By Lori Skurbe, RD, MPH, CDE
Dietitian’s Corner is a monthly column for post-op and pre-op patients of bariatric surgery in NJ written by Prime Surgicare’s Lori Skurbe. Lori has been a dietitian for over 20 years with an extensive background in weight management, bariatric nutrition and diabetes education. She has worked at the local, state and national levels of The Academy of Nutrition and Dietetics, and she has served as president of the New Jersey Dietetic Association.
After weight loss surgery (WLS), you will adopt an improved method for adding fuel to your body in a healthier way, by consuming high-protein, low-fat and low-carb meals. Weight regain is more likely to happen when WLS patients veer away from the bariatric meal plan and fall back on old eating habits.
One way to stay on track is to modify higher-calorie, high fat and/or high sugar recipes to make them more bariatric friendly.
When you change a recipe, the first thing to consider is the purpose of each ingredient — some provide flavor, some offer texture or structure (particularly when making baked goods) and others are used as a binder or for moisture.
With the holiday season fast approaching, I’d like to offer a few ways to prepare your favorite family recipes, but with fewer calories, fat and carbs.
If the ingredient is required for flavor or moisture/binder, you can readily change them. For example, when making dips, use fat-free plain Greek yogurt instead of sour cream. In this case, the sour cream is there to bind the other ingredients and provide moisture.
Greek yogurt serves the same purpose as sour cream, but with far fewer calories and more protein and other important nutrients.
Holiday and everyday recipes can be modified by changing ingredients that add the most calories – usually fats and sugars.
To lower the fat, try these suggestions:
To reduce sugar, try these easy and delicious substitutions:
When modifying a recipe, make one change at a time, so you know how each change affects the recipe’s outcome. Keep a record of how you adjusted the recipe.
Modifying recipes is a great way to make some of your family favorite recipes more bariatric friendly. In addition, by making holiday favorites more healthful, you can stay true to your bariatric plan and not gain weight over the holiday season.
I would love to share your favorite bariatric-friendly recipe with our other patients and our monthly bariatric support group meetings. Please email them to me at firstname.lastname@example.org or leave a comment below.
Prime Surgicare’s one-of-a-kind Bariatric Success Program offers a five-pronged approach to preparing and ensuring your long-term weight loss success, including private visits with bariatric nutritionist, Lori Skurbe.
To find out more, register for one of our free monthly bariatric seminars or webinars, or call our weight loss surgery specialists at (732) 982-2002 to schedule your private consultation.
“You can fully enjoy socializing at your favorite restaurant with friends and family after bariatric surgery,” says Prime Surgicare dietitian Lori Skurbe, MPH, CDE. “The only change is what you eat, drink and the size of your portions.”
Lori provides private nutritional counseling to our patients before and after weight loss surgery. She also facilitates the monthly bariatric support group meetings at CentraState Medical Center in Freehold, which also include Prime Surgicare bariatric surgeons and staff.
“Some patients experienced pushback in restaurants when they ordered child-sized meals or only the appetizer,” Lori explains. “So we created business cards which outline the medical necessity for you to consume reduced-sized meals.”
If you’d like to have one of our bariatric ID cards, you can print one from the image shown here or we would be happy to give you a card at your next office visit.
Lori recommends patients who order full-size meals ask their server to bring a take-home container when their food is served.
“This way, you can separate what you will enjoy during the meal and remove the excess food for tomorrow’s lunch and sometimes even dinner!”
Dr. Seun Sowemimo also reminds people they can personalize their meal and even order off the menu in more places than you might realize. “I have an aversion to heavy sauces and prefer my protein to be prepared without fat or oils,” he says. “I also don’t care for that heavy feeling after I eat potatoes or pasta, so I substitute them with a second vegetable or extra salad.”
“Remember, you are in charge of what you eat when you dine out,” says Dr. Seun. “Order your meal in a way that makes you feel satisfied, not guilty.”
>>> Share your tips and tools for dining out after weight loss surgery on Dr. Seun’s Facebook page.
