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Amanda Downs MS, RD, LDN Registered Dietitian Nutrition for Weight Loss

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Objectives After the presentation, participants will be able to: Understand the basic nutrition guidelines for non-surgical weight loss patient. Recognize the difference between a fad diet and a healthy weight loss plan. Explain healthy food choices from each food group. Understand the basic nutrition recommendations for a surgical weight loss patient both pre-operatively and post-operatively. Describe why good nutrition is an integral part against the battle of obesity.

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Outline Non-surgical approach (Fad) Dieting Exercise Lifestyle changes Weight loss surgery (WLS) Common surgical procedures Adjustable gastric banding Roux-en-Y gastric bypass Sleeve gastrectomy

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Excess body weight Obesity Epidemic Linked to: High blood pressure High cholesterol Type 2 diabetes Heart disease Stroke Gallbladder disease Sleep apnea Some cancers

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(Fad) Diets Galore! Atkins South Beach Cabbage Soup Diet Cookie Diet Nutrisystem Slim Fast Jenny Craig Blood Type Diet Colon Cleanse MediFast Alli Phentermine/Adipex Hydroxycut Detox Diets Mediterranean Diet And on

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A fad diet does not meet basic guidelines for good health. is popular for awhile before it fades away. promises quick weight loss with little effort. sounds too good to be true. doesnt give you the tools you need to help change your eating and exercise behaviors permanently.

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Is this a fad diet? Does it promise quick weight loss of 3 or more pounds weekly? Does it tell you to never eat certain foods? Does it suggest that you buy supplements to make up for what the diet is missing? BE CAREFUL! Anyone can circulate a diet plan and say that it is written by a doctor or backed by a hospital.

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A safe and healthy weight loss plan includes a registered/licensed dietitian, not a self-proclaimed nutritionist. encourages slow weight loss of 1-2 pounds weekly. allows you to eat foods from all the food groups- fruits, vegetables, whole grains, lean protein and low fat dairy. encourages permanent behavior change and exercise. There is no best diet.

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Smart food choices Produce Fill your cart here! Make this the most important section of the store. Non-starchy vegetables are very low in calories and high in fiber. Fresh and frozen fruit offer the same nutritional benefits. Avoid fruit canned in heavy syrup. Use produce as a tool to help feel fuller on fewer calories.

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Smart food choices Meat, seafood, and deli Think lean oBeef- loin, round, and extra lean ground beef oPork- loin oLamb- leg oPoultry- white meat without skin oSeafood- items that are not breaded Portion size is 3 ounces, cooked (deck of cards) Choose cuts with little fat marbling Trim all visible fat prior to cooking Use low fat cooking methods- bake, grill, broil, etc.

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Smart food choices Dairy Keep it skim or low in fat Choose skim or fat free dairy products instead of whole fat products Choose light, non fat yogurt Beware of cheeses that are high in fat Margarine/Butter debate Look for a soft tub margarine with no trans fat Be careful with condiments!

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Smart food choices Grains and Legumes Choose foods made from whole grains Use whole wheat pasta, brown rice, barley and oats Make sure that the grain product that you choose has whole wheat listed as the first ingredient on the label Good source of fiber Beans are an inexpensive source of protein and fiber

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Healthy eating for weight loss Eat a variety of foods. Do NOT skip meals. This can lead to overeating later in the day. PLAN healthy snacks into the day if needed. Drink plenty of water and other low calorie, low sugar beverages. Avoid liquid calories. Limit alcohol. Avoid fried foods. Avoid high sugar foods.

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Mindful eating behaviors Be aware of situations that give you the urge to overeat Watching TV, playing on the computer, reading, socializing with friends. Take at least 20 minutes to consume each meal. Savor and enjoy the food and chew the food well. Distinguish between head hunger and physical hunger. Are you eating because you need to eat to nourish your body or are you eating because you are bored, sad, lonely, nervous?

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Healthful eating If you can not pronounce the ingredients, pass it up. Apple pie is not a fruit. Stop eating when you are full. A moderate diet is a healthy diet. Choose whole foods. Keep a food record or food diary. Realize that you will have good days and you will have bad days.

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Nutrition Guidelines for WLS Pre-operative diet guidelines Post-operative diet progression Micronutrient supplementation

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Pre-op diet guidelines Pre-op very low calorie diet (VLCD) of less than 800 calories Decrease visceral adipose tissue Reduce liver volume Generally 2-6+ weeks duration Low carbohydrate, high protein May or may not include food Many use high protein liquid meal replacement supplements Adequate hydration encouraged No alcohol No tobacco

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Post op diet goals Support healing after surgery and maintain lean muscle mass during rapid weight loss Minimize side effects (reflux, vomiting, diarrhea, etc.) while maximizing weight loss Hydration!

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Post op diet phases Varies from program to program Generally start with all liquids and slowly advance to more solid food over the course of several weeks Exercise encouraged! Example Stage 1: Thin Liquids Stage 2: Full Liquids Stage 3: Pureed Food Stage 4: Soft Foods Stage 5: Regular/Maintenance Phase

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Phase 1: Thin liquids Duration: ~7-10 days Calories: ~600-800, Protein: ~60-80 grams, Fluid: ~64 ounces May include: Water Fluids with very few calories, no sugar, no carbonation (Crystal Light) Broth Sugar free popsicles and gelatin Protein shakes- high quality!! Milk- low fat cows, soy, Lactaid, almond May not include: Carbonation- irritates the stomach lining and can exacerbate reflux Straws- may cause pt to swallow air causing discomfort Excessive amounts of caffeine- possible dehydrating in very large amounts Alcohol- can irritate stomach lining

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Phase 2: Full Liquids Duration: ~5-7 days Calories: ~600-800, Protein: ~60-80 grams, Fluid: ~64 ounces May include: All liquids from Phase 1 Yogurt Pudding Cream-based soups Applesauce Portion size: ~1/4-1/2 cup per meal

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Phase 3: Pureed Phase Duration: ~14 days Calories: ~800, Protein: ~60-80 grams, Fluid: ~64 ounces May include: All liquids from Phase 1 and Phase 2 Pureed chicken, turkey, or fish, tuna fish with light mayonnaise, peeled, pureed fruits and vegetables, oatmeal, scrambled eggs, refried beans Emphasis is on the protein and the fluid Separate out food intake from fluid intake Portion size: ~1/4 -1/2 cup per meal

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Phase 4: Soft Phase Duration: ~14+ days Calories: ~800-1,000, Protein: ~60-80 grams, Fluid: ~64 ounces May include: All liquids from Phase 1 and Phase 2, foods from Phase 3 no longer need to be pureed. Caution with high fiber foods, doughy foods, fried foods, sugary foods. Emphasis is on the protein and the fluid Separate out food intake from fluid intake Portion Size: 1/2-3/4 cup per meal

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Phase 5: Maintenance/Regular Phase Duration: Lifetime Have lean protein with every meal Eat 5-6 small planned meals per day, no grazing Increased dietary variety Mindful eating behaviors: small bites, adequate chewing Consistent follow up with weight loss surgery team INDIVIDUALIZED approach and experience for each patient

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Micronutrient supplementation Chewable multivitamin Bariatric formula with 200% DV of at least 2/3 of the nutrients Should include iron, copper, and zinc Take with meal to improve tolerance Chewable or liquid calcium citrate with vitamin D Sublingual B-12 Chewable elemental iron- taken separately from calcium to improve iron absorption Encourage regular blood work to monitor need for additional supplementation/repletion

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Conclusion Whether the approach to weight loss is surgical or non- surgical, the nutrition changes made should be permanent and should include positive lifestyle changes. Thank you!