IU Health Bariatric & Medical Weight Loss
Surgical Weight Loss Book
Please bring this booklet and your “Personal Journey
Checklist” to every Supervised Weight Loss class.
During Supervised Weight Loss you should:
Follow the Liver Reduction Diet
•LiverReductionDietwillbedeterminedbyyourprovider
Drink at least 64 oz fluids each day
•Nofruitjuice,sweettea,carbonatedbeverages,oralcoholicbeverages
Take the following vitamins
1.CompleteorWoman’sFormulaMultivitamin–1perday.Nomen’s,silver,or50+formulas.
2.1200mgCalciumCitrateeveryday(2tablets–2timesaday.)Donottakewithmultivitamin.
3.2000IUVitaminD3.Onetimeperdayatanytime.
•Samplevitaminschedule:2calciumat10am,2calciumat3:30pm,andmultivitamin
andvitaminD3atbedtime.
Journal what you eat and your activity.Somemayberequiredbyyourinsurance
tokeepafoodandactivityjournal.
No weight gain or you must reach your weight loss goal before surgery.
•Weightlossgoalhastobemaintainedallthewayuntilsurgeryandifyouhadnoweightlossgoal,
youcannotgainweightevenuptodayofsurgery.
•Weightgainmayresultinpostponedsurgerydate.
If you have diabetes, be sure to get your A1C and lipid levels checked and the results faxed to us.
Table of Contents
Activity
Cardio101 .................................................................................................................................................................4
CardioPlanforBeginnerIntervalTraining.............................................................................................................5
CardioPlantoBuildEndurance ..............................................................................................................................6
Flexibility101 ............................................................................................................................................................7
Warm-upandCool-downExercises.........................................................................................................................8
SettingGoalsandMeasuringProgress ..................................................................................................................9
YourSMARTFitnessGoals .................................................................................................................................... 10
StrengthTraining101 ........................................................................................................................................... 11
BasicStrengthTrainingProgram ......................................................................................................................... 12
4-DayAdvancedStrengthTrainingProgram ...................................................................................................... 13
PhysicalActivityinDailyLife ................................................................................................................................ 14
ExercisingwithPhysical“Limitations”................................................................................................................. 16
WhatstudiesshowaboutexerciseandWLS ..................................................................................................... 17
PhysicalActivityforBariatricPatients................................................................................................................. 18
HomeExerciseProgram ....................................................................................................................................... 20
Nutrition
LiverReductionDiet .............................................................................................................................................. 21
LiverReductionRecipes:....................................................................................................................................... 23
LiverReductionDietGuidelines ........................................................................................................................... 25
BariatricSupportOptions ..................................................................................................................................... 27
IUHealthDailyFoodLog....................................................................................................................................... 28
UnderstandingCarbohydrates .............................................................................................................................. 29
EatingOnTheGo ................................................................................................................................................... 31
Fluids,Carbonation,&Caffeine ............................................................................................................................ 32
FlavorUpYourFood ............................................................................................................................................... 34
LiverReductionDiet .............................................................................................................................................. 36
LovetheLiverReductionDiet! ............................................................................................................................. 38
ProteinAfterSurgery ............................................................................................................................................. 39
SupervisedWeightLossTopTenMistakesafterSurgery ................................................................................. 40
AllAboutVitamins ................................................................................................................................................. 42
Psychology
ThePrinciplesofMindfulEating .......................................................................................................................... 44
HowtobeSelfAware:Q&A................................................................................................................................ 45
LooseSkinAfterSurgery ...................................................................................................................................... 46
TransferAddiction .................................................................................................................................................. 47
SupportPersonAgreement .................................................................................................................................. 48
AffordabilityofFollowingourProgramafterSurgery ....................................................................................... 49
EmotionalEating:TheCyclecanbeBroken! ..................................................................................................... 50
EmotionalEating .................................................................................................................................................... 51
GettingYourWeightunderControl ...................................................................................................................... 53
GuidelinesforaGoodGroup ................................................................................................................................ 56
StressManagement .............................................................................................................................................. 57
SupportGroupReflections.................................................................................................................................... 59
ACTIVITY
Cardio 101
Why Cardio?
1.Cardioexerciseisoneofthebestwaystoimproveyourheartandrespiratoryhealth.
Studieshaveshownthatbettercardiohealthreducescomplicationsinsurgery.
2.Cardioexercisehelpsimproveenduranceandabilitytododailyactivities.
3.Cardioexerciseboostsenergyandgetsthebloodflowing.
4.Cardioexercisehelpstoburnexcessenergy(fat)andpromotesfasterweightloss.
General Exercise Guidelines
Aim for 45-60 minutes of moderate intensity exercise on most if not ALL days of the week.
Theseminutesincludecardio,strength,andflexibility—butallactivitiesshouldbedoneata
moderateintensityleveltochallengeyourheart.Theminutescanbebrokendownintosmaller
boutsofexercise(2,10minuteworkoutseveryday).Itisencouragedthatyouworktoincrease
thedurationofyouractivityexercise(especiallyifyourgoalistobuildendurance)to45-60
minutesatatime.Longterm,strivefor200-300minutestotalperweek.
Moderateintensityisreachedbysomeindicators 1.Increasedbreathingrateandheartrateisup
2.Breakingasweat
3.Achieved40-75%ofheartratereserve(seeFitnessCoachforhelp)
4.Reachinga5-7rangeonascaleof1-10.Seescaleforexample
10 Maximumexertion
9 Veryhard
8 Extremelyhard
4
7
6
5
Hard
“IntheZone”
Somewhathard
4
3
2
1
Fairlylight
Light
Verylight
Rest
ayattentiontohowhardyoufeellikeyouareworkingtostartbecomingin-tunewithyour
P
body.Makesurethatifyoubreakupyourworkoutsintosmallersegmentsthroughoutthe
daythatyouarealsogettingyourintensitylevelupduringthoseworkouts.
Activitiesshouldaimtobebothweight-bearingandnonweight-bearingdependingonyour
physicalabilities.Weight-bearingactivitieshavetheaddedbenefitofincreasingthestrength
ofyourbonesandpreventingosteoporosis,sotheyshouldbedoneifyouareable.
Forphysicallimitations,lowimpactandnonweight-bearingactivitiesaregoodoptions.
Becreative!
Itisencouragedthatyouworktobuildupyourphysicalendurancebeforetryingtoincrease
theintensityofyourcardioactivities.Focusonworkingoutforlongerratherthanharderinthe
beginning—thenafteryourfitnesslevelincreasesyouwillbeabletopickuptheintensity.
ACTIVITY
Cardio Plan for Beginner Interval Training
Quick Info about Beginner Interval Training
Onceyouhavebuiltagoodamountofenduranceinasingleactivity,thenextsteptochallenge
yourselfisthroughintervaltraining.Itisagreatwaytoburncalories,decreasebodyfatpercentage,
andboostyourpost-workoutmetabolism.Thistypeofcardioexerciseinvolvesalternatingshort
burstsofintenseactivitywith“activerecovery”orlowerintensityactivity.Thelengthofyourhigh
intensityvs.lowintensitysectionsaredeterminedbyyourfitnesslevelandactivity.Intervaltraining
accomplishesalotinashortamountoftime,mainlybyincreasingthetotalcaloricexpenditureof
yourworkouts—thereforeburningmoreoverallfat.Intervaltrainingalsoimprovescardiovascular
fitness,becauseworkingathigherintensitylevelstrainsyourheartandlungstobecomestronger.
Butsinceintervaltraininginvolvesgettingyourheartrateupnearmaximum,abeginnermust
easeintothistypeoftraining.Asyourheart,lungs,andwholebodygrowstronger—youcanfeel
morecomfortablepushingyourselftothenextlevel.
Minutes
RPE Intensity
Level (1-10)
Warm-up
5minutes
5
3minutes
6
2minutes
7
1minutes
8
30seconds
9
3minutes
6
2minutes
7
1minutes
8
30seconds
9
3minutes
6
2minutes
7
1minutes
8
30seconds
9
Cooldown
5minutes
5
Total
HR Zone %
30 minutes
NOTE:Ifyoufindyourselfhavingahardtimegettingbackdowntolevel6afterbeingatlevel9,
feelfreetostayinlevel6longerthan3minutesinordertobringyourheartratebackdown.This
recoverytimeisimportantandshouldbereached.Asyourfitnesslevelimproves,sowilltheability
foryourhearttorecoverwithinthose3minutes.
5
ACTIVITY
Cardio Plan to Build Endurance
Quick Info about Building Endurance
Toimproveyourenduranceitisnecessarytoincreasetheamountoftimeyoucanwithstanda
certainactivity.Buildingonendurancehelpstoproducemorestaminainyourexercisesessions
aswellasdailylifeactivities.Itisrecommendedthatyouimproveyourendurancewithacertain
activitybeforetryingtomakeitmoreintense.Whentryingtoimproveyourendurance,itis
recommendedthatyoukeepamoderate,steadyintensityleveluntiloptimumenduranceis
reached.Agoodnumbertoworktowardsis60minutesinanygivenactivity.Afteryoureach
thatpointcomfortably,youcanincreasetheintensityoftheactivityandbuildenduranceagain
atthatnewintensitylevel.
Warm-up
Workout
Cool Down
Total Minutes
Week1
5min
5min
5min
15minutes
Week2
5min
8min
5min
18minutes
Week3
5min
11min
5min
21minutes
Week4
5min
15min
5min
25minutes
Week5
5min
18min
5min
28minutes
Week6
5min
21min
5min
31minutes
Week7
5min
24min
5min
34minutes
Week8
5min
27min
5min
37minutes
Week9
5min
30min
5min
40minutes
Week10
5min
33min
5min
43minutes
Week11
5min
36min
5min
46minutes
Week12
5min
40min
5min
50minutes
Week13
5min
45min
5min
55minutes
Week14
5min
50min
5min
60minutes
DuringtheWarm-upandCool-downminutes,youwanttokeepyourheartrateata
low-to-moderateintensitylevel.
Yourlow-to-moderateintensitylevelisbetween____________bpm(5RPE)
and____________bpm(6RPE).
DuringtheWorkoutminutes,youwanttokeepyourheartrateatamoderate-to-highintensitylevel.
Yourmoderate-to-highintensitylevelisbetween___________bpm(6RPE)
and___________bpm(7RPE).
NOTE:Itisbestthatyouperformyourcardioactivitiesatleast3timesperweektobuildyour
endurancewellenoughtomoveonthroughthisplan.Ifforsomereasonyoumisssessionsor
skipaweek,remainatthatsameweekuntilyoucompleteatleast3sessionsatthatlevel.
6
ACTIVITY
Flexibility 101
What is “Flexibility”? And how do you train for flexibility?
Flexibilityreferstotherangeofmovementatajointorseriesofjoints.Youtrainforflexibility
throughdifferentmovementsthatwecall“stretching”.
Why train for more flexibility?
1.Youcanincreaseyourrangeofmotionandimprovephysicalabilities.
2.Youcandecreaseriskofinjury.
3.Youcansignificantlyimprovetheresultsyougetfromexercising.
4.Youcandecreasesorenessfromexercise.
5.Youcanprovideyourbodymore“TLC”!
How do you train for more flexibility?
1.Thegeneralrecommendationis:
a.3-7daysperweek
b.Static(or“holding”notbouncing)stretchesforallmusclegroups.
c.Holdfor15-30secondsperstretch;repeatstretchatleastoncemore
d.Onlystretchuntilyoufeelmuscletightness;slightdiscomfort
2.Someotherrecommendations:
a.Donotpushyourselfinstretchingunlessworkingwithaprofessionalorhave
personalexperience
b.Besttimetostretchisafteryourexercise,becausemusclesarewarmand
jointspliable.However,therearesomedynamic(or“moving”)stretchesyou
candobeforeyouexercisetoo.
What are some ideas for stretching programs?
1.Choosebasicstretchesfromresourcesrelatedtoyourphysicalgoalsandabilitiesanddo
thembeforeyougetup,beforeyougotosleep,whileyouwatchTV,takingabreakatwork,
oranytimeyoufeelstiff.
2.Yoga,TaiChi,orsimilarprogram
3.Pastphysicaltherapyprogramsyouhavedone
7
ACTIVITY
Warm-up and Cool-down Exercises
Reference:http://www.actsa.us/images/warm_ups.gif
8
ACTIVITY
Setting Goals and Measuring Progress
Tips for Setting Goals with Fitness
Thinkaboutyouroverall“bigpicture”goalsasavision,destination,andmission.Thinkabout
whatinspiresyou,givesyoudesiretoexperiencetheresultsofexercise,andconnectswithyou
andyoureffortsonthisjourney.
Examineandunderstandwhereyouarerightnow.
ThinkaboutthefirstfewstepsONLY!
Getspecificwiththenextstepsyouaregoingtotake.UsetheSMARTsystemifneeded.
Don’tbeafraidtoadjustyourgoalsandnextsteps.
Setdays/times/eventsforyoutoreachagoalORjusttomeasuretheprogressyou’vemade.
Tips for Measuring Progress
MyonlyDON’T:Don’tuseweightlossasyouronlyformofmeasurement!!
Thebestindicatorsofprogressphysiologically:inches/bodycomposition,abilities,energy
Beobjective:Measurethenumbersandyourgoals.Areyougettingclosertoyourgoals?
Besubjective:Reflectonhowyoufeel.Doyoufeellikeyouhaveaccomplishedsomething?
Tryyourbesttonotcompareyourselfto“normal”
BESTFITNESSTIP:Writeitalldown.
9
ACTIVITY
Your SMART Fitness Goals
Specific–Whatexactlyareyougoingtodo?Whatdoyouwanttoaccomplish?Howareyougoing
todoit?
Measurable–Howwillyouseewhenyoureachyourgoal?Howwillyouknowyouaremaking
progress?