Everyone’s lifestyle is unique — the way you work, exercise and when and what you enjoy eating. That’s why we created Prime Surgicare’s Bariatric Success Program, comprised of five exclusive bariatric resources tailored to meet your ‘real-life needs.’
“The bariatric journey is much more than just an operation,” Dr. Seun explains. “We created a comprehensive lifestyle change program to help every patient achieve their weight loss goals quickly, safely and permanently.”
To find out more, register for one of our free monthly bariatric seminars or webinars, or call our weight loss surgery specialists at (732) 982-2002 to schedule your private consultation.
Everyone has to meet with a dietitian before Weight Loss Surgery (WLS) to meet insurance requirements. Some people may look at this as a box they need to check or another hoop to jump through along with all the other specialists they need to see to get approved for surgery.
Instead, look at these meetings with your bariatric dietitian as a chance to learn as much as you can about how your diet will change and how you can begin making those changes. Meeting with a bariatric dietitian is an important part of your WLS journey to begin to learn a new way of eating. Nutrition is the cornerstone of WLS success — even with surgery — if you are not following the bariatric way of eating, you will not maximize your weight loss and will regain.
Below are 5 questions you should ask at your meetings with your bariatric dietitian:
Changing habits is hard work and takes patience and perseverance. Don’t wait until you have your WLS to make changes – habits change the longer and consistently you practice them! When you start you WLS journey at your first nutrition visit – you have taken the first step in a healthier, happier you!
What questions do you have about your weight loss? Leave a comment below. We would love to hear from you!
“Weight Loss Surgery is just a tool.” We have all heard this statement many times, but it is absolutely true – Weight Loss Surgery (WLS) does not work, unless you adopt the healthy eating and exercise habits required to lose and sustain your weight loss. Changing habits is hard work and takes a lot of effort. Old habits are always waiting in the wings to jump back in and take over, which can slow down weight loss or cause weight regain. Falling off track can happen to anyone, but there is a way to get back on track. Below are 7 tips to help you get back on a path to success!
If you are not losing or if you are regaining weight, it is worth time and effort to re-evaluate eating and exercise habits to get back on track to success and better health. For further assistance, make an appointment with the dietitian to evaluate your habits and find out more about our exercise programs. We are here to help and are invested in your success!
What do you do to keep up with your weight loss? Leave a comment below. We would love to hear from you!
Summer time is often a fun time of year. Many people go down the shore, have family vacations, backyard BBQs and more social events. For a Weight Loss Surgery (WLS) patient navigating through the food and beverages can be very challenging. Below are tips to stay on track and still enjoy the summer.
Be Mindful of Your Bariatric Plate
Even at summer time gatherings you still want to get your protein in and get it in first. The good news is most BBQs and picnics have some type of healthy protein. Look for grilled chicken or burgers (no bun) to enjoy first. Eat vegetables are second and carbs are last, if you have “room.”
Watch Your Portions
Even though our WLS helps keep the portions at bay, our eyes can still be bigger than our appetite. Use small plates and bowls to limit the amount of food in front of you and minimize grazing.
It is very important to stay hydrated all year round and get in 64 or more ounces of calorie free, caffeine free beverages daily. However, during the hot and humid summer months, you are more likely to become dehydrated if you are not careful. Make sure you are sipping appropriate fluids between all meals.
Caution with Alcohol (beer, wine, liquor and mixed drinks)
More social gatherings can mean more alcoholic beverages. Keep in my mind an occasional adult beverage is usually not a problem. However, alcohol is very high in calories and can affect your ability to lose weight and maintain weight loss. In addition, Weight loss surgery patients do not process alcohol the same way they did before surgery. WLS patients get drunk faster and on much less alcohol – so be very careful when you drink – have a designated driver. If you feel your drinking is becoming a problem – do not hesitate to get help.
Summer is the best time to be active! Walking, biking, swimming, jogging, hiking and summer sports can make staying active easier. Make sure your social calendar does not take away time from your regular physical activity.
Control Your Options
If it is appropriate, bring a dish to a BBQ or picnic that is bariatric friendly, such as marinated grilled chicken, fresh fruit salad or cut up, raw vegetables with a low calorie dip. When you can bring your own food, you control what you eat.
