The Nutritionist is WRONG! Please please help me.

fromfattytohealthy

Congratulations on your loss so far. If you have doubts about this advice or feel the nutritionist wasn't taking your concerns seriously, a second opinion from a RD is always a good idea. I think it is important to consider what is recommended for you might be different than for someone who has not had the surgery--at least in the short to medium term. So I guess I would consider the advice of someone who specializes in that area even if it sounds different to advice you see online or in other sources. I am guessing your nutritionist is actually trying to get you to eat a controlled amount just using a different approach than counting calories as you mention she suggested weighing your portions. And it sounds like she is trying to encourage a balanced diet. And to encourage you to stop worrying so much about the number on the scale...

. She suggested I eat low fat yogurt and I told her I wouldn't do that because the low fat yogurt is usually full of sugar. I eat very low sugar, extremely low artificial sugars, high fat and high protein for the calorie boost. She also said NO MORE protein shakes.

It depends on the yogurt. Flavored yogurt i.e. vanilla tends to be sweetened. I use to eat an unflavored, plain nonfat yogurt that had similar sugar count to other plain, unflavored yogurt--just the sugars naturally in milk. True, some lowfat processed foods have more sugar to make it taste good, but not always. Is there actually a difference in added sugar for flavored lowfat yogurt vs flavored full fat yogurt? Depending on the sweetener used, both would contain added sugars. You sound like someone savvy enough to compare food labels, so you most likely could find a healthy yogurt that is lower in fat.

If it is an option, a second opinion might be a great idea or even a follow-up with the same person to clarify the reasoning behind her suggestions. Are some of them specific to people with your surgery, for example. Does a high fat or high protein diet somehow cause a problem for people recovering from your surgery?

I was going to suggest plain, nonfat Greek yogurt. The sugars are usually low, the protein high, and still good for you. Besides, the sugars in regular flavored yogurt are ridiculously high. Come to think of it, I don't recall high sugars in light yogurts, but they use artificial sweeteners.

Quasita

I had bariatric surgery in 2006 and am in a similar situation as far as losing a lot of weight, then gaining some back, then working through MFP to get back to where I want to be.

I will agree that you should speak to a registered dietician because I'm a little confused by some of the information that the nutritionist is giving you. One of the first things the dietician at my surgeon's office tells us is to start keeping a food diary so that she can look to see what and how much we're eating, etc. etc.

Another thing that I was told was to "go back to the basics" with regards to using the tool of the surgery. Don't drink 1/2 hour - 1 hour before and after eating, chewing food enough, etc. One thing that your nutritionist and my surgeon have in common are that they are both opposed to protein shakes to get calories. My surgeon was very opposed to taking in liquid calories.

Also, have you tried to get in to see your surgeon and talk to him/her? If he is so focused on his upcoming cases that he's ignoring his other patients you may want to consider shopping for a different bariatric provider.

I think the diary statement is likely more about not keeping track of calories more than not keeping track of foods. I would guess they are saying stop the diary because she is so focused on weight and numbers, and not on the health of the body.

mcarter99

The PROBLEM is that I can't get enough healthy foods physically into my stomach to net over 600-900 calories a day after exercise.

I would ignore that 'net calorie' garbage. And I would listen to the pros about your protein intake. You have a special case. Collective MFP 'wisdom' could be 180 degrees wrong for you.

Bentley2718

Because you've had surgery, I wouldn't want to give any suggestions. Maybe a second opinion from a professional would be a better idea. Preferably someone who is an expert in working with people that have had the surgery that you had.

^^ This

Healthymom207

I'm curious to why she said no protein or not very much, is it because of your surgery?

becoming_a_new_me

Because your body no longer absorbes nutrients as efficiently as it did pre-surgery, I would opt to ADD ONE multi-vitamin packed shake once a day. I am not a believer in shakes but in your case, nutrients are more easily absorbed in groups. For example:

Calcium intake alone = body can't absorb.

But

Calcium +. Magnesium intake = body CAN absorb.

Set your caloric intake as per your body size and weight for safe weight loss for now, as you wait to get a second opinion.

