Sally Johnston

I have found that sadly there are a lot of misconceptions around gastric bands. Firstly, there is a misconception that the gastric band creates a small stomach that must be ‘filled’ to feel full. There is also a misconception that a tighter band will result in more weight loss and that the vomitting or regurgitation caused by a tight gastric band is ‘normal’. Another misconception is that you shouldn’t be able to eat certain foods with a gastric band. Let’s get back to basics to understand how a gastric band should work. A gastric band is a silicone device placed around the upper part of the stomach. It was once believed that the gastric band created a new, smaller stomach above the band, where food would sit before passing into the lower, larger stomach. Recent studies at the Centre for Obesity Research and Education (CORE) in Melbourne have shown this to be incorrect. The gastric band actually creates a ‘funnel’ into the larger stomach and exerts pressure on the stomach. Adjusting the gastric band can vary this pressure. The band has an access point called a port, which is stitched to your abdominal muscle deep under the skin. You can usually tell where the port may be as it is likely to sit somewhere under your biggest scar. Your surgeon or weight loss GP uses the port to adjust your gastric band and vary the pressure it places on the stomach. They can inject or remove saline (a salty water) solution via the port to make your band tighter or looser. When food is eaten our oesophagus, or food pipe, squeezes bites of food down towards the band. Once food reaches the band, contractions of the oesophagus, called peristalsis, will squeeze well-chewed food past the band. In a person with a well-adjusted band, it can take between two to six squeezes of the oesophagus to get a bite of food across the band. One study suggests this process takes at least a minute. There are nerves in the stomach that detect when our stomach is stretching, and send a message to our brain that we have had enough to eat. One particular nerve involved in controlling our stomach is called the vagus nerve. With a gastric band sitting around the stomach this squeezes the vagus nerve all the time, and more so when you are eating. The squeezing process triggers a signal to the brain that you are satisfied, or no longer hungry. This means you feel satisfied on a smaller amount of food than you would have prior to surgery. The constant pressure of the band on the stomach also helps you to feel satisfied for a longer period of time, reducing hunger throughout the day. Feeling satisfied is different to feeling ‘full’. Feeling ‘full’ means you have eaten to excess. It may indicate food is sitting above the band, either due to eating too quickly, eating large pieces of food or not chewing food well enough. Try to stop eating when you feel satisfied or no longer hungry, rather than full. Each bite of food must be small and well chewed. An empty, or uninflated band has an opening the size of a twenty-cent piece. A fully inflated band has an opening the size of a five-cent piece. Most people will have their band adjusted somewhere between the two sizes. If you cut food into the size of a five-cent piece size and chew it well, it is more likely to pass comfortably through the band. Eating slowly also helps you to eat comfortably. In theory, you should aim to wait a minute between each mouthful of food, however it is not practical to time every mouthful. It is practical to put your cutlery down between mouthfuls and wait until you have swallowed before cutting the next piece of food ready to eat. People with a gastric band who eat quickly, describe a feeling of discomfort in their oesophagus, like a ‘traffic jam’. Eating slowly will help avoid this. I hope this clarifies how a gastric band works and what you should experience. If your band is not acting like it should, please follow up with your support team.

Weight loss surgery is just one part of the picture of weight management. Surgery alone does not guarantee you will lose weight; it is a tool that can assist you to lose weight when teamed with lifestyle change. Both professionals in the field and those who have had or are considering having surgery themselves seem to be involved in an ongoing debate over what is the best type of weight loss surgery. The three most common forms of surgery in Australia at present, gastric band, gastric bypass and sleeve gastrectomy all have loyal fans and big opponents. In my recently launched Nutrition for Weight Loss Surgery Support Group the pros and cons of the different surgery types are regularly discussed by those who have been through the various procedures. Whilst technically different, what is common to all forms of weight loss surgery is that the surgery itself is just one part of the picture of weight management. Surgery alone does not guarantee you will lose weight; it is a tool that can assist you to lose weight when teamed with lifestyle change. Colleen Cook is a successful weight loss surgery patient from 1995 and is the author of the best selling weight loss surgery book, The Success Habits of Weight Loss Surgery Patients. It is based on her research of the most successful long-term patients and the habits they have in common as they maintain their weight over time. Colleen is also the President of Bariatric Support Centers International, a company that specialises in providing education and support services for those who have had weight loss surgery and the professionals who work with them. Following is a comment from Colleen that stood out to me when reading her work recently: “Successful patients took personal responsibility for staying in control. They were found to have a general feeling that maintaining their weight was indeed their own responsibility and that surgery was a tool that they used to reach and maintain a healthy weight.” Colleen’s words illustrate perfectly that weight loss surgery itself does not cause weight loss. Those undergoing weight loss surgery will need to take responsibility for their lifestyle choices. To achieve the best weight loss results and maintain that weight loss in the long term, you will need to choose healthy and nutritious foods, increase physical activity and maintain regular follow up with your support team. Are you maximizing the support available to you? Do you regularly follow up with your surgeon or bariatric GP to check your progress? For those with a gastric band, have you worked with them to find the green zone? Have you had the blood tests recommended to you to monitor any medical conditions or detect nutrient deficiencies? Have you seen an exercise physiologist or physiotherapist regarding an activity program tailored to you? Did you see your dietitian for the pre and post surgery info but never returned for ongoing support? Are you comfortable with the support team at your clinic? If not, you need to seek out a new support network. Ultimately it is up to you to utilise the support and resources available to you for a successful journey,

