Nutrition for Weight Loss

2. Nutrition for Weight Loss Amanda Downs MS, RD, LDN Registered Dietitian

3. Objectives • After 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.

4. Outline • Non-surgical approach • (Fad) Dieting • Exercise • Lifestyle changes • Weight loss surgery (WLS) • Common surgical procedures • Adjustable gastric banding • Roux-en-Y gastric bypass • Sleeve gastrectomy

5. Excess body weight • Obesity Epidemic • Linked to: • High blood pressure • High cholesterol • Type 2 diabetes • Heart disease • Stroke • Gallbladder disease • Sleep apnea • Some cancers

6. (Fad) Diets Galore! • Atkins • South Beach • Cabbage Soup Diet • Cookie Diet • Nutrisystem • Slim Fast • Jenny Craig • Blood Type Diet • Colon Cleanse • MediFast • Alli • Phentermine/Adipex • Hydroxycut • Detox Diets • Mediterranean Diet • And on • And on • And on

7. A fad diet… • does 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. • doesn’t give you the tools you need to help change your eating and exercise behaviors permanently.

8. Is 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.

9. A safe and healthy weight loss plan… • includes 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.

10. Smart food choices • Produce • Fill 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.

11. Smart food choices • Meat, seafood, and deli • Think lean • Beef- loin, round, and extra lean ground beef • Pork- loin • Lamb- leg • Poultry- white meat without skin • Seafood- items that are not breaded • Portion size is 3 ounces, cooked (deck of cards) • Choose cuts with little fat marbling • Trim all visible fat prior to cooking • Use low fat cooking methods- bake, grill, broil, etc.

12. Smart food choices • Dairy • Keep it skim or low in fat • Choose skim or fat free dairy products instead of whole fat products • Choose light, non fat yogurt • Beware of cheeses that are high in fat • Margarine/Butter debate • Look for a soft tub margarine with no trans fat • Be careful with condiments!

13. Smart food choices • Grains and Legumes • Choose foods made from whole grains • Use whole wheat pasta, brown rice, barley and oats • Make sure that the grain product that you choose has whole wheat listed as the first ingredient on the label • Good source of fiber • Beans are an inexpensive source of protein and fiber

14. Healthy eating for weight loss • Eat 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.

15. Mindful eating behaviors • Be aware of situations that give you the urge to overeat • Watching 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?

16. Healthful eating • If 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.

17. Nutrition Guidelines for WLS • Pre-operative diet guidelines • Post-operative diet progression • Micronutrient supplementation

18. Pre-op diet guidelines • Pre-op very low calorie diet (VLCD) of less than 800 calories • Decrease visceral adipose tissue • Reduce liver volume • Generally 2-6+ weeks duration • Low carbohydrate, high protein • May or may not include food • Many use high protein liquid meal replacement supplements • Adequate hydration encouraged • No alcohol • No tobacco

19. Post op diet goals • Support healing after surgery and maintain lean muscle mass during rapid weight loss • Minimize side effects (reflux, vomiting, diarrhea, etc.) while maximizing weight loss • Hydration!

20. Post op diet phases • Varies from program to program • Generally start with all liquids and slowly advance to more solid food over the course of several weeks • Exercise encouraged! • Example • Stage 1: Thin Liquids • Stage 2: Full Liquids • Stage 3: Pureed Food • Stage 4: Soft Foods • Stage 5: Regular/Maintenance Phase

21. Phase 1: Thin liquids • Duration: ~7-10 days • Calories: ~600-800, Protein: ~60-80 grams, Fluid: ~64 ounces • May include: • Water • Fluids with very few calories, no sugar, no carbonation (Crystal Light) • Broth • Sugar free popsicles and gelatin • Protein shakes- high quality!! • Milk- low fat cow’s, soy, Lactaid, almond • May not include: • Carbonation- irritates the stomach lining and can exacerbate reflux • Straws- may cause pt to swallow air causing discomfort • Excessive amounts of caffeine- possible dehydrating in very large amounts • Alcohol- can irritate stomach lining

22. Phase 2: Full Liquids • Duration: ~5-7 days • Calories: ~600-800, Protein: ~60-80 grams, Fluid: ~64 ounces • May include: • All liquids from Phase 1 • Yogurt • Pudding • Cream-based soups • Applesauce • Portion size: ~1/4-1/2 cup per meal

23. Phase 3: Pureed Phase • Duration: ~14 days • Calories: ~800, Protein: ~60-80 grams, Fluid: ~64 ounces • May include: • All liquids from Phase 1 and Phase 2 • Pureed chicken, turkey, or fish, tuna fish with light mayonnaise, peeled, pureed fruits and vegetables, oatmeal, scrambled eggs, refried beans • Emphasis is on the protein and the fluid • Separate out food intake from fluid intake • Portion size: ~1/4 -1/2 cup per meal

24. Phase 4: Soft Phase • Duration: ~14+ days • Calories: ~800-1,000, Protein: ~60-80 grams, Fluid: ~64 ounces • May 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 fluid • Separate out food intake from fluid intake • Portion Size: 1/2-3/4 cup per meal

25. Phase 5: Maintenance/Regular Phase • Duration: Lifetime • Have lean protein with every meal • Eat 5-6 small planned meals per day, no grazing • Increased dietary variety • Mindful eating behaviors: small bites, adequate chewing • Consistent follow up with weight loss surgery team • INDIVIDUALIZED approach and experience for each patient

26. Micronutrient supplementation • Chewable multivitamin • Bariatric formula with 200% DV of at least 2/3 of the nutrients • Should include iron, copper, and zinc • Take with meal to improve tolerance • Chewable or liquid calcium citrate with vitamin D • Sublingual B-12 • Chewable elemental iron- taken separately from calcium to improve iron absorption • Encourage regular blood work to monitor need for additional supplementation/repletion

27. Conclusion • Whether 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!