PS: I am also not a believer in taking pills: vitamin, diet, herb etc. They are not regulated and 80% of them don't have the exact ingredients as specified. Studies have shown that people who take VITAMIN PILLS everyday live shorter lives than those who don't: http://www.huffingtonpost.com/dr-mark-hyman/vitamin-dangers_b_1018430.html

Bariatric patients have a hard time breaking down the additives in pill vitamins, so a whole foods supplement drink is defnintely the key. I take several supplements each day, but all of them are food-based with no extra additives so I get the majority of my nutrients from those. I suppose you could call me Ironman lol

geekyjock76

Your realistically attainable goal weight is mainly dependent on your lean body mass. For instance, if you're lean body mass is 112, then a goal weight of 140 would require you to be 20% body fat (which is a healthy and sustainable mark). But if your lean body mass is 130 and you wanted 140, then a 7% body fat percentage - which is needed -would certainly be not.

So figure out your lean body mass and it will provide an indication as to what a realistically attainable goal weight may be.

secretlobster

I suppose you could call me Ironman lol

Easier to just create a new element for your arc reactor core!

deaddawn

How tall are you? What is your height's normal BMI range? Are you tracking your vitamins and minerals? Are you getting enough? You are exercising a lot so what is your body fat %?

Before surgery, did the office do anything to address your emotional relationship with food? How you look at it? Did they address emotional issues regarding how you see yourself? You were morbidly obese so you obviously had an unhealthy relationship with food. Concentrating on portion control only is great for a lot of people. I know healthy weight people who swear by it. Personally it has never worked for me. It does not address the game going on in my head. Having one magic calorie curfew everyday does. I do look at proteins/fats/carbs and vitamins/minerals too. Keeping under a maximum amount of total calories without going too low does the weight loss trick for me.

One would hope that a dietician in a bariatric office is trained for your needs, but maybe a second opinion is in order? Your dietician should and probably is, looking at the total package. Weight and dress size is only one part of it. If, however, the way she is going about helping you achieve your best healthy self isn’t working, try a dietician with a different approach.

Also, how many hours are you exercising? What is recommended for someone who has had bariatric surgery? Your body now functions differently. Way too much exercise coupled with too few calories or portions can really wreak havoc on your metabolism and immune system if done indefinitely.

becoming_a_new_me

I suppose you could call me Ironman lol

Easier to just create a new element for your arc reactor core!

lol! First I have to find my father's notes!

mtaylor33557

Because your body no longer absorbes nutrients as efficiently as it did pre-surgery, I would opt to ADD ONE multi-vitamin packed shake once a day. I am not a believer in shakes but in your case, nutrients are more easily absorbed in groups. For example:

Calcium intake alone = body can't absorb.

But

Calcium +. Magnesium intake = body CAN absorb.

Set your caloric intake as per your body size and weight for safe weight loss for now, as you wait to get a second opinion.

PS: I am also not a believer in taking pills: vitamin, diet, herb etc. They are not regulated and 80% of them don't have the exact ingredients as specified. Studies have shown that people who take VITAMIN PILLS everyday live shorter lives than those who don't: http://www.huffingtonpost.com/dr-mark-hyman/vitamin-dangers_b_1018430.html

Bariatric patients have a hard time breaking down the additives in pill vitamins, so a whole foods supplement drink is defnintely the key. I take several supplements each day, but all of them are food-based with no extra additives so I get the majority of my nutrients from those. I suppose you could call me Ironman lol

Oh I SO Tony Stark!!

peachyxoxoxo

Hi there. I'm in school studying to be an RD. So first make sure you are working with a Registered Dietitian, not just a "nutritionist."

Second, I recommend looking at http://www.bariatriceating.com/ for recipes and support.

Also, take a look at this handout for info on protein powder: https://patienteducation.osumc.edu/Documents/protein-bariatric.pdf

^^ from the medical center at Ohio State. Here at our outpatient center we have a whole class for post-op bariatric patients to teach them about their new diet. Is there nothing like that in your area that you could try to attend? It's taught by dietitians and I think it's like a weekly class.

