Hi. I’m Jessica Snyder, a registered dietician and outpatient nutrition director. I look forward to helping you get back on track, and back to the basics, so that you can achieve optimal health and nutrition, post-surgically from your bariatric procedure.

Today, we’ll be discussing how surgery changes your physical body, but also how your lifestyle changes such as your dietary, emotional and behavioral changes, take time to develop. We’ll be discussing weight regain as it is possible, for you to forget the back to basics, and unfortunately go back to old habits. We do want to keep things simple. So make sure you’re working on changes one at a time, and keeping realistic with what those changes look like. We know there are challenges, and we’re here to help you accomplish those challenges, and really navigate through those. We always encourage that you go back to the rules, of the tool though, as it’s important to remember how to use that tool, for your bariatric surgery. It helps you to achieve ultimate weight loss success. Of course, knowledge is power, and we want to help you succeed. So we encourage you to keep learning, as well as stay connected. We know that clients who stay connected, are much more on track with their weight loss, and health goals.

We know that there are adjustments to these rules, of course, as now you are on the solid food plan, and there are individual food preferences, as well as tolerances and volumes, that you may need to be adjusting for. These are the following rules of the tool buckets, that we will be discussing. We will be discussing fluids and hydration, what are adequate meal timings as well as volumes, what should your meal be made up of, what are your eating behavioral guidelines, what about supplementation at this point, and what about activity, as well as exercise? With your fluids, it’s crucial to maintain proper hydration. Are you getting adequate fluids, of at least 60 to 80 ounces a day? That’s two to three liters a day. Are you making sure, that you separate your liquids from your meals? Remember if you’re not separating your liquids, from your meals, this is gonna cause food, to go through your pouch a lot faster, making you feel hungry sooner. Also making sure you know what you’re drinking. Remember, liquid calories add up really quickly. So whether it be the creamer in your coffee, or the beverage that you’re consuming, that you think you need to take an extra look, at that food label for, really thinking about what are you drinking, encouraging no caffeine, no carbonation, no calorie-rich beverages and really no protein drinks. Protein drinks at this point, are for emergency purposes only. For example, if you’re sick, and you don’t have time to eat a meal, or don’t feel well enough to eat a meal, it’s not really intentional, that we should be doing protein supplementation, at this point. Also, your meal timing and meal volume is really important to address. You should be eating denser proteins. Those are things that are going to help you, feel fuller longer every two to four hours. Of course, volume depends on your pouch size, and your pouch size will gradually increase over time. You don’t want your pouch to stretch too quickly, by overfilling your pouch or overstuffing your pouch. And typically about one year out, a pouch sizes between four to eight ounces in volume. Once again, we measure your volume in a measuring cup, not on a food scale. A food scale is not appropriate as that is done by weight, and we’re really trying to do volume restriction, by the tools guidelines.

It’s also best to consume small, frequent meals, throughout the day to make sure, you’re getting adequate nutrition. (5-6 meals per day), This helps to prevent stretching of your pouch. It also keeps your metabolism (energy-burning) high, by making sure you’re fueling your body and your muscle mass with adequate protein and nutrition. And this avoids binging later. If you skip meals, most of our clients will find that, if they skip meals, they often will binge later, and overdo their volumes, overdoing their nutrition and overdoing their limits. However, we do set standards, and we want to make sure you’re not grazing. Grazing is where you eat throughout the day, most of the day, small, frequent meals, where they’re not really nutrient-rich. So avoid grazing. Every single time you eat a food item, you should consider it a mini-meal, and it should be pre-planned, also portioned out. So think of it as five to six mini meals a day, versus grazing or restricting your eating, to where you’re then binging later. So I always encourage our clients to focus on, within the first hour or so of waking up, making sure you’re getting your protein, and produce-rich meal, and every three or so hours thereafter, so that you get those 5-6 six protein-rich meals in per day.