I have found that sadly there are a lot of misconceptions around gastric bands. Let’s get back to basics to understand how a gastric band should work. I have found that sadly there are a lot of misconceptions around gastric bands. Firstly, there is a misconception that the gastric band creates a small stomach that must be ‘filled’ to feel full. There is also a misconception that a tighter band will result in more weight loss and that the vomitting or regurgitation caused by a tight gastric band is ‘normal’. Another misconception is that you shouldn’t be able to eat certain foods with a gastric band. Let’s get back to basics to understand how a gastric band should work. A gastric band is a silicone device placed around the upper part of the stomach. It was once believed that the gastric band created a new, smaller stomach above the band, where food would sit before passing into the lower, larger stomach. Recent studies at the Centre for Obesity Research and Education (CORE) in Melbourne have shown this to be incorrect. The gastric band actually creates a ‘funnel’ into the larger stomach and exerts pressure on the stomach. Adjusting the gastric band can vary this pressure. The band has an access point called a port, which is stitched to your abdominal muscle deep under the skin. You can usually tell where the port may be as it is likely to sit somewhere under your biggest scar. Your surgeon or weight loss GP uses the port to adjust your gastric band and vary the pressure it places on the stomach. They can inject or remove saline (a salty water) solution via the port to make your band tighter or looser. When food is eaten our oesophagus, or food pipe, squeezes bites of food down towards the band. Once food reaches the band, contractions of the oesophagus, called peristalsis, will squeeze well-chewed food past the band. In a person with a well-adjusted band, it can take between two to six squeezes of the oesophagus to get a bite of food across the band. One study suggests this process takes at least a minute. There are nerves in the stomach that detect when our stomach is stretching, and send a message to our brain that we have had enough to eat. One particular nerve involved in controlling our stomach is called the vagus nerve. With a gastric band sitting around the stomach this squeezes the vagus nerve all the time, and more so when you are eating. The squeezing process triggers a signal to the brain that you are satisfied, or no longer hungry. This means you feel satisfied on a smaller amount of food than you would have prior to surgery. The constant pressure of the band on the stomach also helps you to feel satisfied for a longer period of time, reducing hunger throughout the day. Feeling satisfied is different to feeling ‘full’. Feeling ‘full’ means you have eaten to excess. It may indicate food is sitting above the band, either due to eating too quickly, eating large pieces of food or not chewing food well enough. Try to stop eating when you feel satisfied or no longer hungry, rather than full. Each bite of food must be small and well chewed. An empty, or uninflated band has an opening the size of a twenty-cent piece. A fully inflated band has an opening the size of a five-cent piece. Most people will have their band adjusted somewhere between the two sizes. If you cut food into the size of a five-cent piece size and chew it well, it is more likely to pass comfortably through the band. Eating slowly also helps you to eat comfortably. In theory, you should aim to wait a minute between each mouthful of food, however it is not practical to time every mouthful. It is practical to put your cutlery down between mouthfuls and wait until you have swallowed before cutting the next piece of food ready to eat. People with a gastric band who eat quickly, describe a feeling of discomfort in their oesophagus, like a ‘traffic jam’. Eating slowly will help avoid this. I hope this clarifies how a gastric band works and what you should experience. If your band is not acting like it should, please follow up with your support team.

Hi Tara-U, Good question and one best for a doctor or surgeon. The important point is that our oesophagus and stomach can stretch to accomodate lumps of food, a band cannot stretch in this way. Sally

