xpost - Eating disorder after WLS? Need help/advice please...

I posted this also on the RNY forum, but figured coming to the diet/nutrition board might be helpful as well.

 

Hi. I am wondering if anyone here has experienced an eating disorder after RNY (or any other wls?

I am currently about 16 months post op. I have lost 175 pounds, from a high of 315 pounds down to 140 pounds (I'm about 5' 8").

Anyway, I know I have had food issues my whole life, but things have gotten really bad. I am in therapy twice a week - and my therapist said that I indeed have an eating disorder. That I have a lot of anorexic attitudes and behaviors (like being terrified of gaining weight, being afraid to eat, thinking that i look fat, and periods of major restriction/starvation), and also some bulimic behaviors (that just started about 2 months ago - purging, and some binging). I know my binging isn't what it would have been pre-op, but it concerns me still...

One of the things I am supposed to do is see a dietitian...HOWEVER, I am not near where I had my surgery, no follow up surgeon right now...and my insurance will not pay for a dietitian. SO...my therapist helped me find one who works a lot with people with eating disorders, and supposedly has worked with gastric bypass patients.

We haven't met in person, just talked on the phone and email so far...I am very hesitant to work with her...she sent me a sample meal plan, that included lots of empty carbs - WHITE bread, Saltine crackers, Bagel, chips!  She also says I need to get all my protein from food, and I was taught that protein supplements would be a part of my life forever...my husband is also hesistant to use this lady - especially if we have to pay $60/hour for her help.

I need help coming up with a SIMPLE meal plan...I finally started adding protein shakes back in - because I was eating nothing - flavored water (crystal light type stuff) and gum, with the occasional sugar free jello...then every so often I'd 'binge' on foods - sometimes protein, and sometimes empty carbs and sugary stuff - it was the sugary sttuff that got me started in the purging/throwing up - because I would feel sick from it anyway...

I am not good at cooking, and money is tight. I am willing to try new things, but calories scare me, sugar scares me, fat doesn't scare me as  much because I know it's malabsorbed to some degree. I want to keep protein shakes in my diet...I just get so overwhelmed trying to think about all of this...

Can someone help me? I need something to help me get started...I need some direction...

And I wonder if there's anyone else out there that is dealing with an eating disorder as well?

Thanks for listening!

I had mine before my surgery since I was 5 years old.  Was a extreme binge eater.  I got help for it to figure out why I was using food.  But that was like 5 years ago when I got some help.  Please dont take this meanly but have you considered talking to someone.  It may be helpful.  

I am currently seeing a therapist twice a week about all of this...so I am working on it. I just can't get a handle on the nutrition aspect - and I can't find anyone that can help me with that part.

I know I went from one side to the other growing up - I had periods where I would restrict/starve myself for a couple weeks and then overeat with some binging here and there - at least since middle school - when the restrictiion stuff started happening.

I don't know if I have a disorder, but I might be able to offer a couple of suggestions.

Have you tried tracking your intake on one of the online sites?  www.Fitday.com, www.TheDailyPlate.com or www.Sparkpeople.com?  This can be very helpful to see what you are doing.  Sparkpeople is a great site and really encourages healthy, balanced eating.

I have a post-op friend whose dietician recommends the following:
1000-1200 calories per day
Fats 34-60 g per day
Carbs 90-120g per day  (all from veggies and some whole grains and fruits--nothing "white")
Protein 90-140 g per day
Fiber 25-35 g per day.
(I am using my friend's example because my nutritionist sounds like yours.....lots of empty white carbs and no liquid protein---she does not get "us".)

You can put these figures in as "goals" then track your eating to see where adjustments need to be made.  These sites all recognize and have nutritional infor for protein drinks so it should be easy to see what you are doing.

I do not track every day of every week of every month.  What I DO find helpful is to track for about a week or so to see how close I am to my goals.  I can then adjust, and by the end of about 10 days, I am back on track and can see/feel what that should be like.  When I feel out of control, I go back to tracking.

I hope this helps a little bit and I wish you the best of luck.

I forgot to say that I do 2 drinks per day (morning and night) and 3-4 other small meals spaced about 2-3 hours apart.

Also, don't forget your water!  at least 80 oz per day, but I shoot for 120 oz.

Thanks...that's a good baseline for me to think about. I appreciate it.
Those places look like a good place to track some of that stuff. Thanks!

I don't believe it's necessary to continue to have protein shakes a year or more out from surgery. It all really depends on the surgeon. Mine told me no more shakes at 1 year out. I do believe that you can get all your protein from food. I eat about 1600 calories a day and intake about 34% protein most days (130 grams)  I know this flies in the face of some suggestions but it's what I believe and if my labs show I have no problems, then I see no problem in the practice.

I do know there are plenty of people who have eating disorders after surgery because they had them before surgery and they were not addressed. A girl I know on one of the boards is anorexic and weighs under 100 pounds...she eats about 340 calories a day because she just can't get herself to eat...

I believe there more and more people are having WLS and more and more will discover they have eating disorders afterwards.

 Hi, 

 I am a dietitian who works in this field.  I skim the boards from time to time.  I would agree that the dietitian you talked to who offered all the white bread, bagels and such may not be the best choice - although, it may help to actually met in person. 

 Anyway, where do you live?  Let me know and I can see if I can help you find a dietitian in that area. 

 Sara Nejat-Bina, RD, CNSD
 Registered Dietitian