Remember, protein is still a big component, of what you need to be following. 75% of your diet meaning 60 to 80 grams of protein a day, should be your focus. Logging your protein can be helpful, and getting back on track with your nutrition, even keeping a food journal, and then using different tools, resources, and apps to help you keep accountable to your protein goal, of the 60 to 80 grams of protein per day. There should be only about 25% of your diet, from complex carbohydrates. Remember complex carbohydrates are going to be things, like your fruits, your vegetables. If you are doing grains, then make sure they’re whole grain, of course, but protein comes first and complex carbs come after. A good rule of the tool, I say, is protein and produce at all of your meals, making sure you get good nutrition and also good protein, of course. Remember that your protein is typically in animal meats, one ounce is about seven grams of protein. So a good visual for that is about the size, of your index finger. One ounce is about seven grams of protein. So if I’m eating three ounces of meat, that’s about the size of a deck of cards, seven times three is 21 grams of protein. Denser proteins will fill you up much quicker, than softer proteins, like yogurt, like cottage cheese. When we talk about plant-based proteins, so for example, if you’re a vegetarian, or if you’re trying to follow a more plant-based diet, you want to make sure, that you’re still getting enough protein in, because one ounce of plant-based protein, only has two to three grams of protein. So you want to make sure, if you’re following a plant-focused diet, you’re still getting adequate nutrition from your protein. Once again, protein should be 60 to 80 grams per day, minimum to prevent deficiency. Also, it helps to keep your energy levels up, making sure you get adequate amounts. So you don’t want to be fatigued, by skipping out on your protein. Protein helps you to stay satisfied, and it’s really the best tool or fuel, for you to have optimal weight loss, as it does help to support your muscle mass, and drive your metabolism. Once again, as a reminder, protein foods from animal sources are great to keep low fat, once again, lean proteins, avoiding things like high-fat bacon and sausages, and salamis as those really are very fatty, and high in calories and not so great in protein. Animal proteins that you might want to consider, are things like egg whites or egg beaters, cottage cheese, low-fat dairy or non-fat dairy, Greek yogurt, fish such as shellfish, salmon, tuna, tilapia, cod, poultry like lean turkey, chicken, pork that’s low in fat like pork tenderloin. Anytime you see the word loin, whether it be in pork or beef, you’re choosing a lean source, so sirloin for beef, also lean roasts, those are all great options. Also with your plant-based proteins, once again, they’re not as much protein per ounce, but they still do contribute to your protein count. Things that you would consider would be things, like beans and lentils, nuts and nut butters, soy products like edamame, tofu, or tempeh. Once again, many of these foods contain carbohydrates, and fat. So you want to make sure you’re getting, a low-calorie high-protein source in.

Label reading is really important at this time. One of the things we encourage you to do is use the RPV. This is the relative protein value. This is where you take the total calories, of a product that you’re eating, and you divide it by the grams of protein. So let’s use 200 calories for example, and it has 10 grams of protein. So what we’re gonna do is we’re gonna take 200 calories, and divide it by the grams of protein. Also making sure you look at the serving size, that you will be eating. And the rule is if 15 calories or less per gram of protein, that would be considered the best fuel source, as it’s the lowest calories for the highest protein. This means it’s more nutrient-rich. No more than one to two high-fat food choices per day. This is really important. And I see a lot of our clients slip up here. Counting your fat grams and making sure, that you’re not eating more than eight grams of fat, per mini-meal or 48 grams of that on average per day, is a really great way of assessing if you’re eating too much fat. Always be careful of your fat sources, try and choose healthier fats, but still keep your portion sizes in check. Look for these things on your food labels. As often fats and carbohydrates are added to your food. We’re still trying to say, less than 15 grams of carbs per meal, less than eight grams of fat per meal. When we’re talking about the relative protein value, this really discusses what we started to talk about, in the previous slide, where we’re trying to get the most bang for your buck. Good sources are going to be 10 calories, for every gram of protein or less, moderate calorie protein would be 11 to 19, high calorie per protein would be 20 calories, per gram of protein. So once again, if we take that protein bar, and we say 200 calories divided by 10 grams of protein, we’re getting a low-calorie, good protein choice. Once again, this would be optimal for us to be consuming. But if the bar had 200 calories and only one gram of protein, this, unfortunately, would be a high-calorie choice, low protein, not great for us to be consuming. During this time, it’s also important for you to know your portions. We encourage measuring cups to aid in portion control. Once again, not the volume of weight on a food scale. So measure out your food, and the volume therein. Portion foods out ahead of time. So some of our clients will use pre-portion containers, to help them stay on track or a little muffin tins. That helps you to ensure, that you’re getting adequate serving sizes. You can even invest in appetizer plates, or smaller servings so that your plate looks more satisfying, and use the visual guideline if you need to if for some reason you can’t measure it out. For example, one ounce is about the size of a matchbox or a dice. Three ounces is about the size of a deck of cards or a bar of soap. If you’re looking more at something, like a piece of fish that’s flat, you could use a checkbook as a good visual for three ounces. Once again, that’s in length as well as in width, for both of those items. And then when it comes to two tablespoons, if you were measuring out something like peanut butter, that’s about the size of a ping pong ball. And one cup would be about the size of the tennis ball. Of course, eating behaviors and guidelines, are really one of the biggest challenges, that many of our clients face, as it’s easy to fall back into old habits.