When traveling, do a little research to find out what types of restaurants are in the area you will be visiting. Many restaurants have their menus online and many chain restaurants have the nutrition information online. This information can help you make more healthful meal choices. If it is possible, stay at a hotel that has a kitchen in the room so you can cook more of your meals – not only is this cheaper, but it puts you in control over what you eat.
Too often social gatherings are about the foods and beverages and not about the people! When we take the focus off food – we become empowered! Try not to make social events and vacations about the food, make them about family, friends and fun!
Navigating the summer social scene can still be fun and not cause weight regain or put your weight loss at a stall. With some pre planning and mindful eating you can stay on track!
What plans do you have for your summer? Leave a comment below. We would love to hear from you!
Most Weight Loss Surgery (WLS) patients know they need to change their lifestyle habits (diet and exercise) to lose weight and keep it off. What many may not know is that diet and exercise are not enough – what is missing? Your bariatric surgery support group! Research shows that regular attendance of a bariatric surgery support groups is vital to your success both short and long term.
Bariatric surgery support groups are a place where all patients (post ops, pre ops or prospective patients) can learn more about what to expect after surgery from people who have actually had the surgery.
Most support groups have a topic planned for each meeting to help educate patients and allow patients to share their experiences to help others. Some topics we have had at our support group meetings are: emotional eating, food addiction, fitting in fitness, addiction transfer and non-scale victories to name a few.
Getting Back on Track
Some WLS patients have gotten off track, fallen back on old habits and may be experiencing weight regain. Returning to your bariatric support group for guidance and to reconnect with other patients and your bariatric surgery team is a good place to start to lose that regained weight. You will find you are often not alone in your struggle and many can offer support and advice.
Long Term “Veterans”
Many WLS patients who have had surgery 3 or more years ago find it important to stay connected to other WLS patients and their bariatric surgery team to stay on track. Staying involved with their WLS support group not only helps them, but helps newer post ops and pre op patients get advice and support from someone who has been in their shoes.
Making New Connections
Even though you may have a supportive family and friends, it is not the same as having friends who are also WLS patients. Many WLS patients meet and make new friends through their bariatric surgery support group.
Bariatric surgery support groups are a place where WLS patients can feel “safe” sharing their feelings, thoughts, triumphs and challenges with other patients. Friends or family outside of the bariatric community may not fully understand what you are going through.
People who regularly attend a bariatric support group may lose more weight than their peers who do not. In addition, WLS patients who attend a support group may have a better chance of maintaining their new healthy weight.
For all the above reasons, attending a WLS support group provides the support, education, comradery and a safe place to discuss your weight loss journey. At our office we provide monthly support group meetings, usually the second Wednesday of the month from 6-7 pm. Check our website primesurgicare.com or call the office at 732-761-1740 for dates, time and location.
Are you part of a great support group? Leave a comment below. We would love to hear from you!
We understand it can be hard to fit in fitness, which is why we have fitness groups at Prime Surgicare. Usually once a month on a Saturday morning the Trailblazers, Trotters and Trekkers meet to bike, jog or walk for one hour on the Henry Hudson Trail right here in Freehold. This is a great opportunity to get out, get some fresh air, make new friends and burn some calories! We usually meet during the warmer months – May through October.
Check out our Prime Surgicare Fitness Groups page. Here you can find more information about when and where our fitness groups meet. You can also call the office at 732-761-1740 for more information!
Do you have any fitness routines? Leave a comment below. We would love to hear from you!
When people have Weight Loss Surgery (WLS), they often do not realize how quickly they get “full” after eating just a few bites. Your brain (or your eyes) tell you to eat more, but there is no room. For some people this is a relief as they always felt hungry and glad they are now satisfied with meals. For others, sadness, depression and even anger can set in as you do not seem to have the same pleasure in eating as you did before. Food used to be a comfort, your best friend and you may have enjoyed cooking for others – those pleasures are no longer there. This is called food mourning.
How do you cope?
