By Jennifer Rivera
For those who are about to undergo bariatric surgery, there is a lot to consider. It’s a procedure that typically reduces a patient’s risk of potentially life-threatening weight-related health problems, but patients must be willing to make permanent changes to lead a healthier lifestyle. People who have struggled with weight loss may turn to bariatric surgery to either limit how much they can eat or reduce nutrient absorption. The treatment plan doesn’t end after the surgery is complete. Patients are encouraged by their medical team to view this as a lifestyle change.
A recent rotation at the INOVA weight loss (bariatric) surgery clinic allowed me to observe a dietitian who helps keep patients on track before and after bariatric surgery. Here I was able to learn how dietitians help patients improve their health and reach their weight loss goals. While there is a lot of counseling and dietary changes prior to surgery, I want to share what I learned about counseling post-op patients. They begin on a 3-week liquid diet, transitioning into a 6 week “mushy” foods diet, and then advance to regular, everyday foods. Although many elements contribute to successful outcomes in the bariatric setting, four major points were covered at every post-op visit to ensure patients were safely meeting their goals. These include protein intake, optimal hydration, vitamins, and maintenance.
Protein is a key part of post-op bariatric nutrition. After surgery, every patient’s protein needs vary. Post-op food portions are normally around 2-4 oz per meal. This makes it difficult for patients to eat enough protein. Protein is necessary for maintaining and building muscle, hormones, and enzymes. As my preceptor explained, this is where advising patients on lean protein food sources, protein supplements, and shakes comes into play. In the first few months after bariatric surgery, most patients need protein supplements. I learned how to educate patients on protein supplements and how they can increase their protein intake from food. Once they recover from the surgery and are able to eat enough protein-rich food, they are able to reduce or even eliminate the supplements.
Drinking fluids slowly and keeping up with hydration is the next piece to successful outcomes. I learned to encourage patients to sip on fluids all day long, as it can be difficult to drink normally after surgery. Water helps our bodies do some very important jobs. The dietitian recommends patients drink around 64 oz per day. This is an estimate as fluid needs are individualized case by case. She suggested patients drink water, crystal light, decaf coffee and tea, low sodium broths, low-calorie sports drinks, and protein drinks. I learned patients should avoid drinks such as carbonated beverages, alcohol, sweetened coffee drinks, juices, and sweet tea, as these drinks have the potential to cause feelings of nausea or pain.
“Vitamins are for life,” the dietitian told her patients during their post-op-visits. This is important because weight loss surgeries require small meal portions. This changes the digestion and nutrient absorption of foods, increasing the potential of having nutrient deficiencies. The dietitian works closely with the other members of the healthcare team to monitor the patient’s vitamin and mineral levels. My preceptor looks for signs of deficiencies and at blood work results so she can advise her patients on which vitamins they need. Some will be permanent, some will be temporary. Common bariatric supplements include a complete multivitamin/mineral, Vitamin B-50 Complex, Vitamin B-12, Vitamin D, calcium, and iron.
The dietitian’s role in maintenance includes follow-ups, nutrition classes, encouragement, and monitoring for potential post-op complications. Patients are encouraged to participate in physical activity, monitor any unusual symptoms, drink lots of water, eat nutritious foods and seek help when necessary. I learned that it is necessary for RDs to remind patients that this is their new lifestyle, and following this will help them live their most healthy, confident lives.
Although success after bariatric surgery is a multifaceted approach, it can be attained by the help of healthcare providers, encouragement, and diligence of a patient. I am thankful to have had the opportunity to rotate at a clinic that aims to better people’s lives by helping them make healthy choices. This rotation highlighted the positive impact dietitians can bring to the table.