Permanent weight loss is not a guarantee of bariatric surgery. You must do the work to not slip back into ingrained behaviors, habits, and ways of relating to food, as well as physical inactivity. In this 3-part interview with Lori Rosenthal, a bariatric dietician, we examine some of the healthy behaviors necessary and pitfalls to avoid in order to be successful with weight loss for your whole lifelong.
Lori Rosenthal, MS, RD, CDN is a bariatric dietitian at Montefiore Medical Center in the Bronx, New York. She provides individual nutritional counseling for weight management, focusing on dietary and lifestyle modifications needed to promote successful, sustainable weight loss before and after weight loss surgery. Follow Lori on Twitter @LoRoRD.
Lifelong Weight Loss after Bariatric Surgery
Back when I had my gastric bypass in 2003, my bariatric surgeon told me, “I do the surgery. The rest is up to you.” I was on my own, without a clue on what it meant to eat healthy. And everything thing I know today has been self taught. Unlike when I had my weight loss surgery, nowadays bariatric dieticians can help us transform our eating habits from unhealthy to healthy. Let’s read what Lori Rosenthal had to say on the matter…
My Bariatric Life: How do post bariatric patients learn what it means to eat healthy?
Lori Rosenthal: Bariatric patients should be learning how to eat healthy before weight loss surgery. Our program requires patients to complete 3-6 months of weight management prior to surgery. We discuss healthy dietary and lifestyle changes. Patients are asked to choose 2-3 changes to work on at a time, and only add-on once they feel comfortable with the ones they have made. And we encourage patients to find foods they enjoy that work within the post-op guidelines. We want them to be choosing foods because they like them, not because they are on a “diet”.
My Bariatric Life: With regard to post-op guidelines, should bariatric patients eat a low fat diet? I hear of patients following the Keto Diet (ketogenic), which is high in healthy fats.
Lori Rosenthal: Yes, a low-fat diet should be followed. This is not only to promote weight loss, but because high-fat foods are not often tolerated as well after surgery. They slow gastric emptying time, which increase risk of nausea and vomiting. This does not mean that bariatric patients must consume a fat-free diet, but they should limit their intake.
My Bariatric Life: Again with regard to post-op guidelines, The Pouch Rules by Dr. E. E. Mason who developed the gastric bypass indicate that the ideal bariatric meal consists of 1/2 the plate be protein, 1/4 be fresh fruit, and 1/4 be raw or lightly cooked vegetables. Note that no grains are included in that equation. This is similar to the Paleo Diet that many bariatric patients follow after weight loss surgery. Please share your perspective on this plan of eating.
Lori Rosenthal: We tell our patients to avoid rice, bread and pasta for the first two-months after bariatric surgery. After the initial two months, we encourage our patients to include whole grains into their diets, but only after they finish their recommended protein and still feel hungry. Whole grains contain fiber, which makes us feel full for longer, promotes blood sugar control, lowers cholesterol and decreases risk of colon cancer. It has a place in the bariatric diet.
My Bariatric Life: So then, what do you see is the ideal bariatric meal plan and does that look different depending on which bariatric surgery the patient had?
Lori Rosenthal: There are slight differences between the diets based on the surgery, but they are more profound directly post-op. Caloric requirements vary based on current weight loss, desired loss and exercise.
My Bariatric Life: In your experience, what have you seen is the biggest challenges in maintaining permanent weight loss for patients a few years or more out from bariatric surgery?
Lori Rosenthal: People often start to slip as they get further out from surgery. They are able to eat larger portions and tend to fall into old habits. It is important to always remember why you started the bariatric process to begin with. What was your original motivator? If a patient starts slipping back into old routines, it is a good idea to go back to the basics – eating 3 meals/day, meal planning and practicing mindful eating. Keeping a food/exercise journal can also be very helpful. Sometimes we don’t realize where the extra calories are coming from. Try an app or paper and pen. I also highly recommend joining a post-op support group, whether it be online or in person, to help stay on track.
My Bariatric Life: Where can bariatric patients find support online? In person?
Lori Rosenthal: I highly recommend joining a post-op support group, whether it be online or in person. There are a number of great online support groups. For example, many of our patients belong to support groups on Facebook and follow specific bariatric hashtags on Instagram. Just remember that the information shared in these support groups is not necessarily from medical professionals.
Some bariatric programs, such as ours at Montefiore Medical Center, hold post-op support groups. I recommend calling the facility where the surgery was done and asking if they offer post-op support services. The patients that come to our support groups have become a family. They have each others’ phone numbers, support each other on social media and even go on outings. It’s amazing!
If you like this article, be sure to read the entire interview with bariatric dietician Lori Rosenthal, “How to Keep the Weight Off for Life.”
- Part 1, Lifelong Eating after Bariatric Surgery
- Part 2, Comfort Eating after Bariatric Surgery
- Part 3, Two Things that Will Ruin Your Weight Loss
Living larger than ever,
My Bariatric Life