Recently I have found myself spending a lot of time talking with my weight loss surgery clients about getting the most from what they are eating, in particular, feeling satisfied after eating. Whilst the purpose of weight loss surgery is to help you feel satisfied on a smaller amount of food, the type of foods you choose is important to help maximise this. There are two key ingredients in helping you to feel satisfied after eating: 1. High fibre, low glycemic index carbohydrate-containing foods 2. Protein-containing foods. This post will demystify the glycemic index, or GI. Protein will be the focus of a later post. The GI is a measure of the effect that different carbohydrate-containing foods have on blood glucose (blood sugar) levels. It describes the way our body digests and absorbs these foods. Carbohydrate-containing foods include: - breads, cereals, rice, pasta and noodles - starchy vegetables including potato, sweet potato and corn - legumes including baked beans, kidney beans, chickpeas and lentils - fruits and fruit juices - milks, yoghurts, custards and ice cream - any food containing flour or sugar. Some carbohydrate-containing foods are broken down and absorbed quickly, so they raise our blood glucose level faster and higher. These are high GI foods. Other carbohydrate-containing foods are digested and absorbed more gradually, causing a slower, longer lasting rise in blood glucose levels. These are low GI foods. Low GI foods keep us feeling satisfied for longer after eating. Often people experience a 'honeymoon' period following weight loss surgery, where weight loss seems automatic. Unfortunately this may not last forever and weight regain can occur with all surgeries. Maximising the satisfaction you get from the food you eat is crucial to keep losing weight and maintain that lost weight. A lower GI eating pattern also helps us feel satisfied for longer after eating, which can help with losing weight. For example, if you eat high GI foods at your meals, you are likely to become hungry sooner after the meal than if you eat low GI foods. This can make you more likely to snack and if you have not planned for this, you may be forced to grab something from the biscuit barrel or vending machine. Appetite control is not the only benefit of a lower GI diet. Research has shown that people eating a lower GI diet can reduce their average blood glucose levels, which is particularly important for people with diabetes. Lower GI foods are often also higher in fibre. A high fibre diet helps prevent constipation, decreases the risk of heart disease as soluble fibres can help remove cholesterol from the body and helps protect against bowel cancer, haemorrhoids, irritable bowel syndrome and diverticulitis. Foods are classified as low, moderate or high GI. To follow a low GI diet, try to choose one low GI food at each meal. Eat high GI foods in small amounts, or less often. Low GI wholegrain/multigrain breads soy and linseed bread fruit loaf/raisin bread pearl barley pasta (white or wholemeal) Doongara® Clever Rice® Mahatma® rice fresh rice noodles semolina porridge All-Bran® (all varieties) Guardian® Sustain® rice or oat bran Ryvita® Pumpkin Seeds & Oats Ryvita® Sunflower Seeds & Oats Arnott’s® Snack Right® apple apricot banana grapes orange peach pear kiwi fruit mango plum prunes dried apricot dried apple milk or soy milk yoghurt Fruche® custard low fat ice cream sweet corn Carisma® potatoes lentils chick peas split peas kidney, soya, baked beans Moderate GI wholemeal bread crumpets pita bread rye bread Basmati rice wild rice dried rice noodles cous cous popcorn Weetbix® Vita-brits® natural muesli Mini-wheats® (plain) Just Right® Special K® Ryvita® original shredded wheatmeal milk arrowroot biscuits digestives rockmelon pineapple cherries sultanas raisins dried fig fresh paw paw sweet potato broad beans High GI white bread bagels baguettes English muffins Jasmine rice Rice Bubbles® Sultana Bran® cornflakes bran flakes puffed wheat Coco Pops® Mini-wheats® (fruit) water crackers rice cakes rice crackers Corn Thins® Sao® morning coffee biscuits watermelon most other potatoes Go to www.glycemicindex.com for further information. Sally Johnston Accredited Practising Dietitian/Accredited Nutritionist Your Bariatric Dietitian

Hi 2muchfun, Just returning to the site after some time away (had my first baby in December) so responding to some of the comments. Just because watermelon is on the high GI list does not mean you should totally avoid it. You could include it with lower GI foods, for example, in a fruit salad, to modify its effect of blood glucose levels. Sally

Hi 2muchfun, Thanks for your comments. Yes, it is correct that the thickness of our stomach lining and folds within the stoma would complicate things. The only real way to see what exactly is happening in each individual would be to have an endoscopy. My overall point is to try and give a guide that yes, there is not much of an opening for food to get through and that is why we need to take a lot of care when eating. Cut food small, chew well, eat slowly, etc. As an aside, looking at your ticker however I see you are doing well - 50lb lost - great work! Sally

