– Frances, banded September 2009 –
Healthy Living after Surgery
It is now that the real journey begins. It is now up to you to put in place the healthy lifestyle to achieve your goals.
For people who have had bariatric surgery, the journey to better health involves losing a significant amount of weight. This is not always easy on your own.
Studies show that those who regularly attend more follow‐up appointments with their team, including the dietitian, lose more weight. Follow up with your whole team is important, not just your surgeon.
“You have to stick with it if you want it to work.”
– Ricky, banded July 2009 –
What can a Dietician do?
Dietitians don’t just help people lose weight. Some people who have bariatric surgery will have medical conditions with specific dietary needs. Only an Accredited Practising Dietitian (APD) or Registered Dietician (RD) is qualified to advise on the nutritional management of chronic health conditions such as diabetes, heart disease, gastrointestinal disorders and food allergy and intolerance.
APDs/RDs can educate patients, families, partners and carers on life after bariatric surgery, including:
§ Obtaining all the nutrients needed for good health
§ Managing specific health conditions
§ Vitamin and mineral supplementation
§ Practical meal ideas
§ Meal planning and shopping
§ Reading and understanding food labels
§ Appropriate food preparation methods.
Long‐term success with a gastric band involves changes to many aspects of your life. If your surgical team does not include an APD/RD, ask for a referral to one.
Monitoring
After bariatric surgery, you may be at risk of nutrient deficiencies. Nutrient deficiencies can occur if you are not eating an adequate amount of food, not eating a wide variety of foods or not including the supplements recommended to you.
Nutrient deficiencies are not always easy to detect and do not develop overnight. You may feel fine on the outside, but inside your body may not be functioning at its best. This includes losing weight. Your body needs the correct nutrients to lose weight effectively.
It is important to have ongoing blood tests following surgery to make sure your body is getting all the nutrition it needs. Ensure that your surgeon, bariatric GP or usual GP arranges blood tests six monthly in the first year after surgery, and then yearly after that. If you have had nutrient deficiencies in the past, or become pregnant, blood tests will be required more often. Discuss with your doctor. A dietitian can review your blood tests and advise if changes to your diet are needed.
Nutrition Supplements
Whilst the aim of bariatric surgery is to take in less energy (calories or kilojoules) and therefore lose weight, your body still requires adequate vitamins and minerals. Even if you feel you are eating a range of foods, you will still need to take vitamin and mineral supplements for optimum health.
The Allied Health Sciences Section Ad Hoc Nutrition Committee (2008) suggest that following gastric band surgery, people should include the following:
§ A multivitamin and mineral supplement providing 100% of Daily Value (Recommended Dietary Intake) for at least two thirds of micronutrients, at least 18 mg iron, 400 µg folate, selenium and zinc.
§ 1500 mg per day of calcium, preferably calcium citrate (over calcium carbonate) and vitamin D3, split into 500-600 mg doses, spaced evenly throughout day. This should not be taken with iron containing supplements.
For gastric bypass surgery, the following is recommended in addition to the above:
§ The multivitamin and mineral supplement should provide 200% of Daily Value (Recommended Dietary Intake) for at least two thirds of micro nutrients
§ An additional 18-27 mg per day of elemental iron
§ 1000 µg/month intramuscular injection of Vitamin B12 or 350-500 µg tablet daily.
Whilst guidelines for sleeve gastrectomy have not been published it would be appropriate to follow the guidelines above for gastric bypass surgery.
Discuss these recommendations with your doctor or dietitian.
Tips for Success after Bariatric Surgery
Tip 1: Eat slowly, cut food into small pieces and chew thoroughly
Eating too quickly means that you are unlikely to chew foods properly. When food is not chewed properly it can cause discomfort, pain and/or vomiting.
To slow down your eating during meals, put your cutlery down between mouthfuls. Eating slowly may initially feel unusual, but it must become a habit. It may take 20 minutes to finish your smaller meal.
Concentrate while you are eating. Set aside time for meals and don’t do other things whilst you are eating. Sit up straight and avoid slouching. Be especially careful when eating socially, as during conversation it is very easy to become distracted. Cut food into small pieces (the size of a small fingernail) and chew well.
Helen Bauzon, consultant bariatric dietitian and author of “The Gastric Band Nutrition Essential” book, describes a chewing technique that has helped her gastric band patients improve their chewing. In summary, it includes the following steps:
1. Don’t push food straight to the side of your mouth to begin chewing as soon as it enters your mouth. Place the food on your tongue and move it around to experience the textures and flavours.
2. When saliva starts to flow and lubricate the food, move it to the side of your mouth and begin chewing.
3. Bring the food back to your tongue and experience the change in taste and texture.
4. Swallow.
Helen has found this technique extremely successful in helping her patients tolerate a variety of foods. If you are unable to chew food to a smooth texture in the mouth, avoid eating it. For example, avoid tough, chewy or doughy foods. This is particularly important after gastric band surgery.
Tip 2: Eat small amounts of food
Serve small amounts of food. For example, serve an amount of food that fits inside the rim of a bread and butter or entree plate. It is also fine to leave food on your plate if you become full during your meal, even if it is a smaller serve.
For those who have had gastric band surgery, it may take some time before you feel satisfied on small amounts of food. Many people need their gastric band adjusted several times to help them feel satisfied on small serves of food. After gastric bypass or sleeve gastrectomy surgery you are likely to feel satisfied on small amounts of food earlier in your journey.
For those with a gastric band, if small meals do not satisfy you, keep in regular contact with your support team until they do. Some people will find this will occur early in their journey, for others it may take longer. Be patient.
Tip 3: Eat until satisfied
Feeling