Attainable–DoesthisgoalaccuratelyreflectwhatIcanandwillingtodo?Doesthisgoalhelpme
bringonfeelingofsuccessthroughouttheprocess?
Relevant–DoesthisgoalmatchupwithwhatItrulywantformyself?Doesthisgoalchallengeme
safely?DoesthisgoalworkwithwhoIamandnotagainstit?
Timely–DoIhaveacleartargetandtimeframeinmind?DoIhaveastrategyforhowthiswill
becomeapartofmydailylife?
GOAL #1
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Howwillyoumeasure?________________________________________________________________
Whatisyoutime-frame?______________________________________________________________
M A R T
Isyourgoal? S
GOAL #2
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Howwillyoumeasure?________________________________________________________________
Whatisyoutime-frame?______________________________________________________________
M A R T
Isyourgoal? S
GOAL #3
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Howwillyoumeasure?________________________________________________________________
Whatisyoutime-frame?______________________________________________________________
M A R T
Isyourgoal? S
10
ACTIVITY
Strength Training 101
What is strength training?
Strengthtrainingistheuseofresistancetocausemuscularcontractioninordertobuildthe
strength,endurance,andsizeofskeletalmuscles.Therearemanydifferentmethodsofstrength
training,themostcommonbeingtheuseofgravity,weights,orelasticforces.
What does “strength training” or “resistance training” do for me?
Helpsyouavoidlosingmusclemass.Weightlosshappensfromlosingmuscleandfat—strength
traintokeepyourbodystrongandsafe.
Improvesyourphysicalabilities.
Helpsyoufullyutilizetheproteinyoueat.
Helpsyourmetabolismandenergylevels.
Helpsyouhavemoreendurance.
Helpstightenskinasmuchaspossible,improvephysique,anddecreaseinches.
Tips for strength training…
Youwillknowifyouarestrengthtrainingifyoufeelchallengedinyourmuscles,ifyoufeel
aslowburningeffectinyourmuscles,orifyourmusclesaresoreafteranexercisesession.
Toproducespecificresults,amorestructuredandtargetedapproachisbest.
Therearespecificprogramstructuresouttheredesignedtoproducedifferentresults
(forexample,bodybuildingvs.toning).
Followingbasic,simpleguidelinesistheeasiestwaytogetstarted.
Youcanactuallygainweightwithstrengthtraining(especiallyifyouarenotconditioned)
butrememberthisisatemporarygainandwillnotcontinuetoincreaseifyouaredoing
everythingcorrectly.
11
ACTIVITY
Basic Strength Training Program
FREQUENCY
INTENSITY
TIME—Sets
TIME—Reps
TYPE
2-3daysperweek(non-consecutivedays)
Mediumintensity(50-75%ofyour100%maximumliftingpower)
1-3sets
8-15reps
atleast10-12exercisestargetingallmajormusclegroups
Choose1-2exercises
fromeachmusclegroup
toworkon.
Tofindexampleexercises
foreachmusclegroup,visit
www.exrx.netclickonExercise
Instructionandthenclick
onExerciseandMuscle
Directory.
Also,www.acefitness.orghas
anExerciseLibraryintheGet
Fitsection.
Other Principles:
Determinetheamount
ofweightyoushouldlift
intheverybeginning
(Imagefromwww.diabetesincontrol.com©2006bySheriColbergandPatrickOchs)
phasesthroughthe“Trial
andError”process.Start
withthe1set,8repetitionsandloadenoughweightwhereyouexperiencemuscularfatigue
bythetimeyoureach8repetitions.
Thelargestincreasesinyourmusclemassandstrengthwillbeinthefirst6-10weeks
youbegintheprogram.
Whenputtingtogetheryourexercises,theexercisemovesinvolvingthebiggermusclegroups
shouldbedonefirstandthesmallermusclegroupslast.
Asageneralrule,continuewithyourspecificprogramuntilitiseasytoperform—thenyoucan
addthenextchallenge.Ifyouarestillfeelingchallengedwithacertainamountofsets,reps,
weight—thencontinuetoperformthisuntilyoufeelreadytomoveon.Buildonintensityby
bumpinguptheweight5-10%andcomebacktostartingpointwithsetsandrepsORtrynew
exercisemoves(oruseanotherFITTprinciple!)
12
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
A
B
A
B
Workload
Heavy
Heavy
Light
Light
RepRange
8-10
8-10
11-15
11-15
Workout Sets
1
1
2
2
Rest
Longer
Longer
Shorter
Shorter
Workout
ACTIVITY
4-Day Advanced Strength Training Program
Sunday
Workallmajormuscle
groups.
Choose1-2exercises
fromeachmusclegroup
toworkon.
Splitupexercisestocreate
“WorkoutA”and“WorkoutB”
Tofindexampleexercises
foreachmusclegroup,
visitwww.exrx.netclickon
ExerciseInstructionand
thenclickonExerciseand
MuscleDirectory.
Also,www.acefitness.org
hasanExerciseLibraryin
theGetFitsection.
(Imagefromwww.diabetesincontrol.com©2006bySheriColbergandPatrickOchs)
Other Principles:
Determinetheamountofweightyoushouldliftintheverybeginningphasesthroughthe
“TrialandError”process.Startwiththe1set,8repetitionsandloadenoughweightwhere
youexperiencemuscularfatiguebythetimeyoureach8repetitions.
Thelargestincreasesinyourmusclemassandstrengthwillbeinthefirst6-10weeks
youbegintheprogram.
Whenputtingtogetheryourexercises,theexercisemovesinvolvingthebiggermusclegroups
shouldbedonefirstandthesmallermusclegroupslast.
Asageneralrule,continuewithyourspecificprogramuntilitiseasytoperform—thenyoucan
addthenextchallenge.Ifyouarestillfeelingchallengedwithacertainamountofsets,reps,
weight—thencontinuetoperformthisuntilyoufeelreadytomoveon.Buildonintensityby
bumpinguptheweight5-10%andcomebacktostartingpointwithsetsandrepsORtrynew
exercisemoves(oruseanotherFITTprinciple!)
13
ACTIVITY
Physical Activity in Daily Life
EVERYTHING YOU DO BURNS CALORIES. EVERYTHING!
Acalorieisameasurementofenergy.Energyisneededforourbodiestofunctionandtobeable
todoanyphysicalactivity.Ourbodiesconvertthefoodweeatintoenergy.Thisistheprocess
ofmetabolismanditishappeningallthetime!Yourbodyisconstantlytakingthecaloriesfrom
proteins,carbohydrates,andfatsandcombiningitwithoxygentoproducetheenergyyouneed.
Yourmetabolicrateistherateatwhichyourbodyburnscaloriesandusesthatenergy.Ifyouburn
moreorlesscaloriesthanyourbodyconsumesdaily,youwillloseorgainweightaccordingly.
Why are calories burned?
Thereareanumberofreasonswhyweburncalories.Oneofthemostsignificantreasonsisthat
caloriesareneededjusttokeepyoualive!Yourbodyburnscaloriestomaintainbreathing,blood
circulation,digestion,andotheressentialactivities.Thecaloriesyouburnthroughthistypeof
activitymakeupyourBasalMetabolicRate(BMR).Onaverage,theBMRconstitutes60percent
ofthosecaloriesburneddaily.Therestofyourcaloriesareburnedthroughengaginginactivity,
suchassports/exerciseanddailyphysicalactivities.Burningcaloriesthroughactivitiesmakesup
approximately30percentoftotalcaloriesburned.
How can I burn more calories?
Itispossibletoburnmorecaloriesandtospeeduptheburningprocessingeneral.Bybuilding
muscletissue,yourbodyworksharder,thusenablingyoutoexpendmoreenergyorcalories.On
average,foreachadditionalpoundofmuscleamassed,about50additionalcaloriesareused
daily.Inotherwords,witharegularweightprogram,yourBMRcanexperienceanincreaseof15%.
Ontopofthat,youcansimplystartmovingaroundmoreandyourdailyactivitylevelwillrise—
causingmorecaloriestobeburnedforenergy.Thiscanbedoneallthroughouttheday!For
example,takeawalkwithafriendinsteadofacoffeebreak,parkyourcarontwostreetsover
insteadofone,ormovearoundwhenyouchatonthephone.Alltheseadditionalmovementsmay
seeminsignificant,butdon’tbetricked--thecaloriesburnedbytheseactivitiesaddup.Exercise
isalsoasuccessfulandhealthywaytoburncalories.Bypickinguptheintensityofyourdaily
activitiesandexercisesessions,youcontinuetoburnadditionalcalories.
14
Walkingyourdogfor20minutes
86calories
vs.
Standingwhiledogroamstheyard
54calories
Takingthestairs
100calories
vs.
Takingtheelevator
9calories
Playwithyourkids
360calories
vs.
Sitandwatchkidsplay
96calories
Pushmower
396 calories
vs.
Ridingmower
192 calories
Walkingbreakatwork
99 calories
vs.
Coffeebreakatwork
24 calories
Parkinthebackoflot
34calories
vs.
Parkinthefrontofthelot
15calories
DoinglighthouseworkwhilewatchingTV
260calories
vs.
SittingonthecouchwhilewatchingTV
96calories
Cookingdinner
240calories
vs.
Drivingthrutogetdinner
96calories
TOTALS!
1,575caloriesperday
11,025perweek
47,250permonth
vs.
vs.
vs.
567caloriesperday
3,969perweek
17,010permonth
ACTIVITY
Calories Add Up!
Thiswascalculatedusingthetoolonwww.healthstatus.comforatypical200lbpersondoingthese
variousactivitiesfortheminutesitwouldusuallytaketoaccomplishthem(anywherebetween
5-60minutes).Youcanusethistoolaswelltocalculateyourdailyactivities!
Ways to measure your daily physical activity:
1.Trackyourdailyactivitiesandcaloriesburned!(www.livestrong.comorwww.sparkpeople.com)
2.Wearapedometerandtrackyoursteps.
3.Buyafancytoolthattrackswhatyourcaloriesandactivities.
BodyBuggwww.bodybugg.com
FitBitwww.fitbit.com
HeartRatemonitorwww.polarusa.com
GoWearFitwww.bodymedia.com
Informationmodifiedfromvarioussourceslikewww.ediets.com&www.healthstatus.com
15
ACTIVITY
Exercising with Physical “Limitations”
Tips for Exercising with Physical Obstacles
Rememberthatnomatterwhat—thereisalwaysanexerciseoptionforyou.
Exercisehasbeenfoundtoactuallyhelpmostphysicallimitations.
•Arthritis/JointPain,Diabetes,Fibromyalgia,COPD,andmore
Searchandseekoptionsrelatedtoexactlywhatisgoingonwithyou.Usetheinternet
andFitnessCoachforhelp.
Listentoyourbody—itwilltellyouwhentostoporkeepgoing!Learnyourbody’s
responsestoactivityandplanyourprogressbasedonhowyoufeel.
Iftheamountofexerciseyouwanttododoesn’tmatchupwiththeamountthatyoucando
safelyrightnow…rememberthatstartingwhereyouareatisthefirststeppingstoneandis
onlytemporary!Createaplanthathelpsyoumakestepstowardsgettingbetter.
Rememberthatphysicalabilitiesdon’tnecessarilyimprovewithweightlossalone.Ittakes
doingphysicalactivitiestobemorephysicallyfit!
Resources to Check out
Arthritis Today (Magazine & Website)
www.arthritistoday.org/fitness
Multipleworkoutsforallkindsofarthritisandjointpain.
Chair Aerobics for Everyone (Videos)
www.chairaerobics.com
Multiplevideosforseatedexerciseoptions.
Flourish Your Life Volume 2 (Video & Website)
www.flourishyourlife.com
Fullbodyfitnessroutineincludedforpeoplewithphysicallimitations(instructedby
theIUHealthFitnessCoachandsoldatthisclinic).CheckouttheFitnessBlogtoo!
The National Center on Physical Activity and Disability (NCPAD)
www.ncpad.org
1-800-900-8086
Awealthofresources,articles,videos,andmore.
Collage Video (Videos)
www.collagevideo.com
Compilesallkindsofexercisevideosforspecialtysituations.Clickon“Specialty”tofind.
New Mobility (Magazine & Website)
www.newmobility.com
Amagazineforactivewheelchairusers.
Other options:
WaterAerobics
ExerciseConditioning&PhysicalTherapy
AsktheFitnessCoach!
16
ACTIVITY
What Studies Show about Exercise and WLS
Everyonceinawhileresearcherspublishstudiesbasedontheeffectsofexerciseonweightloss
surgeryoutcomes.Alltoooftenthesestudiesarepublishedinjournalsthatthemajorityofthe
publicandweightlosssurgerypatientsdon’tregularlygettosee.ThemostrecentstudyI’veread
waspublishedintheAmerican Journal of Lifestyle MedicineMarch/April2010issueandwas
titled“TheRoleofPhysicalActivityParticipationinWeightLossOutcomesFollowingWeightLoss
Surgery.”Iwantedtosharesomegreatquotesfromthisarticlethatcansummarizetheimportance
ofphysicalactivityonhealthstatus,weightloss,andtheabilitytoreachgoalweight.
“Althoughtheincidenceofcertaincomorbidities(eg,diabetes)mayinfluencepostoperativeweight
loss,mostfactorsassociatedwithsuccessfulweightlossarerelatedtocompliancewithspecific
medical,nutritional,andphysicalactivityrecommendationsfollowingsurgery.”
“Exerciseduringtheperiodleadinguptosurgeryhasthepotentialtoimproveweightlosssurgery
outcomesbyimprovingcardiovascularfitness,reducingcardiovasculardiseaserisk,andreducing
surgicalcomplications.”
“[Researchers]observedgreaterpercentexcessweightlossandreductioninBMIinthosereporting
participationinphysicalactivityduringpost-operativefollow-upvisitsupto2yearsafterweight
losssurgery.”