Both professionals in the field and those who have had or are considering having surgery themselves seem to be involved in an ongoing debate over what is the best type of weight loss surgery. The three most common forms of surgery in Australia at present, gastric band, gastric bypass and sleeve gastrectomy all have loyal fans and big opponents. In my recently launched Nutrition for Weight Loss Surgery Support Group the pros and cons of the different surgery types are regularly discussed by those who have been through the various procedures. Whilst technically different, what is common to all forms of weight loss surgery is that the surgery itself is just one part of the picture of weight management. Surgery alone does not guarantee you will lose weight; it is a tool that can assist you to lose weight when teamed with lifestyle change. Colleen Cook is a successful weight loss surgery patient from 1995 and is the author of the best selling weight loss surgery book, The Success Habits of Weight Loss Surgery Patients. It is based on her research of the most successful long-term patients and the habits they have in common as they maintain their weight over time. Colleen is also the President of Bariatric Support Centers International, a company that specialises in providing education and support services for those who have had weight loss surgery and the professionals who work with them. Following is a comment from Colleen that stood out to me when reading her work recently: “Successful patients took personal responsibility for staying in control. They were found to have a general feeling that maintaining their weight was indeed their own responsibility and that surgery was a tool that they used to reach and maintain a healthy weight.” Colleen’s words illustrate perfectly that weight loss surgery itself does not cause weight loss. Those undergoing weight loss surgery will need to take responsibility for their lifestyle choices. To achieve the best weight loss results and maintain that weight loss in the long term, you will need to choose healthy and nutritious foods, increase physical activity and maintain regular follow up with your support team. Are you maximizing the support available to you? Do you regularly follow up with your surgeon or bariatric GP to check your progress? For those with a gastric band, have you worked with them to find the green zone? Have you had the blood tests recommended to you to monitor any medical conditions or detect nutrient deficiencies? Have you seen an exercise physiologist or physiotherapist regarding an activity program tailored to you? Did you see your dietitian for the pre and post surgery info but never returned for ongoing support? Are you comfortable with the support team at your clinic? If not, you need to seek out a new support network. Ultimately it is up to you to utilise the support and resources available to you for a successful journey,

Sorry for the very delayed reply - I am just back on the site. I don't know a lot about edamame, but from what I can see it looks like a good choice.

We all know there are steps we could be taking to improve our health. How often when the new year ticks over do you or those around you resolve to ‘get fit’ or ‘lose weight’? Interestingly often this resolve to do so is repeated as we welcome the next new year, as little has changed from when we last set this goal. Why does this happen? Kickstart 2013 in the right direction We all know there are steps we could be taking to improve our health. How often when the new year ticks over do you or those around you resolve to ‘get fit’ or ‘lose weight’? Interestingly often this resolve to do so is repeated as we welcome the next new year, as little has changed from when we last set this goal. Why does this happen? Often we set the goal too big. We embark on a complete lifestyle overhaul which involves far too many changes to be sustainable once the holiday season ends and we are back into the routine of work and family life. Studies have found that anyone can have long term success – the key is to make small, gradual changes. So what are some small changes you can put in place to kickstart your new year in the right direction? Whether you are new to the weight loss surgery journey or had surgery some time ago, all of us have something we could improve to better our health. Which of these small steps would be steps in the right direction for you? Make sure there is some sort of vegetable or salad in your lunch each day, whether it be in a wrap, on top of crackers or in the leftovers you packed the night before. Are you still using normal sized plates and bowls? Whilst some say they are serving less on them, you are more likely to serve less on smaller crockery. Downsize your plates and bowls or try the Portion Perfection for bands and sleeves range (available at www.greatideas.net). Use the stairs whenever it’s an option. Include fish at least twice a week. Fresh, frozen or canned is fine. Fish is a great source of protein to help you feel satisfied, but also provides you with the healthy fats, the omega-3s. Experiment with legumes. Tinned varieties are such a convenient source of protein that can be easily added to salads, soups, casseroles and stir-fries. If you are looking for new and interesting ideas on using legumes, head to the Sanitarium website www.sanitarium.com.au. Do you take the weekends off from exercise to reward yourself for doing so well during the week? To successfully manage your weight, keep active most, if not all, days of the week. Savour and enjoy your favourite foods in small portions. Denying yourself of your favourite foods will only lead to you craving them more and overeating them when you do finally indulge. Remove ‘good food’ and ‘bad food’ from your vocabulary. Food is neither good nor bad, it is what we do with it that is important. Are you choosing low GI foods? Low GI foods will help you feel satisfied for longer after eating and help control your blood glucose levels. There is an article on low GI foods on my blog (www.nutritionforwls.com.au/blog). Boost your fibre intake. Not only good for our waste disposal system, but important for weight management and heart health. Try sprinkling some psyllium husks, oat bran or seeds on your breakfast cereal, leave the skins on fruit and vegetables wherever you can and choose the grainiest breads, wraps or crackers possible. Do you eat in front of the TV, the computer, the newspaper? Spend meal times at the table, free of other activities where you can focus on eating. You are more likely to register that you are eating and stop when you have had enough. Get into the habit of eating with your family without distractions to set a good example for them all. Are you using low fat milk? Low fat milk has all the calcium of full cream, with less fat, particularly saturated fat. Low fat milk is fine for everyone in the family aged over 2 years. Avoid having food on the table to help yourself at meal times. Serve cereal in your bowl, then put the box away. Dish up your meal on a small plate and put leftovers in the fridge, rather than putting all the dishes on the table which makes ‘seconds’ easier. Downsize your drinks. When you go for coffee do you order a mug rather than a cup, a tall rather than a standard? Enjoy your coffee, but skip the upsizing. Don’t skip meals! No matter how busy you are, treat meals as an appointment that you schedule in your diary and commit to like you would any other appointment. Keep it simple. Rather than scouring food labels for the perfect packaged food, choose those with no labels. The foods without labels, such as fruits and vegetables, are always good options. Consider choosing one change a month that you can tackle over the coming year. You may have other changes that you feel are more important for you to tackle at your stage of your journey. Shortlist the suggestions that are relevant to you and add any others you feel are important. Aim to make the changes one by one over the year. Wait until you have mastered one change before embarking on another. All the best for a happy and healthy 2013!

