New Guildline ?'s

I tried to get in to my nut this week but he is on leave for the month. So I have some questions I hope maybe I can get answered here.  My last consult with the nut was many pounds ago and I am wondering a few things. First I am 5'6" tall, I currently weigh 180-184 depending on the day, lol.  My goal was 160 but has been adjusted to 170, which still is a bit high according to BMI charts but I believe that the BMI is not the best account of my body composition. I have more lean muscle than my BMI accounts for. So here are the questions. Should I be counting calories, carbs fat and protein?  Should they be counted in ratio, like the 40, 30 30 method with a calorie limit, or am I trying to get a certain number of protein with less than a certain number of carbs  and fat, within a calorie limit? What would my counts for them be? What would be the best aproach to lose these last pounds.  I currently take pilates twice a week and do one day of intense cardio on the treadmill and stairclimber one day per week.   What do I need to do?  I admit I have not been taking in protein in the form of shakes, I just never found one I liked... do I need to incorporate those back in? I do have a few I can tolerate. I really need to get myself on track this week before T-Day and then the big month of goodies... Thanks for any help. I do have a telephone apt with my nut when he gets back next month, but that wont help me this week or next!  Thanks so much! Mechelle

Dear Michelle,  You want to lose another 10-15 lbs - but really, you're right around the corner to maintenance.  Way to go!  We all (especially dietitians) like to have a solid eating plan.  Counting calories, carbs, proteins, fats  - oh, what fun.   However, I don't ever want to encourage anyone to count EVERYTHING that goes into your mouth.  I want to encourage you to adapt a "healthy" lifestyle.  I personally don't think writing down everything you eat is healthy.  I think it could be considered disordered eating.  However, I do realize that you've come a long way in your weight loss and are looking for some guidelines.   First of all, regarding your question on losing the last 15 (ish) pounds:  1. Try to increase the amount of exercise or intensity of exercise.  Try to burn a few more calories that way.  2. Take a good look at your current eating habits.  Are you cheating at all?  How much junk food are you eating?  How are your portion sizes?  Regarding guidelines for eating (carb, pro, fat).  I personally like 40-35-25 for gastric bypass patients.  40% carbs, 35% protein, 25% fat.  Based on a 1500 calorie per day diet.  Now, those of you who are exercising hard are going to have more calories, but I still like the 40-35-25 breakdown.  Even though you are 1 year post op - I still like to push the protein a little bit.  Try to eat lean meats, fish, legumes.  Eat fresh fruits and vegetables.  Use olive oil or canola oil on salads and in cooking.   Your nut will likely give you better goals as he probably knows your weight loss history much better than I do.   As for the upcoming holidays -- same as your birthday.  Those days are calorie-free, right?   Really, my philosophy on holidays --- taste everything - enjoy everything you eat.  Don't go overboard -- being sick during the holidays is worse than not eating the food -- but the next day - get back on track.  Holiday eating happens on the holiday -- not the month before the holiday, the month of the holiday, and the month after .....  Good luck.

Hi, Sara.  I'm in a very simliar position to Michele and, for the most part, what I'm doing is on track with your advice.  I do have a question though, which I'm hoping you can address.   A bit of background to put my question into context.  I had WLS on 10/25/2005.  My surgery weight was 386 and I currently weigh 192.  I'd like to lose another 10-15 pounds.  I've been averaging 2300 calories per day, with roughly 140 grams of protein, 55 grams of fat, and 300-310 grams of carbs.  I lift weights 2x per week and aim for 50-60 minutes of cardio 3-5x per week, as my schedule permits.  I'm working to cut my calories back to a 2000 calorie per day average; I have done that for a couple weeks and dropped 5-6 pounds.   My question is does the 40-35-25 guideline also apply if I'm eating 2000 calories per day?  That would put my protein at 175 grams, fat at 55 grams, and carbs at 200 grams.  I think I could manage that, but am wondering if that's too much protein on an long-term basis.  I would appreciate your thoughts on this issue, and thank you in advance for your time.   Kellie

Hi Kellie,  Well, this has become a very good example.  Thank you for your question.  You see, nutrition is very individual.  What works for some, does not necessarily work for others.  You may have noticed that sometimes we (the dietitians with enutritioncare.com) don't post individualized recommendations.  We often tell OH-posters that we would need to do a full nutrition assessment to answer questions about calories, protein, fat, and carbs.  One plan does not work for all.   As you can see, someone on an average post-op diet of 1200-1500 calories, the 40-35-25 model I discussed would work well.  But it doesn't work for all, like you just pointed out to me.  We do want people to see dietitians for an individualized plan not only because we want to make money and earn a living, but because it's really important that you have someone tell you what is right for YOU and that you don't adapt someone else's diet plan to you.  EveryBODY is different - I'm sure you've heard that before, but really, it's true.   You do exercise a lot - and 2000 calories is a good level for you.  Now, I don't know your history, but with the information you have given me, I'd probably give you extra carb calories as 175 g of protein is high for long term.  Unless, of course, you are heavily lifting weights, but 2 times per week is not "heavily lifting".   My recommendation for you would be: 125 g (ish) pro, 250 g  (ish) carb, 50 g (ish)  fat.  Getting the carbs from whole grains, fresh fruit and vegetables.  Protein from lean meat/fish and legumes & fat from 'good fats' like olive oil, canola oil, avacodo ...  If you start lifting more, you will need to increase the protein.  50 g of fat can also be difficult to stick to --- There are so many things that go into these calorie recommendations that it's really important to seek and individualized nutrition assessment from a registered dietitian.  I'm giving you these recommendations with the little information I have.  If you have a dietitian in your area or in  your surgeon's office, I would recommend you seek his/her advice as well.   Good luck!! 

Hi, Sara.  Thank you so much for your thoughtful and thorough response.  I totally agree about the need for individualized nutrition planning; we all have somewhat different needs, and that needs to be taken into account with our planning.  Your recommendation of 125 g. protein, 250 g. carbs, and 50 g. of fats is in line with what I've been aiming for.  I'm feeling great and my labs have been good consistently for a while now.  So I think I'm in a good place.   I do appreciate the confirmation that 175 g. of protein on a long-term basis is probably too much for me.  I'm not likely to get into heavy weight lifting, so doubt I will ever need that much protein on a daily basis.  I'm just trying to build some muscle mass and improve my tone and definition.  So 125 g. of protein a day should cover my needs. 

I will follow-up with a registered dietician in my area after my next round of blood work.  I do appreciate your interim advice and hope you had a great Thanksgiving!

Kellie

Thank you, very much!  I have been struggling with these last lbs.  Yes in all honestly, I know that my portions are getting a little bigger... So I will go back to childs plates and utencils starting today. I am going to add a yoga class two days per week and evening walks every night, I have a great 2 mile walk that takes me past a friends house, and I will make an effort to build that friendship back up with my walks. I like the suggestion of the modified 40-30-30, Thanks for your reply, it forced me to take a look at some bad eating habits that have crept back up. Thanks again, Mechelle