For many weight loss patients, bariatric surgery represents more than a medical procedure: it’s also a last hope for a better life. But the reality is that weight loss surgery isn’t a cure for obesity in and of itself. Rather, it’s a tool that patients must use correctly in order to achieve their weight loss goals.
Registered dietitians can play a vital role in helping bariatric patients learn how to make the surgery work for them. It all starts with the pre-surgical consultation. Read on for a closer look at best practices for bariatric surgery prep.
It’s easy to think of the preoperative screening and assessment as an opportunity for teaching. After all, there’s a lot of information for patients to absorb. However, the initial consultation is also an important opportunity for understanding. In fact, the more RDs understand about each bariatric patient they see, the better they can target each session to their unique, individual needs.
Certainly, this applies to the topic of nutrition knowledge. Says Jody Halouska, RD: “Some of the clients we see have been dieting their whole life and understand what they should be eating but haven’t been able to translate that knowledge into their lifestyle. Others may have no clue about basic nutrition, how to cook, or how to make good choices with regard to eating.”
Understanding where a patient falls on this spectrum can help RDs hone in on the most appropriate strategies and approaches. When in doubt, keep it simple by focusing on the fundamentals.
Suggests dietitian Kristen Smith, MS, RD, CDN, “I focus on basic healthful eating and encourage patients to start making gradual changes, such as eating more fruits and vegetables, drinking less sugary drinks, or eating less fried food.”
The potential of RDs for helping bariatric patients succeed extends beyond a focus on nutrition knowledge. Dietitians can also use the initial consultation to better understand each patient’s mindset when it comes to making necessary lifestyle changes.
Continues Smith, “Some patients may not have even considered making changes to their food habits; some may have just started to think about it, while others have already started making significant changes.”
Perhaps bariatric dietitian Renee Cooper, RD, LD, put it best by suggesting: “As a clinician, you must ask yourself if the patient is going to be successful after surgery. If not, what can you do to help them be successful?” There's no better time to ask this question than during the initial consultation.
As we all know, obesity is a complex disease influenced by many factors, of which nutrition is only one. Identifying other barriers to adherence is also essential. These may include emotional minefields, bad habits, aversion to exercise, social scenarios, and the temptation to think of the bariatric surgery as a “magical” cure-all.
In order to lose weight and maintain that weight loss for the long haul, patients must accept the familiar adage that goes, “If you do what you’ve always done, you’ll get what you’ve always gotten.” In other words, patients must be truly ready to embrace lifelong lifestyle changes in order to remain on track.
Dietitians can share with pre-op patients all of their most brilliant weight loss and weight management tips. However, this advice is ultimately meaningless for patients who aren’t willing to take ownership over their weight loss.
It’s not enough for patients to understand what to expect after bariatric surgery; they must also assume responsibility for adherence measures, such as attending appointments, self-monitoring and tracking, meal prep and planning, and taking medication and supplements.
This is also a beneficial time to reiterate the value of having a strong support system. Michelle Lewis, LCSW, told Everyday Health, “Bariatric surgery is an emotional roller coaster — developing a support network is key.”
Meanwhile, patient Esther Wolkowitz, who has maintained a 133-pound weight loss more than 10 years following bariatric surgery, reveals: “Support groups provide the answers to many questions and can guide you in ways that surgeons do not address. The support groups provided me with information on managing plateaus and food alternatives for the different stages of recovery. These groups also offer key moral support and encouragement pre- and post-surgery.”
And because the home environment may or may not be conducive to a bariatric-friendly lifestyle, these support groups can become a true lifeline.
According to Smith: “Bariatric surgery is only one tool in the toolbox for long-term success. Commitment to a permanent lifestyle change is a must and working alongside a team of experts can help a patient to commit to and maintain these changes.”
Registered dietitians occupy a key position on these teams — both before and after surgery. Concludes Lewis, “Several studies have seen greater weight loss in patients who routinely follow up with a registered dietitian.”