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How does Nutrition Impact Recovery from Bariatric Surgery?

Amanda Wilde (Host): After bariatric surgery, you enter a new phase of healing. Today we talk about how nutrition affects recovery. Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm Amanda Wilde. We're talking about how nutrition impacts recovery from bariatric surgery and lifelong implications with Cathy Todd, Bariatric Coordinator and Regina Gill, Registered Dietician, both with UM Capital Region Health. Welcome to both of you and thank you for being here today.

Cathy Todd, RN, MSN: Thank you for having us.

Regina Gill, MS, RD, LDN: Thank you.

Host: Cathy, we have a full podcast, by the way, in our library on the Live Greater series on the topic of bariatric surgery. But, to set the stage, can you give a brief overview of what bariatric surgery is?

Cathy Todd, RN, MSN: Thank you. I would be happy to. Bariatric surgery is a surgical procedure that reduces the stomach size to promote health and wellbeing and weight loss. This surgery is an option for obese patients who have not had success with other weight loss methods. In other words, you have to have tried some other methods in order to achieve weight loss.

After these procedures, patients are able to eat less and feel fuller and more satiety with their meals. Bariatric surgery is provided by a specially trained surgeon in the operating room under general anesthesia. Bariatric procedures work by restriction and changing the patient's perception of hunger and fullness. Healthy food choice is integral for the patient's optimal success. Bariatric surgery, along with healthy food choices and increased physical activity is a recipe for success in managing obesity.

Host: Cathy, you just mentioned that we reduce the stomach size, reduce the perception of hunger. This is weight loss surgery, regina, so how does nutrition play a part in the process?

Regina Gill, MS, RD, LDN: Nutrition plays a huge role in the bariatric process. So the roles of the registered dietician nutritionist, and nutritionist are key to having a successful journey in achieving your desired weight loss. So adapting a healthier way of eating before surgery and continuing those healthier habits after surgery that supports your new body, will not only allow you to lose weight, but keep the weight off, long term. So this is the true measure of success. Now, basic through advanced nutrition skills are taught to give patients the tools to be successful. So I work with patients typically anywhere from three to six months in order for them to establish these skills. This gives patients the opportunity to change eating behaviors which may have caused weight gain in the first place, but also build a better relationship with food.

Host: Well, Cathy, how long does someone need to focus on nutrition after surgery? Is it just during the recovery stages or it's important through the whole life?

Cathy Todd, RN, MSN: I'll share with you that nutrition is a major focus for these patients for the rest of their lives. Immediately after surgery, of course, because patients are focusing on ways that they can minimize complications after surgery. We all know that patients find it difficult to focus from meal to meal to meal on what they're supposed to eat.

In our program, Regina and I have a wonderful opportunity in that she teaches food and how to read labels and how to change behaviors for food choice. And I teach how after surgery, the patient's experience of food, their experience of eating, the dynamic food choices that they will have and explore after surgery is their journey.

That's their exploration. If you wanted to know further about patients after bariatric surgery versus patients who choose other mechanisms to lose weight; you would recognize that our patients, because the surgery has made their stomach smaller, have to pay attention to how their body is responding to how they eat. Before surgery, they eat for a feeling, after surgery, they eat because of a feeling. So we teach them to eat according to hunger patterns. We teach them to understand how their body responds to food. They must consume smaller food servings. At the same time, they must consume foods that are higher in protein and lower in carbohydrates and fats.

So Regina teaches the content of food for our patients, and our patients also get the understanding of how the mechanism of eating changes after this surgery. I will share with you that our patients express a concern for having to pay attention to how and what they eat, because they have families, they have to go to family reunions and family gatherings.

We know that they have to continually recognize what they're eating is important regardless of the circumstance. And so we help them to make that adjustment and to make sure that they know that their food habit is a major portion of their success after bariatric surgery.

Host: So it's habits and it's diet. And with that in mind, Regina, what foods or nutrition plans do you recommend after bariatric surgery and are there foods that should be avoided?

Regina Gill, MS, RD, LDN: Sure. There are specific nutrition recommendations and plans that I teach to all of my patients, and these are required to ensure that you are adequately nourished while losing weight. So immediately after surgery, a full liquid diet is followed to allow for healing as well as weight loss.

This is a very low calorie, high protein diet that consists of protein drinks, broth, and low fat soups, light Greek yogurt, low fat milk, unsweetened applesauce, water, and a few other sugar-free foods. So, this should be followed very specifically for about three weeks depending on which surgery you have.

And then foods that should be avoided include high fat and greasy foods, high sugar foods like juices and sweets, and foods that are tough to digest, such as vegetables with skins and seeds, or for some, beef.

And this is until you're allowed to have it at about seven or eight weeks postop. But some never get used to that feeling and still find it very hard to digest even years later after surgery.

So these foods should be avoided because they can cause nausea, abdominal pain, bloating, and so forth, and they add excess calories that will slow your weight loss. So specific bariatric nutrition recommendations prioritize protein, so with recommendations of 80 to 100 grams of protein per day, while consuming lower amounts of carbohydrates and fats.