“[Researchers]observedgreaterreductionsinfatmassandlessfat-freemass(muscle)inthe
“exerciser”group”
“Onthebasisoftheirfindings,the[researchers]concludedthatpatientswhodidnotrecoveror
improvetheirphysicalactivityafterweightlosssurgeryhada2.3timeshigherriskofnotobtaining
atleast50%excessweightlossfollowingsurgery.”
Justbasedonthesequotes,youcanseehowimportantexerciseisintheweightlosssurgeryjourney.
Thesefindingswerebasedontheminimumphysicalactivityrecommendationsof150minutesper
weekofmoderateorhigherintensityactivity.Itcansometimesseemoverwhelmingtoaccomplish
thismuchactivity,butyoudon’thavetostartatthetop!Beginwith60minutesaweekandbuild
upfromthere.Ifyouarefacingphysicallimitations,trytogetcreative...rememberanymovement
thatchallengesyourbodyisgoodforyou(whetheryouareexercisingseated,inyourbed,orjust
movingaroundyourhouse!)
17
ACTIVITY
Physical Activity for Bariatric Patients
ByBryanLoweBS,CSCS,CPT
Physicalactivityisextremelyimportanttothesuccessofbariatricsurgery.SurgeonsDavidDyer,
MD,HughHouston,MD,andDouglasOlsen,MDoftheCentennialCenterfortheTreatmentof
ObesityinNashville,Tennessee,believethat“surgeryisonesmallportionoftheoverallequation
tosuccessfulweightcontrol.”Establishingaphysicallyactivelifestylepriortosurgerywillbenefit
thepatientintherecoveryphase.Implementinggoodnutritionhabitsandsmokingcessation
arealsoveryimportant.FollowingbariatricsurgeryatCentennial,patientsparticipateina
comprehensiveAftercareProgram.TheAftercareProgramincludesnutrition,exercise,and
psychologicalcounselingservices.AccordingtoDr.Olsen,thisprogramhelpsdevelop“the
properhabitsthatallowapatienttoutilizethetoolsthatwehavenowgiventhemtofight
thatbattleofobesityandnowwinthatbattle.”
25 Reasons to Exercise
1. Achieveandmaintaingoalweight
2. Buildmuscletissue
3. Increasestrengthandendurance
4. Increasemetabolism,burnfat
5. Improvemobility
6. Improveskinelasticity
7. Enhancemood
8. Improveself-esteem
9. Lowerbloodpressure
10. Lowerbloodsugar
11. Reducestiffnessinjoints
12. Improveheartandlungfunction
13. Promotehealing 14. Helpwithsmokingcessation
15. Strengthenbonesandreduceboneloss
16. Increaseenergylevel
17. Improvelipids(increaseHDL/lowerLDL)
18. Improveposture
19. Improvementalalertnessandmemory
20. Promotesleep
21. Decreasestress,depression,andanxiety
22. Improveflexibility
23. Increasecapacityforphysicalwork
24. Increaselifeexpectancy
25. ExercisePhysiologistsaidso
4 Steps to a Lifestyle of Physical Activity
Step 1: Set Personal Goals
Setgoalsbasedonthe“reasontoexercise”listedabove.Example:“Mygoalistoachieveand
maintainmygoalweight.”
Step 2: Determine How to achieve Goals
Chooseactivitiesthatfityourlifestylefromeachofthefollowingcategories:
Cardiovascular–Examples:walking,biking,treadmill,waterexercise
StrengthTraining–Examples:weightmachines,freeweights,resistancebands
Flexibility–Example:stretchingbeforeandafterexercise
Scheduletimingofphysicalactivity(TheFITPrinciple):
F–Frequency:numberofexercisesessionsperweek
I–Intensity:calculateTargetHeartRate(THR)
220-age-RestingHeartRate(RHR)x.60+RestingHeartRate=lowerlimitofTHR
220-age-RestingHeartRate(RHR)x.60+RestingHeartRate=upperlimitofTHR
RestingHeartRateisthenumberofbeatsperminuteatrest
(Medicationsthatlowerheartrateinvalidatethisformula.)
T-Time:durationofexercise
Chooselocationforexercise:Examples:home,mall,park,work,fitnesscenter,churchorschool
18
ACTIVITY
Step 3: Implement Plan
Makeacommitmentandstarttoday
Getstartedslowlyandpaceyourself
Stayconsistent
Fitphysicalactivityintoyourdailyroutine
Step 4: Regularly Evaluate Plan
Discusswithexercisephysiologist
Monitorprogress
Recognizeachievement
Exercise Expectations Before and After Bariatric Surgery
Pre-op
Beginanexerciseprogrampriortosurgery.Meetwithexercisephysiologisttoindividualizedplan.
Post-Op Day 1
Walkinroom2-3timesandsitinchairwithnurseassistance
Post-Op Days 2-7
Walk3-5minutes,4-6timesaday
Post-Op Weeks 1-2
Continuewalking,increasingthetimeofthewalkto5-15minutes,3timesaday
Post-Op Weeks 2-4
Continuewalking10-15minutes,3timesaday.Maybeginweighttrainingwithdoctorapproval.
Post-Op Months 1-3
Continue30minutestoonehourofcardiovascularactivityatleastfivesaysperweek.Beginor
continueweighttraining.Allwoundsmustbehealedbeforeparticipatinginwaterexercise.
Post-Op Month 3 and On
Staycommittedtoexerciseandbariatricaftercareprogram.
Sample Work-out Routines
Routine 1
Monday–Cardiovascularactivityfor30-40minutesandupperbodyweights
Tuesday–Cardiovascularactivityfor30-40minutesandlowerbodyweights
Wednesday–Cardiovascularactivityfor30-40minutes
Thursday–Cardiovascularactivityfor30-40minutesandupperbodyweights
Friday–Cardiovascularactivityfor30-40minutesandlowerbodyweights
Routine 2
Monday,Wednesday,Friday–Cardiovascularactivity20-40minutesandupper
andlowerbodyweights
SaturdayandSunday–Walk15-30minutestwiceaday
19
ACTIVITY
Home Exercise Program
1.Beginbyperformingonesetof10-15repetitionsforeachexercise.Graduallyincreaseto3-5
setsof10-15repetitionsovera4-7weekperiod.
2.Thespeedofeachmovementshouldbe2secondsupand4secondsdown.
3.Beginwithdumbbellweightthatyoucaneasilylift10-15times.
4.Wearshoestopreventfalls.
Fromobesityhelp.com
20
Theliverreductiondietisahighprotein,lowcarbohydratedietthatwillpromoteadecreasein
liversizepriortosurgeryalongwithpreventingsurgicalcomplications.Byfollowingthisdiet,your
bodyreducesitsglycogenstores(glycogenisaformofsugarstoredintheliverandmusclesfor
energy).Witheachounceofglycogen,thebodystores3–4ouncesofwater,sowhenyoufollowa
dietthatislowinstarchandsugar,yourbodylosesitsglycogenstoresandsomewaterresulting
inweightlossandasmallerliver.
NUTRITION
Liver Reduction Diet
No weight gain prior to procedure!
Youmayevenhaveaspecificweightlossgoalyoursurgeonordietitianhasgiventoyouthat
youmustmeetpriortohavingsurgery.
Onthisdiet,thereisnorestrictiononportionsizes.Eat3mealsperdayandstopassoonas
youfeelfull.
The liver reduction diet consists of:
Protein/VeryLeanorLeanMeats–Nobreadedorfriedmeats
•Beef:Round,sirloin,andflanksteak;tenderloin,roast(rib,chuck,rump);steak(T-bone,
porterhouse,cubed),groundchuck,groundround,groundsirloin;beefjerky
•Pork:Freshham;canned,curedorboiledham;Canadianbacon;tenderloin,centerloinchop.
•Veal:Allcutsokay
•Poultry:Cornishgamehen,chicken,turkey(whitemeat,withoutskin)
•Fish:Freshorfrozenunbreadedfishsuchascod,flounder,haddock,halibut,trout,tuna
(fresh,pouch,orcannedwithwater),herring,salmon(fresh,pouchorcannedwithwater),
catfish,sardines.
•Shellfish:Crab,lobster,scallops,shrimp,clams,oyster.Nodeepfryingorsoakinginbutter.
•Game:Buffalo,elk,deer(venison),rabbit,squirrel
•Delimeats:Turkey,chicken,ham,roastbeef,turkeypastrami.Nobolognaorsalami
•Soy:Bocaburgers,MorningStarproducts,tofu,tempeh
•Eggs:Wholeeggs,eggwhitesorEggbeaters
•Bacon/Sausage:Noregularbaconorsausage.Canadianbaconorturkeybaconandlite/light
turkeysausageokay.
•Lowfatorfat-freecottagecheese
•Fatfree,reducedfator2%cheese:Stringcheese,Kraftorstorebrand2%shreddedcheese,
slicedcheeseorcheesecubes
•TofuShiratakiNoodles-findtheseinAsianmarketsoratMeijerbythetofu
LeanDairy(limitmilkandyogurtto2servingsperday)
•8oz(1cup)ofskimor1%milk
•6ozcontaineroflight/NoSugarAddedyogurtwithoutchunksoffruitorfruitpieces
(i.e.DannonLightn’FitorYoplaitLightandFatFree)
Vegetables
•Choose:tomatoes,broccoli,cauliflower,cucumber,lettucevarieties,spinach,cabbage,celery,
carrots,garlic,onion,leeks,greenbeans,mushrooms,squash,zucchini,eggplant,pumpkin,
asparagus,bellpeppers,artichoke,radishes
•Avoid:corn,peas,potatoes(white,redandsweetpotatoes),limabeans,olives,avocado
21
NUTRITION
Condiments
•Choosereducedfat,fat-freeorlightcondiments(mayo,sourcream,creamcheese).
•Usespraypumpmargarineandspraysaladdressings
•Salsaandmustardareexcellentchoicesforcondiments
•UseketchupandBBQsauceinmoderationassugarisnormallythesecondingredient
forbothofthese.
Soups
•Choosebrothbasedsoupswithavarietyofmeatsandvegetables(nosoupswithriceornoodles)
Avoid:pasta,rice,breads,beans(kidney,pinto,navy,etc),rolls,crackers,pancakes/waffles/
Frenchtoast,cereal(includinghotcereal)
•Canhave“OriginalFiberOne”cereal(notflakes,clustersorbars)or“AllBranBuds.”
Limit½cupdaily.
Avoid:Snackfoodsincludingregular,sugarfreeandfatfreeversionssuchascakes,pies,
cookies,icecream,candy,pudding,Cool-Whip,potatochips,popcorn,nuts,peanutbutter,
granolabars/fiberbars,proteinbarsandproteinsupplements,mealreplacementdrinks,etc.
Avoidallfruitorfruitjuiceofanytype.
Fluids
Yourgoalistodrinkatleast64ouncesoffluids(optionslistedabove)eachday.Nopop,sweet
tea,fruitjuice,andalcoholicbeverages.Thefollowingliquidscanbetakeninanyamountaslong
asthereare0-10caloriesperserving:
SugarfreebeveragessuchasCrystalLightorstorebrandofCrystalLight,SugarfreeKool-Aidor
Sugar-freeTang,DietSnapple,FuzeSlender,Fruit20,PropelZero,PoweradeZero,VitaminWater
Zero,SoBeLifeWater0calorie,decaffeinatedcoffeeorteawithsugarsubstitute,water,V8tomato
juice(notFusionorSplash)or100%vegetablejuice,diethotcocoamixmadewithwater.
Sugarfreepopsiclesandsugarfreegelatin
Brothsoups–chooselowsodium
Nutrition and Activity Journaling
Beginkeepingadailyfoodandactivityjournalthatincludes:
Everythingyoueat
Howmuchyouate
Whydidyoueat…wereyoubored,stressed,watchingTV,tired,hungry(ifyou’reeatingfor
reasonsotherthanhunger,startworkingonwaystopreventthisasyoucan’tdothisafter
surgery.Findahobby,readabook,goforawalk,chewgum,callafriendonthephone,write
inajournal,etctopreventeatingfornon-hungerreasons)
Howmuchphysicalactivitydidyoudo
Vitamins
Multivitamin:Werequireyoutotakeaonedailycompletemultivitaminsupplementbefore
bedtime.Anynamebrandorgenericwillwork.
CalciumCitrate:Pleasestarttakingcalciumcitrate+VitaminD,thenamebrandisCitracalor
store/genericbrand.Take2tablets2timesaday(2inmorning,2inafternoon).Donottake
withyourmultivitamin.
VitaminD-3:Take2,000IU/day.CanfindthisdoseatWal-Mart(SpringValleybrand).Youcan
takethiswiththemultivitaminorcalcium.
22
ThefollowingrecipesareoptionsforyouwhilefollowingtheLiverReductionDiet.Takethistime
totrynewrecipesandincorporatevarietyintoyourdiet.Websiteslikewww.sparkrecipes.com,
www.allrecipes.com,orwww.hungrygirl.com.Remember,notallrecipesarebariatricfriendly.You
mayneedtomodify,addordeleteingredients.Becreativeandhavefun!
NUTRITION
Liver Reduction Recipes
Crustless Pizza
1lbleangroundbeeforgroundturkey
1smalljarofpizzasauce
8ozpackageof2%mozzarellacheese
Anychoicetoppings:turkeysausage,greenpeppers,tomatoes,onions,mushrooms,
turkeypepperoni,etc…
Patgroundbeeforgroundturkeyoncookiesheet.Bakefor15-18minutesat400degreesF.
Patwithpapertoweltoremoveexcessivegreasefromthemeat.Spreadpizzasauceovercooked
beeforcookedturkey.Sprinkleyourfavoritetoppingsandsprinklemozzarellacheese.Bakeagain
inovenfor15minutesoruntilcheesemeltsandislightlybrown.
