquid diet?
- Clear liquids are transparent or you can see through it. Full liquids are opaque or you cannot see through it.
- Examples of clear liquids include water, clear protein supplements, sugar-free gelatin and popsicles, and clear broths.
- Examples of full liquids include non-fat or 1% milk, soy milk, protein supplements, sugar-free yogurt and pudding, and low-fat strained cream soups.
What do patients with high blood pressure or diabetes need to know about diet after weight loss surgery?
- Following a diet that is low sodium and controlled carbohydrate is beneficial for all patients, especially those with high blood pressure or diabetes.
- For patients with diabetes, be sure to talk to your primary care physician and Endocrinologist about monitoring blood sugar levels and adjusting insulin and/or medications relating to the management of diabetes to prevent low blood sugar due to the decrease in carbohydrate intake.
- For patients with high blood pressure, be sure to talk to your primary care physician and cardiologist about monitoring blood pressure levels and adjusting medications related to the management of high blood pressure.
What diet progression should patients expect in the weeks following surgery?
- The diet after surgery progresses through five stages:
- Day before, day of, and day after surgery: clear liquids
- Day 3 through day 9: full liquids
- Day 10 through day 20: pureed diet
- Day 21 through day 29: soft diet
- Day 30 and forward: regular diet
- The dietitian will review the diet progression in detail with patients prior to surgery.
- Eating protein first and at each meal, low fat options, and incorporating vegetables is important throughout each stage.
What type of vitamins should patients be taking based on the procedure selected?
- It is imperative to take the recommended vitamins and minerals after surgery. Patients will need to take the recommended vitamins and minerals permanently or until otherwise instructed by his/her doctor.
- Patients undergoing the Sleeve Gastrectomy: take a high-potency multi-vitamin that contains 100% of the daily value of nutrients (can be found over the counter). Vitamin B12, iron, calcium, and vitamin D may also be required as well. Be sure to discuss vitamin B12, iron, calcium, and vitamin D levels with your surgeon.
- Patients undergoing Roux-En-Y Gastric Bypass or the Duodenal Switch (DS): a multi-vitamin, calcium, iron, vitamin B12, fat soluble vitamins (A, D, E, K), and zinc are recommended.
- If taking calcium, calcium supplement is divided into 3 doses taken at least 2 hours apart from iron to promote absorption.
- One month after surgery, vitamins need to be chewable or liquid while the surgical area heals.
- Prior to surgery, patients are recommended to trial different brands and flavors of vitamin supplements to find one that he/she may like.
Why is it important that patients consume enough calories?
- Consuming enough calories is essential for meeting the body’s energy needs while promoting weight loss and muscle retention. Once advanced to regular diet after surgery, women will resume a 1200 calorie diet and men will resume 1500 calorie diet. Regular exercise is important for muscle retention and weight management.
Why is it important that patients consume enough protein in his/her diet?
- Protein is essential for wound healing after surgery. Continuing adequate protein intake is essential well after surgery to prevent and maintain muscle mass. The continuation of protein supplementation is encouraged in post-op patients. Patients should consume about 70 grams protein per day. High protein foods include egg whites, lean meats (e.g. chicken or turkey), fish, tuna, soy milk, tofu, and low fat dairy products.