Jennifer Shobert, RD, LD

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Nutrition for Bariatric Surgery

• Jennifer Shobert, RD, LD
• Registered Dietitian
• National Naval Medical Center
• [phone]
• Jennifer.shobert_at_med.navy.mil

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Weighing Your Options
Adjustable Gastric Band
Gastric Sleeve Resection
Restrictive and Malabsorptive
Restrictive
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The Basics How do I eat to live not live to
eat?

• Protein is the priority
• Must be eaten first
• Must be eaten at each meal
• STOP at the first sign of fullness
• Intake at meals should be ¼- ½ cup (4-8 Tbsp)
• Eat/sip slowly, take small bites, and CHEW until
  liquid
• Limit snacking

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The Basics How do I eat to live not live to
eat?

• Eliminate high fat and high sugar foods
• Beverages must be sugar free (lt10
  calories/serving), non-carbonated, and caffeine
  free. No straws
• Liquids must be separate from meals by 30 min
  before and after eating
• Vitamins/minerals must be taken daily for the
  rest of your life
• Weight re-gain is probable if you do not follow
  the diet guidelines
• Exercise is also essential to get to goal and
  prevent re-gain

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Diet Stages Pre-Surgery

• Pre-Surgery Liquid Diet - 2 weeks
• You MUST resist the temptation of having a Last
  Supper. Doing so will enlarge your liver and
  make your surgery more difficult.

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Diet Stages Post-Surgery

• Post-Surgery
• Clear Liquid Diet while in hospital
• Full Liquid Diet 2 weeks
• Pureed Diet 1 week
• Soft Diet 1 week
• Regular Diet

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Beyond the Food

• Surgery will not fix your eating problem. It is
  only a tool, albeit a powerful one, to help you
  do that yourself.
• Weight loss and maintenance still takes work.
• Some things to think about
• What will I do when I cannot turn to food for
  comfort? How will I deal with those underlying
  emotions/memories?
• Am I willing to sacrifice the foods I currently
  like and a normal eating pattern for the
  benefits of weight loss?
• Will my family and friends support my changes?
• Do I think that just because I am finally thin,
  all my problems will be solved? What if they
  arent?

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Working with Your Dietitian (RD)

• 3 required pre-surgery nutrition appointments
• Goals
• Know what is expected of you
• Education about the necessary dietary
  restrictions and modifications associated with
  weight loss surgery
• Show that you understand and are willing to
  follow guidelines
• Initiate weight loss. 10 weight loss is required
  prior to scheduling your first appointment with
  the surgeon. Do not worry. If you lose enough
  weight for your BMI to be lt35, it will not affect
  your approval for surgery.
• Adopt as many of the post-surgery guidelines as
  possible before surgery
• You are required to bring a daily food and
  exercise log to each nutrition appointment. If
  you do not bring it, you will need to reschedule
  your appointment

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Working with Your Dietitian (RD)

• Periodic post-surgery appointments
• Follow-up with an RD is very important for
  success with weight loss and prevention of
  malnutrition
• Gastric Band
• 2 weeks
• Monthly x 12 months
• Every 2-3 months
• Sleeve and Bypass
• 2 weeks
• 3 months
• 6 months
• 9 months
• Every 6 months x 2 years
• Yearly

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While You Wait

• Start aligning your diet to the recommendations
• Start keeping a food and exercise diary
• Making changes now helps you to determine if the
  benefits of surgery are worth the necessary
  sacrifices
• Eliminate beverages with sugar, caffeine, and
  carbonation
• Do not drink with meals
• Eliminate fried food, processed meats, and other
  fatty foods
• Start listening to hunger and fullness cues
• Take smaller bites and chew 20-30 times before
  swallowing
• Eat a protein source at each meal (3 meals/day)
• Start an exercise/walking program (if physically
  unable, a note from your doctor is required
  stating such)
• What else?

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Dietitians

• National Naval Medical Center
• Jennifer Shobert
• Walter Reed Army Medical Center
• Beth Triner
• Malcolm Grow Medical Center (Andrews AFB)
• Lt Sarah Mueller
• DeWitt Army Community Hospital (Ft Belvoir)
• Judy Hart and Becky Campbell
• Andrew Rader Health Clinic (Ft Myer)
• Patrice Williams
• Woodbridge and Fairfax Family Health Centers
• Karen Vonderhaar and Liz Bonometti
• Kimbrough Ambulatory Care Center (Ft Meade)
• Nancy Reed (also at Aberdeen)
• Annapolis
• Jane DeVane

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Questions?

• Visit us on the web
• http//www.bethesda.med.navy.mil/patient/health_ca
  re/surgery_services/bariatric_surgery/index.aspx