Success Habits of Weight Loss Surgery Patients

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‘The Success Habits of Weight Loss Surgery Patients’ by Colleen M. Cook has become a bariatric bestseller and the research-based principles taught here continue to be a standard for success throughout the bariatric community. These principles are now taught in hundreds of bariatric programs all over the world and are recommended by many Bariatric Centres of Excellence, surgeons and bariatric health professionals (including ourselves).

In this article, we have provided a summary of the book’s guidelines on how to lose weight following the surgery, and more importantly, forming good habits to maintain your weight loss long term. (Summarised by Psychologist Fiona Tzouramanis).

Habit 1: Personal Accountability

Be responsible for your own success, remember bariatric surgery is only a tool, the rest is up to you.

Regular weighing keeping yourself in check (on average once per week)
Set a day and time to weigh yourself regularly each week
Select a weigh-in location – home, office, gym
Create a weight loss chart to track progress
Set a weight loss goal and write it down
Set a goal weight and then a warning weight goal (2.2kg – 3.2kg) above your weight.
Set a weight goal that you are comfortable with – look for someone similar in height and frame to get a better idea.

Habit 2: Portion Control

One of the primary benefits of having weight loss surgery is that you now have the physical ability to feel full and satisfied on very little food, helping to reduce the amount of calories we consume. It is important to learn to recognise what “full” feels like. It is important to learn to stop eating when you are feeling full and equally important to learn to eat enough.

Eating and feeling full is important as then it stops the grazing through the day which can lead to higher calorie intake. We need to understand the difference between “hunger” which is the primary physiological drive to find food to eat and “appetite” which is the desire to eat which has little to do with nourishment.

The foods we choose to eat play an important part in how long we are able to stay full. For example the more protein a food contains the longer it will satisfy. Eating solid foods is important, including legumes.

Slow down the emptying of the stomach/pouch by avoiding liquids for 15 minutes before eating and 1 1⁄2 – 2 hours after eating
Adequate protein is needed with each meal
To measure the size of your pouch do the Cottage Cheese Test** (www.bariatricsupport.com) to guide you on how much you need to eat per meal.
Take 20-30 minutes to eat your meal – as it takes time for your mind to recognise the signal of satiety (feeling of fullness)
Eat only – learn to sit down to eat and enjoy your meal
Chew your food thoroughly to aid digestion
Use a small plate and small utensils
Measure your food
Eat protein first
Avoid grazing

Habit 3: Nutrition

Protein (70% then 50%) – our body digests protein more slowly than other foods and protein stays in our system longer. Your diet should primarily contain protein.

Vegetables (30%) – Vegetables are an important and essential source of vitamins, minerals and fibre, which are low in fat and calories.

Understanding Carbohydrates – during the weight loss phase following weight-loss surgery, patients are encouraged to eat 70% protein and 30% vegetables and eliminate refined carbohydrates from their diet (specifically bread, pasta, rice, potatoes, chips, cookies, candy, cakes etc). In doing so, the body is encouraged to utilise its fat stores for energy.

Carbohydrates are classified into two categories: complex and refined carbohydrates. Complex carbohydrates require our body to work to break them down into a simpler form. Vegetables are complex carbohydrates and are an important source of energy. Refined carbohydrates require little digestion and are too quickly absorbed. They come with lots of fat and very few vitamins. Once you have reached your weight goal you can slowly reintroduce refined carbohydrates in moderation. If you start to put on weight then refined carbohydrates must be the first to go.

Fat in a limited quantity is important for our bodies. The body requires fat to maintain good health. Things such as a strong immune system, healthy skin and hair and the ability to clot blood normally all depend on sufficient stores within the body.

Habit 4: Fluid Intake

Weight loss surgery patients are encouraged to avoid eating and drinking at the same time for one primary reason; our need for satiety. So if the aim is to feel full on little food then you don’t want to eat and drink at the same time or drink right after you eat, as it will flush the food out of your system quickly. The consequence is that you feel hungry again sooner than you should, then you will eat sooner than required resulting in greater calorie intake and weight gain.

Coffees, Teas, Energy Drinks – can cause ulcers and inflict damage to the stomach pouch. Studies have shown that caffeine increases psychological stress, perceived stress and increases blood pressure (physiological stress). If we have a stressful job and drink caffeine this will enhance the stress experienced. When we are stressed we may likely reach for food as a way to self-sooth and make us feel better. Caffeine is also a stimulant and has been known to increase hunger! It is known that caffeine contributes to calcium loss in women. As a weight loss patient it is important not to consume anything that would limit the capacity to absorb essential vitamins and nutrients.

Alcohol – alcohol is often high in calories and can be rapidly absorbed in weight loss patients. So you may get intoxicated much more quickly than expected.

The importance of water – when your body is dehydrated, fat cells become rubbery and cannot easily metabolise. This means that it is harder to lose weight when you don’t drink water. Water helps us maintain proper muscle tone, improves our skin and hair, helps the body get rid of waste and harmful toxins. It increases our energy levels, suppresses our appetite, and helps to maintain our weight. You must drink water between meals!

Carbonated drinks – do not drink them as they cause 1. stretching of the stomach and if it is stretched the ability of feeling full is compromised and overeating is usually the result, 2. increased calorie intake, raising insulin levels and increased hunger, 3. many of these drinks contain caffeine which is an appetite stimulant.

Habit 5: Regular Exercise

Exercise is very important for weight loss and maintaining weight loss – Just do it!

Reward yourself when you do exercise, not with food!
Find a training partner
Join a group fitness program as other people can help with motivation
Consult with a personal trainer
4 times per week for at least 40 minutes each session
Exercise is also important for health reasons such as stimulating blood flow, stimulating growth in muscle and bone, relieves fatigue and helps prevent and fight disease.
A combination of aerobic and strength training is best.

Habit 6: Vitamins & Supplements

Multi-vitamins and a calcium supplement daily
Some people have to take vitamin B12 and iron supplements
The smaller size of the stomach along with a diet and less calories consumed means fewer nutrients are eaten
There is less contact with stomach acid, and some nutrients require acid for processing
There is less contact and less production of a substance called Intrinsic Factor which is needed for vitamin B12 absorption
Many important nutrients were absorbed in the duodenum, so they become deficient when the duodenum has been bypassed. Iron is absorbed in the duodenum and upper jejunum. In many cases the duodenum has been bypassed and therefore patients often struggle with low iron
Do your blood test annually and/or as regularly as directed by your doctor.

For more information on Vitamins and Supplements, talk with your doctor, practice nurses and dietician.