Weight loss surgery can be a tremendous help to individuals who need to lose 100 lbs or more to achieve a healthy weight. However, surgery is only a tool. How patients use this tool determines their overall success, and RDs play an important role in helping patients achieve success.
As part of the medical team, dietitians perform the preoperative screening and assessment required by insurance companies for coverage of weight loss surgery. During this assessment, RDs evaluate whether or not the patient is a good candidate for surgery in addition to factors that may hinder a patient’s postoperative success.
Barriers to Success
Limited nutrition knowledge: Many patients have little understanding of basic nutrition. We can assist patients by helping them identify food groups and healthful choices within each group, and provide instruction on reading food labels, as this often is a source of confusion.
Information overload: Just as we have patients with limited nutrition knowledge, we encounter just as many who have spent most of their lives following various diets, restricting calories, keeping food logs, and eating “diet” foods. These patients generally know what foods are healthful and which aren’t, but they may not have been successful at sustaining a healthful eating pattern long term. These patients also do plenty of their own research, but may not always know where to look. As we all know, there’s a wealth of nutrition information available to the public, some of which isn’t accurate. Instruction on the basics of healthful eating and mindful eating can set patients up for lifelong change and move them away from quick fixes.
Limited cooking skills: Not all patients grew up in a family that cooked meals at home; as a result, they may never have learned basic cooking skills. I frequently encounter patients whose skills are limited to opening a box, boiling water, and microwaving. Offering classes or resources on basic cooking will help them decrease their reliance on convenience foods.
Limited resources: Weight loss surgery patients come from all walks of life and all socioeconomic levels, and many of them may be on limited budgets. Before surgery, patients may have relied on fast foods and other convenience foods that fit into their budget. However, teaching them how to eat healthfully on a budget will help them sustain success.
Emotional issues: All patients undergo a psychological evaluation to determine whether there are any issues that may hinder their ability to cope with stressful situations or the significant physical and lifestyle changes that may occur after surgery. Despite our best efforts to help patients learn to deal with emotional/stress eating before surgery, these issues often arise postsurgery and can sabotage a patient’s success. As RDs, we have an important role in helping patients identify issues related to stress eating and assisting them in getting connected with the proper health care professional to learn coping strategies.
Lack of social support: Many patients have the full support of their family and friends when undergoing weight loss surgery; however, just as many don’t. It’s difficult for weight loss surgery patients to make lifestyle changes when their family and friends stand in their way of making healthful food choices or engaging in regular physical activity. For patients who lack support, there are many support groups available through hospital programs and social media.
Weight loss surgery patients have spent most of their lives striving for permanent weight loss. Surgery is often their last effort—no one wants to fail. Adequately preparing for surgery will increase their changes of lifelong success.
— Jennifer Pullman, MA, RDN, LDN, has been a practicing dietitian since 2001. Since 2007, she has worked solely with patients undergoing a variety of weight loss procedures, including Roux-En-Y gastric bypass, lap-band, and sleeve gastrectomy. In addition to her work as a bariatric dietitian, she publishes two blogs: Nourished Simply, a general nutrition and recipe blog, and Bariatric Bits, a website dedicated to providing nutrition information for weight loss surgery patients.