As registered dietitians, we devote a great deal of attention to the importance of the initial preoperative consultation with bariatric patients. However, RDs should not underestimate or overlook the value of postoperative nutritional consultations when it comes to facilitating adherence and supporting best outcomes. Here’s a closer look at why the post-op consults matter so much, along with advice aimed at maximizing your follow-up meetings with weight loss patients.
The preoperative consultation is critical in positioning RDs to assess how best to help their patients go into surgery prepared to achieve their weight loss goals. From assessing each individual’s level of nutrition knowledge to identifying specific barriers to adherence (along with strategies for overcoming these barriers), the initial consult is full of opportunities to set bariatric patients on the path to success.
However, the RD’s work is far from over after the surgery. In fact, the postoperative nutritional consultation amplifies dietitians’ abilities to help their patients.
Contends bariatric dietitian Renee Cooper, RD, LD in Today’s Dietitian: “Those who’ve experienced the rewards of weight loss surgery no doubt can attest to the challenges they encountered along the way. Consistent follow-up care with a dietitian — along with an interdisciplinary healthcare team — is a vital component of successful surgery outcomes.”
After all, while we can do our best to give surgical patients an idea of what life will be like after weight loss surgery, there’s no way for them to be 100 percent certain of what’s ahead. Unanticipated problems may include new food intolerances, rising challenges pertaining to healthy eating habits, and difficulty with meeting basic nutritional recommendations, including adherence to protein, vitamin and mineral supplementation guidelines.
Therefore, the post-op consult provides the opportunity for RDs to identify these stumbling points, and to help patients hone their behaviors toward better adherences. Jody Halouska, RD, told Today’s Dietitian, “We can’t expect a patient to come in to our office three months after surgery having changed all of their habits.”
Her solution: “At the end of our talk, I provide them with a written handout summarizing their specific recommendations and highlight what they’re already doing well,” Halouska says. “To address areas that need improvement, I work with the client to set specific goals to work on until the next visit.”
It’s also essential to note that all post-op challenges aren’t nutritional in nature. Less obvious barriers to adherence also exist, including everything from financial barriers related to buying healthy groceries to mental slips and slides. This is particularly the case for weight loss patients who haven’t yet accepted the degree to which the changes they make — as opposed to the surgery in and of itself — impact whether they’ll ultimately succeed or fail.
The postoperative consultation is also an opportunity for RDs to reinforce that weight loss patients must remain mentally and emotionally vigilant in their commitment to lifelong change — regardless of the natural ups and downs that people face throughout life.
Says Cooper, “The individuals that fall back into their old ways and regain weight are often those who experience something tragic or perhaps become a caregiver to an ailing family member.”
And speaking of family members, post-op patients may also be up against lack of stable support systems at home. Continues Cooper, “If the individual having surgery doesn’t have adequate support, the likelihood of being successful is much lower.”
This is another way in which the RD is integral to the weight loss journey. “Sometimes I share my personal story that I didn’t grow up eating healthfully,” Kristen Smith, MS, RD, CDN, tells Today’s Dietitian.
“This approach helps patients understand we’re human, and everyone struggles with making changes to their diet,” she continues. “I think patients come in the office feeling judged and like they can’t be truthful about their eating. We must break that barrier and create an environment in which they feel comfortable and supported.”
Adds Cooper, “I think one of the most important things a dietitian can do is be as available as possible and always remain in communication with his or her clients, whether via one-on-one counseling, e-mail, telephone, or at support group meetings. The more you stay in touch with bariatric surgery patients, the more likely they are to stay on track with their weight loss goals.”
Just how important is the role of the RD during the postoperative nutritional consult? Research published in the journal Surgery for Obesity and Related Diseases determined that patients who had consults with RDs in addition to surgeons had significantly lower readmissions rates, more favorable cardiovascular changes, and fewer minor complications.
The ultimate takeaway: Registered dietitians not only play a vital role in the preoperative context, but also as part of an interdisciplinary follow-up system for bariatric patients.