Amanda Downs MS, RD, LDN Registered Dietitian Nutrition for
Weight Loss
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Objectives After the presentation, participants will be able
to: Understand the basic nutrition guidelines for non-surgical
weight loss patient. Recognize the difference between a fad diet
and a healthy weight loss plan. Explain healthy food choices from
each food group. Understand the basic nutrition recommendations for
a surgical weight loss patient both pre-operatively and
post-operatively. Describe why good nutrition is an integral part
against the battle of obesity.
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Outline Non-surgical approach (Fad) Dieting Exercise Lifestyle
changes Weight loss surgery (WLS) Common surgical procedures
Adjustable gastric banding Roux-en-Y gastric bypass Sleeve
gastrectomy
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Excess body weight Obesity Epidemic Linked to: High blood
pressure High cholesterol Type 2 diabetes Heart disease Stroke
Gallbladder disease Sleep apnea Some cancers
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(Fad) Diets Galore! Atkins South Beach Cabbage Soup Diet Cookie
Diet Nutrisystem Slim Fast Jenny Craig Blood Type Diet Colon
Cleanse MediFast Alli Phentermine/Adipex Hydroxycut Detox Diets
Mediterranean Diet And on
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A fad diet does not meet basic guidelines for good health. is
popular for awhile before it fades away. promises quick weight loss
with little effort. sounds too good to be true. doesnt give you the
tools you need to help change your eating and exercise behaviors
permanently.
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Is this a fad diet? Does it promise quick weight loss of 3 or
more pounds weekly? Does it tell you to never eat certain foods?
Does it suggest that you buy supplements to make up for what the
diet is missing? BE CAREFUL! Anyone can circulate a diet plan and
say that it is written by a doctor or backed by a hospital.
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A safe and healthy weight loss plan includes a
registered/licensed dietitian, not a self-proclaimed nutritionist.
encourages slow weight loss of 1-2 pounds weekly. allows you to eat
foods from all the food groups- fruits, vegetables, whole grains,
lean protein and low fat dairy. encourages permanent behavior
change and exercise. There is no best diet.
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Smart food choices Produce Fill your cart here! Make this the
most important section of the store. Non-starchy vegetables are
very low in calories and high in fiber. Fresh and frozen fruit
offer the same nutritional benefits. Avoid fruit canned in heavy
syrup. Use produce as a tool to help feel fuller on fewer
calories.
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Smart food choices Meat, seafood, and deli Think lean oBeef-
loin, round, and extra lean ground beef oPork- loin oLamb- leg
oPoultry- white meat without skin oSeafood- items that are not
breaded Portion size is 3 ounces, cooked (deck of cards) Choose
cuts with little fat marbling Trim all visible fat prior to cooking
Use low fat cooking methods- bake, grill, broil, etc.
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Smart food choices Dairy Keep it skim or low in fat Choose skim
or fat free dairy products instead of whole fat products Choose
light, non fat yogurt Beware of cheeses that are high in fat
Margarine/Butter debate Look for a soft tub margarine with no trans
fat Be careful with condiments!
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Smart food choices Grains and Legumes Choose foods made from
whole grains Use whole wheat pasta, brown rice, barley and oats
Make sure that the grain product that you choose has whole wheat
listed as the first ingredient on the label Good source of fiber
Beans are an inexpensive source of protein and fiber
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Healthy eating for weight loss Eat a variety of foods. Do NOT
skip meals. This can lead to overeating later in the day. PLAN
healthy snacks into the day if needed. Drink plenty of water and
other low calorie, low sugar beverages. Avoid liquid calories.
Limit alcohol. Avoid fried foods. Avoid high sugar foods.
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Mindful eating behaviors Be aware of situations that give you
the urge to overeat Watching TV, playing on the computer, reading,
socializing with friends. Take at least 20 minutes to consume each
meal. Savor and enjoy the food and chew the food well. Distinguish
between head hunger and physical hunger. Are you eating because you
need to eat to nourish your body or are you eating because you are
bored, sad, lonely, nervous?
