Slide 1

1Amanda Downs MS, RD, LDNRegistered DietitianNutrition for Weight Loss

2ObjectivesAfter 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.

3OutlineNon-surgical approach(Fad) DietingExerciseLifestyle changesWeight loss surgery (WLS)Common surgical proceduresAdjustable gastric bandingRoux-en-Y gastric bypassSleeve gastrectomy

4Excess body weightObesity EpidemicLinked to:High blood pressureHigh cholesterolType 2 diabetesHeart diseaseStrokeGallbladder diseaseSleep apneaSome cancers

5(Fad) Diets Galore!AtkinsSouth BeachCabbage Soup DietCookie DietNutrisystemSlim FastJenny CraigBlood Type DietColon CleanseMediFastAlliPhentermine/AdipexHydroxycutDetox DietsMediterranean DietAnd onAnd onAnd on

6A fad dietdoes 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.

7Is 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.

8A safe and healthy weight loss planincludes 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.

9Smart food choicesProduceFill 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.

10Smart food choicesMeat, seafood, and deliThink leanBeef- loin, round, and extra lean ground beefPork- loinLamb- legPoultry- white meat without skinSeafood- items that are not breadedPortion size is 3 ounces, cooked (deck of cards)Choose cuts with little fat marblingTrim all visible fat prior to cookingUse low fat cooking methods- bake, grill, broil, etc.

11Smart food choicesDairyKeep it skim or low in fatChoose skim or fat free dairy products instead of whole fat productsChoose light, non fat yogurtBeware of cheeses that are high in fatMargarine/Butter debateLook for a soft tub margarine with no trans fatBe careful with condiments!

12Smart food choicesGrains and LegumesChoose foods made from whole grainsUse whole wheat pasta, brown rice, barley and oatsMake sure that the grain product that you choose has whole wheat listed as the first ingredient on the labelGood source of fiberBeans are an inexpensive source of protein and fiber

13Healthy eating for weight lossEat 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.

14Mindful eating behaviorsBe aware of situations that give you the urge to overeatWatching 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?

15Healthful eatingIf 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.

16Nutrition Guidelines for WLSPre-operative diet guidelinesPost-operative diet progressionMicronutrient supplementation

17Pre-op diet guidelinesPre-op very low calorie diet (VLCD) of less than 800 caloriesDecrease visceral adipose tissueReduce liver volumeGenerally 2-6+ weeks durationLow carbohydrate, high proteinMay or may not include foodMany use high protein liquid meal replacement supplementsAdequate hydration encouraged No alcoholNo tobacco

18Post op diet goalsSupport healing after surgery and maintain lean muscle mass during rapid weight lossMinimize side effects (reflux, vomiting, diarrhea, etc.) while maximizing weight lossHydration!

19Post op diet phasesVaries from program to programGenerally start with all liquids and slowly advance to more solid food over the course of several weeksExercise encouraged!ExampleStage 1: Thin LiquidsStage 2: Full LiquidsStage 3: Pureed FoodStage 4: Soft FoodsStage 5: Regular/Maintenance Phase

20Phase 1: Thin liquidsDuration: ~7-10 daysCalories: ~600-800, Protein: ~60-80 grams, Fluid: ~64 ouncesMay include:WaterFluids with very few calories, no sugar, no carbonation (Crystal Light)BrothSugar free popsicles and gelatinProtein shakes- high quality!!Milk- low fat cows, soy, Lactaid, almondMay not include:Carbonation- irritates the stomach lining and can exacerbate refluxStraws- may cause pt to swallow air causing discomfortExcessive amounts of caffeine- possible dehydrating in very large amountsAlcohol- can irritate stomach lining

21Phase 2: Full LiquidsDuration: ~5-7 daysCalories: ~600-800, Protein: ~60-80 grams, Fluid: ~64 ouncesMay include:All liquids from Phase 1YogurtPuddingCream-based soupsApplesaucePortion size: ~1/4-1/2 cup per meal

22Phase 3: Pureed PhaseDuration: ~14 daysCalories: ~800, Protein: ~60-80 grams, Fluid: ~64 ouncesMay include:All liquids from Phase 1 and Phase 2Pureed chicken, turkey, or fish, tuna fish with light mayonnaise, peeled, pureed fruits and vegetables, oatmeal, scrambled eggs, refried beansEmphasis is on the protein and the fluidSeparate out food intake from fluid intakePortion size: ~1/4 -1/2 cup per meal

23Phase 4: Soft PhaseDuration: ~14+ daysCalories: ~800-1,000, Protein: ~60-80 grams, Fluid: ~64 ouncesMay 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 fluidSeparate out food intake from fluid intakePortion Size: 1/2-3/4 cup per meal

24Phase 5: Maintenance/Regular PhaseDuration: LifetimeHave lean protein with every mealEat 5-6 small planned meals per day, no grazingIncreased dietary varietyMindful eating behaviors: small bites, adequate chewingConsistent follow up with weight loss surgery teamINDIVIDUALIZED approach and experience for each patient

25Micronutrient supplementationChewable multivitaminBariatric formula with 200% DV of at least 2/3 of the nutrientsShould include iron, copper, and zincTake with meal to improve toleranceChewable or liquid calcium citrate with vitamin DSublingual B-12Chewable elemental iron- taken separately from calcium to improve iron absorptionEncourage regular blood work to monitor need for additional supplementation/repletion

26ConclusionWhether 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!

27