According to the Centers for Disease Control and Prevention, 42% of the United States classifies as obese. With the numbers continuing to rise, bariatric surgery proves to be a useful solution for some to achieve a healthier weight. Bariatric surgery is an umbrella of procedures that alter the digestive tract resulting in weight loss. The benefits of bariatric surgery include fast weight loss and a higher success rate of weight loss compared to traditional non-surgical weight loss. The downsides of bariatric surgery include a potentially higher cost (depending on insurance coverage), increased risk of nutrient deficiencies, adverse GI symptoms and higher mortality rate compared to traditional diet and exercise. Traditional, non-surgical weight loss typically has a higher failure rate and takes longer to see results, but also has more flexibility, lower mortality rate and lower risk of complications. I learned about various experiences and motivations for traditional and surgical weight loss at a recent rotation with Inova’s bariatric clinic in Fairfax, VA.
In order to qualify for bariatric surgery, there must be previous difficulties with weight loss through diet, exercise or medications. Two counseling sessions I was involved with included women who had difficulties with maintaining previous weight loss but had the confidence in themselves to try again and find a method that works for them through the help of the Registered Dietitian (RD). One of those patients had success with short-term diets in the past but did not create sustainable healthy habits. Another patient’s biggest struggle was snacking and grazing throughout the day, with sweet foods as her biggest vice. She was open to change and motivated to alter her habits but did not know where to start. Perhaps these two patients believed in their ability to achieve a healthier weight naturally either due to previous success or self-confidence and just needed accountability to get on the right track. Another patient considered herself a “healthy eater” and described her weight history as always overweight her entire life. Further into the session, she revealed her biggest difficulties included portion sizes, chocolate, pretzels, brownies and high-calorie coffee drinks. Her lack of previous weight loss success despite having high motivation conveyed that she was not confident in the traditional route, but was determined to begin the surgical journey.
Lack of basic nutrition education is common in people struggling to attain a healthier weight. The education and goal-setting requirements are slightly different for bariatric and traditional weight loss methods. Patients in the bariatric clinic often perceive their typical diet intake as healthy, so instead of asking what their normal daily food intake looks like, the RD asks them to describe what an unhealthy day of eating looks like. This usually depicts the reality of their usual intake more accurately. They may be eating foods considered healthy, but portion sizes may be too large. Once they have the educational tools and a solid plan in place, they may achieve weight loss with an overall healthy diet and exercise. Others seek nutrition education but have difficulty implementing the behavior change for various reasons, such as an emotional or physical condition. For the patients trying the traditional weight loss route to learn nutrition basics, I helped transform a plain, unappealing 20-page diet manual into an engaging, easily digestible manual. This project helped me develop digital design skills by balancing color, fonts and texts. For the patients trying the traditional weight loss route to learn nutrition basics, I helped transform a plain, unappealing 20-page diet manual into an engaging, easily digestible manual. This project helped me develop digital design skills by balancing color, fonts and texts. Some people may understand this basic education yet have difficulties with meal planning, budgeting, meal preparation and cravings. Likewise, their life may feel too stressful to undertake these challenges. One patient I observed in the clinic was a busy gentleman with children, seemed to enjoy following a regimen and was open to lifestyle changes. He knew that if he stayed with the bariatric regimen, he would be successful without worrying about the draining demands of non-surgical weight loss. Bariatric meal plans include daily protein shakes along with small, easy-to-prepare meals. The education with bariatric nutrition is more about following a simple and specific plan, whereas those who undergo natural weight loss follow a more vague and variable plan. This can open the door to “falling off track” and slowly going back to old habits.
Unwanted side effects that occur with nonadherence, such as nausea, vomiting and diarrhea after bariatric surgery incentivize behavior change. One patient I observed during a post-op appointment admitted to eating a bowl of sugary cereal and immediately throwing it up. Even though she knew she shouldn’t eat that sugary cereal, she had a strong difficulty with the impulse control of her strong craving. In this case, the bariatric surgery essentially caused a negative feedback loop to get her back on track by rejecting that food. Due to situations such as this, a handout about behavior change was needed in the bariatric clinic. I created an infographic explaining the stages of behavior change to help patients identify where they are at in their weight loss journey. Furthermore, it gives the dietitian an opportunity to visually show the patient their progress. Some clients struggle with creating practical individual goals, so I created a worksheet to guide patients through setting goals using the S.M.A.R.T method. This stands for specific, measurable, attainable, relevant and time-based. Often if someone tries weight loss without the help of a professional, they may not know where to start. Creating the “Stages of Behavior Change” and “SMART Goals” handouts enhanced my skills with explaining psychological concepts visually and balancing graphics with white space.
Although it is not a risk-free solution, bariatric surgery is a great last-resort option to decrease risk of negative health outcomes if all other methods of weight loss, such as medication, diet and exercise were not successful in the past. It may be especially useful if a large weight loss is necessary, such as in the case of needing another medical procedure done. The bariatric team works with each patient to determine if surgery or traditional weight loss is better suited for them. The team considers the patient’s motivations and past experiences, such as previous weight loss attempts, nutrition education, and their stage of behavior change. Transforming a diet manual and creating materials on setting goals and behavior change enhanced my digital design skills while also helping patients at the clinic. Overall, my experience at this rotation was educational and provided me with insight on patients and their readiness for change as well as bariatric weight loss surgery.
“Adult Obesity Facts.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 30 Sept. 2021, https://www.cdc.gov/obesity/data/adult.html.