More than a decade ago when I had my gastric bypass, my bariatric surgeon told me "I do the surgery. The rest is up to you." I was on my own, with no training on what it meant to eat healthy. Everything thing I know today has been self taught. Fortunately, unlike when I had my weight loss surgery in 2003, we now have bariatric dieticians like Lori Rosenthal to help us transform our eating habits from unhealthy to healthy. In this sharepost series, we examine the healthy behaviors post bariatric patients need to develop in order to be successful with long term weight loss. Lori Rosenthal Lori Rosenthal, MS, RD, CDN is a bariatric dietitian at Montefiore Medical Center in the Bronx, New York. She provides individual nutritional counseling for weight management, focusing on dietary and lifestyle modifications needed to promote successful, sustainable weight loss before and after weight loss surgery. Follow Lori on Twitter @LoRoRD.
Lifelong Healthy Eatiny Bariatric Life: In your experience, what do you see as the biggest challenges to maintaining long-term weight loss for post Bariatric patients who are a few years or more out from their surgeries?
Lori Rosenthal: People often start to slip as they get further out from surgery. They are able to eat larger portions and tend to fall into old habits. It is important to always remember why you started the bariatric process to begin with. What was your original motivator? If a patient starts slipping back into old routines, it is a good idea to go back to the basics - eating 3 meals/day, meal planning and practicing mindful eating. Keeping a food/exercise journal can also be very helpful. Sometimes we don't realize where the extra calories are coming from. Try an app or paper and pen. I also highly recommend joining a post-op support group, whether it be online or in person, to help stay on track.
y Bariatric Life:he pouch rules that gastric bypass patients are told to follow indicate that the ideal meal consists of 1/2 the plate be protein, 1/4 be fresh fruit, and 1/4 be raw or lightly cooked vegetables. Note that no grains are included in that equation. Please share your perspective on this plan of eating.
Lori Rosenthal: We tell our patients to avoid rice, bread and pasta for the first two months after surgery. After the initial two months, we encourage our patients to include whole grains into their diets, but only after they finish their recommended protein and still feel hungry. Whole grains contain fiber, which makes us feel full for longer, promotes blood sugar control, lowers cholesterol and decreases risk of colon cancer. It has a place in the bariatric diet.
y Bariatric Life:hould post Bariatric patients eat a low fat diet?
Lori Rosenthal: Yes, a low fat diet should be followed. This is not only to promote weight loss, but because high fat foods are not often tolerated as well after surgery. They slow gastric emptying time, which increase risk of nausea and vomiting. This does not mean that bariatric patients must consume a fat free diet, but they should limit their intake.
My Bariatric Life: So then, what do you see is the ideal long term Bariatric meal plan and caloric intake, and does that look different depending on what weight loss procedure the patient had?
Lori Rosenthal: There are slight differences between the diets based on the procedure, but they are more profound directly post-op. Caloric requirements vary based on current weight loss, desired loss and exercise.
My Bariatric Life: How do post Bariatric patients learn to eat healthy?
Lori Rosenthal: Bariatric patients should be learning how to eat healthy before surgery. Our program requires patients to complete 3-6 months of weight management prior to surgery. We discuss healthy dietary and lifestyle changes. Patients are asked to choose 2-3 changes to work on at a time and only add on once they feel comfortable with the ones they have made. We encourage patients to find foods they enjoy that work within the post-op guidelines. We want them to be choosing foods because they like them, not because they are on a "diet".