Hi Mike, Sorry for the very delayed response - I'm just back on the site. Yes, low GI is low glycemic index. Sally

Hi Joanne, If you dislike meat it is fine to avoid it, as long as you replace it with Meat Alternatives (as listed above). Milk and milk products will also help add protein to your diet. There can be a range of factors why your weight loss slowed, not just eating meat. I would suggest you speak to a dietitian with experience in weight loss surgery for a full assessment of your diet and they will be able to advise you. Regards, Sally

Kickstart 2013 in the right direction We all know there are steps we could be taking to improve our health. How often when the new year ticks over do you or those around you resolve to ‘get fit’ or ‘lose weight’? Interestingly often this resolve to do so is repeated as we welcome the next new year, as little has changed from when we last set this goal. Why does this happen? Often we set the goal too big. We embark on a complete lifestyle overhaul which involves far too many changes to be sustainable once the holiday season ends and we are back into the routine of work and family life. Studies have found that anyone can have long term success – the key is to make small, gradual changes. So what are some small changes you can put in place to kickstart your new year in the right direction? Whether you are new to the weight loss surgery journey or had surgery some time ago, all of us have something we could improve to better our health. Which of these small steps would be steps in the right direction for you? Make sure there is some sort of vegetable or salad in your lunch each day, whether it be in a wrap, on top of crackers or in the leftovers you packed the night before. Are you still using normal sized plates and bowls? Whilst some say they are serving less on them, you are more likely to serve less on smaller crockery. Downsize your plates and bowls or try the Portion Perfection for bands and sleeves range (available at www.greatideas.net). Use the stairs whenever it’s an option. Include fish at least twice a week. Fresh, frozen or canned is fine. Fish is a great source of protein to help you feel satisfied, but also provides you with the healthy fats, the omega-3s. Experiment with legumes. Tinned varieties are such a convenient source of protein that can be easily added to salads, soups, casseroles and stir-fries. If you are looking for new and interesting ideas on using legumes, head to the Sanitarium website www.sanitarium.com.au. Do you take the weekends off from exercise to reward yourself for doing so well during the week? To successfully manage your weight, keep active most, if not all, days of the week. Savour and enjoy your favourite foods in small portions. Denying yourself of your favourite foods will only lead to you craving them more and overeating them when you do finally indulge. Remove ‘good food’ and ‘bad food’ from your vocabulary. Food is neither good nor bad, it is what we do with it that is important. Are you choosing low GI foods? Low GI foods will help you feel satisfied for longer after eating and help control your blood glucose levels. There is an article on low GI foods on my blog (www.nutritionforwls.com.au/blog). Boost your fibre intake. Not only good for our waste disposal system, but important for weight management and heart health. Try sprinkling some psyllium husks, oat bran or seeds on your breakfast cereal, leave the skins on fruit and vegetables wherever you can and choose the grainiest breads, wraps or crackers possible. Do you eat in front of the TV, the computer, the newspaper? Spend meal times at the table, free of other activities where you can focus on eating. You are more likely to register that you are eating and stop when you have had enough. Get into the habit of eating with your family without distractions to set a good example for them all. Are you using low fat milk? Low fat milk has all the calcium of full cream, with less fat, particularly saturated fat. Low fat milk is fine for everyone in the family aged over 2 years. Avoid having food on the table to help yourself at meal times. Serve cereal in your bowl, then put the box away. Dish up your meal on a small plate and put leftovers in the fridge, rather than putting all the dishes on the table which makes ‘seconds’ easier. Downsize your drinks. When you go for coffee do you order a mug rather than a cup, a tall rather than a standard? Enjoy your coffee, but skip the upsizing. Don’t skip meals! No matter how busy you are, treat meals as an appointment that you schedule in your diary and commit to like you would any other appointment. Keep it simple. Rather than scouring food labels for the perfect packaged food, choose those with no labels. The foods without labels, such as fruits and vegetables, are always good options. Consider choosing one change a month that you can tackle over the coming year. You may have other changes that you feel are more important for you to tackle at your stage of your journey. Shortlist the suggestions that are relevant to you and add any others you feel are important. Aim to make the changes one by one over the year. Wait until you have mastered one change before embarking on another. All the best for a happy and healthy 2013!

