Meeting with the dietitian?

Describe the dietitian’s role in treating the weight loss surgery patient.

• The role of the dietitian is to provide nutrition education, counseling and support to guide patients through healthy lifelong changes that promote weight loss. Working with a dietitian has been shown to increase the chances of successful weight loss.

What is the goal of the dietitian when caring for the weight loss surgery patient?

• The goal of the dietitian is to improve patient outcomes and satisfaction through guidance in making healthy lifestyle choices that assist each patient in achieving their weight loss goals.

What are some things you look for when first sitting down with a patient?

• First I review the patient’s weight and diet history, their current exercise schedule and future plans for exercise. We then discuss the patient’s weight loss goals, their reasons for seeking bariatric surgical intervention and level of commitment to achieving their weight loss goals.

What can I expect from my first appointment with a dietitian?

• Each patient will complete a nutrition questionnaire that includes a 24 hour food intake record, questions regarding existing attitudes towards food and eating. Education includes: diet and behavioral modifications in preparation for surgery, protein supplements that are best to use during the clear and full liquid diet phase of recovery, and recommended vitamin/mineral supplements. Diet FAQ

What are some of the diet or behavior changes that patients should expect?

• To achieve lifelong success, lifestyle changes should include a diet that is: low fat, high protein, caffeine-free, and beverages that are non-carbonated. A daily routine of three healthy meals with one to two snacks if needed is recommended.

• Behavioral changes include eating protein first and limiting high calorie, high fat, and high carbohydrate foods. Patients might want to use smaller plates and utensils for eating. It is also suggested to chew each bite 20 times, avoid frequent snacking, do not drink with meals, avoid alcohol, track food intake via a journal, and establish an exercise regimen.

Do you have any tips or guidelines for eating and preparing meals?

• Patients will achieve success when they commit to choosing healthier cooking methods. Crock pot cooking is ideal for preparing moist digestible meals. Always including a protein at each meal, eating protein first while practicing mindful eating by eating slowly, purposefully, and taking the time to chew food properly. Savoring the taste and texture of food and being aware of hunger and feelings of fullness. Patients should drink 48-64 ounces of water daily. It is important to avoid simple sugars as they might cause dumping after Roux-Y Gastric Bypass surgery. Small portions of lower fat, healthy, nutrient-dense foods can help to reduce overall food consumption while increasing nutrient intake.

What diet changes should patients expect leading up to surgery and after surgery?

• Two weeks prior to surgery, patients start a meal plan of 600-800 calories per day. The goal of this low calorie meal plan is to facilitate the breakdown of fat without causing muscle loss.

• Once cleared after surgery, patients start clear liquids for two days. The diet should then progress to full liquids, pureed, and soft foods until they are ready to start a regular diet. Patients should follow the diet progress chart guidelines as developed by their dietitian.

What is the difference between a clear liquid diet and a full liquid diet?

• Clear liquids, you can see through. Full liquids, you cannot see through and are milky in appearance.

What do patients with high blood pressure or diabetes need to know about diet after weight loss surgery?

• Patients should follow low sodium, controlled-carbohydrate diets and make use of herbs and natural seasonings to flavor food. Carbohydrate intake will decrease significantly, therefore patients using insulin and other diabetes medications, will need adjustments to prevent low blood glucose levels. Additionally, patients should develop a plan with their primary care doctors to regularly monitor their blood pressure and blood sugar.

What diet progression should patients expect in the weeks following surgery?

The diet after surgery progresses through 5 stages:
• Clear Liquid Diet for the day of surgery and the day after surgery.
• Full Liquid Diet for day 3 through day 9 after surgery.
• Pureed Diet for day 10 through day 20 after surgery.
• Soft Diet for day 21 through day 29 after surgery.
• Regular diet from day 30 forward.

Lifelong diet should consist of low-fat protein sources, vegetables, fruits and healthy whole grains.

What type of vitamins should patients be taking based on the procedure selected?

• All bariatric patients require a high-potency multivitamin which contains 100% of the daily value for the rest of their lives. Patients undergoing the Sleeve Gastrectomy may purchase a high-potency over the counter multivitamin. Sleeve Gastrectomy patients also require additional vitamin B 12 supplements and may require Iron and Calcium.

Patients undergoing the Roux-(en)-Y Gastric Bypass and the Duodenal Switch (DS) are required to purchase a bariatric multivitamin/mineral supplement and take as recommended. Roux-Y Gastric Bypass and the Duodenal Switch patients also require larger doses of Calcium daily. This should be separated into three to four separate doses as Calcium is not absorbed in large doses. DS patients are going to malabsorb fat soluble vitamins (A, D, E, and K), Vitamin B 12, iron, and Zinc; all nutrients require to be supplemented in a bariatric formula.

All bariatric patients require Vitamin D during the winter season. Iron Fumarate is the preferred Iron supplement. Calcium Citrate is preferred over other calcium supplement sources. Note that Iron and Calcium supplements should be taken two hours apart. Iron and vitamin C should be taken together to improve absorption first then followed by Calcium and vitamin D two hours later.

Why is it important that patients consume enough calories?

• Adequate calorie consumption is an essential component to meeting the body’s energy needs while also promoting weight loss. In the first year following surgery, most patients may average around 800 kcals. Long-term, most women need 1200 calories per day and most men need 1500 calories per day to maintain weight loss.

Why is it important that patients get enough protein in their diet?

• Protein is required for optimal healing after surgery and aids in the prevention of hair loss. Protein is also required to protect and preserve muscle tissue. Additionally, protein is essential in maintaining a healthy metabolism. High-protein foods include eggs, lean red meats, fish, tuna, poultry, soy milk, tofu, cottage cheese, sugar-free yogurt and other low-fat milk products. Aim for 60 to 85 grams of protein daily.