Author- Mariam Lakdawala (Registered Dietician) Common questions I generally get from my patients suffering from obesity, “I don’t eat much, still why am I gaining weight?” “I eat less than one of my friend, but why is she so thin and I am not?” My […]
Author- Mariam Lakdawala, Registered Dietician The most common observation made among diabetic patients is that they generally grab on sugar or sugary beverages when they get hypoglycaemic (a drop in the blood sugar levels). But are these sugar shots really helpful? Temporarily – yes, but […]
Mariam Lakdawala, Bariatric nutritionist; Dr. Aparna Govil Bhasker, Bariatric Surgeon
Honeymoon period is basically the golden period in the first year post bariatric surgery wherein the patient experiences drastic weight loss. Obesity surgery leads to weight loss through a combination of various mechanisms such as restriction of food intake, a decrease in hunger sensation, mal-absorption of calories, action of gut microbes and hormonal activity in the gut.
An interesting fact about the “post-bariatric surgery honeymoon phase” is that it is relatively longer than the “post-marriage honeymoon phase”. However, like the other one, this too is a temporary phase which sadly comes to an end after 6-9 months of surgery. After about 6 months or so, weight loss starts slowing down, but continues to happen until 1 year-18 months. Most patients reach the nadir of weight loss between 18 to 24 months.
By the end of 12 to 18 months, there is a considerable increase in food intake and hunger. Bariatric surgery is a tool that must be used for pushing one into a lifestyle change. Patients who embrace a healthy diet and an exercise regime, tend to do better in the long term. Varying degrees of weight regain is seen after obesity surgery in the long term. Regular follow up is the key to maintenance of weight loss in the long term.
In the first 6 to 9 months after the surgery, the main focus must be on conditioning the mind to, adopt a low calorie well balanced diet:
- Your diet is important not only during the honeymoon phase but is even more important after 12 to 18 months to prevent weight from coming back
- Restricting outside eating & intake of fried food, ice-cream, chocolates, processed foods, sugary foods etc.
- Fat gives double the amount of energy as compared to carbohydrates and proteins, hence it should be restricted in the diet.
- The body spends more energy to digest protein; thus, a high protein diet is very important for weight loss and maintenance. It is wise to distribute protein rich foods in all the meals in order to ensure better absorption.
- Avoid keeping long gaps between meals, eat every 3-4 hours to prevent overeating in the subsequent meal
- Maintaining a food diary is the best method to be aware of the food choices you make.
- Grazing which is a repetitive eating behaviour, in an unplanned manner not associated with hunger or satiety sensations, could develop post the surgery. It might lead to poor weight loss if not corrected. A simple way to deal with it is to eat the entire meal at a go and keep a decided gap consciously between the meals.
The story doesn’t end on what to eat, how to eat? how much to eat? When to eat? Is equally important. Given below is the cycle of mindful eating created to make you more mindful about your eating habits.
Mindful eating basically involves the practise of eating food slowly, in a relaxed environment by limiting other distractions so that you can focus well on your meals. As a result, you will be more conscious of portions and food intake.
Make exercise a way of life – Engage in any form of physical activity daily for at least 40-45 minutes. Make exercising fun by engaging in the activities you like so that you don’t leave it in between.
In addition to a focused exercise, increase the nonspecific exercise activities like usinga stairs instead of taking elevators or escalators, park your vehicle a little away from the intended destination, avoid using vehicle for short distances, etc
Stay away from lifestyle stressors like alcohol, smoking, erratic sleeping, sedentary lifestyle, work stress, etc.
Engage in meditation/ yoga/ breathing techniques or spend 30-40 minutes of your time daily in any activity that keeps you away from negative thoughts.
Dr. Aparna Govil Bhasker is one of the best bariatric surgeons in India and is associated as a consultant bariatric surgeon in Mumbai with many renowned hospitals.
