Help me with my Grad School Project, please? :)

[BlueBongo 52]

So as I was going through my process pre-surgery almost 3 years ago, I struggled and learned a lot through my own research and understanding. I made sure I was prepared for surgery and am pretty much on top of tracking food, Water, Vitamins, and calorie intake (meeting my macros every day). I had a good experience because I wanted to get the most from this bariatric process. However, it was a struggle and I feel like everyone struggles through this are very unique. I've known more than a handful of people that passed in the almost 3 years I've been going through this and I have really wanted to find a way to help other bariatric patients on an individual (and community) level. So I have been working in and on education in Nutrition. I am going to grad school currently and will be an RDN/Nutritionist once completed. My overall goal is to work with and for people going through the various processes of bariatric surgery as well as provide more in-depth long term support.

SO, long story short, I need help narrowing my focus for an intervention with and for bariatric patients in my small forest town and I thought I would reach out here to see if anyone is willing to help! I am interested in knowing what people at any level of the bariatric process think may have helped them, had this help been available or accessible? Is there any program, care, or process that you feel would be or have been helpful on an individual level? And/or are there things you think could have been improved upon that were provided from the program, doctor, or insurance company that approved or provided your surgery?

I want to help bariatric patients and provide substantial support and nutrition assistance. In reality I wish I could do this for everyone, but realistically I have to implement something smaller for my graduate project and I am just trying to collect information from other bariatric patients that will help me narrow my scope of focus to a more useful and specific intervention that will help me to meet my professional goal and genuinely help people at all stages of this weight loss journey.

Any help or ideas would be great, but I do have to provide the disclaimer that I am not a doctor and do not want personal health information, I am only looking for insight into anything that might have helped from a provider in making the process easier as it is a struggle and I don't feel that there is enough medical, nutritional, or individualized support for bariatric patients on a long-term basis.

Thank you!

[James Marusek 5,244]

I had RNY gastric bypass surgery over 5 years ago. I have documented my experiences in the following two articles:

http://www.breadandbutterscience.com/Surgery.pdf

http://www.breadandbutterscience.com/Surgery2.pdf

From my experience, there are two phases to weight loss surgery. These are the weight loss phase and the maintenance phase. I feel the medical community pretty much has the guidance for the weight loss phase down pat. But they seem at a loss in the maintenance phase. Better guidance is needed here. Much of this transition has to do with the change in dieting routine between the two phases.

[FLHappyGirl 171]

I'm about 1 1/2 years out from surgery. I feel that I was well prepared about the actual surgery and eating during each stage for the most part. I always planned on changing my lifestyle to include exercise but it never dawned on me I would become the girl lifting weights, building strength and looking for muscles under my droopy skin.

The last 10 lbs have not come off easily even with vigorous exercise, strength training and conditioning. I know I am stronger, leaner and have good cardio stamina for someone my age. I know I have more muscle than when I started but I have no idea what I should be eating to maintain or lose that last 10 lbs of fat while building MORE muscle.

In short, I'd love to see nutrition programs specifically for bariatric patients and our inability to ingest large meals at one sitting that allow for muscle building along with the typical maintenance programs.

I hope that makes some sense!

I wish you much success with your studies! Keep us posted on what area you decide to focus on.

[BlueBongo 52]

Thank you both! I really appreciate that feedback. It is definitely quite interesting how we are so well prepped ahead of time to handle the beginning of the process and there just isn't much more to it, where we navigate and learn on our own.

I'm thinking small for my graduate project, but I really hope to and look forward to helping patients with long-term care and support.

Thank you again for your time and assistance! :)

-Trisha

[BlueCrush 408]

On 10/1/2018 at 10:09 AM, James Marusek said:

I had RNY gastric bypass surgery over 5 years ago. I have documented my experiences in the following two articles:

http://www.breadandbutterscience.com/Surgery.pdf

http://www.breadandbutterscience.com/Surgery2.pdf

From my experience, there are two phases to weight loss surgery. These are the weight loss phase and the maintenance phase. I feel the medical community pretty much has the guidance for the weight loss phase down pat. But they seem at a loss in the maintenance phase. Better guidance is needed here. Much of this transition has to do with the change in dieting routine between the two phases.