The other thing I wanted to mention was that it's fine to have lower fat yogurt, just choose the plain flavor, not one with lots of added sweeteners. I'm sure you know that you have to be careful of your carb intake to avoid dumping syndrome, as was mentioned elsewhere in this thread. You could always pick a plain, low-fat yogurt then mix in a small amount of some fresh chopped or pureed fruit for sweetness.

JenMull44

How tall are you? What is your height's normal BMI range? Are you tracking your vitamins and minerals? Are you getting enough? You are exercising a lot so what is your body fat %?

Before surgery, did the office do anything to address your emotional relationship with food? How you look at it? Did they address emotional issues regarding how you see yourself? You were morbidly obese so you obviously had an unhealthy relationship with food. Concentrating on portion control only is great for a lot of people. I know healthy weight people who swear by it. Personally it has never worked for me. It does not address the game going on in my head. Having one magic calorie curfew everyday does. I do look at proteins/fats/carbs and vitamins/minerals too. Keeping under a maximum amount of total calories without going too low does the weight loss trick for me.

One would hope that a dietician in a bariatric office is trained for your needs, but maybe a second opinion is in order? Your dietician should and probably is, looking at the total package. Weight and dress size is only one part of it. If, however, the way she is going
about helping you achieve your best healthy self isn’t working, try a dietician with a different approach.

Also, how many hours are you exercising? What is recommended for someone who has had bariatric surgery? Your body now functions differently. Way too much exercise coupled with too few calories or portions can really wreak havoc on your metabolism and immune system if done indefinitely.

AGREED !

fairc3jam

Because you've had surgery, I wouldn't want to give any suggestions. Maybe a second opinion from a professional would be a better idea. Preferably someone who is an expert in working with people that have had the surgery that you had.

Agreed! Maybe get a 2nd opinion. Your in a unique situation and should heed professional advise.

moxiecowgirl

I'm only a pre-op, so you can take or leave what I'm about to say, but I say it from the point of view of someone who has done a TON of research and is working closely with a team of medical professionals, including a therapist, a general practitioner, a gastroenterologist, and yes, a registered dietitian: PLEASE do not look for nutritional advice or validation from complete strangers on the interwebz!

The information you've gotten in this post alone is drastically conflicting and some of it is downright dangerous for a post-op bariatric patient, not because people are actually out to hurt you, but because they want to help, but don't fully understand your unique nutritional needs. They are speaking from the standpoint of people who haven't had exposure to these issues, and only know what applies to the average person. At best, some of them are making "educated" guesses, some of which are pretty close to being on target, but they're not quite there.

Myself, I disagree with a few things that your nutritionist is telling you, but I agree with other things she said. I won't say what things those are because I'm NOT a registered dietician, but if you're not comfortable with her treatment plan, it's never a bad idea to seek a second opinion. Just don't be surprised if they match.

This journey is a learning process, for sure. It's important that you be fully educated and able to advocate for yourself to get the best treatment. Best of luck to you, and congratulations on some truly impressive success already!

tconklin

I agree with a lot of these posts... Get a second opinion if you feel you can't connect with this individual. Obviously, if you are not seeing results and feel like you're doing something wrong then by all means find someone to give advice that will work for you.

I have been seeing a dietitican as well and she told me to stop focusing on the scale too. I think the point they were trying to make was to stop getting hung up on a NUMBER. You need to focus on wellness and how you want to feel inside and out. Your best YOU may at 150, who knows... you don't know until you reach it but if you keep focusing purely on a number then you are missing the point of being healthy.

itsuki

You've had surgery, we are not doctors. If you don't like what your nutritionist has said, see another doctor and get a second opinion. Keep in mind it might be the same opinion as the first.

Doctors have had years (sometimes decades) of training and they know exactly what your surgery has done to your body.

We're just a bunch of people on the internet.

WendyTerry420

I think you should give yourself plenty of time to be comfortable at your new weight and not worry so much about your BMI, at least for now. Any kind of surgery like that takes a long time to heal.