You may have been told by your support team to avoid liquid foods or meals. There is good reason for this. After weight loss surgery you want to feel satisfied for longer after eating, not looking for the next meal soon after you finish. Solid food tends to empty slower from a stomach than liquid, helping us feel satisfied for longer after eating. This is a natural part of the digestion process. Whilst it hasn’t been widely studied following bariatric surgery, a small study at LAPSurgery Australia in Melbourne found that solid food appears more satisfying than liquid meals in those with a gastric band. As this occurs naturally in people who have not had bariatric surgery, and those with a gastric band, it is likely to also occur in those who have had a sleeve gastrectomy or gastric bypass. For this reason, we generally encourage solid meals following bariatric surgery to help you feel more satisfied. Feeling more satisfied for longer after eating helps avoid grazing or snacking, which may help maximise weight loss and maintenance of that weight loss. However, soups are a popular winter meal in our colder climates (yes, it is winter where I am writing this post in Australia). They are convenient, can be prepared in bulk and frozen and with the right ingredients, can be very nutritious. So should you avoid soup because it is, technically, a liquid meal? There is not a simple yes or no answer. Soup means different things to different people. To some, soup means instant soup powers that you mix with hot water. These are not a great meal option. Apart from being high in salt, they offer very little nutrition and are not likely to be satisfying. Some people may think of soup as the tinned or tetra pack varieties. These offer a little more nutrition, but some varieties are better than others. Smooth, liquid soups will empty quickly from the stomach and provide little satiety (the feeling of satisfaction after eating). The chunky varieties with meat and vegetables pieces are a better option, as the chunks need chewing, taking you through the process of eating and allowing your body to recognise more of the signals you have eaten. The best option is thick, chunky, home made soups, filled with lots of nutritious ingredients. The more chewing required to eat the soup, the more it will help satisfy you. Avoid thin broths or pureed soups, opting for chunks of vegetables and a protein containing food, either meat, chicken, seafood or legumes. Some pasta, rice, barley or noodles are also a good addition. The following recipe for Chunky Winter Soup is one of my favourites for lunch on a cold winter day. Chunky Winter Soup Makes 4 cups Oil spray ½ onion 1 small or ½ large leek, thinly sliced 2 cups salt reduced chicken stock 1 small or ½ large zucchini, diced 1 small or ½ large carrot, diced 1 cup no added salt, chopped tinned tomatoes ½ teaspoon curry powder 1 tablespoon no added salt tomato paste Freshly ground black pepper 2 tablespoons macaroni 1 cup cooked red kidney beans Heat a saucepan that has been sprayed with oil. Add onion and leek and cook until they are starting to soften. Add the stock, carrot, zucchini, tomatoes, curry powder, tomato paste and season with pepper. Bring to the boil then simmer for 20 minutes, until vegetables are tender. Add macaroni and kidney beans and simmer for a further 15-20 minutes until the macaroni is cooked. Nutrition information (per cup): kilojoules 485, calories 116, protein 5.5g, fat 2g, saturated fat negligible, carbohydrate 15.5g, fibre. Weight Loss Surgery Tip: This recipe makes approximately four cups (4 x 1 cup serves). Half to one serve may be adequate for those with a gastric band. Early in the gastric bypass or sleeve journey you should only require half of one serve and over time you may tolerate greater amounts, up to 1 cup. Those with larger appetites (family and friends) may require two serves. For more recipe ideas, head to my blog, Bariatric Bites.

Red meat is an excellent source of protein iron and zinc, important nutrients for all but particularly after weight loss surgery. However, after surgery, some people may have difficulty eating red meat. Learn how to make meat work for you. Red meat is an excellent source of protein iron and zinc, important nutrients for all but particularly after weight loss surgery. After surgery, people may report difficulty eating red meat. This may be due to a poor eating technique, or not knowing how to best prepare food. To eat meat comfortably it needs to be tender, cut into small pieces the size of a five-cent piece and chewed thoroughly – until it is a puree in the mouth. Whilst a steak on the barbeque or grill can be difficult to tolerate, marinating, slow cooking, or cooking in a sauce can help tenderise meat making it easier to chew. Lean red meat, trimmed of fat is the best choice as it contains less teaspoons of fat and saturated fat. However, the fat in meat can help it to soften during cooking and adds flavour. Lean meat is therefore often assumed to lack tenderness and flavour. Whilst lean cuts of meat can be expensive, cheaper cuts with the fat removed respond well to marinating and slow cooking so can be an economical choice. Try slow cooking in crushed tomatoes, soup bases or salt reduced stock with lots of vegetables and your favourite herbs. To reduce the amount of fat, skim from the top prior to serving. Marinating meat is another way to enhance the flavour and tenderness of meat. Whilst adding oil to a marinade may seem like defeating the purpose of choosing lean meat, unsaturated oils are a better choice than the naturally occurring saturated fat in meat. Commercial marinades can be high in sugar. Try the following ideas for tasty homemade marinades: red wine, a dash of olive oil, Worcestershire sauce and garlic complements red meat for an Asian flavour combine soy sauce, a dash of sesame oil, sherry oil, white pepper and honey lime juice, sweet chilli sauce, fish sauce, brown sugar, coriander and a dash of peanut oil adds a Thai flavour to meat white wine, wholegrain mustard and crushed garlic cloves works well with beef lemon juice, oregano, garlic and a dash of olive oil complements lamb. These tips and others like these can be found in our book, Spoons for Thought.