Enlist the help of a bariatric dietitian to help you learn how to manage food choices and a therapist (psychologist or other licensed behavioral health specialist) that has a background in bariatric surgery to help you learn how to manage the depression, anger or sadness you may be feeling.
Some find it helpful to learn new ways to enjoy foods and create new recipes that your whole family will enjoy. It can be helpful to channel your love of food into a more balanced and healthy eating style. In addition, eating slowly post-op not only helps you tolerate foods better, it can also help you savor each bite. Think about quality not quantity.
A therapist can help you learn better coping strategies to get through this part of your WLS journey. The tools that you learn will help you throughout your journey and in other aspects of your life. For additional support, talk to the bariatric surgeon and come to our free monthly support group meetings. Our support group is well attended by bariatric patients who have been in your shoes and can offer sage advice to help you get through this challenging time.
You are not alone if you feel like you miss food after WLS, it is a real phenomenon. Talk to your bariatric surgeon, dietitian, and/or therapist and attend support group regularly to help you get through this challenging time in your weight loss journey.
Do you experience food mourning? Leave a comment below. We would love to hear from you!
For those that have had Weight Loss Surgery (WLS) eating protein based meals is important. Making sure you are eating healthfully to prevent heart disease is also important since many bariatric patients have had or still have high blood pressure and high cholesterol levels. Heart disease is still the leading cause of death in the United States.
The good news is much of the bariatric way of eating does fall in line with a heart healthy lifestyle. Here are some things you can do to stay on your weight loss journey and have a healthy heart, too!
Learning healthful eating habits and physical activity is a process – set new goals for yourself regularly to help you stay heart healthy and on track with your weight loss journey.
What goals do you have to stay on track? Please share them with us. We would love to hear from you!
With the winter chill in the air and ice and snow on the ground, many of us go into hibernation until the spring thaw.
Weight Loss Surgery (WLS) patients should be active all year round to lose or maintain their weight. It can be hard to get motivated to move during this time of year, but instead of lamenting that you can’t ride your bike, go for your walk or swim in your pool, let’s look at the fun things winter has to offer to get moving! Below are some seasonal activities to consider:
Skiing: Do you ski? Want to learn? There are many places to ski in our area. Skiing gives you a chance to be outdoors, get some fresh air and exercise in some beautiful scenery! Many people enjoy this sport and you may find you do too!
Snowboarding: Many places that offer skiing also offer snowboarding. Another great way to get outside, get moving and enjoy the winter season!
Ice skating: There are many local ice skating rinks in the area that have open skate times and skate rentals. This activity is indoors, so if you are really not a fan of the cold weather this might be an option for you!
Snow shoeing: This can be a fun activity! If you like being outside blazing through fallen snow, this might be your new activity! There are many parks and nature preserves in NJ that offer snowshoeing trails.
Hiking: The same trails people hike on during the warmer months may be open during the winter. Check with your local or state parks for more information.
The above are also great family or group activities! Get the whole family active or get a group of friends together who may also enjoy these activities! Remember to dress appropriately for the weather conditions, check the local forecast and make sure your gear is in working order so you have a safe and fun experience!
What fun activities do you do to stay active during winter? Please share them with us. We would love to hear from you!
At the end of each year, some take time to reflect on their experiences over the past year. Now is a good time to take stock in how you are doing with your Weight Loss Surgery (WLS) journey. Some things to think about are:
What have you accomplished this past year?
What are you most proud of?
What was your biggest success(s)?
What was your biggest challenge(s)?
How did you overcome that challenge(s)?
What did you learn about yourself?
What do you wish could have done better/differently?
What event or individual most influenced your WLS journey?
The above questions can help you understand how far you have come, where you have been and also help you figure out where you would like to be in 2017. Based on your responses to these questions, you can determine what weight loss goal(s) you want to set for the upcoming year.
Having goals helps us stay on track, remain focused and minimize setbacks. People who set a goal that is truly meaningful, usually have a much better chance of reaching that goal, rather than making a generic New Year’s resolution.
What are your goals for 2017? We would love to hear what plans you have below!
Have a Happy and Healthy 2017!