Anotheroptionisittopaportabellamushroom,greenpepper,orzucchiniwiththetoppings.
Mashed Cauliflower
1headcauliflower
1Tbsplightbutterspread
¼cup1%milk,plusalittlemore
¾tspsaltandfreshgroundpepper
Cutfloretsoffthecauliflowerandsteamthemuntiltheyareverysoft,about25-30minutes.
Transferthecookedcauliflowertoafoodprocessororblender.Addthebutterspreadand¼cupof
themilk.Blenduntilcauliflowerbecomestheconsistencyofmashedpotatoes,usingalittlemore
milkifneeded.Seasonwithsaltandfreshgroundpepper.Serves4
Mock French Toast
4eggwhites
1 egg
1tspvanilla
¼cupcottagecheese
Dashofcinnamon
1packetofSplenda
ICan’tBelieveIt’sNotButterspray
SugarFreemaplesyrup
Mixalltogetherinabowlandbeatwithafork.Pourintopanlikeyouwouldasifyouweremaking
pancakes.Topwithbuttersprayandsyrupandenjoy!
23
NUTRITION
Bacon Cheeseburger Quiche
1lbleanhamburgerorgroundturkey
1smallonion,chopped
4slicescrispcookedturkeybacon,choppedinbits
3 eggs
½cupliteoroliveoilmayonnaise
½cupskimmilk
8oz2%shreddedcheddarorSwisscheese
Garlicpowdertotaste
Optionalwhitepepper
Preheatovento350.Brownhamburgerinskilletwithonion.Removeandmixinbowlwithbacon
pieces,breakingupanylargerclumpswithaforkorpastrymixertoafinemix.Drainwell.Press
intoadeepdishpiepanthansetaside.Combineremainingingredientsinmixerbowlandwhip
well.Pourmixtureoverbeefcrustandbake40-45minutes,oruntiltopisbrownedandset.Cool
15-20minutesbeforeslicing.Thiscanbepackagedinplasticbagsorcontainersformealsquickly
microwaveableoverthenext3-5days.Doesnotfreezewell.
Chicken Parmesan
2-4ChickenBreast
1TbItalianSeasoning
½cupParmesanCheese
4slicesProvolone,Swiss,orMozzarellacheese
1jarPastaSauce–yourChoiceRagu,Prego,etc.
CombineParmesancheeseandItalianseasoning.Coateachchickenbreastwiththecheese
seasoningmixture.Sauteeinskilleteachchickenbreastuntilgoldenbrown.Chickendoesnot
havetobecookedthrough.Coatthebottomofglassormetalbakingpanwiththepastasauce
andplaceasinglelayerofchickenbreast.Placeonesliceofcheeseontopofeachchicken
breast.Addpastasaucetopanuntileachchickenbreastiscovered.Bakeinovenat350degrees
for30minutes.
Italian Beef
3-4lbsbonelessbeefroast
1choppedonion
1jarofpepperoncinipepperswithjuice
1canbeefbouillon(or4cubesand2c.Water)
Seasonwithgarlicandoregano
Cookinslowcooker8-10hoursonlow.Shredmeat,ifneeded.Servewithyourfavoritevegetables.
24
Begin practicing the following rules
NUTRITION
Liver Reduction Diet Guidelines
1.Eatthreemealsperdayandspreadthemeals5-6hoursapart.
2.Avoidsnacking.Followtheliverreductiondietguidelinesifyoudosnack.Choosesugarfree
popsicles,sugarfreejello,cheese,orvegetablesandlowfatdip.
3.Slowdownwheneating.Cheweachbiteatleast20timesandspendonly30minuteseatingat
mealtime.
4.Noliquidswithmeals.Stop30minutesbeforemealtime,take30minutestoeat,andwait30
minutesafteryoueattodrinkanyliquids.Gastricbandpatientswait60minutesaftermealsto
drinkanyliquids.
5.Drinkatleast64ouncesor2quartsoffluidseachday.
6.Limityouruseofcondiments–mayonnaise,miraclewhip,saladdressings,andbutter
margarine,unlessyouarechoosinglightversions.
7.AvoidthethreeC’sinliquids.Donotdrinkanyliquidsthathavecarbonation,calories,
orcaffeine.
8.Increaseactivitylevel.
9.Journaleverythingyoueatanddrink.
Frequently Asked Questions?
Why do I have to follow the liver reduction diet?
Yourliverprocessesallthenutrientsthatyoueat.Whenyouareoverweightyourbodywillstore
extraenergyorcaloriesasasubstancecalledglycogen.Thepurposeoftheliverreductiondietis
burnoffandnotreplenishestheglycogenstores.Thisisaccomplishedbyreducingtheamountof
carbohydratesthatyouconsumefromdiet.Inaddition,theliverreductionwillhelpyouadjustto
newfoodchoicesthatwillbeessentialaftersurgery.
Will I ever be able to eat carbohydrates – pasta, potato, breads, rice, etc?
Reducingthesizeofliveriscriticaltopreventcomplicationsandgiveyoursurgeonmorespace
toworkduringthelaparoscopicsurgery.Therearetworeasonswhywewantyoutoeliminateas
manycarbohydratesbeforeandaftersurgery.Carbohydratesarenotbad.Theyareenergytoyour
bodyandkeepyourliverthesizethesameifyoucontinuetoeatthesecarbohydratesbeforesurgery.
Aftersurgeryyourpouchwillbesignificantlysmalleraboutthesizeofpingpongballorsmallhot
dog.Ifyoufilluponthecarbohydratesyouwillnotbeabletoeatenoughproteinfromdiet.
I heard beans, nuts, edamame are a good protein source, are they okay to eat at this time?
Beans,nuts,andedamameareanexcellentsourceofproteinbutduringtheliverreductionphase
weconsiderthemacarbohydrate.Avoidallbeansandnutsatthistimeexceptgreenbeans.Nuts
areacaloricdensefood–½cupofalmondscontainupto275caloriesandonly10gramsprotein
(comparison3ounceschickenbreast–130caloriesand25gramsprotein.)
I thought fruit was good for you, why can’t I have fruit or fruit juices?
Yourbodyusescarbohydratestorestorethatstoredenergyorglycogen,sotoreducethesizeof
yourliverrequiresdecreasingcarbohydrateintake.Foodswithcarbohydratesarebreads,potato,
pasta,rice,cereals,fruits,fruitjuice,starchyvegetables–corn,peas,andmanysnackfoodscake,
pie,cookie,candy,chocolate,etc.Avoidingthesefoodswilldecreasethesizeofyourliverandhelp
youadjusttothefoodchoicesthatwillbeessentialaftersurgery.
25
NUTRITION
Why can’t I eat whole grain pasta or rice?
Wholegrainsare—thewholegrain.Anunrefinedkernelofgrainisactuallymadeupofthree
layers:thegerm(innermostlayer),theendosperm(centralcore)andthebran(protectiveouter
layer).Refinedorplain(white)grains,ontheotherhand,havehadtheirbranandgermremoved
intherefiningprocess.Wholegrainsarebetterforyoubecausetheycontainmoredietaryfiber,
vitamins,andminerals.Both,wholegrainandregularpastacontainaboutthe100caloriesper
halfcupserving.Youshouldavoidbothwholegrainandplainpasta,rice,breads,etcbecausewe
wantyoutoeliminateasmuchcarbohydratestoreducethesizeofyourliver.
Can I eat sugar free and/or fat free desserts or snack foods?
No.Sugarfreeandfatfreearenotnecessarilycaloriefree.Manysnackfoodsanddessertsthatare
sugarfreeandfatfreemaycontainmorecaloriesthantheregularitemduetochangesiningredients
used.Aftersurgery,foodsthatcontainsugarandsugaralcoholswillpromotedumpingsyndrome.
Finally,dessertsandsnackfoodsneedtobeeliminatedforlongtermweightmanagement.
What am I going to eat for breakfast?
Youmustthinkoutsideoftraditionalfoodchoicesthathavebeenpartofyourentirelife.Good
proteinsourcesforbreakfastarescrambledegg,friedeggusingsprayoilorspraymargarine,deli
ham,Canadianbaconwhichisham.Mixandmatchandadd2%cheese.Useanyseasonings,or
hotsaucestochangeupthetaste.YoucanalsomixtheFiberOnecerealintoalightyogurtor
Greekyogurt.Inaddition,whosaysyoucan’teatchicken,pork,beef,orfishatbreakfast.
Do you recommend any cookbooks on the liver reduction diet?
Thereisnospecialcookbookforliverreduction.Therearesimpletipsthatyoucanfollowthatwill
allowyoutouseanyrecipethatyoucurrentlymakeathome.
Adjustrecipesby:
1.Removingallstarchbasedingredientsthat–pasta,potato,rice,bread,peas,corn,etc.
2.Removealladdedcookingoils,butter,andmargarineintherecipe.
3.Experimentwithnonsaltbasedherbs,spices,andflavorings,e.g.thyme,rosemary,
garlic,ginger,etc.
4.FindacopyofSouthBeachorAtkinsbutsubstitutewithleancutsofmeat,fish,andpoultry.
5.Searchonlineforrecipes:www.allrecipes.com,www.sparkrecipes.com,www.cookinglight.com
6.Takeacookingclassandeitherrelearnorlearnhowtocook.
What condiments can I use?
Reducingoreliminatingcondimentsisaneasywaytoeliminateunnecessarycaloriesfromyour
diet.Choosecondimentsthatarelowfat,reducedfat,light,orfatfreeandreducehowmuchyou
usebyhalformore.Foodsthatarefatfree,light,reducedorlowfatarenotcaloriefree.
26
SupportGroupsareimportanttoyourlongtermsuccess.Studiesshowlongtermsuccessisbetter
forthosewhoattendsupportgroup.IUHealthisdedicatedtohelpingpatientsachievelongterm
successbyofferingavarietyofsupportoptions.Pleaseseetheinformationbelowtofindoutwhat
worksinyourschedule.
NUTRITION
Bariatric Support Options
In House Support Groups
InhousegroupsarefacilitatedbyhealthprofessionalsatIUHealthBariatricandMedical
WeightLoss.Groupsvarybytopic,opendiscussionoractivities.Groupsmeetmonthlyat
IUHealthNorthHospital.Checkourcalendarsforspecificinformation.Typically,onegroup
permonthisofferedonline.
Fitness
Findingasettingyouarecomfortablewithtobeginanexerciseprogramcanbechallenging.
Werealizethisisastruggleforpatientsandcanhelpyouaddfitnesstoyourdailyroutine.
Blog
Manypatientsstruggletoattendgroupsduetohecticschedules.Thereismorethanoneway
toconnectandgetsupportyouneed.Checkoutourblogforupdates,newrecipes,andarticles
regardingweightandhealthatiuhealth.org/bariatricsblog.
27
NUTRITION
IU Health Daily Food Log
Food
Breakfast
Lunch
Dinner
Vitamins
Water
Exercise
Other
Foods
Comments
28
Date
________
Date
________
Date
________
Date
________
Date
________
Date
________
Date
________
What are carbohydrates?
NUTRITION
Understanding Carbohydrates
Macronutrientthatexistsinfoodandisusedforfuelbythebodyafterit’sbeenbroken
downtoglucose.
Existsinthebodyin2mainplaces:
Theblood(glucose)
Glycogen(liverandmuscles)
What’s the difference?
Complex Carbohydrates
Importantsourceofenergy
Requiresyourbodytoworkhardertobreakthemdown
Maintainalongersenseofsatiety
Bloodsugarsremainmorestable.
Ex:certainvegetables,beans,oats,bran
Simple Carbohydrates
Knownassimplesugars
Requireslittleefforttodigest
Absorbveryquickly,causingdumpingsyndromeinRNYpatientsaftersurgery
Oftenfoundinveryprocessed“junkfoods”
Aspatients,thesetypesofcarbsneedtobegivenupforever!
What foods have carbohydrates:
Bread/rolls/biscuits
Pancakes,waffles,croissants,
Bagels,cereals
Candy,candybars,sugar,cakes,icing,icecream,
Pastries
Pastaandrice
Beansandlentils
Fruit
Milk
Vegetables:potatoes,sweetpotatoes,peas,corn
29
NUTRITION
Important Tip
Aftersurgery,whenlookingatfoodstofindthesugaralwayslookattheIngredientListandfollow
thethreeingredientrule–“Ifthereisasugarwordinthefirst3ingredients,it’sbesttostayaway.
(iesugar,brownsugar,molasses,highfructosecornsyrup,cornsyrup,etc)”
Following the LRD….
yourbodyisremovingthestoredglycogentherebygettingridofexcess“waterweight.”
yourbloodglucoseiskeptatanormalleveltoencouragefatmetabolismandweightloss
youhavegottenoffalljunkfoodsourcesofcarbohydrate:refinedsugars,processedfoods,etc.
What is Fiber?
Fiberisakindofcarbohydratethebodycannotdigestorabsorb.Mostpeopleneed25-30goffiber
perdaybutonaveragemostAmericansgetonly5-9g/day.
How fiber works for you?
Helpsmovefoodthroughthedigestivetrackwhichremoveswastefromthecolon
Mayreduceriskofcoloncancerandothertypesofdiseaseandhelprelieveconstipation
MaylowerLDLcholesterolandtotalcholesterol
Helpsfillyouupandkeepsyoufulllonger
Fiber intake after surgery…
Primarysourceoffiberwillbevegetables:onlycookedinitially,eventuallyfresh
Mayneedtosupplementwithfibersupplement
Asyougetclosetoyourgoal–wholegrainsandfruits
Types of Fiber
Soluble Fiber
dissolvesinliquids:“bulksthingsup”
bindswithfattyacids,prolongsstomachemptyingtimesosugarisreleasedand
absorbedmoreslowly,lowercholesterol
examples:oats,fruits,andbeans
Insoluble Fiber
doesn’tdissolveinliquids
promotesregularbowelmovements
examples:fruits,vegetables,wholegrains,darkleafygreens
30
Culture of Fast Food
NUTRITION
Eating On The Go
Fastfoodisnotbadbutcanbepartofatoxicenvironmentwhenitcomestohealth
Canbeastumblingblockinyoursuccessaftersurgeryifcarefulplanningisn’tinvolved
Ashumans,weweren’tintendedtoeat“onthego.”Thinkofhoweatinghasevolvedovertime
Strategies for Eating on the Go
Knowyourselfwell.IfyouareaddictedtoArby’scurlyfries,don’teatatArby’s.