Changes take time to develop. And we know that your tool is most effective, during the first and second year. So it’s really important that you get back on track now, and start building these back to basic habits, into your routine. Be careful of those personal triggers, such as social events, emotions that may lead you to eat differently, like stress or boredom, also maybe people that you’re socializing with, that could challenge you and entice you to eat out, more often or eat sweet treats more often, trying to really address that, and then comfort foods or cravings. These are all important things for us to address, and make sure we’re avoiding those personal triggers, as everyone has them. Everyone’s journey is different. So don’t compare yourself to others. Really know yourself. Know what you can improve upon and what challenges, you face. For behavior changes, we encourage setting aside 30 minutes for meals. Try and do no TV, no distractions, while eating as this can lead to overfilling your pouch, and really what I call the fork to mouth syndrome, where you’re really unaware of the fact, that you’ve overeaten. It’s important for you to feel satisfied, but remember your brain takes about 20 minutes, for you to get that signal that you’re satisfied. You don’t want to be full or stuffed. So once again, listen to your body, but slow down, really assess that situation, assess that time, and assess if you are satisfied, Take small bites and chew your food really well. Once again, you might’ve heard this before, but smaller utensils such as baby spoons, cocktail forks, smaller plates can be really helpful, in taking smaller bites and using smaller portions, and even the sensible guideline, of putting your fork down between bites can be helpful. Some of our clients will also set a timer for their meals. If you are the type of person that forgets to eat, maybe set an alarm on your phone, that reminds you to eat every three hours so that you don’t skip meals and then binge later on, or if you are rushed and you constantly are shoveling, your food into your mouth, then once again, slow down and maybe set that timer, for 20 minutes before you really even question, “Am I satisfied or not?”. Chew each bite about 20 to 30 times. I know this seems laborious, but it’s an important way, for you to remember to slow down at meals. Your food should be about the thickness of applesauce before you start to swallow and digest it, and this also prevents food from getting stuck and avoiding things like vomiting, or unnecessary complications. Do a pantry makeover during this time, and really find out what’s lurking in your kitchen, that’s maybe derailing you. We really want you to focus on pantry makeover, fridge makeover, reducing: smaller portions and having smaller plates and, utensils, choosing appropriate food substitution, and making your home a safe place for you. If you have family or friends in the house, that is derailing you, talk to them and maybe set their pantry separate from yours. You want to create a healthy kitchen and remove trigger foods. Too many options can often cause inappropriate choices. If you’re really craving something, and you really want to have a treat, schedule your off time, make it a part of a meal, make sure your protein is put first, and don’t keep it in your home if it’s a trigger. If it’s something that you know you struggle with, whether it be chocolate or whether it chips, once again, don’t make it in your home environment, and plan out your cheats.

We know that you’re human. We expect that you’re gonna have these treats, but once again, limit them, try and make them less often, and not a part of your healthy kitchen. Also address head hunger. I always ask my clients, “Are you really eating, for physical hunger or emotional hunger?” and assess the difference between those two things. This will help to prevent grazing as well as binging. And you can really work through some of these challenges, that you might be having by assessing physical hunger, versus emotional hunger. We encourage you to, of course, eat every two to four hours to prevent grazing, and once again, set meal times for yourself.

