Provide advice to a bariatric dietitian/nutritionist as a current/former patient

[Registered Dietitian Nutr 2]

Hi all, I am a bariatric surgery dietitian/nutritionist and would like some feedback from any of you that is willing to share your valuable thoughts or experiences through this journey so that I can provide the most helpful resources and care to my patients.

As a current or past bariatric patient, are there any things you wish your dietitian/nutritionist had done better to help you before, during or after your surgery?

Has anything your dietitian/nutritionist done or provided to you that has been particularly helpful? Has there been something that was certainly NOT helpful to you?

Any particular resources, pages, ideas, recipes you were provided with that were the most helpful? Any preferred method of obtaining all the information in preparation for or after surgery (written, oral, in groups, individual, etc)?

Thank you in advance for anyone willing to share!!

[shedo82773 1,236]

After y RNY I had Strictures and had 5 Endoscopes with 4 Dialations. Along the way, I developed an aversion to food. I was afraid to eat anything but the bare minimum I was eating: oatmeal, Beans, and cheese was basically all I could eat. I also developed a bad habit of eating CHEETO's. When I told my Dr what I was eating he told me that he didn't care if I ate Oatmeal 10X's a day, that I needed my Protein. So I think that was when it all transferred in my head that I couldn't eat regular things. The Endo's started in NOV of 2013 then I had one in Dec 2013, next was Jan of 2014. July of 2014 with my last one being Jan of 2015. I finally went to see a Counselor, but she had no idea how to help me. Finally, I went to a Bariatric Nutritionist. I drove 1 and 1/2 hour for her to tell me to eat every 1/2 hour I was awake and to drink Boost for my Snacks. I felt like I had traded one eating disorder for another. The fact was she should have dealt with me differently. A person that has gone thru WLS and to be told to eat every 1/2 hour is TOTALLY SCARY for someone that has fought her weight hard for many years!! I don't know if that was her idea to help me but she defintly hadn't helped me. Sorry if this isn't exactly what you wanted but there it is. LOL I can now eat a variety of Proteins, some veggies and a little fruit once in a while. I still don't have physical hunger and I am not interested in food now. By the time I eat my Protein I don't have much room. Thank you for reading my weird life. LOl

[Sosewsue61 3,185]

My NUT is pleasant but I can tell she is just doing her job, all she wants is a record to put into her computer that shows she is doing her job. She offers standard advice but has NO idea how to really assist a wls patient on this journey. Also she is on the 'low fat' bandwagon despite new evidence to the contrary on full fat dairy, etc. - seriously quibbling on 2% and skim milk is the least of a patient's issues. She puts in her 15 minutes with me and that is it, at the group mtg she was barely paying attention - was chatting with another staff person - however the psychologist was fabulous at caring and it shows.

[blackrosevamp 78]

I really like my nutrionalist, she is very friendly and nice. I do wish she had more info for me as a vegetarian. She gave me tons of packets of info and sample meals, but nothing vegetarian specific. Her main advice on it was that i would be supplementing with shakes and bars for much longer than a meat eater.

Sent from my SM-G930T using BariatricPal mobile app

[istytehcrawk 256]

If you are affiliated with a program that has multiple nutritionists, PLEASE do your best to keep patients consistently seeing the same one. I was in a WLS program for ~2 years that swapped me around between approximately 9 different nutritionists over that time (*partially* due to staff turnover), and though they *said* they were all on the same page, they were very inconsistent with their recommendations/instructions, and it was highly frustrating for me.

[FluffyChix 17,418]

I my RD. She's been such a help/support in this process. Without her careful instructions and planning, I would not have a clue about expectations either pre or post surgery. It was also very important to work with someone capable of flexibility so that we could work within my comfort zone with respect to diet paradigms. I first came to her eating very low carb (<30g net carbs per day) and also seriously restricting calories (<600-800 cals). I would have quit if she'd immediately thrown me into the deep end and given me a Weight Watchers style diet (1200 cals/100g carbs, etc) and said, "Lose the weight." Instead, she slowly helped me walk up so that I was eating 1500 cals per day and averaging 50-60g of net carbs (healthy, low-glycemic sources) per day. I'm still pre-surg, but I'm still losing 1-2lbs per month eating at a 1500 cal level. Prior to that, I was gaining on a 1200 cal/day low carb diet. So she made a plan that fit my individual needs instead of fitting me into a cookie cutter diet plan given to every person.

Important things she's taught me:

1. About the whole WLS process in general.

2. About the time line for re-feeding post surgery.

3. About the vitamins/supplementation needed post surgery.

4. About why exercise and physical activity is so important.

5. Provided strategic plans to drink, eat, supplement and exercise for each phase of WLS from pre-op to 1year post surg.

The value is that I feel about as well-educated/prepared as any noobie who's never gone through WLS can feel. I feel positive about the upcoming next stages in the journey and confident that I will be able to weather the storms ahead.