Author: Mariam Lakdawala RD Bariatric nutritionist and diabetic educator Hair loss is one of the most important concerns that patients have after weight-loss/bariatric surgery. In the first 6 months, more than normal amount of hair fall may be experienced depending upon the age, gender, genetic […]
Author: Mariam Lakdawala, RD Bariatric nutritionist and diabetic educator My last blog emphasized on the importance of protein supplementation post weight loss/bariatric surgery. It is extremely important to meet the protein requirements (especially for vegetarians) to prevent or decrease the consequences of possible protein insufficiency after […]
Author: Mariam Lakdawala
Registered Dietician and Bariatric Nutritionist
Protein is very crucial as it forms a part of every cell, tissue and organ in the body. Post weight loss surgery meeting your ideal protein requirement is extremely important. All bariatric surgeries lead to restricted intake which in turn leads to a drastic decrease in the total number of calories consumed daily. In case of mal-absorptive bariatric surgeries, along with restriction the absorption of proteins is also affected. Indians are primarily vegetarian. Even those who consume non-vegetarian foods, do so in small quantities. Hence post bariatric surgery, it is extremely important to lay stress on this aspect of nutrition.
The major role of protein is to rebuild and maintain muscle mass. In addition, protein has many other roles to play, like it enhamces the wound healing post surgery, it enables the immune system to work efficiently, helps to maintain healthier hair, skin and nails and provides satiety which prevents hunger pangs in the subsequent meals.
Low caloric intake post-surgery, compels the body to use fat stores as well as muscle mass as a source of energy which results in the loss of lean muscle mass.
A daily protein intake of 1.5g/ Kg/ Ideal Body Weight has shown to prevent muscle loss (Moize. V. et. al., 2003). After bariatric surgery, for vegetarians, it is difficult to meet such high protein requirements through diet alone. Adding protein supplements to a high protein vegetarian diet thus becomes necessary to reach the ideal protein intake.
To keep up with the protein requirement of the body, the golden rule post weight loss surgery is to include a protein rich food in every meal. Let us have a look at few vegetarian foods rich in protein,
- Low fat milk/ Low fat curds/ Unflavoured Yoghurt
- Home-made Cottage cheese/ Tofu
- Soy granules/ Soy chunks
- Dals and Pulses
- Combining dal/ pulse/ sprout with cereals (Rice/ Wheat/ Jowar/ Bajra/ Ragi/ Maize) in 1:1 proportion increases the quality of proteins.
You can incorporate one or more of these protein supplements listed below as prescribed by your Bariatric Nutritionist keeping in mind your requirements,
- Protein powders – Whey isolate/ Whey Concentrate/ Other high protein blends (E.g. Soy + milk proteins/ Peanut + milk proteins, etc)
- Protein bars
- Protein chips
- Threptin biscuits
Protein supplements are very important for atleast the first 10-12 months post the surgery. Later on, your intake increases fairly to meet the protein requirements through diet. Even after 1 year if protein rich foods are not consciously included in the diet, then continuing protein supplementation through external sources becomes unavoidable.
The compliance with protein supplements has always been poor due to its strong aftertaste, and food aversion post-surgery makes it even worse. However, with technological advancements the protein powders are getting better in terms of their taste and texture. There is a wide variety of flavours available in the market. In case you have tried many and still not being able to get your taste buds accustomed to it then you can try few tips to improve palatability,
- Opt for vanilla flavour, as you can add some coffee powder/ fresh fruit to it for taste
- Consume it chilled
- Make it into a Smoothie by adding some yoghurt and fruit
- You can add the protein powder to oat flour and make mini protein pancakes
What happens in case of protein insufficiency
Proteins play a very important role in the transport of various vitamins and minerals. Insufficient proteins in the body can affect the availability of vital nutrients such as iron, calcium, copper, and vitamins A & D.
Its insufficiency results in various symptoms like,
- muscle wasting,
- thinning or brittle hair,
- pale skin,
- flaky or dry skin,
- headache, etc.
Few suggestions to ensure sufficient protein intake are as follows,
- Don’t miss your follow-ups
Being regular with your follow-ups will help you to identify if you are deficient in protein
- Maintain a diary
This option works great as you are aware how close or far you are from meeting your requirements. You just need to take out 10-15 minutes to write it down. End of the day is a good time to reflect and note down. Probably its even more effective than Almonds for improving your memory.
- Maintain a checklist
You can consult your Bariatric Nutritionist to prepare a checklist of protein rich foods to be consumed daily as per your requirements. Put up that checklist in the kitchen so that you don’t forget your PROTEINS.
So please ensure that after bariatric surgery you are taking enough protein. If you are unable to do that, please get in touch with your bariatric nutritionist for her guidance. Prevention is always better than cure!
Moize, V., Geliebter, A., Gluck, M. E., Yahav, E., Lorence, M., Colarusso, T., … & Flancbaum, L. (2003). Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obesity surgery, 13(1), 23-28.