Hi – this is Debbie, your registered dietitian. Congratulations on making it to 6 months out from surgery. By now, you are probably busy with your new life and taking in all kinds of compliments on your dramatic weight loss! You may even notice that your rate of weight loss is changing.
By 6 months post-op, the rate of weight loss slows and the rapid weight loss phase comes to an end. At this point, we hope you have lost about 50% of your excess body weight. If you remember, when we talk about weight loss after Bariatric surgery, we talk in terms of excess weight. Excess weight is the difference between your weight on the day of surgery and what would be a good weight for your height. Of this excess weight, the goal is to lose HALF of it by 6 months post-op, at which time the rate of weight loss slows. We hope you will continue to lose weight for another 6 to 12 months, losing another 15% of your excess weight. We are happy to discuss with you your percent weight lost when you come in to clinic for your 6 month visit.
There are several reasons your weight loss is starting to slow. First, by this point, your pouch does stretch out a little. It is by no means as large as your old stomach but it may be able to hold what we would consider a regular sized meal where a regular sized meal is perhaps the size of a petite lean cuisine. Secondly, your gut that was rerouted and malabsorbing some of the food you eat has now learned how to be more efficient at absorbing the nutrition you take in. Finally, knowingly or not, you may have started to stray from the prescribed diet.
Chances are you are starting to take in more starch – bread, rice, pasta, potato, crackers, cereal, etc. Your pos-op diet prescription allows for 2 starches per day. For example, if you can tolerate a whole sandwich with 2 slices of bread, that is ALL the allowed starch for the day. For the 6 month post-op patient, the mantra is cut back on the starch, cut back on the starch, cut back on the starch. Try to keep your breakfast starch free. Have an egg for breakfast, instead of toast. Have your lunchtime sandwich filling in wrapped in a lettuce leaf instead of on bread or eat tuna or chicken salad on cucumber slices instead of crackers. At dinnertime, fill ½ your plate with veggies so the starchy foods don’t take over. Most importantly, avoid crackers, popcorn and the like at snack time. Instead, fill up on fruit, yogurt, cottage cheese or low fat cheese sticks. When you do include starches in your diet, make sure they are high in fiber. For example, choose brown rice over white, whole grain pasta or regular pasta, Fiber one cereal or oatmeal over cornflakes and low calorie whole grain bread over wonder bread. And always measure your portions as ½ cup of cooked pasta, rice or potato is a lot less than you think.
If you are finding yourself hungrier, use vegetables to add bulk to your diet. Fill half your plate with cooked veggies or start a meal with an all vegetable based soup or salad. Just make sure you aren’t loading these veggies with added fats like butter, cheese or salad dressing.
Some people also start testing the waters with alcohol or sugar at this point out from surgery. Alcohol is forbidden during the rapid weight loss phase because it is harmful to the liver to consume alcohol when losing weight quickly. At this point, if you choose to try alcohol, there are several things to consider. First, alcohol is digested by the stomach, which has been cut away. This means you are now a ‘cheap drunk’ so use caution when trying alcohol. Alcohol is also very high in calories – one gram has twice as many calories as a gram of carb or protein. It is difficult to continue to lose weight if you consume alcohol.
Some folks also start testing the diet with sugar. It is true that you may start to tolerate more sugar now that the gut is becoming more efficient at digesting simple carbohydrates. Keep in mind that if sweets are a food group that got you into trouble with your weight before surgery, you don’t want to start reintroducing them. Satisfy your sweet tooth with fresh fruit or artificially sweetened products such as sugar-free popsicles, jello, pudding, gum or mints.
At this point out from surgery, each person’s diet is different from the next. If you find that you can eat more – again, a meal the size of a small lean cuisine – then you may no longer need to have snacks in between meals but could move to a breakfast, lunch, dinner meal plan. However, if you find that you still get full on very small portions, under ½ cup total per meal, then you still want to put a couple snacks in your meal plan to make sure you are taking in enough nutrition each day. Remember not to eat and drink at the same time – you don’t want to flush food out of your pouch too quickly or you won’t maintain that prolonged sense of fullness. Also, keep increasing your exercise. As you lose weight, you don’t burn as many calories as you once did when you weighed more even doing basic daily activities such as shopping, vacuuming, etc. The reality is, the less you weigh, the more you have to move and the less you get to eat just to maintain the new smaller you.
Most importantly, make sure you are seen in clinic for your 6 month visit. We will check the percent of your weight lost, discuss how your diet is changing and order nutrition labs on you to make sure you are developing any deficiencies. If you need a clinic appointment, please call our schedulers at 792-7929. Until next time, keep up the great work!
Your MUSC Bariatric Surgery Team wants you to be successful and stay in touch. If you need an appointment, call us at (843) 792-7929 or visit us at www.muschealth.com/weightlosssurgery