[Registered Dietitian Nutr 2]

14 hours ago, blackrosevamp said:

I really like my nutrionalist, she is very friendly and nice. I do wish she had more info for me as a vegetarian. She gave me tons of packets of info and sample meals, but nothing vegetarian specific. Her main advice on it was that i would be supplementing with shakes and bars for much longer than a meat eater.

Sent from my SM-G930T using BariatricPal mobile app

Ahh that's a bummer! There are certainly other options for vegetarians. Creating and providing recommendations specific to different diet preferences like vegetarianism is key, this is very helpful thank you!

[Registered Dietitian Nutr 2]

14 hours ago, Sosewsue61 said:

My NUT is pleasant but I can tell she is just doing her job, all she wants is a record to put into her computer that shows she is doing her job. She offers standard advice but has NO idea how to really assist a wls patient on this journey. Also she is on the 'low fat' bandwagon despite new evidence to the contrary on full fat dairy, etc. - seriously quibbling on 2% and skim milk is the least of a patient's issues. She puts in her 15 minutes with me and that is it, at the group mtg she was barely paying attention - was chatting with another staff person - however the psychologist was fabulous at caring and it shows.

Noted, tailoring recommendations to each wls patient journey is important. Is there anything that comes to mind you wish she had done to better assist you on your journey? Right, the 2% or skim milk can be the least of the issues. If you wouldn't mind sharing, are group meeting more helpful than individual sessions? What topics do these typically cover? Glad to hear the psyc is so great. Thank you!

[Registered Dietitian Nutr 2]

9 hours ago, istytehcrawk said:

If you are affiliated with a program that has multiple nutritionists, PLEASE do your best to keep patients consistently seeing the same one. I was in a WLS program for ~2 years that swapped me around between approximately 9 different nutritionists over that time (*partially* due to staff turnover), and though they *said* they were all on the same page, they were very inconsistent with their recommendations/instructions, and it was highly frustrating for me.

Thank you!! Yes, being consistent with recommendations and staying with the same provider is a key aspect to keep in mind, in the case of bariatric surgery being so personal having the same nutritionist during follow-ups would better help patients.

[Registered Dietitian Nutr 2]

51 minutes ago, FluffyChix said:

I my RD. She's been such a help/support in this process. Without her careful instructions and planning, I would not have a clue about expectations either pre or post surgery. It was also very important to work with someone capable of flexibility so that we could work within my comfort zone with respect to diet paradigms. I first came to her eating very low carb (<30g net carbs per day) and also seriously restricting calories (<600-800 cals). I would have quit if she'd immediately thrown me into the deep end and given me a Weight Watchers style diet (1200 cals/100g carbs, etc) and said, "Lose the weight." Instead, she slowly helped me walk up so that I was eating 1500 cals per day and averaging 50-60g of net carbs (healthy, low-glycemic sources) per day. I'm still pre-surg, but I'm still losing 1-2lbs per month eating at a 1500 cal level. Prior to that, I was gaining on a 1200 cal/day low carb diet. So she made a plan that fit my individual needs instead of fitting me into a cookie cutter diet plan given to every person.

Important things she's taught me:

1. About the whole WLS process in general.

2. About the time line for re-feeding post surgery.

3. About the vitamins/supplementation needed post surgery.

4. About why exercise and physical activity is so important.

5. Provided strategic plans to drink, eat, supplement and exercise for each phase of WLS from pre-op to 1year post surg.

The value is that I feel about as well-educated/prepared as any noobie who's never gone through WLS can feel. I feel positive about the upcoming next stages in the journey and confident that I will be able to weather the storms ahead.

Meeting the patient were they are at and individualizing recommendations is always a must:) glad she is doing this with you and that you are so happy with her. If you don't mind me asking, how many times have you met with her pre-op and has this been required by the wls program or insurance? Thank you these are such great recommendations as well! Have you felt overloaded with information? Or more details on each diet stage (booklet style, several pages, specific recommendations) more helpful vs just keeping it simple and straightforward (bullet points and very few pages)?

[Registered Dietitian Nutr 2]

16 hours ago, shedo82773 said:

