Eating After Weight Loss Sugery: Tips From Margaret Furtado, RD

By Carlene Helble-Elite Nutrition Intern

I just finished reading The Complete Idiot’s Guide to Eating Well After Weight Loss Surgery by  Margaret Furtado MS, RD, LDN, RYT.  Margaret is a clinical dietitian at Johns Hopkins Bayview Medical Center who specializes in bariatric surgery. Her book is well thought out and chock full of great information for RDs and potential weight loss surgery candidates alike. I had the amazing opportunity to interview her and share my answers with you. Read on for part one of two!

1. How did you start to get involved as a dietitian in weight loss surgery?

I had been an RD for about 10 yrs, and was working in renal in Boston, MA when I first became intrigued by bariatric surgery.  I had had some hemodialysis patients who were seeking GBP to lose enough weight to be considered renal transplant candidates, and worked closely with the bariatric RD at Boston Medical Center, since I worked at a dialysis unit affiliated with Boston Medical Center, and on the same campus.  Then, one of the hemodialysis techs had gastric bypass, and I became totally intrigued by her progress and weight loss success.  I then researched it further, thought it would be so nice to get into that field, and voila, there was suddenly an opening at Tufts Medical Center (then known as New England Medical Center) in bariatric surgery.  I interviewed, got the job, and essentially fell in love with the whole field, especially  when I saw first-hand how it significantly improved the quality of people’s lives, as well as their families.  It’s still something I never tire of seeing!

2.What is a real gem of information for R.D.’s to remember when counseling post op. patients?

Everyone is individual, and has different needs and perhaps challenges, in terms of not only losing weight, but keeping it off.  However, caveats include assuring their goals are realistic, wanting to have surgery for the right reasons (e.g. health vs. an unattainable weight and/or thinking weight loss will make their lives perfect), and of course the essentials postop, such as adequate fluid, protein, adherence to vitamins, calcium for life, etc.  Also, family and overall support is key.  Bottom line: the surgery, no matter how involved, is just a tool and doesn’t change your brain and/or relationship with food.  That has to change for long-term success.

3.With the surplus of resources available on the Internet, do you find patients often come to you with misconceptions or false information on the topic of weight loss surgery?

Absolutely!  A big one is that they can never eat carbs again, or that they need an inordinate amount of protein (say over 150 grams per day) and/or that their hair won’t fall out if they take this or that over-the-counter supplement.  The hair loss, often overall thinning 3-6 months postop which returns to normal within another 3-6 months, is usually due to the stress of surgery and the weight loss.  Also, the lower-quality collagen (aka bullets) are all over the internet as being superior, but are generally low in protein quality (PDCAAS) due to missing key indispensible amino acids and/or low % of those amino acids.

4. Metabolic vs. restriction diets: do you find patients have an easier time relearning diet and nutrition after one vs. the other?

Not necessarily, they have to change their relationship with food.  The purely restrictive procedure is the gastric band, and the failure rate overall is higher, perhaps because there aren’t the metabolic changes which are a “head start” for patients.   Also, patients who have a restrictive procedure (e.g. gastric band) are at higher risk to “eat around it” by snacking all day (I don’t like the term “grazing” but it sums up the constant nibbling all day some patients do that tends to increase weight loss failure).  However, I have seen very successful band patients who are diligent with their diet and exercise, and I’ve seen GBP pts who gained their weight back because they reverted to old habits and/or never changed their relationship with food, so individual support and determination and success really varies.

5. It seems like with metabolic surgeries you need to consider more nutrient planning in a diet since there is malabsorption with a reroute of the G.I. tract. Would an R.D. have to consider each intake throughout the course of a week in order to be sure the client is getting adequate amounts of all nutrients/vitamins?

We have a very strict vitamin/mineral regimen we recommend for our bariatric surgery patients, but of course, the diet is very important.  I think it’s important to look at the overall picture and assess the patients USUAL diet, regardless of which bariatric procedure they had.  However, having said that, patients who have gastric bypass, and certainly duodenal switch patients, must be diligent with their multivitamin/mineral supplements or possibly risk significant and sometimes irreversible vitamin/minerals deficiencies, such as iron, B12, thiamin, copper and zinc.

6.One tip I didn’t expect to hear in this book was to never diet again after surgery since it can reverse your weight set point. That must be difficult to have a client so used to dieting lifestyle to stop cold turkey!

Absolutely, and it’s a big leap of faith for many of my patients.  However, I feel it’s key to utilize mindful eating and intuitive eating to help patients trust their bodies again and to eat when physically hungry vs. emotionally hungry.  However, in the first 6 months after gastric bypass and some of the other procedures with metabolic components, many patients aren’t hungry for at least 6months (the “honeymoon period”) so they may need to remind themselves to eat.

Margaret has lots of great tips in her book and even more through her gracious interview! Tune in again to read part two of our interview.