There are two key ingredients in helping you to feel satisfied after eating: 1. High fibre, low glycemic index carbohydrate-containing foods 2. Protein-containing foods. This post will demystify the glycemic index, or GI. Protein will be the focus of a later post. The GI is a measure of the effect that different carbohydrate-containing foods have on blood glucose (blood sugar) levels. It describes the way our body digests and absorbs these foods. Carbohydrate-containing foods include: - breads, cereals, rice, pasta and noodles - starchy vegetables including potato, sweet potato and corn - legumes including baked beans, kidney beans, chickpeas and lentils - fruits and fruit juices - milks, yoghurts, custards and ice cream - any food containing flour or sugar. Some carbohydrate-containing foods are broken down and absorbed quickly, so they raise our blood glucose level faster and higher. These are high GI foods. Other carbohydrate-containing foods are digested and absorbed more gradually, causing a slower, longer lasting rise in blood glucose levels. These are low GI foods. Low GI foods keep us feeling satisfied for longer after eating. Often people experience a 'honeymoon' period following weight loss surgery, where weight loss seems automatic. Unfortunately this may not last forever and weight regain can occur with all surgeries. Maximising the satisfaction you get from the food you eat is crucial to keep losing weight and maintain that lost weight. A lower GI eating pattern also helps us feel satisfied for longer after eating, which can help with losing weight. For example, if you eat high GI foods at your meals, you are likely to become hungry sooner after the meal than if you eat low GI foods. This can make you more likely to snack and if you have not planned for this, you may be forced to grab something from the biscuit barrel or vending machine. Appetite control is not the only benefit of a lower GI diet. Research has shown that people eating a lower GI diet can reduce their average blood glucose levels, which is particularly important for people with diabetes. Lower GI foods are often also higher in fibre. A high fibre diet helps prevent constipation, decreases the risk of heart disease as soluble fibres can help remove cholesterol from the body and helps protect against bowel cancer, haemorrhoids, irritable bowel syndrome and diverticulitis. Foods are classified as low, moderate or high GI. To follow a low GI diet, try to choose one low GI food at each meal. Eat high GI foods in small amounts, or less often. Low GI wholegrain/multigrain breads soy and linseed bread fruit loaf/raisin bread pearl barley pasta (white or wholemeal) Doongara® Clever Rice® Mahatma® rice fresh rice noodles semolina porridge All-Bran® (all varieties) Guardian® Sustain® rice or oat bran Ryvita® Pumpkin Seeds & Oats Ryvita® Sunflower Seeds & Oats Arnott’s® Snack Right® apple apricot banana grapes orange peach pear kiwi fruit mango plum prunes dried apricot dried apple milk or soy milk yoghurt Fruche® custard low fat ice cream sweet corn Carisma® potatoes lentils chick peas split peas kidney, soya, baked beans Moderate GI wholemeal bread crumpets pita bread rye bread Basmati rice wild rice dried rice noodles cous cous popcorn Weetbix® Vita-brits® natural muesli Mini-wheats® (plain) Just Right® Special K® Ryvita® original shredded wheatmeal milk arrowroot biscuits digestives rockmelon pineapple cherries sultanas raisins dried fig fresh paw paw sweet potato broad beans High GI white bread bagels baguettes English muffins Jasmine rice Rice Bubbles® Sultana Bran® cornflakes bran flakes puffed wheat Coco Pops® Mini-wheats® (fruit) water crackers rice cakes rice crackers Corn Thins® Sao® morning coffee biscuits watermelon most other potatoes Go to www.glycemicindex.com for further information. Sally Johnston Accredited Practising Dietitian/Accredited Nutritionist Your Bariatric Dietitian

Thanks for sharing your experiences and ideas, I hope your experiences with eating meat improve with these suggestions. Sally