For supplementation, I know that sometimes we forget to go to the grocery store, and pick those up or they fall off of our ordering list, but it’s important that we stay on track, with our supplements. For your multivitamins for gastric bypass, you should be taking them two times per day the dose. You should be taking sublingual B12, 1,000 micrograms per day, or you can do the nasal injections or the intermuscular injections. Calcium citrate, 500 milligrams, three times a day is ideal, and vitamin D, 2,000 IUs per day. For a gastric sleeve, you take your multivitamin once per day, calcium citrate, two to three doses of 500 milligrams, once again, broken up, so 500 milligrams in the morning, 500 milligrams at lunch and 500 milligrams at dinner. B12, 1,000 micrograms per day, vitamin D, 2,000 IUs per day. For duodenal switch, you really want to focus on making sure, you get your multivitamin in twice per day, iron 30 to 60 milligrams per day, fat-soluble vitamins A, D, E and K as listed below, and making sure you stay on track with these, as it is important to make sure you get optimal nutrition. Additional supplements may include fiber. This can help with digestion. So two to three doses of three to five grams of fiber, in an addition to your normal food, will help out with digestion. This can be over-the-counter powders or pills. Oftentimes, we’ll encourage you to mix the powder, into your water and sip on it throughout the day. And once again, you can do up to 15 grams, of fiber supplement throughout the day, to help your digestion if needed. Omega 3 fatty acids, which are fish oil are recommended. Two brands that are liquid are Coromega or Nordic Naturals. And these are good brands, as they have good amounts of EPA and DHA, although other brands can be found, and this helps to decrease inflammation. And then other supplements, that we encourage you to take may be based off of your lab results, such as iron, B6. And once again, this is why it’s really important, for you to make sure you’re getting your labs drawn, every year and make sure that they’re really checking, those vitamin panels so that you prevent deficiencies. This is an example of your supplement schedule. Oftentimes, clients will say, that they break up their supplements between breakfast, their mini-meal number three, their mini-meal number four, five, and six, and this helps them to stay on track. And many of our clients find that pill containers, are helpful so that they know, did they take their supplements and are they making sure, that they have adequate amounts for the week? Exercise helps you to lose and maintain weight loss. So although many of you have maybe said, that you’re starting an exercise routine in the beginning, now is a great time for you to revamp, and reevaluate your activity. The main way for weight to come back on is by not engaging in activity, as this causes your metabolic rate to decrease. And unfortunately, it’s something that you’re battling against. So we’re really encouraging that you make exercise, a part of your daily routine. Set realistic weekly goals, and schedule you time. Many of our clients will find, that if they make an appointment with themselves, as it would be like you would make an appointment, with your doctor or make an appointment with your dietician, that they’re more likely to keep it. So make an appointment with you today, for activity or exercise and determine the length, of the activity and what activity you’re going to be doing. So you could even say, “At 10:30 today, I am going to go on a brisk walk, or at 10:30 today, I am going to do a bootcamp video.” Those are types of things that will help you, to stay on track by budgeting in that you time. And also reassess, is that exercise getting too easy?

As you get stronger, it’s important to revamp those exercise routines. And if you’ve had an injury, is it time for you to start to rethink, about what you can do instead of focusing, on what you can’t do. Your exercise routine should change, about every six to eight weeks, as your body gets accustomed to the same routine, day in and day out. So unfortunately over time, it will not have the same effect, on your metabolism. So now is a great time for you to start thinking about, “Should I be changing the frequency in which I do exercise, the intensity so how hard I work, maybe the type of exercise that I’m doing?” So instead of walking, maybe I’m gonna try walk and jog, or maybe I’m gonna incorporate lifting into my routine, or focusing on time. Maybe instead of a 15-minute walk, I’m gonna start going for a 30-minute walk. Once again, adding weight training, changing up the time, intensity, frequency, all of these things will help you to not only be excited, about your exercise routine, but help your body to stay challenged, and keep your weight loss accelerated. Stay connected, of course. We want to help you through these challenges, that life gives you. So we encourage your follow-up with your doctor appointments, as well as your lab work.

We want you to stay supported with in-person visits, and we also offer virtual or telemedicine visits, as well as teleconferences, and then your registered dietician visits, which can be done, once again, at your doctor’s office, over the phone or by telemedicine as well. So stay accountable or staying on track, and staying connected. Once again, making sure you take a look, at the whole picture. Should you be food logging again? Check out to make sure you’re getting adequate proteins, adequate fluids, not too many fats and not too many carbs. What’s your exercise gonna be? What’s the plan for that? What are you gonna start incorporating? What’s going to be different? With your supplements, make sure you take those daily. Don’t let them slip to the side. Address behavioral challenges, stay connected and keep focusing on success. We thank you, for joining us today for the Back to Basics video. We really, sincerely enjoy being a part of your journey. And once again, please reach out, should you have any additional questions or concerns.