Donotgolookingfortemptation.
Resolvetostarttakingyourlunch(xnumberofdays)insteadofgoingout.You’llsavemoney
andcalories.Youcanmaketheexactsamethingathomeforlowernumberofcalories
Don’tbefooledbydishesnamed“lowcarb.”Mostoftheseareveryhighinfat.Instead,order
whatyouwantminusthebun,getveggiesinsteadoffries.
Orderthewayyouwantit.Don’tbeafraidtogetyoursalmonwithoutbutterororderingveggies
inplaceoffriesormashedpotatoes.YOUarepayingforitandtheywillcooktoorder.
Lookatthemenuonlinebeforegoingsoyou’llknowwhatyoushouldgetratherthanbe
temptedbythemenuorotherpeople’sorders.
Portion sizes are generally much larger than necessary
TypicalPortions:
Burgers:6-8oz=2-3servings
Meat/poultry/fish:8-12oz=3-4servings
PatofButter:2tsp=2servings
PastaPlate:2-3cups=4-6servings
Saladdressingladle:¼cup=2servings
Bagel=4servingsofbread
The “Extras” YOU Need to Know About
Extrafoodsthataddextracaloriesquickare:saladdressing,bread,chipsandsalsa,sourcream,
guacamole,appetizers,cheese,sauces,andsodas.
Lookforfoodsthatare:grilled,baked,poached,stirfry,steamed,orroasted.
Avoidfoodsthatare:creamy,buttery,fried,breaded,crispy,smothered,augratin.
Need tips on Portions
1.Get½order
2.Shareentreeswithafriendorfamilymember
3.Orderfromsidesandappetizers
4.Askforsmallsize
5.Orderlunchsizeportions
Ask Questions/Ask for Substitutions
1.Saucesanddressingsontheside
2.Preparefoodswithlessoilorbutter
3.Substitutefrieswithvegetables,salad,orfruit
31
NUTRITION
Fluids, Carbonation, & Caffeine
Why you need 64oz of fluids/day?
Preventdehydration
60-75%ofbodyiswater
Waterisneededforeveryprocessinthebody
Preventsconstipation
Helpstoabsorbandutilizenutrients
Reducetheriskofkidneystones
Helpsregulatebodytemperature
Why NO carbonation?
Whenacoldcarbonatedbeverageisconsumed;itwarmsandreleasesgas.
Thisexpandsthestomachpouchandthisstretchingcancauseunduestress.
Ifstretched,theabilitytofeelfulliscompromisedandovereatingisusuallytheresult.
“ButIletitgoflat….”Sodasnevergocompletelyflat.Thiscanbeaslipperyslopetohavethat
mindsetbecauseonedayyoumightstarttojustifyhavingpopagain.
The benefits of giving up sweetened, carbonated and caffeine beverages
You’resavingcalories
You’resaving$$$
You’resavingandpreservingthesizeofyourstomach
Yourbonesarethankingyou
Beverages okay to drink prior to and after surgery (following LRD)
Water
Crystallightorstorebrand
SF-Kool-Aid
OceanSprayOntheGo
FuzeSlenderize
Unsweetenedicetea
Decafcoffee
Propel
PropelZero
VitaminWater0cal
SoBeLifeWater0cal
Fruit2O
DietLiptonCitrusGreenTea
32
FruitJuice
Caffeinatedcoffeeortea
Pop(regularordiet)
Carbonatedwaters
VitaminWater
RegularFuze
Gatorade,G2,Powerade
Alcohol:Beer,Wine,MixedDrinks,Liquor,etc.
NUTRITION
Beverages to AVOID!
The calorie problem
Sodaisoftenhighincaloriesandalmostnonutritionalvalue.Sweetenedsodasareabsorbed
quicklyintothebloodstream,sometimescausingarapidriseinbloodsugar,elevatinginsulin
levelsandincreasinghunger.
Did you know?
Avendingmachinesodacancontain250calories.Ifonedrinksthiseverydayandthisisover
yourcalorielevel;thatcancontributetoanextra25lbsinayear.Lessontolearn…Don’tdrink
yourcalories!
The calcium problem
Darkcolashavephosphoricacid
Calciumandphosphorusmustbekeptatspecificlevelsintheblood
Ifyouraiseyourphosphorouslevel,yourbodymustraiseitsbloodcalciumlevel
Wheredoesitgetthecalciumfrom…yourBONES
AfterRNYsurgery,yourcalciumabsorptionisalreadyalteredandyouwillbe
oncalciumsupplements
The caffeine problem…
Isadiuretic
Canirritatetheliningofthestomachandaftersurgerymayincreaseone’sriskofulcers.
Excessiveintakemayincreasecalciumlossfromthebody.
Whygiveupbeforesurgery…youdon’twanttodealwithcaffeinewithdrawalheadaches
aftersurgery.
33
NUTRITION
Flavor Up Your Food
Seasonings and Spices
Seasoningscanreallyaddsomeflavortoanyvegetableandmeatitem.Trysomeofthesefavorites
BlackeningSeasoning
CayennePepper
MontrealSeasonings
Mrs.Dash
GarlicPowder
OnionPowder
SmokedPaprika
Herbscanalsoaddagreatflavor.Buysomefreshherbsandaddthemtoamarinaderub,salad,
orsteamthemwithsomevegetables.Basil,rosemary,parsley,thymeareallgreatonmeatand
vegetables.
AlsotryaddingsomeButterBudstogiveabutteryflavortovegetables.
Montreal Steak Marinade
For2steaks
1Tbspoliveoil
1/4cupwater
3tbspMontrealSteakSeasoning
2tbspsoysauce
1/2tbspmincedgarlic
Mixingredientstogetherinbowl.SeasonsteakonbothsideswithMontrealSteakSeasoning.Put
steaksintomixtureandcoat.Allowtomarinateforaboutanhour.
Lemon Chicken Marinade
11/2tbspextravirginoliveoil
1/2cuplemonjuice
1tbsplemonzest
1/2tbspkoshersalt
1tspgroundblackpepper
4largeclovesofgarlic,peeled&roughlychopped
Putallingredientsintoafoodprocessoruntilliquidsarefullymixedandgarliciswellpureed.
Mixtureshouldbeopaqueandfairlythick.Pouroverchickenandmarinadefor4-8hours.
34
1/2cupbalsamicvinegar
2tbspoliveoil
1/4cupwater
Fewdropshotpeppersauce
1/4cupmincedfreshbasil
Freshlygroundpeppertotaste
NUTRITION
Basil Balsamic Marinade for Grilled Fish
Usewithafirmfleshedfish(swordfish,mahimahi,salmonsteaks).Whisktogetherthevinegar,oil,
hotpeppersauce.Stirinthebasil.Pouroverfishandmarinateabout45minutes,turningonce,
beforegrilling.
Fish Marinade
1cupfreshsqueezedorangejuice
2clovesofgarlic
1tbspsesameoil
1/4cupsoysauceortotaste
Mixalltheingredients.Pouroverfishandmarinateforanhour.
Rosemary Pork Kabobs
RosemaryVinegar
2cupswhite-winevinegar
6(6inch)sprigsfreshrosemary
3clovesgarlic,crushed
Kabobs
2tbspoliveoil
1tbspDijonmustard
2tspchoppedfreshrosemary
1/8tspblackpepper
1poundporktenderloin,1inchcubes
RosemaryVinegar:Insaucepan,bringvinegartoaboil.Pourintoglassbowl;addrosemaryand
garlic.Cover;letstandatroomtemperatureovernight.Strain.
Kabobs:Inbowl,whisk1/2cupvinegar,oil,mustard,rosemaryandpepperforvinaigrette.Inplasticbag,combine1/2cupvinaigretteandpork.Chill30minutes.
Heatgrillorbroiler.Threadporkalternatingwithsomeofyourfavoritevegetables,andusethe
remainingmarinadeforbasting.
35
NUTRITION
Liver Reduction Diet
Why are you on the liver reduction diet?
Toshrinktheliver–surgerieshavebeenabortedoncestartedduetotheliverbeingtoolarge.
Liverisanoverlookedorganinthebody,performsover500functions
Keepsusfromhaving“lastsuppersyndrome”
Functions of the Liver
Largestinternalorganinthebody
Storesvitamins(A,D,K,iron,andB12),andglucose
Performsseveralrolesincarbohydratemetabolism
Controlsproductionandremovalofcholesterol
Producesbile(requiredforfatdigestion)
Mission for the Month
Keepanutrition/exercisejournal.Takeitonatrialrunallmonthandseewhatitdoesforyou.
Try3newliverreductiondietrecipes.
Tryonenewvegetable–Useyourresources:IUHealthforrecipesandadvice:blog.iuhealth.org
Flavorings and Condiments
No margarine, butter, or cooking oil
Salt:usedlightly,saltisaneffectivewaytoseasonasitbringsoutthenaturalflavorinfoods.
•don’taddsaltifyouhavehighbloodpressure,CHF,or“saltsensitive”
•usingspices,herbs,orMrs.Dashasareplacementforthosewhoneedtowatchtheirsaltintake
Fresh or dried herbs and spices
Onions and garlic
•usewhensautéinganyvegetables,useinsoups,stews,roasts,sauces,etc.
Mustard:usewhenmakinganyroll-ups,useasadip
Salsa:useinplaceofdressingorcombinewithplainorGreekyogurtasasauce
tocookchickenin.
The Power of a Nutrition Journal
Thebesttoolyouhaveforweightlossrightnowisinexpensiveandrightatyour
fingertips:apenandpaper
Howtodoit:“Ifyoubiteit,writeit!”It’simportantnottomakeyourselffeelguiltyover“wrong”
choices.Writeitdownandmoveonwithyourday.Indoingso,youwillpractice2characteristics
neededfortherestoryourbariatricjourney:persistenceandforgiveness
Strategiestomakingitwork:Keepalittlenotebookwithyouatalltime.Whenyoueat,quickly
jotdownitemseaten.
Whydoit?
•It’simportanttotrackwhatwearedoingtoseechangesthatneedtobemadeinourlives.
•Habitsaremindlessactions.Keepingajournalwillhelpyouseewhatbehaviorsmayhave
becomehabitsandwhetherthosehabitsarebenefitingyouorbriningharmtoyou.
•Plateaus:Wheneverwehaveplateaus,it’simportanttochangesomethingup.
36
1. Steam
Placefoodinacolanderandsuspendaboveboilingwater.Addseasoningstothewaterto
flavorthefood.Manygrocerystoressellbagsoffrozen/freshvegetablesthatcanbesteamed
inamicrowave–quickandeasy
Benefits: Foodsretainmuchofthevitaminsandnutrients.
Good for: broccoli,cauliflower,fish
NUTRITION
Some Great Ways To Cook On the LRD
2. Stir-frying
Sprayaskilletorwokwithnon-stickcookingspray.Heatskilletonmediumhigh.Addmeator
vegetablesandcookquickly.Youdonotneedoliveorvegetableoil
Benefits: Quickcooking,typicallymeatorvegetableswilldevelopasearonthem
whichisdelicious
Good for: bagsoffrozenvegetables(noneedtothaw)chunksofchickenorslicesorsirloin
3. Grilling
Greatduringthesummertofixfoodsoncharcoalorgasgrill.Duringthewintertime,thereare
grillpansthataremadeforthestove-top.
Benefits: lowfat,easywaytocook,mostpeoplelovethegrillflavor,easyforlargegroups
Good for: Anyandallmeats.Trymarinatingmeatinsoysauce,redwinevinegarandgarlicbeforegrilling.Grilledvegetablesarealsogreat!
4. Roasting
Similartobakingbutdoneathighertemperatures.Importantthatfoodisnottouchingandisin
asinglelayerwhenroasting.
Good for: anyvegetables,butespeciallyrootordensevegetables.
5. Braising
Tocookintheoveninacovereddish/potwithasmallamountofliquidinthepot.
6. Poaching
Gentlysimmeringfoodinwaterorinaflavorfulbrothuntilitiscookedthrough.
Good for: foodsthatarenaturallytendersuchaseggs,chicken,andfish
Helpful Kitchen Equipment
Blender/foodprocessor
GeorgeForemanGrill:cooksinhalfthetimebecauseitgrillsfromthetopandbottom.
Dutchoven:greatforcookinganystewsorsoups
RoastingPan
Cookiesheetorbakingpan
37
NUTRITION
Love the Liver Reduction Diet!
Healthy Cooking Methods
Baking:tocookbydryheatinanovenoronheatedmetalorstones
Broiling:tocookbydirectheat,asisinanovenundertheheat
Poaching:tocook(eggs,fish,etc)inahotliquidthatiskeptjustbelowtheboilingpoint
Stir-Frying:tocookfoodquicklybycuttingintosmallpiecesandstirringconstantlyinaWokor
fryingpanoverhighheat:acommonmethodofChinesecooker
Roasting:tobake(meatorotherfood)uncovered,especiallyinanoven(itisimportantwhen
roastingvegetablesthattheybeinasinglelayer,andnotbetouching)
No Recipe Recipes
Roll-Ups:Take2slicesofleandelimeat,placedontopofasliceoflow-fatcheese(suchasSwiss
orprovolone).Addapickleinthemiddleandrolluplikeaburrito!Dipinmustardifdesired!