Red meat is an excellent source of protein iron and zinc, important nutrients for all but particularly after weight loss surgery. After surgery, people may report difficulty eating red meat. This may be due to a poor eating technique, or not knowing how to best prepare food. To eat meat comfortably it needs to be tender, cut into small pieces the size of a five-cent piece and chewed thoroughly – until it is a puree in the mouth. Whilst a steak on the barbeque or grill can be difficult to tolerate, marinating, slow cooking, or cooking in a sauce can help tenderise meat making it easier to chew. Lean red meat, trimmed of fat is the best choice as it contains less teaspoons of fat and saturated fat. However, the fat in meat can help it to soften during cooking and adds flavour. Lean meat is therefore often assumed to lack tenderness and flavour. Whilst lean cuts of meat can be expensive, cheaper cuts with the fat removed respond well to marinating and slow cooking so can be an economical choice. Try slow cooking in crushed tomatoes, soup bases or salt reduced stock with lots of vegetables and your favourite herbs. To reduce the amount of fat, skim from the top prior to serving. Marinating meat is another way to enhance the flavour and tenderness of meat. Whilst adding oil to a marinade may seem like defeating the purpose of choosing lean meat, unsaturated oils are a better choice than the naturally occurring saturated fat in meat. Commercial marinades can be high in sugar. Try the following ideas for tasty homemade marinades: red wine, a dash of olive oil, Worcestershire sauce and garlic complements red meat for an Asian flavour combine soy sauce, a dash of sesame oil, sherry oil, white pepper and honey lime juice, sweet chilli sauce, fish sauce, brown sugar, coriander and a dash of peanut oil adds a Thai flavour to meat white wine, wholegrain mustard and crushed garlic cloves works well with beef lemon juice, oregano, garlic and a dash of olive oil complements lamb. These tips and others like these can be found in our book, Spoons for Thought.

Solid food tends to empty slower from a stomach than liquid, helping us feel satisfied for longer after eating. This is a natural part of the digestion process. Whilst it hasn’t been widely studied following bariatric surgery, a small study at LAPSurgery Australia in Melbourne found that solid food appears more satisfying than liquid meals in those with a gastric band. As this occurs naturally in people who have not had bariatric surgery, and those with a gastric band, it is likely to also occur in those who have had a sleeve gastrectomy or gastric bypass. For this reason, we generally encourage solid meals following bariatric surgery to help you feel more satisfied. Feeling more satisfied for longer after eating helps avoid grazing or snacking, which may help maximise weight loss and maintenance of that weight loss. However, soups are a popular winter meal in our colder climates (yes, it is winter where I am writing this post in Australia). They are convenient, can be prepared in bulk and frozen and with the right ingredients, can be very nutritious. So should you avoid soup because it is, technically, a liquid meal? There is not a simple yes or no answer. Soup means different things to different people. To some, soup means instant soup powers that you mix with hot water. These are not a great meal option. Apart from being high in salt, they offer very little nutrition and are not likely to be satisfying. Some people may think of soup as the tinned or tetra pack varieties. These offer a little more nutrition, but some varieties are better than others. Smooth, liquid soups will empty quickly from the stomach and provide little satiety (the feeling of satisfaction after eating). The chunky varieties with meat and vegetables pieces are a better option, as the chunks need chewing, taking you through the process of eating and allowing your body to recognise more of the signals you have eaten. The best option is thick, chunky, home made soups, filled with lots of nutritious ingredients. The more chewing required to eat the soup, the more it will help satisfy you. Avoid thin broths or pureed soups, opting for chunks of vegetables and a protein containing food, either meat, chicken, seafood or legumes. Some pasta, rice, barley or noodles are also a good addition. The following recipe for Chunky Winter Soup is one of my favourites for lunch on a cold winter day. Chunky Winter Soup Makes 4 cups Oil spray ½ onion 1 small or ½ large leek, thinly sliced 2 cups salt reduced chicken stock 1 small or ½ large zucchini, diced 1 small or ½ large carrot, diced 1 cup no added salt, chopped tinned tomatoes ½ teaspoon curry powder 1 tablespoon no added salt tomato paste Freshly ground black pepper 2 tablespoons macaroni 1 cup cooked red kidney beans Heat a saucepan that has been sprayed with oil. Add onion and leek and cook until they are starting to soften. Add the stock, carrot, zucchini, tomatoes, curry powder, tomato paste and season with pepper. Bring to the boil then simmer for 20 minutes, until vegetables are tender. Add macaroni and kidney beans and simmer for a further 15-20 minutes until the macaroni is cooked. Nutrition information (per cup): kilojoules 485, calories 116, protein 5.5g, fat 2g, saturated fat negligible, carbohydrate 15.5g, fibre. Weight Loss Surgery Tip: This recipe makes approximately four cups (4 x 1 cup serves). Half to one serve may be adequate for those with a gastric band. Early in the gastric bypass or sleeve journey you should only require half of one serve and over time you may tolerate greater amounts, up to 1 cup. Those with larger appetites (family and friends) may require two serves. For more recipe ideas, head to my blog, Bariatric Bites.