By Carlene Helble-Elite Nutrition Intern
Margaret really filled us in on her great book Eating After Weight Loss Surgery. Read on to part two and see more of what she had to say!
1. It must be important to be very in touch with your body when you have gastric banding. Do you find it’s difficult for a recent patient to learn to‘listen’ to what the body says with, for example, being full or with food or liquid not passing through the stoma?
It’s very important for all bariatric surgery pts, including band patients, to listen to their bodies. My patients tell me, in general, that their feeling of fullness is more like a chest fullness/chest pressure, which escalates to chest pain if they continue to eat, so I review that with them on a continual basis. I also warn band patients regarding possible blockage/obstruction if they don’t chew thoroughly, especially with meat, chicken, etc., and advise them to chew until food is absolutely liquid prior to swallowing. I use the analogy “think of your teeth and mouth as you new stomach.”
2.The gastric sleeve surgery is new to me. Is it the best type of weight loss surgery right now since there is no malabsorption and it takes some of the traits of a metabolic surgery?
It’s hard to say if it’s the best, since there are still some risks, and we only have 5-year data right now. I recently attended a bariatric surgery conference in Lisbon, Portugal, and some of the surgeons in Europe commented that they had 5-year sleeve patients with stretched-out stomachs and significant regain, but this was anecdotal. The current research on the sleeve, again 5-year data, seems quite promising, in terms of excess body weight loss, but we’ll have to wait and see what the long-term data looks like. Anecdotally, the sleeve patients I’ve been working with seem, overall, to be losing weight almost at the GBP level, but again, too soon too tell. It is, in my opinion, though, a nice “middle-of-the-road” surgery that may help with diabetes and may be converted into a GBP or switch if weight loss is not significant. Also, vitamin B 12 and iron deficiencies may be an issue, so I’m having my sleeve patients take additional B12 (sublingual) and watching iron for now.
3. Protein malnutrition seems like a huge problem post op. What’s on the forefront of protein supplements and powders for post op weight loss pts.
I don’t see as much protein malnutrition as you might guess, and the current labs we have, such as albumin, and even prealbumin, aren’t perfect. However, I still advocate protein supplements, particularly within the first few months postop, to help fill the protein gaps. High-quality protein supplements in general include whey or soy protein isolate. Also, I discourage collagen-based protein supplements (e.g. bullets or shots) as I explained before due to low protein absorption related to missing and/or low indispensable amino acids. In terms of what’s on the forefront, I know of at least one bariatric surgery company that’s included multivitamins, calcium and protein into a powder, and this may help facilitate things for bariatric surgery patients.
4. Mindful eating helps us from over eating. Do you think eating on the run is habitual and can cause people to eat even when you’re not hungry? (By the way I love the chopsticks suggestion to get people to slow down.)
Absolutely. Studies have suggested that when we eat on the run, our brain tends to not “register” the food or beverage as well as if we sit and take our time, and this may exacerbate hunger and weight issues. I also have been advocating, where appropriate, the possible use of utensils that tell patients when to eat and when to stop (e.g.www.mydietdinnerware.com is something some of my patients find helpful: disclaimer: I have absolutely no ties to any industry, including this one). However, even with this dietdinnerware tool, one of my patients ate around it by shoveling the food in during the 40-second “green light” on the dinnerware, before the 25-second red light came on. I then told her she could take no more than 2 bites per 40-second green light, and that seemed to work for her.
5.Support groups post op with R.D.’s can help someone stay on track. Do you find people have misconceptions about R.D. ’s as ‘food police’?
Absolutely, but I try to overcome that. I’m present at all 3 of our monthly support groups, and my patients know I’m not there to judge them. I highly encourage all bariatric surgery patients to regularly attend support groups, and the research suggests patients who do attend them regularly do better, in terms of weight loss and avoiding and/or minimizing weight regain.
6. Weight loss and regain- do you often have to remind pts that it’s a process-not to expect perfection immediately/ instantaneous- we live in a world of instant gratification.
Yes, and I tell them their body will want to regain some weight for “famine insurance” which scares them but reassures them too. I tell them no one expects perfection , and to just keep going, even if they have some dietary indiscretions.
7. One of my favorite quotes from the book, which you often tell people in your classes is “If it doesn’t have a mother, it doesn’t have cholesterol.’ What’s another good simplified nutrition reminder?
I’d say “your teeth and your mouth is your new stomach” and also “keep in mind that no matter which bariatric surgery procedure you have, they don’t operate on your brain, so you need to change your relationship to food and physical activity forever.”
Many thanks to Margaret! It was a pleasure to interview her!