QuickandEasyStir-Fry:Sautéchunksofchickenbreast(orleangroundbeef)inahotskillet,
thenaddabagoffrozenAsianvegetables.Pourinasplashofsoysauceandenjoy!
BunlessPhillyBurger:Sautéonions,greenbellpeppers,mushrooms,addasprinkleofsalt.Pour
overMorningStarFarmsvegetarianburgerandaddasliceofprovolonecheesemeltedoverthe
top.Sogoodyouwon’tmindeatingitwithafork!
NoNoodleDinner:TakeLightTomatoSauceandaddcookedgroundsirloin.Eatascoopofthe
meatysauceinacupwithlow-fatmozzarellaontop.
NoTacoDinner:Browngroundbeeforturkey.Addapacketoftacoseasoning(orgroundcumin
andgroundchilipowder).Addchunksoffreshorcannedtomatoes.Eatascoopinamugtopped
withnon-fatGreekYogurt(inplaceofsourcream)andlow-fatMexicancheese.
CreamyDip:Combine2cupsoflow-fatcottagecheese,asplashofwater,andapacketof
seasoning(suchasranch,pesto,dill,etc).Blendinafoodprocessororblenduntilsmooth.
SalsaChicken:Pourajarofyourfavoritesalsaoverboneless,skinlesschickenbreastsand
bake.Sprinklealittlelow-fatMexicanshreddedcheeseontop.
ItalianChicken:MarinatechickeninlightItaliandressing,thensprinklealittleParmesancheese
ontop.Bakeuntildone.
NoCrustMiniPizzas:Take2Canadianbaconrounds(theyareabout3inchesindiameter)and
putinovenunderlowbroiluntilitistoasted.RemoveandspoonalittleMarinarasauceover
andasprinkleoflow-fatMozzarellacheeseovereach.Returntoovenuntiltoasty!
38
What is the purpose of protein?
NUTRITION
Protein After Surgery
1.Componentofeverycellandtissueinthebody
2.Hormone
3.Enzyme
4.Cellregenerationandfunction
How much protein will you need after surgery?
Aftersurgeryyouwillneed60-80gramsofproteineachday.
Yourbodycannotstoreprotein,sowithoutDAILYprotein,itwillbegintobreakdownyourmuscles.
Themoremuscleyouhave,thehigheryourmetabolism.
Good Sources of Protein
1.Meats–beef,chicken,pork;thisincludesallgroundversions,delicuts,cannedversions,etc.
2.Fish–shrimp,lobster,salmon,tuna,cod,flounder,etc.
3.Dairy–milk,cheese,cottagecheese,yogurt
4.Beans–cannedordried
5.Soybasedfoods–tofu,tempeh,edemame,soynuts,soymilk
Protein shakes
Whenwillproteinshakescomeintoplayandhowlong?
Dependsonpersonsandtheprocedure
Nomatterwhatsurgeryyouhave,youwillworkindividuallywithaRDtodeterminewhento
stoptakingtheproteinshakes.
NOproteinshakesduringsupervisedweightloss!!!
Yourgoalistoobtainproteinfromadietarysource.Useproteinshakestosupplementwhatyou
can’tgetfromyourdiet.
What about protein bars?
Trytoavoid–donotuseduringsupervisedweightloss.
Proteinbarsonlyserveapurposeinyourlifeifyouareliftingweightsconsistentlyortraveling.
Itisbesttogetyourproteinthroughfoodsourcesduringmealtime,andthensupplementwitha
shakeinbetween.
What if I am lactose intolerant?
Commonwithgastricbypasspatientsaftersurgerysincebodycannotbreakdownlactoseormilk
sugar.Symptoms:bloating,cramping,gas,diarrheaafterdrinkingmilkordairyproducts.Treatwith:
DairyEaseorLactaidmilk
Lactaidtablets–soldoverthecounter
Strategies to Increase Protein
1.Chooseleanmeatsanddairy
2.Centermealaroundprotein
3.Aftersurgery–goalwillbetoeat3-4ozofmeat,dairy,orotherproteinsourcesateachmeal.
Thiswillgiveyou60-80gramsofprotein.
39
NUTRITION
Supervised Weight Loss Top Ten Mistakes
after Surgery
TheNationalAssociationforWeightLossSurgery(NAWLS)helpspatientsshapenewlives.Ina
November2005pollconductedbyNAWLS,thefollowingwereidentifiedasthetop10longterm
mistakesthatbariatricpatientsmake:
1st Mistake: Not Taking Vitamins, Supplements, or Minerals
Everyweightlosssurgery(WLS)patienthasspecificnutritionalneedsdependingonthetypeof
surgeryyouhavehad.Notonlyisitagoodideatoaskyoursurgeonforguidelines,butalsoconsult
withanexperiencedWLSdietitian.Understandthereisnotastandardpracticethatallsurgeons
andnutritionistsfollowinguidingWLSpatients.So,itisimportanttodoyourownresearch,get
yourlabtestsdoneregularly,andlearnhowtoreadtheresults.
Someconditionsandsymptomsthatcanoccurwhenyouaredeficientinvitamins,supplements,
ormineralsinclude:Osteoporosis;perniciousanemia;musclespasms;highbloodpressure;burning
tongue;fatigue;lossofappetite;weakness;constipationanddiarrhea;numbnessandtinglingin
thehandsandfeet;beingtired,lethargic,ordizzy;forgetfulness,andloweredimmunefunctioning.
2nd Mistake: Assuming You Have Been Cured of Your Obesity
ThehoneymoonexperienceiscommonfollowingWLS.Duringthehoneymoonexperienceyouwill
notbehungry,willnotwanttoeat,andfoodsandbeveragesmaynotsmellandtasteastheydid
beforesurgery.Youwillalsobefeelingbetterthanyouhaveinyears,andtheweightiscomingoff
easily,it’shardtoimagineyouwilleverstruggleagain.Butunfortunately,itisverycommonfor
WLSpatientstonotlosetotheirgoalweightortoregainsomeoftheirweightback.
Asmallweightregainmaybenormal,buthugegainsusuallycanbeavoidedwithsupport,
education,effort,andcarefulattentiontolivingahealthyWLSlifestyle.FormostWLSpatients,
ifyoudon’tchangewhatyou’vealwaysdone,you’regoingtokeepgettingwhatyou’vealways
gotten--evenafterweightlosssurgery.
3rd Mistake: Drinking with Meals
Yes,it’shardforsomepeopletoavoiddrinkingwithmeals,butthetoolofnotdrinkingwithmeals
isacriticalkeytolong-termsuccess.Ifyoudrinkwhileyoueat,yourfoodwashesoutofyour
stomachmuchmorequickly,youcaneatmore,yougethungrysooner,andyouareatmorerisk
forsnacking.Beingtoohungryismuchmorelikelytoleadtopoorfoodchoicesand/orovereating.
4th Mistake: Not Eating Right
Ofcourseeveryoneshouldeatright,butinthissocietyeatingrightisachallenge.Youhaveto
makeitaseasyonyourselfaspossible.Eatallyourmeals--don’tskip.Don’tkeepunhealthyfood
insightwhereitwillcalltoyouallthetime.Trytofeedyourselfatregularintervalssothatyou
aren’tastemptedtomakeapoorchoice.
Andconsiderhavingacoupleofabsolutes:forexample,avoidfriedfoodscompletely,avoidsugary
foods,alwaysuselow-fatoptions,oronlyeatinarestaurantonceaweek.Chooseyour“absolutes”
basedonyourtriggerfoodsandyourselfknowledgeaboutwhatfoodsand/orsituationsare
problematicforyou.
40
MostWLSpatientsareatriskfordehydration.Drinkingaminimumof64oz.ofwaterperdaywill
helpyouavoidthisrisk.Adequatewaterintakewillalsohelpyouflushoutyoursystemasyoulose
weightandavoidkidneystones.Drinkingenoughwaterhelpswithyourweightloss,too.
NUTRITION
5th Mistake: Not Drinking Enough Water
6th Mistake: Grazing
ManypeoplewhohavehadWLSregretthattheyeverstartedgrazing,whichisnibblingsmall
amountshereandthereoverthecourseoftheday.Limittothreemeals.Workonwhyyouare
hungryorworkonthementalhungerormindlesseating.Grazingcaneasilymakeyourweight
creepup.Eatingenoughatmealtimewillhelpyouresistgrazing.
Makeaplanforwhatyouwilldowhenyoucravefood,butarenottrulyhungry.Forexample,take
upahobbytokeepyourhandsbusyorcallonsomeoneinyoursupportgroupforencouragement.
7th Mistake: Not Exercising Regularly
ExerciseisoneofthebestweaponsaWLSpatienthastofightweightregain.Notonlydoes
exerciseboostyourspirits,itisagreatwaytokeepyourmetabolismrunningstrong.Whenyou
exercise,youbuildmuscle.Themoremuscleyouhave,themorecaloriesyourbodywillburn,
evenatrest!
8th Mistake: Eating Too Much
Let’sfaceit;justbecauseyouhaveWLSdoesn’tmeanthemindlesseatingorcravinggoaway.
Ifyougiveintothoseoldhabitstheywillreturn.Askyourself,“Whyameatingsomuch?”“Why
ameatingsofast.”Makesureyoustopafter30minutesandnofluids30-60minutesbefore
andaftermeals.
9th Mistake: Going Back to Drinking Soda
DrinkingsodaiscontroversialinWLScircles.Somepeopleclaimsodastretchesyourstomach
orpouch.Thebestthingyoucandoisfindother,healthierdrinkstofallinlovewith.Thisrequires
tryingnewbeveragesandnotgoingbacktooldbadhabit.
10th Mistake: Drinking Alcohol
Ifyoudrankalcoholbeforesurgery,youarelikelytowanttoresumedrinkingalcoholfollowing
surgery.Itisinyourbestinteresttounderstandtheconsequencesofdrinkingalcoholbefore
youdoit.
Alcoholisconnectedwithweightregain,becausealcoholhas7caloriespergram,whileprotein
andvegetableshave4caloriespergram.
1ounceLiquor=5ounceswine=12ouncesBeer=100–150calories.
Also,somepeopledevelopanaddictiontoalcoholafterWLS,sobeverycautious.Dependingon
yourtypeofWLS,youmaygetdrunker,quickeraftersurgery,whichcancausehealthproblems
andputyouindangeroussituations.Ifyouthinkyouhaveadrinkingproblem,gethelprightaway.
41
NUTRITION
All About Vitamins
Why are vitamins so important after surgery?
Decreasedfoodvolume
Malabsorption(withRoux-En-Y)
Vitamin Supplements
Itsimportanttotakethetypeswerecommendasthese
recommendationsarebasedonscientificresearchand
recommendationsfromASMBS.
Youwillbeonthisregimenforthe rest of your life
after surgery.
Multivitamin
Why:Youneedthisvitaminduetothedecreasedfoodvolumeandmalabsorptive
effectaftersurgery.
Encouragedtotakeatbedtimebecauseofthetimingofothervitamins.
Optionaftersurgery:Centrum,storebrandsofCentrum,CelebrateVitamins,Generic.
B-Complex
B-Complexisagroupof8vitaminsthatareessentialinhelpingthebodycreateenergyfromfoods
thatareeaten,andfortheproperfunctioningofyournervoussystem.
Calcium
Mostabundantmineralinthehumanbody.
Playsavitalroleinbodystructureandisusedfornervetransmissionandtoprevent
osteoporosis/osteomalacia.
Allformsofweightlosssurgeryhavebeenshowntoproduceincreasedboneturnover
andlossofbonemass.Onestudyfound66%ofwomenhadevidenceofboneloss3-5
yearsafterRNYsurgery.
Aftersurgery—1500mgCalciumCitrate/day
Options:Citracal,BariatricAdvantage,CelebrateVitamins,CalcetCreamyBites.
Donottakemorethan500-600mgatonetime.
Idealtimetotakecalciumis30minutesaftermeals
Avoidcaffeinatedbeveragesbecausethiscausesincreasedcalciumlossfromthebody.
Takingironwithacalciumcandecreaseironabsorptionbyupto62%.
Thiamine
Thiamin-partofcoenzymewhichassistsinenergyproduction.Occupiessiteonmembranes
ofnervecells.
DeficiencyknownasBeriberi
Knownriskfactorsfordeficiencyinclude:poorintake,intestinalloss(primarilythrough
vomiting),alcoholintake,eatingdisorders,dialysis.
RisksinWLSinmostcasestiedtovomitingintheearlyweeksandmonthspostoperatively.
Studiesshowthatthebodyonlystores30mgthiaminethereforedepletioncanoccurrapidly.
Symptomsofdeficiency:milddeficiency–fatigue,weakness,difficultyconcentrating.
Othersymptoms:vomiting,lossofappetite,weakness,sleepiness,burningfeet,calfandleg
pain,abdominalpain,constipation.Burningpain,especiallyinfeetisahallmarksymptom.
42
NUTRITION
Iron
Ironisanessentialmineralthatreliesoncontactwithstomachacidforabsorption.
Forthisreason,somepatientsdevelopirondeficiency.
Ironhelpscarryoxygentoeverycellinthebody;therefore,adeficiencywillleave
youfeelingtired.
Options:FerrousGluconateorFumarate,BariatricAdvantageChewableIron
IfyoutakeaMVI,youwillneedextraironifyouareamenstruatingwoman,anemic,
oradolescentofeithersex.
Donottakeironwithcalciumasthe2competeforabsorption.
Donottakeironwithcoffeeortea.
Vitamin B12
AreunabletoabsorbB12throughdigestivetractafterbypassandgastricsleevesurgery.
Thisvitaminisactingasareplacement,notasupplement
B12deficiencycancausesevereandirreversibledamage,especiallytothebrainand
nervoussystem.
Options:Sublingual–purchaseoverthecounterandtakeonetimeperweek.