So very true. At my 9 month follow-up appointment, I was already 5 pounds below my goal weight, and the doctor wanted me to transition to maintenance and stop losing weight.

Nutritionist told me to increase from 1600 to 1800 calories per day and she didn't want me going above 1800 calories. I knew immediately that do nutritionist didn't have very good advice for patients on maintenance. At almost 6 foot 3, and working out 6 days a week, there's no way I would NOT keep losing weight eating only 1800 calories a day. Discussion ended in and agree to disagree. I've been trying to adjust my diet based on results week the week, and I found about 2400/day is my maintenance. I've fluctuate about the same 1/2 of a pound the past few weeks at that calorie intake. If my nutritionist knew that's how much I was eating, I think I think she would s*** herself.

Edited October 6, 2018 by BlueCrush

[BlueBongo 52]

On 10/6/2018 at 11:24 AM, BlueCrush said:

So very true. At my 9 month follow-up appointment, I was already 5 pounds below my goal weight, and the doctor wanted me to transition to maintenance and stop losing weight.

Nutritionist told me to increase from 1600 to 1800 calories per day and she didn't want me going above 1800 calories. I knew immediately that do nutritionist didn't have very good advice for patients on maintenance. At almost 6 foot 3, and working out 6 days a week, there's no way I would NOT keep losing weight eating only 1800 calories a day. Discussion ended in and agree to disagree. I've been trying to adjust my diet based on results week the week, and I found about 2400/day is my maintenance. I've fluctuate about the same 1/2 of a pound the past few weeks at that calorie intake. If my nutritionist knew that's how much I was eating, I think I think she would s*** herself.

I had arguments like that with my nutritionist post surgery, too. Just more fodder on my fire and whimsy to get into nutrition for bariatrics as a Registered Dietitian. Does your nutritionist specialize in working with bariatric patients?

I know the first one I went to pre-op had placed me on a very very bad diet and so I found a better program and set of professionals to work with through my process almost 3 years ago. Given the amount of future medical issues that can arise post-op, I am interested in and currently work with people on a local level going through their own weight loss journey. There is so much to be taken into consideration on an individual level when going through nutritional counseling and putting together your macros, I managed to get a hold on it before surgery and haven't let myself slide from meeting my daily macros though I eat roughly 1300-1500 calories a day (and up that to over 2,000 when I am doing the longer hikes and trail runs a few days a week between grad classes). Definitely fluctuates depending on activity, but I enjoy getting in my trail runs most days and lengthier hikes, kayaking, or swimming, when I am not bogged down in school or medical work for school).

It really is interesting learning what other's have found helpful and not helpful in their own experiences going through bariatric surgery.

Thank you for sharing

[BlueCrush 408]

23 hours ago, BlueBongo said:

I had arguments like that with my nutritionist post surgery, too. Just more fodder on my fire and whimsy to get into nutrition for bariatrics as a Registered Dietitian. Does your nutritionist specialize in working with bariatric patients?

I know the first one I went to pre-op had placed me on a very very bad diet and so I found a better program and set of professionals to work with through my process almost 3 years ago. Given the amount of future medical issues that can arise post-op, I am interested in and currently work with people on a local level going through their own weight loss journey. There is so much to be taken into consideration on an individual level when going through nutritional counseling and putting together your macros, I managed to get a hold on it before surgery and haven't let myself slide from meeting my daily macros though I eat roughly 1300-1500 calories a day (and up that to over 2,000 when I am doing the longer hikes and trail runs a few days a week between grad classes). Definitely fluctuates depending on activity, but I enjoy getting in my trail runs most days and lengthier hikes, kayaking, or swimming, when I am not bogged down in school or medical work for school).

It really is interesting learning what other's have found helpful and not helpful in their own experiences going through bariatric surgery.

Thank you for sharing

Yep. She's the nutritionist in my surgeons office that only works with bariatric patients. I just don't think they're used to patients hitting their goal weight so soon. I lost almost 90lbs in the 6mo pre op before the surgery, so I was at goal about 7 months post-op. I think another issue is that 90% of their patients are women who just want to get and stay skinny. The nutritionist struggles with me being a guy who is now interested in GAINING weight (muscle) after the sleeve. I just don't think she's had this scenario before.