So protein is important for wound healing, immune function, and maintaining muscle mass. High protein eating will also help to fuel bodily organs. So this turns into your primary source of energy instead of carbs. So it's gonna be a protein. So this will help decrease your risk for nutrient deficiency and help you feel fuller while eating smaller portions.

And the thing that is most helpful, it will help minimize excess snacking throughout the day. So in our program, we do like to promote protein shakes to help you meet your protein needs, along with small balanced meals with a variety of foods. So a huge component of the post-surgery nutrition plan is vitamin and mineral supplementation.

So you have to follow a healthy diet that's high in protein and is nutrient dense, but the vitamin and mineral supplements are just as important. Bariatric patients must take a multivitamin with iron, B Complex, which includes vitamin B12 and all other B vitamins, calcium citrate, as well as vitamin D3. And there are some optional supplements as well, such as biotin and zinc, which are mostly used for management for hair loss.

Host: There are a lot of changes it sounds like people might be required to make on the long term. Cathy, how can a patient plan to set themselves up for success after they're home?

Cathy Todd, RN, MSN: I like to say that our patients, they enjoy the way they understand things and the way that they can put things in order based on their home environment and based on their work and responsibilities and family responsibilities. One of the things that we promote and encourage is that they continue with the dietician after surgery, that they keep their appointments with the dietician as well as with the bariatric program and their surgeon. Having healthy foods in the home is essential. Making some changes around eating out versus preparing meals at home, as well as having a plan for their meal intake day by day. Many of our patients do meal prep, making it more convenient to prepare foods at home and have a healthy meal without feeling rushed in their busy life once they return to work.

We also have our patients to consume water, to stay well hydrated and avoid skipping meals, or going for too long or prolonged periods without drinking their protein or consuming a healthy meal. Acknowledging that a healthy meal is a small meal after this surgery, it still is essential that our patients focus on not allowing themselves to get too hungry and never eating in excess.

The journey after this surgery is identifying the happy medium between eating too frequently and not eating frequently enough. The foods that our patients choose to eat, that we've taught them to eat, we expect them to have in their home like protein drinks, vegetables, like fresh fruit, and enjoy when they go to the grocery store, to shop on the perimeter of the store where there are less packaged foods and less canned foods that have additives and added calories included in them. We also like our patients to understand that after this surgery, their eating relationship and their food relationship is altered, but they are in control. And that they should take back control over their food choice and acknowledge that that's empowering and that they can choose from a wider variety of foods changing the way they prepare their foods.

Baking, boiling, broiling, air frying are all options for them. Managing calories by reducing eating out and planning what you eat when you are attending family gatherings or other social events. But focusing on high protein foods first, and then implementing changes suggested during your appointments with your dietician and sharing them with your spouse and family members or loved ones who may be also living in the home.

Consuming water means most people think that that's going to keep them running to the bathroom, but it helps your body to function more efficiently if your body is well hydrated. One of the things we also focus on is sleeping well. So we have our patients to develop a nighttime ritual that promotes rest and going to bed earlier, and so that they are eating to nourish themselves rather than eating for quick bursts of energy during a busy day. Also, one of the things that's difficult for us as well is stop multitasking your meals. We ask them to stop eating in front of the television and eating in front of the computer, or eating on the fly, or making food choices at the last minute, which tends to be foods that are higher in fat and carbohydrates.

Host: I can see from this conversation how you are the behavior expert and how it can be an exciting journey to wellness with you there to use your expertise to guide people through this journey. Are there any last bits of wisdom or anything either of you would like to add for our listeners?

Cathy Todd, RN, MSN: You can count on after bariatric surgery, an entirely new eating experience. Yet another reason why focusing on nutrition is important. Forever, the patient will have to eat slower, chew their food more thoroughly for positive dining experiences.

Taking smaller bites and allowing food to enter the stomach much slower will encourage a more enjoyable eating experience. Also, remember, every effort spent improving on your health and food relationship is a moment well spent. Allow yourself to be new and explore the broad variety of healthy foods available to all of us. Find your joy in knowing that you're in charge of how and what you eat. Thank you.

Regina Gill, MS, RD, LDN: I'll add to that. Last bits of wisdom is to have an open mind and willingness to change and improve your eating habits to be the best and healthiest version of you. Doing this will make the journey feel easier.

Host: It is a big life change and we can all take something from this conversation whether we are bariatric patients or not, to be more proactive in our handling of our food choices. Cathy, Regina, thank you so much for the great information and for your work helping bariatric surgery be successful.

Regina Gill, MS, RD, LDN: It's our pleasure.

Cathy Todd, RN, MSN: Thank you for having us.

Host: That was Cathy Todd, Bariatric Coordinator and Regina Gill, Registered Dietician both at UM Capital Region Health. For more shows just like this one, go to umms.org/podcast and on YouTube and please share this on your social media. Thank you for listening to Live Greater a health and wellness podcast, brought to you by the University of Maryland Medical System.

We look forward to you joining us again.