Nutrition and Bariatric Surgery

Several years ago, my father was diagnosed with end-stage renal disease. This diagnosis was the latest in a long list of diseases my dad had been dealing with as he grew older: type 2 diabetes, colon cancer, heart disease, and high blood pressure. As his daughter, I had inherited his genes; I looked much like the women in his family: short, strong, and round. As a teen and young adult, I had been quite active, but as I aged and had children, my lifestyle changed and my weight had climbed steadily. I objectively knew the dangers and results of obesity on overall health but struggled to lose any amount of meaningful weight and lacked the ability to keep off the weight once I lost it.

According to the Centers for Disease Control and Prevention, 39.8 percent of the U.S. adult population, or 93.3 million U.S. adults were obese in 2015–2016. Obesity is a complex disorder and one that many people struggle with on a daily basis. For some people, diet and exercise may not be enough; that is when other tools for weight loss may be considered, like bariatric surgery.

My primary physician suggested I attend a bariatric program seminar, just to see if I was interested. My body mass index was almost 44 at the time, I had type 2 diabetes and high blood pressure, and I was taking a slew of medications to control both conditions. My diabetes was becoming a larger concern as the oral medications were starting to no longer work for me. When my doctors started talking about insulin, I knew I needed to become very serious about my weight.

I followed advice and found an American Society for Metabolic & Bariatric Surgery-accredited program that was housed in a teaching hospital. I met with a nutritionist and a physician assistant. It wasn’t a forgone conclusion that I was going to get surgery, but we needed to make a series of decisions to get to that stage. I had to prove I could do this as a patient; I needed to make a commitment and stick to it.

The surgery is not a quick fix. Once the surgery is over and you heal you need to learn a whole new way of living, and develop a new relationship with food. I’ve heard many people explain that the surgery is a tool you use to help take off weight, but the tool must be used correctly to work. This means an entire rethinking of my relationship with food, with people, with my day I knew that it was permanent intellectually, but I’m not sure I realized as a patient what that meant, or how drastically my life would change and how different my relationship with food would be.

I still love to eat, but that love is tempered with the small amount that I can eat at one time. I’m limited to what I can eat, how it can be cooked, and how fast I can eat it. I need to take vitamins and be careful with my nutritional choices, choosing protein and vegetables over carbohydrates and sweets.

If you are considering weight loss surgery, there are several habits that you can start now to maximize your success after surgery. Carmen Roberts, registered dietitian/nutritionist and instructional faculty at Excelsior College, recommends the following tips:

#1: Slow Down

In our fast-paced society, we typically race through mealtime to move on to our next activity. It is crucial to get in the habit of allowing ample time to enjoy your meal. Practice eating slowly so that you can recognize your feeling of fullness. Stop eating when you feel comfortably full. Sit down and focus on eating your meal, and avoid distracting activities during mealtime such as watching TV or talking on the phone.

Chewing your food thoroughly is essential after surgery. Since the size of your stomach will be drastically reduced, you must be able to chew your food into an almost liquid consistency before swallowing. Not doing so could result in pain, nausea, and even vomiting after meals. Try cutting your food into smaller pieces and taking smaller bites to avoid overeating. Put down your knife and fork between each bite, taking the time to savor the flavor of your food. Chewing each bite approximately 20 times will ensure that your food is a liquid consistency. Choose moist meats rather than dry meats to help with digestion.

#2: Think before you drink

Proper hydration is necessary after surgery to prevent the side effects of dehydration. Aim for a minimum of 64 fluid ounces of water each day. After surgery, it may seem difficult to consume adequate fluids because you will feel full quickly. Get in the habit now of sipping water throughout the day. Immediately after surgery, you may only be able to drink 4 to 8 ounces of fluid within an hour, so you will need to drink constantly throughout the day to prevent dehydration.

If you enjoy coffee, soda, or alcoholic beverages, now is the time to slowly wean yourself off. Caffeine can lead to dehydration, irritate the lining of your stomach, and increase your risk for developing a stomach ulcer. Alcohol can also cause dehydration, and the excess calories may hinder your weight loss efforts. Carbonated beverages, including diet soda, may cause stomach pain after surgery. Water is the best beverage choice. If you need more flavor, try sugar-free beverages or add slices of fresh fruit to your water. Decaffeinated tea and coffee are also good choices.

Practice sipping water slowly and avoid using straws that can introduce air into your stomach. Drinking too quickly or drinking excessive fluid at meal times may cause pain and discomfort after surgery.

#3: Become a savvy food label reader

After surgery, you will want to avoid foods and beverages high in sugar, so start looking at food labels now to find foods that have no more than 15 grams of sugar per serving. Consuming high-sugar foods may have unpleasant side effects, and the excess calories could hinder your weight loss efforts. Be on the lookout for sugar alcohols found in sugar-free foods such as xylitol, mannitol, and sorbitol. They can cause cramping and abdominal pain.

Select foods that are labeled as “light,” “low-fat,” or “fat-free.” High-fat foods can slow down your rate of weight loss and can also have negative gastrointestinal side effects after surgery.

The bottom line:

Bariatric surgery is not a cure for weight loss. It is merely a tool to assist you in losing weight. Successful weight loss requires a lifelong commitment that includes diet, exercise, nutritional supplements, and routine medical and nutritional follow-up to ensure you stay healthy. If you are considering bariatric surgery, talk with your physician about treatment options.

This post was written in conjunction with Carmen Roberts. 

Disclaimer: The views expressed here are solely those of the author(s) and do not necessarily represent or reflect the views of Excelsior College, its trustees, officers, or employees.