Trytotakearoundsametimeeveryweek.
What vitamins are needed for each surgery?
Bypass or Sleeve
1.2MVI/day
2.1500mgcalciumcitrate
3.1B-complex/day
4.B121x/week
5.1ironpill/dayifneeded
Band
1.1MVI/day
2.1000mgcalcium/day(doesn’tmatterwhichform)
43
PSYCHOLOGY
The Principles of Mindful Eating
Principles of Mindfulness:
Mindfulnessisdeliberatelypayingattention,non-judgmentally.
Mindfulnessencompassesbothinternalprocessesandexternalenvironments.
Mindfulnessisbeingawareofwhatispresentforyoumentally,emotionallyand
physicallyineachmoment.
Withpractice,mindfulnesscultivatesthepossibilityoffreeingyourselfofreactive,habitual
patternsofthinking,feelingandacting.
Mindfulnesspromotesbalance,choice,wisdomandacceptanceofwhatis.
Mindful Eating is:
Allowingyourselftobecomeawareofthepositiveandnurturingopportunitiesthatareavailable
throughfoodpreparationandconsumptionbyrespectingyourowninnerwisdom.
Choosingtoeatfoodthatisbothpleasingtoyouandnourishingtoyourbodybyusingallyour
sensestoexplore,savorandtaste.
Acknowledgingresponsestofood(likes,neutralordislikes)withoutjudgment.
Learningtobeawareofphysicalhungerandsatietycuestoguideyourdecisiontobegineating
andtostopeating.
Someone Who Eats Mindfully:
Acknowledgesthatthereisnorightorwrongwaytoeatbutvaryingdegreesofawareness
surroundingtheexperienceoffood.
Acceptsthathis/hereatingexperiencesareunique.
Isanindividualwhobychoice,directshis/herawarenesstoallaspectsoffoodandeating
onamoment-by-momentbasis.
Isanindividualwholooksattheimmediatechoicesanddirectexperiencesassociatedwith
foodandeating:nottothedistanthealthoutcomeofthatchoice.
Isawareofandreflectsontheeffectscausedbyunmindfuleating.
Experiencesinsightabouthowhe/shecanacttoachievespecifichealthgoalsashe/she
becomesmoreattunedtothedirectexperienceofeatingandfeelingsofhealth.
Becomesawareoftheinterconnectionofearth,livingbeings,andculturalpracticesand
theimpactofhis/herfoodchoiceshasonthosesystems.
©TheCenterforMindfulEatingFreetoreproduceanddistributionforeducationalpurposesonlywww.tcme.orgorinfo@tcme.org
44
How do you keep track of your progress, lapses, and successes?
Possibleanswerscanincluderegularweighing,lookinginthemirror,comparingclothingsizesnow
vs.previously,journalingaboutfeedbackfromothersandnewthingsthatyoucando,comparing
numberofprescriptionsbeforeandafter,andfood/exercisejournaling.
PSYCHOLOGY
How to be Self Aware: Q & A
Why do you think that self-monitoring is important?
Itbreaksthroughdenialthatsomeindividualswithobesityhave(e.g.,somehaveavoidedbeingin
pictures).Ithelpsyouseeyourvictoriesmoreclearly.Itidentifiestriggersandkeyareastowork
on.Charting/journalingassistsyourhealthcareprovidersingivingyoudirection.
Why can’t we just keep track of our progress in our heads?
Everyoneofus,whenitcomestoretrospectivelyreportinghealthyhabits,tendstobeinaccurate.
Ourinformal,retrospectivereportofourownbehaviorisdistortedby1.)mood-congruentmemory
(e.g.,whenIfeellousyIrecallmorefailures),2.)forgetting,3.)consistencybias(i.e.,mymemory
isinfluencedbywhatI’vedonemostrecently),4.)wishfulthinking.
Astudypublishedin2008gave1500overweightandobeseadultslifestylechangeinformation.
Everyonereceivedthesameeducation.Afterfivemonths,allparticipantslostanaverageof13
pounds,butthosewhokeptafooddiarylostnearlydoublecomparedtothosewhodidnot(about
18lbsvs.9lbs)!
What are you willing to commit to today, and to whom will you
be accountable?
Are you willing to bring in your nutrition journals next time to show others?
Ifso,theactivitywouldnotbea“gotcha”exercise,butrather,adiscussiononwhatjournaling
revealedtotheindividual,barrierstocompletingit,whatindividualsdidtomakesuretheydidit,
whateatinghabitstheyareworkingontoimprove.
Theformatofthejournalisnotsoimportant;itcanstartbybeingablankpieceofpaperora
sophisticatedwebapplication.Weencouragepatientstoenterthetimeoftheireating,andinthe
caseofanyunplannedand/orunhealthyeating,writingdownthesituation/triggers/emotions.
Othersuggestions:makeanentryassoonasyouhaveeaten;itisevenmorehelpfultobe
attentivetoportionsizeswhenjournaling;journalonevenonthe“bad”days,especiallyonthose
days,becausewhatgetsmeasuredismorelikelytochangeinthepositivedirection.
45
PSYCHOLOGY
Loose Skin After Surgery
Oneimportantissueforpatientstothinkaboutwhenconsideringsurgeryistheprobabilityof
looseskin.Whydoeslooseskinhappen?Thebodylosesweightquickly,theskincannot“bounce
back”quicklyenough,andsotheexcessskinremains.
Thereareafewmainfactorsthatcanpredicthowmuchlooseskintherewillbeaftersurgery.
Age:youngerpeoplehavemoreelasticskinsotheyarelikelytohavelesslooseskin
YourinitialBMI
Amountofweightlossandthetimeinvolvedinlosingthatweight:slowerweightlossallows
fortheskintoadjustbetter
Genetics:yourgenesdeterminehowmuchelasticityyourskinwillhaveasweage
Sunexposure:thedamagedonetoyourskinbythesunwillaffectitselasticity
Smoking:smokedamagesthecollageninyourskin,therebyaffectingtheelasticity
Treatment Options
Manypeoplethinkfirstaboutplasticsurgeryorbodycontouringasawayofcopingwithlooseskin
aftersurgery.However,thereareimportantfactstoknow.
Bodycontouringhappensafterweighthasstabilizedaftersurgery.Thisisusuallytwelveto
eighteenmonthsafterthesurgery.Manyinsurancecompaniesdonotpayforcosmeticsurgery,
unlesstheyconsideritmedicallynecessary(e.g.,recurrentinfections).Theseprocedurescanbe
veryexpensive.
Other Ways of Managing Loose Skin
Strengthtrainingwhilelosingweightcanhelpretainelasticity.Strengthtrainingisimportantto
dowhilelosingweightandnotjustafter.
Makesuretodrinkenoughwatertohelptheelasticityofyourskin
Eatingleanproteinswillhelpdevelopleanmuscletohelpfirmtheskinifyouareexercisingat
thesametime.
Experimentwithusingshapingundergarments.
Besuretoexploreyourthoughtsandfeelingsaboutlooseskinpriortosurgery.First,consider
thecontributingfactorsandhowtheyapplytoyou.Youshouldalsothinkabouthowlifestyle
optionsdiscussedaboveapplytoyou.Shouldyouhavequestionsorconcerns,pleaseletusknow.
Cost of Plastic Surgery
Averagesurgeon’sfeein2012foratummytuck(abdominoplasty):$5,241
(Statisticfromwww.plasticsurgery.org)
For more information:
http://www.plasticsurgery.org/Media/stats/
2008-US-cosmetic-reconstructive-plastic-surgery-minimally-invasive-statistics.pdf
http://www.obesityhelp.com/forums/plasticsurgery/Plastic-Surgery-After-Weight-Loss.html
46
PSYCHOLOGY
Transfer Addiction
Objectives
Defineaddiction
Understandriskoftransferaddiction
Learnhowtoavoidandmanagecravings
Common features of addiction
InabilitytoconsistentlyAbstain
ImpairmentinBehavioralcontrol
Craving
Diminishedrecognitionofsignificantproblems
AdysfunctionalEmotionalresponse
Can Food be Addictive?
Thereisnoconsensusonthis,but….
Researchsuggeststhatsugar,fat,andsalthaveaddictive-likeproperties.
Iffoodisaddictive,andintakeofsugar,fatandsaltisreduced,can“addiction”
transfertosomethingelse?
How things change after gastric bypass
PeakAlcoholContentmeasuredfromdrinkingfiveouncesofredwine
Pre-op=.024(recoveryto0BAC:49min.)
6mo.post-op=.088(recoveryto0BAC:88min.)
Therefore,oneglassofwineleadstolegalintoxication.
Conclusions
3 Relapse Types (ASAM)
Directexposuretoaddictive
substanceorexperience
Strategy
Acceptance
•“Turningtoward”
•Mindfulness
Exposuretoconditionedcues
Behavioral
•“Turningaway”
•OA/abstinence
Stress(events,depression,
anxiety,lowself-esteem)
Cognitive(traditional)
•“Turningagainst”bychallenging
erroneousthinking
47
PSYCHOLOGY
Support Person Agreement
IUHealthBariatric&MedicalWeightLossrecognizestheimportanceofhavingthefullparticipation,
cooperationandcommitmentofacaregivertohelpourpatientsbesuccessful.Theduties/
responsibilitiesforthecaregiverroleinclude,butarenotlimitedto,thefollowing:
1.Ensurethepatienthasreliabletransportationandmakesallfollow-upappointmentsatour
clinicontime(dependingsomewhatonschedules,1or2weekspost-op,4weeks,3months,
6months,1year,18months,2years,andatleasteveryyearthereafter).
2.Ensurepatienthastransportationtoandfromthehospitalandfornecessaryerrands.
3.Monitorandassistwithmedicationsaftersurgeryuntilthepatientisabletobeindependent
withtakingmedicationsasprescribed.
4.Attendenougheducationalmeetingstothoroughlyunderstandtherisksandbenefitsofsurgery,
andthelifestylechangesthatareneeded.Thisshouldincludesupervisedweightlossclasses
and,mostimportantly,the5-hourpre-opclass.
5.Remindpatienttorefertothepre-opeducationbinderasquestionscomeuppost-operatively,
asthiscontainstheanswerstomostquestions.
6.Provideemotionalsupport,includingstayingwiththepatientandensuring24hoursupervision
forafewdaysaftersurgery.
7.Assistwithbariatric-friendlycookingandhousework,asneeded,duringtherecoveryperiod.
8.Atleastoncepermonth,jointhepatientinattendingabariatricsupportgroup,atleastfor
thefirstyearaftersurgery.
9.Contactyourpsychologistiftheabovedutiescannotbemet.
Pleasesignthisformandincludeyourcontactnumberifyouarewillingtocommittohelping
______________________________________________________.Thisformshouldbereturnedto
theattentionofyourpsychologist.
_____________________________________________________________________________________
PrimarySupportPerson
Signature
Relationshiptopatient
PhoneNumber
Date
_____________________________________________________________________________________
Patient
Signature
PhoneNumber
Date
_____________________________________________________________________________________
AdditionalSupportPerson
48
Signature
Relationshiptopatient
PhoneNumber
Date
PSYCHOLOGY
Affordability of Following our Program
after Surgery
Inthesedifficulteconomictimes,somepatientshavefounditachallengetofullyengagein
requiredtreatmentandhealthyhabitsaftersurgery.Thisnoteistohelpyouanticipatesomeof
thecoststhatyouwillhaveafteryoursurgery.Pleasekeepinmindthattheseareonlytheroutine
costs,andotherunexpectedneedsmayarise.
Gas and dependable transportation for follow-up visits to our Center.Thisdepends,ofcourse,
howfarawayyoulive.Takeamomenttoreviewyoursurgeon’sexpectationsforfrequencyof
aftercarevisits.
Healthy eating.Whetherhealthyeatingismoreexpensivethanunhealthyeatingdependsonhow
itismeasured.DatabytheUSDepartmentofAgriculture(May,2012)suggestthatunhealthy
foods(highinsugar,saturatedfats,andsalt)areactuallymoreexpensivethanhealthieroptions
suchasvegetables,fruitsanddairy.Also,manyofourpatientshavetoldusthattheyhaveactually
savedmoneybygoingtorestaurantslessoften.However,ifyoufindthatyouarespendingmore
moneyonrecommendedfoods,pleaseaskourdietitianstohelpyouwithideasonhowtomake
affordablechoices.Pleasenotethatsupportgroupsareoftenaimedatthistopicaswell.
Supplements and Vitamins.Ourdietitiansestimatethatpurchasinggenericswillcostyouabout
$30permonth.Ontheotherhand,manypatientsfinditanetgainwhensubtractingtheirco-pays
forthemedicationstheynolongerhavetotake!
Exercise.Youmayhavespecialneedsthatincurout-of-pocketcosts.PleaseseeourFitness
Specialistforideasabouthowtodevelopaverylowcostworkout.
Labs.Laboratorytestsareorderedtwiceperyearthefirsttwoyearsaftersurgery,andannually
thereafter.Withoutinsurance,labscarryanout-of-pocketcostof$1000.Thesetestsarean
importantpartofassessingyourhealth.
Copays.Mostinsurancesdonotpaythefullamountforvisitswiththesurgeon,soyoushould
anticipatethattherearecopaymentsinvolved.
Childcare costs.
Ihavecarefullyconsideredmyabilitytoaffordfullparticipationinhealthyhabitsandmedicalcare
afterbariatricsurgery,and,tothebestofmyknowledge,believethatfinanciallimitationswillnot
beanobstacletolong-termadherencetotheIUHealthBariatric&MedicalWeightLossprogram.
______________________________________
PatientName(printed)
______________________________________ PatientSignature
________________________
Date
49
PSYCHOLOGY
Emotional Eating: The Cycle can be Broken!
