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How to Be a Successful "Loser" After Weight-Loss Surgery
We also provide some Recommended Reading.
Approximately 75% of the National Weight Control Registry (NWCR) participants weigh themselves at least once a week. Keeping track of weight fluctuation once a week is ideal: more often can become obsessive, less often makes it too easy to slip.
- Be consistent about weighing yourself. Weigh yourself on the same day of the week, same time of day, on the same scale, in the same amount of clothing.
- Have a weight loss goal in mind and record progress on a weight chart or graph. Ask yourself these questions to decide what a good goal is for you:
- If you've ever felt good about your weight, what was it?
- Talk to your doctor or a registered dietitian about what a healthy weight range or BMI (body mass index) would be for you.
- At what weight do you think you'd be comfortable?
- What size do you think is right for you based on your height and your body type? Do you know anyone else who is of a similar height and frame as you? What size do they wear and what do they weigh?
Approximately half of the NWCR participants document what they eat and drink to maintain their weight loss. They know how many calories they are consuming. The best way to keep track of this is to keep a food diary.
In the initial phases of gastric bypass surgery, your stomach is about the size of a thumb and can hold about ½ cup (4oz) of food at a time. If you have an adjustable band in place, the amount of food consumed varies until you reach the “sweet spot” or “right fit.” At this point, optimal food intake ranges from ½ cup to 1 cup (4-8oz) of food/meal or snack.
Each meal/snack should last 20-30 minutes. See your handout on "Addressing Your Eating Habits" for more tips on change the pace of each eating episode.
Understand that hunger is what you feel when your stomach growls - it is a true physiological need for nourishment. Appetite is simply a desire for food - what you feel when driving past your favorite restaurant or when you smell your favorite food cooking. Satiety is the sensation of being full and satisfied after eating. Satiety is affected by many things including hunger, cravings, social situations, emotions, food choices, and eating habits.
- What time of day is grazing most likely to occur?
- What else is happening while grazing: watching television, preparing a meal, studying, etc?
- What are you grazing on and how did you get it?
- What type of food do you crave when you graze or are tempted to graze: chewy, crunchy, sweet, salty?
- How do you feel when you graze or are tempted to graze: bored, tired, stressed, anxious, depressed, etc?
1. Limit calorie intake.
Even people who have had bariatric surgery have to be cognizant of their calorie intake. Your small stomach pouch helps you to do this, as long as you do not stretch it or graze all day. One National Weight Control Registry (NWCR) study compared and contrasted the behaviors and characteristics of people who lost weight with surgery versus a nonsurgical approach, and both groups had an average caloric intake of only 1,460 calories per day, which is considered a low calorie diet.
The NWCR reported that people use a variety of ways to limit their calories. The most common approach is to limit the intake of certain types of food such as: sweets and “junk” foods, fast food, refined and processed carbohydrates, and high calorie drinks such as soda and juice.
2. Eat "nutrient-dense" foods.
When your stomach size is severely reduced and can only fit approximately ½ cup (4 ounces) of food in it at a time, you must make every bite count. Foods that are nutrient-dense include lean meats, poultry, and fish; low-fat or fat-free dairy products; fruits and vegetables; and high fiber carbohydrates. Read the Nutrition Facts panel to find carbohydrates with at least 5 grams of fiber per serving and the first ingredient as whole grain. Ask the dietitian for help if needed. Generally, sweets, snack foods, fried foods, refined and processed carbohydrates, soda and juices are not considered nutrient-dense, just calorie-dense!
3. Ensure adequate protein intake.
Adequate protein intake is critical for bariatric patients. There should be at least 2 to 3 ounces of a high protein food eaten at all meals/snacks. The high-protein portion of the meal should be eaten first before consuming any other food group. Your protein intake goal after surgery will be 60 to 80 grams per day. (Adjustments will be made by the dietitian on an individual basis as necessary.) The 60 to 80 g/day goal is not difficult to reach, as long as protein is the focus at each meal/snack.
There are two different kinds of protein: complete and incomplete.