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Healthful eating If you can not pronounce the ingredients, pass
it up. Apple pie is not a fruit. Stop eating when you are full. A
moderate diet is a healthy diet. Choose whole foods. Keep a food
record or food diary. Realize that you will have good days and you
will have bad days.
Pre-op diet guidelines Pre-op very low calorie diet (VLCD) of
less than 800 calories Decrease visceral adipose tissue Reduce
liver volume Generally 2-6+ weeks duration Low carbohydrate, high
protein May or may not include food Many use high protein liquid
meal replacement supplements Adequate hydration encouraged No
alcohol No tobacco
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Post op diet goals Support healing after surgery and maintain
lean muscle mass during rapid weight loss Minimize side effects
(reflux, vomiting, diarrhea, etc.) while maximizing weight loss
Hydration!
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Post op diet phases Varies from program to program Generally
start with all liquids and slowly advance to more solid food over
the course of several weeks Exercise encouraged! Example Stage 1:
Thin Liquids Stage 2: Full Liquids Stage 3: Pureed Food Stage 4:
Soft Foods Stage 5: Regular/Maintenance Phase
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Phase 1: Thin liquids Duration: ~7-10 days Calories: ~600-800,
Protein: ~60-80 grams, Fluid: ~64 ounces May include: Water Fluids
with very few calories, no sugar, no carbonation (Crystal Light)
Broth Sugar free popsicles and gelatin Protein shakes- high
quality!! Milk- low fat cows, soy, Lactaid, almond May not include:
Carbonation- irritates the stomach lining and can exacerbate reflux
Straws- may cause pt to swallow air causing discomfort Excessive
amounts of caffeine- possible dehydrating in very large amounts
Alcohol- can irritate stomach lining
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Phase 2: Full Liquids Duration: ~5-7 days Calories: ~600-800,
Protein: ~60-80 grams, Fluid: ~64 ounces May include: All liquids
from Phase 1 Yogurt Pudding Cream-based soups Applesauce Portion
size: ~1/4-1/2 cup per meal
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Phase 3: Pureed Phase Duration: ~14 days Calories: ~800,
Protein: ~60-80 grams, Fluid: ~64 ounces May include: All liquids
from Phase 1 and Phase 2 Pureed chicken, turkey, or fish, tuna fish
with light mayonnaise, peeled, pureed fruits and vegetables,
oatmeal, scrambled eggs, refried beans Emphasis is on the protein
and the fluid Separate out food intake from fluid intake Portion
size: ~1/4 -1/2 cup per meal
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Phase 4: Soft Phase Duration: ~14+ days Calories: ~800-1,000,
Protein: ~60-80 grams, Fluid: ~64 ounces May include: All liquids
from Phase 1 and Phase 2, foods from Phase 3 no longer need to be
pureed. Caution with high fiber foods, doughy foods, fried foods,
sugary foods. Emphasis is on the protein and the fluid Separate out
food intake from fluid intake Portion Size: 1/2-3/4 cup per
meal
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Phase 5: Maintenance/Regular Phase Duration: Lifetime Have lean
protein with every meal Eat 5-6 small planned meals per day, no
grazing Increased dietary variety Mindful eating behaviors: small
bites, adequate chewing Consistent follow up with weight loss
surgery team INDIVIDUALIZED approach and experience for each
patient
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Micronutrient supplementation Chewable multivitamin Bariatric
formula with 200% DV of at least 2/3 of the nutrients Should
include iron, copper, and zinc Take with meal to improve tolerance
Chewable or liquid calcium citrate with vitamin D Sublingual B-12
Chewable elemental iron- taken separately from calcium to improve
iron absorption Encourage regular blood work to monitor need for
additional supplementation/repletion
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Conclusion Whether the approach to weight loss is surgical or
non- surgical, the nutrition changes made should be permanent and
should include positive lifestyle changes. Thank you!