Stressor
Delayedemotions:
Guilt,shame,
regret
Immediate
emotions:Pleasure,
gratification,comfort
(ordecreaseof
negativeemotions)
50
Negative
Emotion
Emotional
Eating
Information about Behavioral Medicine Services
Youwillhaveapsychologicalevaluationpriortosurgery.Thiswillincludeathorough
assessmenttohelpuscreateatreatmentplantohelpyoubesuccessfulwithsurgery.
Ourotherservicesinclude:
•MentorProgram
•SupportGroups
•IndividualCounselingwithapsychologystudent
•AdolescentProgram
Contactusifyouhavequestions!
PSYCHOLOGY
Emotional Eating
Psychological Aspects of Surgery
AddictionTransfer
MindfulEating
EmotionalEating
StressManagement/Relaxation
ImportanceofRecreation
Relationships
BodyImageIssues
Accountability
Problems with Emotional Eating
Canleadtoovereatingandnutritionaldeficiencies
Providesonlyshort-termrelief
Canlowerself-esteem
Ultimatelyleadstomoredistress
Recognizing Emotional Eating
Emotional Hunger:
Comesonsuddenly
Impulsive
Relyononetypeoffoodforcomfort
Morelikelytocontinueeatingevenwhenfull
Canresultinfeelingsofguilt
Physical Hunger:
Occursgradually
Opentomanyfoodoptions
Morelikelytostopeatingwhenfull
Usuallydoesnotresultinguilt
Treating Emotional Eating
Addresstheunderlyingneed
•Boredom:seekstimulation
•Depression:seektherapy
•Frustration:seekspace
•Loneliness:seekcontact
•Distress:seekcomfort
51
PSYCHOLOGY
Obesity Contributes to Depression & vice versa
Eachofthefollowingareindependentlyrelatedtoincreasedriskofdepression
•Heartdisease,diabetes,sleepapnea,lowhealth-relatedqualityoflife,beingsubjectedto
weight-bias,andobesity.
Depressioncanincludesymptomsthatleadtoweightgain:
•fatigue,lossofinterest,sleepproblems,appetitedisturbance.
•Also,somemedicationsusedtotreatmooddisorderscancauseweightgain.
Managing Emotional Eating
Minimizetemptation
•Keepcomfortfoodoutofthehouse,anddon’tgogroceryshoppingwhenyou’refeelingdown
Recognizeemotionaleating
•Keepafoodlog.Recordyouremotionsandrankyourphysicalhungerfrom1-10each
timeyoueat
•Ifyou’renotphysicallyhungry,whyelsecouldyoubeeating?
Distractyourself
•Createalistofotherthingstodo(e.g.,takeawalk,playagame,pursueahobby)
•Usethe10minutetimer
Getsupport
•Callafriend,attendasupportgroup,orseektherapy
Forgiveyourself
•Ifyouhaveanepisodeofemotionaleating,startfreshrightaway
•Learnfromtheexperienceandplanhowtopreventitinthefuture
52
How Psychologists Help with Weight Management
Manypeoplestrugglewithweightcontrol.AccordingtotheCentersforDiseaseControland
Prevention,33percentofU.S.adultsareoverweightandanadditional36percentareobese.
ApproximatelyoneinsixchildrenintheU.S.isobese.Peoplegainweightinavarietyofways,such
aswhilerecoveringfromaninjuryorhealthissueorslowlyaddingpoundswhilegrowingolder.
PSYCHOLOGY
Getting Your Weight under Control
Whenitcomestolosingweight,manyindividualsknowtofocusoneatinglessandexercising
more.Butamajoraspectofweightcontrolinvolvesunderstandingandmanagingthoughtsand
behaviorsthatcaninterferewithweightloss.
Seeing a Psychologist About Weight Control
Psychologistsareexpertsinhelpingpeoplemakebehavioralandlifestylechangesthatassistwith
weightmanagement.Theymayworkwithindividualsandfamiliesindependentlyintheirprivate
practiceoraspartofahealthcareteam,ofteninasettingwherementalhealthandmedical
servicesareintegrated.Sometimesapsychologistwillworkonweightcontrolwithapatientwho
hasbeenreferredbyaphysician,dietitianorotherhealthcareprofessional.
Peoplewhoseekhelpfrompsychologistsrangeinagefromchildrentoadults.Theyincludethose
whosimplystrugglewithmanagingtheirweight,aswellasindividualswhoseweightproblemsare
relatedtochronicillnesseslikediabetesandheartdiseaseorotherconditionslikedepression,
anxietyoreatingdisorders.
Developing a Treatment Plan
Bytheendofafirstvisit,psychologistsusuallyhaveacomprehensivepictureofapatient.They
discusswhatpatientsarealreadydoingwellandshouldcontinue,andtheyidentifyareasofneed
anddifficultyrelatedtoweightmanagement.Aftertheinitialvisit,thepsychologistandpatient
schedulefollow-upappointmentsandstarttocreateatreatmentplan.
Treatmentplansdifferfromoneindividualtoanotherbuttendtobebrief.Theplanofteninvolves
teachingself-monitoringbehaviors,changingoldbeliefs,buildingnewcopingskills,andmaking
changestohomeandworkenvironmentstosupporthealthgoals.Psychologistshelpindividuals
addressobstaclestoweightloss,identifypositivewaystochangeunhealthyhabits,anddevelop
newskillsandwaysofthinking.
Manypsychologistsconcentrateononehealthbehavioratatime.Forexample,ifeveningsarea
challengingtimetomaintaingoodeatinghabits,thepsychologistmayaskthepatienttokeepa
logoffoodeatenintheeveningsandmakenotesabouttheirenvironment,howtheyfeltandwhat
theywerethinkingatthattime.Thesefactorsprovideimportantinformationaboutwhatisdriving
eatingbehaviorsandhelpthepsychologistandpatientfigureoutawaytoaddressthebehaviors.
53
PSYCHOLOGY
What Happens During Visits with a Psychologist
Aninitialvisitwithapsychologistusuallyinvolvesadiscussionaboutyourhistoryandconcerns.
Thismayincludeyourweightmanagementgoalsandpasteffortstoloseweight,medicalhistory,
stresslevels,currentlifesituation,andyoursourcesofsocialsupportlikefamilyandfriends.
Inordertohelp,psychologistsalsowanttolearnaboutyourhabitsandattitudesaboutfood,
eating,weightlossandbodyimagethatmaynotsupportyourhealthgoals.Commonunhealthy
beliefsthatpatientsexpressinclude:havingtocleantheirplate;needingdessertaftermeals;
andfeelinglikeafailurewhenweightlossstalls.Sometypicalbehaviorsinclude:eatingwhatever
theywantafterexercise;usingfoodtocopewithfeelingsofboredomorstress;andcontinuingto
eatwhentheyarenolongerhungry.
Thesetypesofbehaviorsandbeliefsoftensabotageweightlossefforts.Psychologiststalkto
patientsabouttheirchallengestomakinghealthychoicesandidentifythetriggersthatprompt
thepatienttomakeunhealthychoices.Apsychologistmayalsoevaluateapatientforanxiety,
depressionandeatingdisorderssuchasbingeeating.Theseconditionscansometimescontribute
toweightissues.
Progressing and Improving
Afterevenafewsessions,mostpatientsbegintonoticechanges.Forexample,patientsmaystart
tochallengeoldbeliefsaboutfoodandpracticenewonesthatsupporttheirhealthgoals.
Togetherwiththepsychologist,apatientcandeterminehowlongtreatmentshouldlast.People
withextremeanxietyanddepression,eatingdisordersorchronicphysicalhealthconditions
mayrequirelongerand/ormorefrequenttreatment.
Theultimategoalistohelppeopledevelopskillssotheycanleadhealthylives.
Changing Your Eating Habits
Considerthefollowingstepsthatcanbehelpfulinchangingunhealthyeatingbehaviorsandthoughts:
Monitor your behaviors. Researchisclearthatpeoplewhowritedownwhattheyeatinadailylog
aremoresuccessfulatlosingweight.Recordyourthoughts,feelingsandinformationaboutthe
environmentsuchaswhereyouate,whenandwhatyouweredoing.Thiswillhelpyouunderstand
youreatingbehaviorsandidentifyareastochange.
Track your activity level.Thisisanotherimportantaspectofself-monitoring.Itincludesnotonly
howmuchyouexercisebutalsotheextenttowhichyoumovearoundduringthedayratherthan
remainingseatedorinactive.Onehelpfultacticinvolvesusingapedometertorecordthenumber
ofstepsyoutakeeachday.
Eat regular meals. Patientsoftenskipbreakfastwiththethoughttheyarereducingcaloriesor
can“saveup”caloriesforlater.Butskippingmealscanslowyourmetabolism,makeyouprone
tolatereatingbingesandhaveanegativeeffectonyourhealth.
Practice “mindful” eating. Researchshowsthatindividualswitheatingproblemsoften
don’tpayattentiontowhethertheyarereallyhungrywhentheyeat.Psychologistscanhelp
youlearnmindfulnessexercisestoheightenyourawarenessofhungerlevelsandtomake
eatingmoreenjoyable.
54
PSYCHOLOGY
Understand the things you associate with food. Behaviorsarehabitualandlearned.Sometimes
peoplemayassociatecertainemotions,experiencesordailyactivitieswithparticularbehaviors.
Forexample,ifyoutypicallyeatwhilewatchingTV,yourbrainhasmadeanassociationbetween
foodandTV.Youmaynotbehungry,butinyourmindTVandeatingarepairedtogether.Sowhen
youwatchTVyousuddenlyfeeltheurgetoeat.Youcanbegintobreakthisassociationbynot
eatingwhilewatchingTV.
Identify your emotions. It’simportanttofigureoutwhatishappeningemotionallywhilesnacking,
overeatingorchoosingunhealthyfoods.Identifythefeeling:Isitboredom,stressorsadness?
Patientsneedtodetermineiftheyarereallyhungryorjustrespondingtoanemotion.Ifyou
aren’thungry,findanotherwaytomeetthatneed.
Modify your unhealthy thoughts and behaviors. Reinforcinghealthybehaviorsisimportantto
achievingyourweightmanagementgoals.Toooften,peoplehavenegativethoughtsandfeelings
aboutchangingtheirhealthbehaviorsandseetheprocessaspunishment.Somepeoplehave
an“allornothing”attitudeandthinkaboutweightlossintermsofbeing“on”or“off”adiet.
Psychologistsworkwithpeopletoaddressnegativefeelingsandfindwaystorewardhealthy
changestotheireatinghabits.
The American Psychological Association gratefully acknowledges Amy Walters, PhD, director of
behavioral health services at St. Luke’s Humphrey Diabetes Center in Boise, Idaho, and Kathleen
Ashton, PhD, Bariatric and Metabolic Institute at the Cleveland Clinic in Ohio, for contributing to
this fact sheet.
55
PSYCHOLOGY
Guidelines for a Good Group
Everybodyisuniqueandhastheirownsetofexperiences,feelingsandwaysofviewingtheworld.
Itisimportanttorespectsuchdifferencesinourgroupandtopromoteasenseofteamwork.
Somegeneralguidelinesforagoodgroupexperienceinclude:
Attendmeetings
Donotrushtojudgment
Reallylisten
Participate–beactive
Share the air
Besupportive
Welcomethosewhoarenewtothegroup
Respectconfidentiality–whatwetalkabouthere,stayshere(seebelowforthe
paragraphincludedoneverysign-insheet).
IMPORTANT:Bysigningthisattendancesheet,Iamagreeingtokeepinformationdiscussedin
thisgroupconfidential.ThismeansthatIwillnotdiscussanyidentifyinginformationwithpeople
outsideofthegroup.ImayonlyprocesswithoutsiderswhatIhavepersonallylearnedinthe
group.IfIhappentorunintoanothersupportgroupattendeeinpublic,Iwillnotsharewithany
companionshowIknowhim/her.Ihavetheoptiontosignacleanformandhanditpersonallyto
thesupportgroupfacilitatorifIdonotwantotherstoseemyname.Bywritingmye-mailaddress
onthisform,Iamagreeingtobeaddedtothesupportgroupdistributionlist.
56
Psychological Aspects of Surgery
AddictionTransfer
MindfulEating
EmotionalEating
StressManagement/Relaxation
ImportanceofRecreation
Relationships
BodyImageIssues
AwarenessandAccountability
PSYCHOLOGY
Stress Management
10 Tools for Managing Stress
1. Connect with others
Reachout
Enrollinaclass
Joinabookclub,hikingclub,supportgroup,etc.
2. Stay Positive
Writeaboutyourgreatfuturelife
Searchforthesilverlining
Changeunhealthyself-talk
3. Exercise
Trackyourexercise
Markitonyourcalendar
Makeitfun
Findanexercisebuddy
Addressanybarriers
Rewardyourself
4. Get enough sleep
Setaregularbedtime
Exercise(butnotbeforebed)
Takeahotbath,meditate,envisionasoothingscene…
whateveryouneedtodotorelaxbeforebed
5. Create joy and satisfaction
Watchorlistentocomedyshows
Trytolaughatsomeofyourlifehassles
Puttogethersayingsorphotosthatmakeyousmile,andpostthemsomewherevisible
Dosomethingyoulovedasakid
Dosomethingyou’vealwayswantedtodo
Pursueacreativeinterest
Shareleisuretimewithpeopleyoulove
Tellothersaboutyourpositiveexperiences
57
PSYCHOLOGY
6. Deal directly with hard times
Writeaboutit
Tackleyourproblems
Askforhelp
7. Set aside time for relaxation
Practicedeepbreathing
Listentocalmingmusic
Visualizepeacefulscenes
Repeatcalmingphrasestoyourself
8. Practice time-management
Set goals
Makelists
Prioritize
9. Be flexible
Acceptthatchangeisanormalpartoflivingandis
anopportunitytoexperiencelifealittledifferently
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©2014IUHealth03/14