But it never hurts to get a second opinion, whether it's a nutritionist or doctor or any professional. I wouldn't stress over it. Stressing yourself out will exacerbate the situation.

Also, as far as logging, if it makes you feel better, then keep doing it. There is no harm as long as you don't stress over it.

Laurie1267

How tall are you? What is your height's normal BMI range? Are you tracking your vitamins and minerals? Are you getting enough? You are exercising a lot so what is your body fat %?

I'm 5' 4" tall. BMI today at 178 lbs. is 30.55 obese. Normal BMI range in pounds is 109-146. Yes, I'm tracking vitamins and minerals. I don't know my body fat %.

I appreciate all the good advice and recommendations. A second opinion is definitely in my future.

becoming_a_new_me

You've had surgery, we are not doctors. If you don't like what your nutritionist has said, see another doctor and get a second opinion. Keep in mind it might be the same opinion as the first.

Doctors have had years (sometimes decades) of training and they know exactly what your surgery has done to your body.

We're just a bunch of people on the internet.

Just as an FYI...when I approached my surgeon with similar questions, he literally told me that I know more about nutrition and eating than he does...that is not what he studied and that if I have concerns, I should go to the RD who did study it. He was nice about it, but admitted straight up that it is not a focus in medical school.

moxiecowgirl

How tall are you? What is your height's normal BMI range? Are you tracking your vitamins and minerals? Are you getting enough? You are exercising a lot so what is your body fat %?

I'm 5' 4" tall. BMI today at 178 lbs. is 30.55 obese. Normal BMI range in pounds is 109-146. Yes, I'm tracking vitamins and minerals. I don't know my body fat %.

I appreciate all the good advice and recommendations. A second opinion is definitely in my future.

Another crazy thought: is it possible you've gotten taller since you lost weight? I know it sounds weird, but increases in height of an inch or more in bariatric patients are not as unheard of as you might think. When the pressure on the spine from excess weight decreases, people stand up straighter, resulting in taller height measurements. That's oversimplifying it, but you get my drift!

At 5'5" and 178 lbs, you'd be in the "overweight" range, with a BMI of 29.6, per this calculator: http://www.nhlbisupport.com/bmi/

Captain_Tightpants

I'm 5' 4" tall. BMI today at 178 lbs. is 30.55 obese. Normal BMI range in pounds is 109-146. Yes, I'm tracking vitamins and minerals. I don't know my body fat %.

Just a word of warning - if anyone on here gives you specific numeric advice regarding BMR or TDEE based on this information, definitely double check it with a medical professional. Calculations based on standard metabolic equations will be way off in post-bariatrics.

marshan1970

Personally, 140 lbs was too little for me and focusing on it caused me to be very, very depressed and eat. It took me almost a decade to pull myself out of it. In 1988 I weighted between 175-180 lbs., I'd lost over 80 lbs. I tried and I tried to loose more. I was in a size 13/14. Everyone told me I looked awesome, the professionals told me not to stress over it. But I did!

Last month I finally went back to the dietian. I was guessing I was probably up around 300 lbs. I wished I was wrong. I weighted in at 327.8 lbs. Now I wish I was only 180lbs. I'm starting my journey again. If I reach 180 lbs I'll jump for joy! But if I can't make it, as I'm almost 25 years older, I'll just be happy for the weight I can loose.

You should be so proud and happy of yourself. You have done sooooooo will! Be proud! Enjoy your new weight! If you're meant to loose more your body will let you. But for now just enjoy your new body and being happy!!!!! :-)

DrMAvDPhD

Maybe your nutritionist said these things because s/he is worried that by tracking your calories, you are forcing yourself to eat too little. You see numbers over 1200 and convince yourself you are full and can't possibly eat anymore, and are becoming malnourished. My entire family besides myself has undergone the lap band surgery and have managed to lose weight while avoiding malnourishment. They do not eat a lot at one time, but are often able to eat more after a rather short amount of time. Having this surgery leads to malnourishment if you don't eat enough which can lead to even more health problems then obesity!

kehuizenga

I would suggest seeing a registered dietician.