Complete protein is also known as high biological value protein and most commonly is found in foods that come from animals. It is called "complete" protein because it has all of the essential amino acids in it. Low-fat foods that are excellent sources of high biological value (HBV) protein and should be included in your eating plan include:
- White meat chicken and turkey (not fried)
- Fish and shellfish (not fried)
- Eggs, egg whites and egg substitutes
- Lean cuts of beef (round, sirloin, flank, tenderloin, rib/chuck/rump roasts)
- Lean cuts of pork (fresh ham, Canadian bacon, center loin chop, tenderloin)
- Buffalo (bison)
- Veal or lamp chops and roasts
- Venison, duck and pheasant
- Lean deli meats (turkey, ham (not chipped), roast beef)
- Low-fat or fat-free cheese
- Low-fat or fat-free cottage cheese, ricotta cheese, and yogurt
- Low-fat or fat-free Greek yogurt
- Skim or 1% milk, low-fat soy milk, lactose-free (Lactaid®) milk
Though good sources of complete protein, the following foods are high in fat and calories and should be eaten on a severely limited basis:
- Bacon and sausage
- High-fat cuts of beef (ribeye, prime rib, T-bone)
- Regular cheese (American, cheddar, Swiss, etc)
- Bologna, salami and pepperoni
- Hot dogs
- Any fried meat, chicken, or fish
Incomplete protein does not contain all of the essential amino acids, and is usually found in plant-based foods. Incomplete protein counts toward your total protein intake for the day though more emphasis should be placed on the HBV protein. Sources of incomplete protein include:
- Beans and lentils
- Nuts (unroasted, unsalted should be chosen)
- Peanut butter (natural version should be used)
- Carbohydrates (whole grain, high fiber [5+ grams per serving] are the best choices)
Soy is one exception! Soy foods are great sources of complete protein, even though soy is a plant food. Go ahead and include soy milk, tofu, tempeh, soybeans, soy cheese and other soy-based foods in your diet regularly and count them as high biological value proteins.
Keep in mind that protein supplements should only supplement your food intake. Focus on food sources of protein first, and then add a supplement only in emergency situations. Always be mindful of the first ingredient in your protein supplement. If it does not state, “whey protein isolate” or “soy protein isolate” as the first ingredient, do not use it. Also keep in mind that protein bars may be more filling and satisfying than a protein shake, because liquids can be consumed quickly and easily. The same first ingredient rule applies to bars as it does to shakes.
4. Eat breakfast!
Approximately 78% of NWCR participants eat breakfast seven days a week, and 90% of them eat it at least four days a week. Remember, most of these participants have lost 70 pounds and have kept it off for at least 5 to 6 years. Breakfast should be eaten within 1 to 2 hours after waking. Talk to the dietitian about healthy breakfast options.
Physical activity is a critical component in their ability to maintain significant weight loss. Research demonstrates consistent correlations between physical activity, self-monitoring behaviors and maintenance of weight loss. It's been proven time and again that people who exercise, weigh themselves regularly and keep track of what they eat tend to maintain their weight loss.
The biggest risk of exercise is to not start. Any activity is better than none at all. Start with 20 to 30 minutes, three or four days a week, and take time to build up to 30 to 60 minutes, five to seven days a week. Explore a variety of activities to find something you enjoy so that you don't get bored. Confront your reasons for not exercising and overcome them.
If you are having trouble motivating yourself, try one of these tricks:
- Choose a place on the map you'd like to visit and find out how many miles away it is. Then, theoretically, walk there. Every mile you walk counts as one more mile toward your destination.
- Write down ten different rewards on ten pieces of paper and put them in a bag. If you meet your exercise goal(s) at the end of the week or the month, pick one reward out of the bag. Keep in mind, though, that food should never be part of any reward.
- Activity Bank: Place $1 in a bank every day that you meet your exercise goal(s). Do not place any money in the bank on the days that you do not meet your exercise goal(s). At the end of the month, use the money to treat yourself to a facial, manicure, tickets to a sporting event, etc.
We recommend the following reading and Registry participation:
The Success Habits of Weight-Loss Surgery Patients by Colleen M. Cook, published in 2003 by Bariatric Support Centers International in Salt Lake City, Utah. www.bariatricsupportcenter.com
Gastric Bypass Cookbook: Culinary Classics: Essentials of Cooking for the Gastric Bypass Patient by Chef David Fouts, published in 2003 by U.S. Bariatric in Fort Lauderdale, Florida.
One year after surgery you may qualify to participate in the National Weight Control Registry.
Find out more online or by calling 1.800.606.NWCR (6927).