The holidays are a wonderful time of year where we celebrate giving and togetherness with family and friends. However, all of the holiday preparations can get out of control and lead to increased stress.
For many people who have had weight loss surgery (WLS), stress can lead to increased eating and less time for physical activity. Not to mention the holidays are fraught with all types of obstacles to sticking to your bariatric eating and exercise plan. How can you get through the holiday season with the least amount of stress? See the list below for some tips to remain calm and joyful during the holiday season.
What are your suggestions to minimize stress over the holidays? Please share with us what you do to remain calm and joyful over the holiday season. We would love to hear from you!
At our last support group meeting the topic was: What Do You Wish You Knew Before Weight Loss Surgery (WLS) to Better Prepare You for Life After Surgery? What followed was a lively discussion on the long term issues people face post op. Here is a summary of the key points we discussed:
Does anyone else have any thoughts on this topic? Please send us your comments – we would love to hear them!
Many people ask if they can have a “drink” once in a while after weight loss surgery (WLS). According to the American Society for Metabolic and Bariatric Surgery (ASMBS) the use of alcohol is not advised after weight loss surgery.
Alcohol, whether it is beer, wine, liquor or mixed drinks, contains a lot of calories and minimal nutrition. The poor nutrient content and high calories found in alcohol can sabotage your weight loss goals and may cause weight regain. In addition, your body absorbs and metabolizes alcohol differently after WLS. Many people find they get “drunk” faster and with much less alcohol than before surgery. Alcohol is absorbed more quickly, is “stronger” and takes longer for blood alcohol levels to return to normal after WLS. These variations in how alcohol affects WLS patients are more prominent in those who have had the gastric bypass, but similarly affect people who have had the sleeve gastrectomy.
The use of alcohol after WLS can be dangerous for many reasons. When you become intoxicated quickly, it can impair your judgement and your ability to safely drive or operate heavy machinery. In some WLS patients, it may lead to alcohol dependence, organ damage and weight regain.
Since alcohol is absorbed and metabolized differently after WLS, patients are more vulnerable to becoming addicted (especially in those that already have an addiction, even if that addiction is to food). After WLS, people cannot get the same “high“ from food, so they switch to alcohol because it works faster and is stronger. Alcohol addiction can replace the food addiction or other addictions, which is called Cross Addiction or Addiction Transfer.
Alcohol irritates the lining of the stomach and can damage other organs, even your brain. In addition, drinking alcohol can affect your ability to lose or maintain your weight as you are consuming lots of empty calories and the lack of inhibition increase your chances of making unhealthy food choices.
If you can stop drinking — do it! If you cannot stop drinking — GET HELP!! Call our office at 732-414-2707 or speak to your primary care physician to get information on your treatment options. Alcoholism can ruin your life – not just your weight loss.
Questions, comments or concerns? Send me a message below! I’d love to hear from you.
Shadle, Benjamin, MD, Should WLS Post-ops Drink Alcohol After Surgery?, July 15, 2016, ObesityHelp.com, accessed 9/8/16.
Stapleton, Connie, Drinking Alcohol After Weight Loss Surgery, September 30, 2015, ObesityHelp.com, accessed 9/8/16
Wilson, Cathy, Crossing the Line to Cross Addiction, December 15, 2014, ObesityHelp.com, accessed 9/8/16
Staying hydrated after Weight Loss Surgery (WLS) can be a challenge. You can no longer guzzle down your water or other beverages the way you did before WLS — you now have to sip fluids slowly. You can no longer eat and drink at the same time — you have to get your fluids down in between meals. You also cannot drink a lot at one time as you may get full quickly. In addition, physical activity and hot weather may increase sweating, which increases your need to drink even more fluids each day.
We recommend getting in 64 or more ounces of calorie free (or very low calorie – 10 or fewer calories per serving), non-carbonated and caffeine free fluids in daily. If you are having trouble getting in your fluids, here are some tips:
If you have any further questions about staying hydrated – do not hesitate to call the office at 732-414-2707 or leave a comment below. We are happy to help!
