10 Things To Know About Nutritional Care After WLS

July 11, 2016

You have been through all of the pre-op tests, checking off the nutritional care visit(s), psychological assessment, and any tests required prior to surgery. You survived the pre-operative diet. Finally, you underwent surgery and are now on your way towards your weight loss goals.

At times, some of you may be wondering, now what? What comes next? Others may be frustrated by what appears to be little weight loss or a stall in the weight loss during the pre-operative diet and/or the first few weeks following surgery.

Nutritional Care & Long-Term Goals

Many patients find themselves in this dilemma. For some, they have prepared so much for the surgery itself and the period directly following surgery, that they have not put much thought into long term weight loss and what that will entail. For many others, they may not have been prepared for how much weight loss surgery can impact them psychologically, as there are many lifestyle changes that must be made in order to be successful and maintain that success. Here are 10 important factors to consider after weight loss surgery to aid in achieving your long-term goals.

1. There is a healing period. This period is usually in the first six weeks following surgery, but may also be more in the range of 6-12 weeks, depending on the person, type of weight loss surgery performed and any factors that may impede healing. This timeframe is generally where we are more concerned with you following the post-surgical diet progression, as was laid out by your surgeon and dietitian, and less concerned about large amounts of weight loss. It is vital that you give your body time to heal – skipping or not following parts of the diet progression during this period can lead to dire consequences, including death.
2. Weight loss and the amount of time it takes to lose weight vary with each individual. Percentages are usually based on excess weight, defined as your starting weight, minus your ideal body weight (IBW). It may be slower than you expected, and most likely will be different from what your peers have experienced. However, some basic averages can be expected (again, these are AVERAGES!):
   

   Excess Weight In 6 to 12 weeks	Excess Weight In 6 months	Excess Weight In 1 year

3. Protein is key throughout your weight loss journey. Adequate protein (which may range anywhere from 60-120 grams/day, depending on your body weight), is necessary to maintain your lean body mass (muscle), which is your metabolically active tissue. Thus, the more you have, the more efficient your body is at burning calories. Furthermore, the more muscle mass you lose, the weaker and more fatigued you will feel. Protein is also what keeps you from losing your hair!
4. Hydration is equally as important. Drink, drink, drink. Water preferably, but zero calorie, non-carbonated drinks can provide good hydration as well. The more dehydrated you become (which can be easy to do in the weeks to months following surgery), the worse you are going to feel (i.e. nausea, fatigue, etc).
5. Be careful what you drink – high-calorie liquids (including coffee drinks, smoothies, and alcohol) can be your enemy. People often do not think about the number of calories that they may be drinking. And because liquids move through our digestive system quicker, it is easier to take in more calories through beverages than we intend to). This can be a huge saboteur towards weight loss, as well as weight maintenance, as the further out from surgery one gets, the more likely they are to reinstate some of these drinking habits.
6. Caffeine should be limited, especially during the initial post-op period. Why? Because caffeine can be an irritant to the stomach, which can impede healing. Caffeine is also a diuretic, so in large amounts, it may contribute to dehydration, as well as contribute to nausea and other digestive issues.
7. Exercise is extremely important in helping you to achieve your maximum success. It is a key piece, along with diet, in getting you where you want to go. Exercise is often discounted as less important to diet, when, in fact, the two go hand in hand. Current recommendations by the American Heart Association are for 150 minutes/week of moderate exercise, or 75 minutes of vigorous exercise. Preferably, your regimen should entail a combination of cardiovascular exercise and strength training.
8. You can gain the weight back. Choose wisely. Weight loss surgery is not the end-all, be-all to losing weight and keeping it off. You have to work with it in order for it to be successful, both short and long term. It is merely a tool to help you get where you want to go.
9. Remain consistent with your vitamin and mineral supplements. Do not stop taking them. These are recommended for a reason and are a lifelong commitment to prevent  nutritional deficiencies (i.e. bone loss, anemia, etc).
10. This is not just a physical transformation/journey – it is often also a psychological and behavioral change journey as well. Food is more than sustenance to many people. We are surrounded by food and we tie food to many different emotions and events, like celebration and grieving. It is important to focus on your relationship to food and how those relationships may impact what your final goals are. The surgery helps with the physical aspect of weight loss, but it is up to you (with the help of a support system of family, friends, and team of healthcare professionals) to make the behavioral changes necessary to bring you success.

ABOUT THE AUTHOR Keri Layton RD, CSO, LD has a strong background in providing medical nutrition therapy for many nutrition-related health issues, including diabetes, renal disease, heart health, nutrition support, as well as general nutrition and weight loss. For the past three years, Keri does private nutrition consulting as well as bariatric consulting with Bariatric Dietitian Services. Read more articles from Keri!

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