Nutrition Managementof the Bariatric Patient:

Rosemary Mueller, MPH, RD, LDN, Advocate Weight Management and

Emily Schumann, MPH, MS, RD, LDN, Advocate LGH and Bariatric/ Metabolic Center

September 26, 2014

Breaking Down Barriers

Objective One: Understand the barriers

that bariatric patients’ face related to nutrition and weight management

Objective Two: Recognize the various

types of patients and how to best address their nutrition and weight management needs

Objective Three:

Learn key tips for improving your patients’ nutrition compliance and success at your facility or practice

Objective 1: Barriers to Nutrition Recommendations

Variable Stages of Change

Nutrition Myths & Mixed messages

“Do something different and the weight stays off.” Ex.,

raw food, gluten-free, eat based on your blood type, most

current T.V. celebrity’s advice – whatever is popular at

the moment.

“Just take a diet pill, tea, herb, colon cleanse, etc.

and you will safely control your appetite and burn

unhealthy fat without dieting.”

“You can diet and not exercise and still keep the weight

off.”

Common Denominator: Sense of shame or failure over repeated diet attempts and inability to maintain weight loss

“I really don’t eat that much..just don’t understand why I cannot lose more…must be my thyroid.”

Denial is an ineffective way of coping with painful emotions and embarrassment

about body size and weight.

Minimizing and Distortion

Portion Distortion: “What is there, I eat, and what is there is not necessarily what I need to eat.”

Objective 2: Addressing Different Types of Patients

 Type of Patient  Description Best Diet Approach 

The Rule Follower Follows all instructions to a “T”

Give sample meal plan and/or encourage specific changes

The Just Gets It Understands concepts- can understand moderation and is reasonable with choices

Ask questions to find an area of improvement (diet recall) to help pt recognize need for change

The Know-It-All Does not follow directions, gives up easily, claims they have tried everything, nothing works

Encourage small change first and explore desires to make changes

The Firecracker Excited about changes, easily motivated, does well at first, then back to old habits

Encourage 1-2 changes at a time and follow up often.

Open-Ended QuestionsAssessment Phase:

What are your health concerns?

How do you see your food affecting your health?

How does your day go with respect to food?

How do snacks fit in?

Could you describe what your house is like at dinner time during the week?

After Providing Information/Advise:#59):

What is your response to this handout/information/suggestion?

How do you see using this information?

What are your thoughts?

How might your life be different if you were to do this?

Patient Expresses Motivation to Change:

What steps are you ready for?

What do you see as your next steps?

Where do you want to go from here?

What do you see yourself doing this week?

After planned action:

How might you do that?

How do you see yourself doing this at home? During the weekdays?

What could get in your way? What else?

© 2011 Molly Kellogg, RD, LCSW www.mollykellogg.com

Objective 3:Most Important Nutrition Tips to Tell Patients

Key Tips

Frequent, smaller meals- 5-6/day

Protein at each meal to assist with satiety and sensation

of fullness

Track your intake

Mindfulness and learning to discern hunger and fullness

cues; slowed eating speed

Key Tips

Rethink your drink

Adequate fiber through vegetables, fruits, whole grains

Refer to a dietitian

Food journaling: facing facts

Sample Food Journals

Time Food Item(s) Portion Size Length of Meal (Goal 25-30 mins)

Name:_________________________Date: __________

Dietary Log:

So why don’t our patients journal their eating and exercise?

It is self-confrontational.

It takes some time and effort.

It destroys “magical thinking” and makes one accountable

for changes in weight.

Some patients are embarrassed to share this with their

dietitian or other health professional.

Keys to overcome this barrier: Encouragement

Accountability for journaling

Non-judgmental evaluation by health professional

Specific and personalized recommendations

Application: Patient Presentation Frank, 44 year old male with arthritis in knee causing

mobility issues. Family history of heart disease. Pt

reports knows he should probably lose weight but he likes

food too much and can’t stand “all that healthy stuff”.

He says he knows you are going to tell him to eat less

and more things that taste like grass. Weight has been

gradually increasing over the last 10 years.

Application: Patient Presentation Susie, 53 year old female with DM, HTN, BMI: 48 has tried

Phentermine, Cranberry cleanse, and currently taking

Garcinia Cambodia extract that she heard about on Dr. Oz.

Has tried over 25 diets but only ever lost 5-8 lbs and gains

back weight plus some. Pt feels she doesn’t eat that much

food during the day (only eats breakfast and dinner) so

doesn’t understand why she can’t lose weight.

Our Role as Health Care Providers

Our Objective: Restore hope, assist as change agents Let patients know you care

Speak/inform/educate with frankness regarding

nutrition/health risk

Frequent visits- accountability is key

Speak/inform/educate with respect about nutrition

behaviors that need to change

Correct myths/distortions and provide guidance and tips

for incorporating appropriate health behaviors

Summary Understand where patients might be coming from and

barriers they have or will face

Recognize that each patient is different

Ask open-ended questions and permission

Provide key tips to help them with behavior changes for

weight loss

Refer to other professionals

References: 1. “Transtheoretical Model of Behavior Change”, James

Prochaska, Ph.D.

2. Kellog, Molly. (2011). Counseling Tips for Nutrition

Therapists Series 2011. Tip #108: Forming Effective Open

Questions. Retrieved from

http://www.mollykellogg.com/archive11.html#108.

Questions?