Summer months are often filled with trips to the shore, BBQs and family vacations. Whether you’re taking a day trip or traveling for an extended period of time, some pre-planning is necessary to help weight loss surgery patients stay on track. Below are some tips to help guide you when planning a family vacation or even a business trip.
Whether you are driving, flying, taking a train or going on a cruise, you want to make sure your food environment is supportive of your weight loss/maintenance goals.
If you are driving make sure you bring a cooler that has bottled water or any calorie free beverages to stay hydrated. Pack protein-rich, high fiber foods such protein drinks or bars that you can grab in a pinch if you need a quick meal. Also pack fresh fruit and 100 calorie packs of nuts if you need a quick snack and nothing else is available.
If you’re traveling by plane or train, call the airlines, transit company or travel agent to find out what type of meals (if any) will be served. You may be able to get a lower fat, healthful option if you ask.
If you’re going on a cruise — do not make the trip about the food and beverages. Take advantage of the onboard activities and ports of call.
In addition, most cruise lines offer special “spa menus” with more healthful options so you can still enjoy your meals while staying on track. You will also find many cruise lines have state-of-the-art fitness centers and walking/jogging tracks on board so your physical activity does not take a vacation.
Check out what type of eateries are in or around your destination so you can review the menu options beforehand and plan what your best choices are. Many restaurants have their menus online and some chain restaurants have the nutrition information on their websites. You can also find menu information in smart phone apps such as My Fitness Pal.
Book a hotel that offers rooms with a kitchen. This allows you to bring in your own food and increases your control over what you eat. It’s also a lot more healthful (and cheaper) to cook some of your meals instead of dining out all the time.
Always remember your bariatric basics which are:
Most restaurants offer grilled, baked or broiled meat, seafood and poultry, a variety of vegetables and healthy carbs for the choosing. Don’t come back from your trip heavier than you left. You worked so hard to lose the weight, a little pre-planning can help you continue to lose or maintain your weight, even when traveling.
If you have any further questions, do not hesitate to call the office at 732-414-2707 or leave a comment below.
The summer time is usually a season filled with trips to the beach and summer BBQs. For some, all the eating and extra drinking can lead bariatric surgery patients off track. How can you still enjoy all the summer fun without undoing your hard work? Below are some tips to get through the summer months like a pro.
For Weight Loss Surgery patients, high protein foods are always the focus at each meal and/or snack. Since protein gets top billing, other foods may get over looked. Some of those foods are fruits and vegetables. Spring and summer are great times of the year to explore the rich variety of fruits and vegetables available, especially the ones that are locally grown right here in the Garden State.
After you get your protein in, try to get in a variety of produce. Look for vibrant colors in your fruits and vegetables to ensure you are getting in a lot of vitamins such as vitamin C, Vitamin A and folate. Fruits and vegetables are also a good way to get in extra fiber.
With a huge assortment of locally grown fruits and vegetables to choose from, such as cranberries, bell peppers, spinach, summer squash, snap peas, cucumbers, peaches, blueberries and world famous Jersey tomatoes and sweet corn, you can’t go wrong! Some fruits and vegetables you can get at your local grocery store or road side farmers market, and others you can get directly form a local farm in your area.
Some local farms have you pick your own options. Picking your own fruits and vegetables is a great way to get out into the fresh air, get some exercise and teach your families about how and where food is grown. To find a local farm near you, go to: jerseyfresh.nj.gov, then click on the “Find Jersey Fresh” tab.
Here is a great recipe to get in those Jersey Fresh vegetables:
Roasted Summer Vegetables
2 Jersey Fresh yellow summer squash
1 Jersey Fresh green bell pepper, sliced
1 large Jersey Fresh onion, sliced
2 TBS extra virgin olive oil
2 tsp Jersey Fresh thyme salt and freshly ground pepper, to taste
2 small Jersey Fresh eggplant
1 Jersey Fresh red bell pepper, sliced
½ pound white mushrooms
3 TBS balsamic vinegar
Cut vegetables into chunks, about one-inch in size. Place in a single layer in low-sided rectangular baking pan. Drizzle oil over the pieces and, using your hands, rub vegetables to distribute oil. Drizzle vinegar over all. Season with salt, pepper, and thyme (or any herb you prefer). Bake, uncovered at 350 degrees for about 1 hour, stirring occasionally, until vegetables are tender. Some vegetables may become caramelized. This can be served hot, warm or at room temperature.