After y RNY I had Strictures and had 5 Endoscopes with 4 Dialations. Along the way, I developed an aversion to food. I was afraid to eat anything but the bare minimum I was eating: oatmeal, Beans, and cheese was basically all I could eat. I also developed a bad habit of eating CHEETO's. When I told my Dr what I was eating he told me that he didn't care if I ate Oatmeal 10X's a day, that I needed my Protein. So I think that was when it all transferred in my head that I couldn't eat regular things. The Endo's started in NOV of 2013 then I had one in Dec 2013, next was Jan of 2014. July of 2014 with my last one being Jan of 2015. I finally went to see a Counselor, but she had no idea how to help me. Finally, I went to a Bariatric Nutritionist. I drove 1 and 1/2 hour for her to tell me to eat every 1/2 hour I was awake and to drink Boost for my Snacks. I felt like I had traded one eating disorder for another. The fact was she should have dealt with me differently. A person that has gone thru WLS and to be told to eat every 1/2 hour is TOTALLY SCARY for someone that has fought her weight hard for many years!! I don't know if that was her idea to help me but she defintly hadn't helped me. Sorry if this isn't exactly what you wanted but there it is. LOL I can now eat a variety of Proteins, some veggies and a little fruit once in a while. I still don't have physical hunger and I am not interested in food now. By the time I eat my Protein I don't have much room. Thank you for reading my weird life. LOl

I can certainly see how this was not helpful for you nor what you were looking for when you went out of your way to obtain professional help! This is also super helpful for me to know, the good, the bad, and the things that must definitely be improved in someone's wls journey! I'm glad you are able to eat more foods now and hopefully you will find a better nutritionist to help you in the future if that is something you are looking for. Thank you!!

[Diana_in_Philly 1,426]

My RD was a blessing. The best thing she did was give me The Bible at my first visit - it was a binder put together by the RNP, Surgeon and RD with everything I needed to know about having the sleeve done - my pre-op plan for the three months prior to surgery and all the testing necessary, sections about exercise and diet and nutrition, a section to be filled with the pre-surgery liver shrinking diet when I attended that three hour class two weeks before surgery, and sections for my post-op diet. There were areas for me to complete and record things (or I could use My Fitness Pal and show my logs at visits) and I had to bring the Bible to every visit.

It was super helpful because I was able to share all the information with my husband and say - no I can't do that - here - see - it's in the book. My team recently launched an app with much of that information for patients in the program. (I haven't downloaded it because I'm 17 months pot op.)

Making sure you understand the process of the surgery and understand that people who make the decision to finally investigate bariatric surgery know they are fat. They know the basics of nutrition, but being told eat less and exercise more doesn't work - if that had worked, then they wouldn't be in your office.

Recipe ideas, suggested menus for that 1200 calorie a day diet, ideas for using Protein Shakes and powders, visual aids of portion sizes are all important.

[FluffyChix 17,418]

23 hours ago, Registered Dietitian Nutr said:

Meeting the patient were they are at and individualizing recommendations is always a must:) glad she is doing this with you and that you are so happy with her. If you don't mind me asking, how many times have you met with her pre-op and has this been required by the wls program or insurance? Thank you these are such great recommendations as well! Have you felt overloaded with information? Or more details on each diet stage (booklet style, several pages, specific recommendations) more helpful vs just keeping it simple and straightforward (bullet points and very few pages)?

I will have 180days of consecutive monthly meetings with my RD. I have a binder of information. She inserts new pages with each visit and we discuss/digest the new information at each visit. We've had enough time to do recaps and Q&As about areas that might be unclear. So no. I do not suffer from information overload. I would rather have too much information and have to highlight an area on a page--than have brief bullets that might not address the entire scenario or process/instruction.

In my opinion, you need WAY more information than bulleted soundbites because of the complexity of this process. Your challenge is to offer "feedings" at intervals and in small enough segments so that people aren't overwhelmed. My RD said she has about 20/30minutes each meeting in which to introduce new material and to retain the patient's focus and attention.

[xoxococojay 842]

My nutritionist/ surgeon said that you never feel hungry and you'll have new signs of fullness.

Those are both very true statements- but i wish they would have told me that those both go away after awhile it's not permanent. So you really do have to portion everything out and only do your 3 meals or 6 meals or whatever in order to prevent regaining.

I also obviously knew about silder foods and that they were bad for me. Nobody told me that those foods you will be able to eat way more than 3 oz of them though. And that there are certain healthy foods that you can eat way more of like salads.

[summerset 5,265]

I think nutritionists should ditch the standard advice - if the nutritionist is going to dish out standard advice the patient can as well refer to a high gloss booklet. Costs less money and might be more informative as well in some cases.

IMO nutritionists should give out tailored advice. For standard advice: see a booklet.

When visiting a nutritionist when it comes to bariatric surgery I demand that the nutritionist is able to do a few things:

- different surgeries and the challenges that come with them, this includes supplement advice according to bloodwork

- different dietary approaches (e. g. the low carb approach vs. the pound of cure)

- being able to advice patients of different cultural backgrounds when it comes to food choices

- being able to change gears when one approach obviously doesn't work instead of scolding the patient and telling him to "just try harder"

- being able to cater to different dietary preferences of patients (might not be a good idea to advice patients to eat more fish when the thought of eating fish makes the patient want to gag, you maybe also shouldn't advice "lean meats" to a vegetarian)

- being able to incorporate the patient's activity level and lifestyle into the dietary advice (e. g. shift workers, patients with high activity levels)