May 2, 2017 – Clinical Pearls to Prevent Weight Regain

Facilitator:  Chris Bovos, RN, CBN

Taken from The Bariatric Times, November 2016

 

There is a lifelong threat of weight regain after surgery.  A small amount of weight regain (3 – 5%) is expected after a patient reaches their lowest weight; but maintaining that weight loss is a challenge for most patients.

Some of the areas we looked at include:

Behavioral Health

Risk factors for weight regain include:

• Preoperative binge eating, which can become loss of control eating after surgery;
• Depression – many of the drugs used can increase weight Need to get depression under control prior to surgery and monitor after surgery;
• Night eating or grazing – early, brief intervention can improve this.

Obesity Medicine

People frequently have trigger foods that trigger the dopamine or reward response.

• Need to identify what your triggers are and avoid them;
• Keep a food journal. Most people begin to have more liberal meals once they have lost their weight, and need to become aware when they are eating high glycemic, high-fat and carbohydrate-rich foods by journaling every day;
• To “reset” things, cut to 1000 – 1200 calories a day for women; 1200 – 1600 for men;
• Follow the physician orders and nutritional guidelines:
  1. Meet daily fluid goals of 64 ounces a day at least;
  2. Wear CPAP – poor sleep can increase cortisol and slow your weight loss;
  3. Eat 3 meals a day – skipping meals slows your metabolism.
  4. Get at least 1200 mg Calcium with Vitamin D each day to improve body’s ability to burn fat;
  5. May need to take a metabolic boosting medication.

Nutrition

Meal composition and portion control are critical:

• 50% of your plate should be lean protein;
• 30% of your plate should be vegetables (non-starchy);
• 20% or less should be complex carbohydrates – not processed foods;
• Eat slowly and take 2 bites of protein to 1 bite of something else – helps keep protein a priority, and wait 5 seconds between bites.

Physical Activity

Focus on making your muscles healthy in addition to losing weight

• Muscle has a higher metabolism and increasing lean body mass increases metabolism;
• Begin with 150 minutes/week and work up to 200 – 300 minutes a week;
• Once you lose weight, your body is so much more efficient at using energy that you have to work harder than you did in the beginning;
• Any kind of activity can be modified – don’t say “I can’t”.

Ongoing Monitoring

The most vulnerable time for people to start regaining is at 2 years’ post op.  Usually will see one of the following start:

• Going from 3 meals a day to grazing;
• Intake has switched from protein, fruits and vegetables to carbohydrates, sugars and fats;
• Decreased physical activity;
• Loss of Control eating.

In Summary

• Eat real foods, not packaged foods (eat food that will rot over time);
• Make protein a priority and omit all processed food, sugar and simple carbs;
• No snacking or grazing. Be aware of mindless eating (eating from boredom);
• 8 glasses of water daily, and don’t drink with meals or 30 minutes after meals;
• Walk as alternative to driving. Take the stairs;
• Follow up with physician and support groups;
• You can regain control!