Contributed by Donna D’Amato, Maplewood, NJ
Recipe from Jersey Fresh website accessed 4/26/16.
I posted a similar article a while ago about choosing and taking vitamin and mineral supplements after bariatric surgery, but I think this information bears repeating. Too many weight loss surgery (WLS) patients:
All weight loss surgery patients must be on a daily regimen of vitamin and mineral supplements to prevent nutritional deficiencies – this is for life. All, if not most, bariatric surgery patients must be on a high potency multivitamin and calcium with vitamin D. Some patients may need additional iron and B12 depending on blood work results. Let’s take a closer look at the supplements needed after WLS.
A good quality, high potency multivitamin is an essential part of the weight loss journey. There are many different types of multivitamins on the market, but not all of them are the best choice for weight loss surgery patients. According the American Society for Metabolic and Bariatric Surgery’s Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient, gastric bypass and gastric sleeve patients should have a high potency multivitamin with 200% Daily Value of at least 2/3 of the nutrients. Additionally, we recommend the following:
It is very difficult to get all nutrients from foods alone due to the limited amount that can be eaten after WLS. Also, patients who have had the gastric bypass or duodenal switch do not absorb all the vitamins and minerals that are in foods. To avoid osteoporosis and dental issues, it is important to take calcium with vitamin D.
We recommend 1200-1500 mg calcium for gastric sleeve and gastric bypass patients (some gastric bypass patients may need 1500-2000 mg calcium daily). Calcium citrate is the preferred form of calcium as it is better absorbed. We suggest starting a chewable or liquid calcium citrate with vitamin D by week four post-surgery. Calcium usually comes in 400 mg, 500 mg or 600 mg doses. Make sure you read the supplement facts labeling carefully so you know:
Calcium should not be taken at the same time as iron or iron containing multivitamins because it can affect how you absorb them. In addition, you can only absorb up to 600 mg of calcium at a time, so all calcium doses should be taken 3-4 hours apart.
In our practice, we often give our patients a prescription for Ferocon®, which contains both iron and B12. You may get this prescription at your 1 or 5 week post op visit to the office. Ferocon® also contains digestive enzymes to help you absorb it better. If you are taking Ferocon® you usually do not need to take any additional iron or B12.
If you are not taking Ferocon®, and take a different iron or B12 supplement, be sure you know what the dosage is for the iron or B12 supplements you take. Iron and B12 supplements come in different doses and it is possible to take too much or not enough.
If you have trouble remembering to take your vitamins – put reminders on your smart phone and/or put your supplements in a place you’ll remember to take them. There are also apps to help remind you as well!
If you need help selecting a multivitamin or cannot tolerate the one you are taking – call the office for guidance. We have a Vitamin and Mineral Shopping Guide to help you choose supplements that are right for you.
Post a comment or question below! I’d love to hear from you.
Source: ASMBS, Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient, L. Aills, et.al. 2008.
Even though bariatric surgery helps people eat less food in one sitting, it’s still important to keep an eye on portion sizes. When you first had weight loss surgery you might have struggled with getting in protein and fluids. A year or more later, you may notice you can eat more. At this point in your journey, calorie levels can quickly increase above and beyond what we need to lose or maintain our weight loss.
These are very simple tips that you can easily use to help get portions under control.
If you have any further questions, do not hesitate to call the office at 732-414-2707 or leave a comment below.
In the early months after weight loss surgery, it may be difficult to eat — getting your protein and fluids in each day is a challenge. Overtime, meeting your daily protein and fluid goals gets easier.
However, with being able to tolerate more foods and beverages, it is easy to start to slip back into old eating habits. At this point in your weight loss journey, it is more important than ever to stay true to your bariatric basics.
I often say to patients: “The strategies you use to lose weight are the very same strategies you use to keep the weight off for good.”
Notice the strategies are identical — the plan does not change. If you find you are regaining weight, start to log all foods and beverages into MyFitnessPal app (or a similar app). Logging foods and beverages creates a sense of awareness and accountability needed to help get back on track. Be sure to be as detailed as possible; sometimes it’s something like a condiment or a cooking method that’s increasing your calorie intake.
Has your physical activity levels decreased? Get moving! Exercise is a critical part of weight loss and weight maintenance. Still struggling? Call the office at 732-982-2002 for an appointment with the dietitian and start to attend our bariatric support group meetings regularly.
Post a comment or question below! I’d love to hear from you.
*protein needs may vary depending on the individual
When I meet with bariatric patients I often explain that Weight Loss Surgery (WLS) limits how much you can eat in one sitting, but it does NOT change the types of foods you eat or affect emotional eating issues. We make many food related choices each day. Our food choices are largely driven by many factors – emotional eating being one of these factors.
For the first 6 months to 1 year post WLS, many people do not feel the same level of hunger or food cravings they did prior to surgery. In addition, your pouch limits what you can eat and you may not be able to tolerate certain foods. But for many bariatric patients, the appetite and cravings return. As the appetite and cravings return, weigh regain may be an issue and emotional eating plays a large role in this process.
Emotional eating is when you eat in response to an emotion (stress, anger, boredom, etc.) and not physical (true) hunger. Physical hunger is when you have not eaten for at least 3 hours, your stomach is empty, blood sugar might be dwindling and your body needs fuel. Emotions are often a trigger that makes us “think” we are truly hungry, when we are not. We were all born with the ability to feel true hunger and fullness. Babies cry when they are hungry and stop eating when they are full. Somewhere along the line we lost touch with the feeling of true hunger and fullness. To control emotional eating one must relearn how to feel true hunger and separate it from the false hunger/emotional hunger.
It is not a simple task to start to relearn your body’s true signs of hunger and fullness. But with consistent practice you will begin to recognize and separate the true hunger from the false hunger associated with emotional eating. Ask yourself, “Am I truly hungry?” If you are truly hungry you will eat whatever is there even if it is something you are not crazy about. However, if you are experiencing false hunger from emotional eating, you might be looking for a specific food or “comfort” food. If you are not truly hungry, find something else to do instead of eat (e.g.: if you are bored – find something to do or if you are stressed, look for alternatives to stress relief, etc.)
One strategy to reign in emotional eating is to use a hunger/fullness scale. The scale below can be used as a tool to help begin the process.
|Neutral (not hungery or full)||4 – 5|
|Comfortably full||6 – 7|
|Very full||8 – 9|
1 = absolutely famished, will eat anything!
2 = need to eat now, stomach is growling
3 = just starting to feel hunger, stomach not growling yet
4 – 5 = do not feel hungry or full
6 – 7 = full, but not uncomfortable
8 – 9 = getting uncomfortably full
10+ = you overdid it, feeling stuffed
The goal is to avoid the extremes. You do not want to allow yourself to get to a 1 on the scale. When we are overly hungry we do not make sound food choices, we eat too fast and overeat. Make sure you plan your day’s meals and snacks so you rarely get overly hungry. When eating, try not to go over a 5 on the scale. Anything higher on the scale and you’ve overeaten.
Remember your bariatric basics — eat slowly, cut food up into tiny pieces and chew each bite 20 – 30 times. Eating slowly allows you to pay attention to fullness cues so you stop eating before you get overstuffed. Put your fork or spoon down between bites and reassess your level of fullness on the scale throughout each meal. Truly taste your food and enjoy the textures – savor the experience of eating. When you savor the eating experience you might find you are satisfied with less food.
Keep a record of your level of hunger and fullness at these 4 times using the hunger/fullness scale above:
Make notes of any trends – are you allowing yourself to get overly hungry? Are you overeating? What emotions where you experiencing? This information can be invaluable to help you, your therapist or dietitian work with you to come up with a plan to control emotional eating for good.
And if you have any further questions, do not hesitate to call the office at 732-414-2707 or leave a comment below
Source: Celebrate Vitamins Website accessed 11/2015