Walking the walk

I recently started working at a hospital in Washington, DC as a bariatric dietitian. I work with patients who have excess weight to the point of being medically dangerous. Basically, my job is to help patients learn healthy lifestyle behaviors, skills, and strategies for weight loss and weight maintenance, while also preparing them for surgical intervention, if they chose it. Insurance companies that cover bariatric surgery all have their own requirements; across the board, though, they all require months of nutrition education prior to surgery. I have to say, I LOVE my job. It’s tough, but I am grateful for the chance to educate and motivate patients who are really struggling with their own health and well-being. I am NOT pro-surgery. I am NOT anti-surgery. I am all about behavior change. With or without the surgery, every single patients needs to take care of their minds and bodies, learn their triggers, practice making healthy decisions, and prepare for obstacles that they may face. I get to teach classes and provide counseling to patients who are just making the first steps in the process, folks who have just had surgery, and others who had surgery years ago and just need a little motivational encouragement. Part of the education process includes walking patients through the various diet stages. There’s the Pre-op Diet, the Stage 1A Clear Liquid Post-Op Diet, the Stage 1B Full Liquid Post-op Diet, the Stage 2 Soft Foods Diet, and the Stage 3 Maintenance Diet.

Last week, the nurse practitioner at my clinic came into the dietitian’s office that I share with another Registered Dietitian (RD) and asked if we’d be interested in trying out the pre-surgery (“Pre-Op”) diet that we prescribe to patients for the 2 weeks leading up to surgery. The idea of the high-protein, low-calorie, liquid “Pre-Op” diet is to jump start patient weight loss, shrink the liver and abdomen, and clear out the digestive tract for the operation. It’s mostly protein shakes, unsweetened applesauce, sugar-free Jell-O and pudding, broth, and oatmeal. Not a whole lot to it. AND they have to continue it for 2 weeks after surgery while their bodies heal.

People complain about the diet, and I don’t blame them. It’s a lot of sipping, very little chewing. Some patients get headaches from the lack of sugar or caffeine. It’s tough, but it’s truly only a small taste of the hoops that patients have to jump through after surgery. The discipline is somewhat forced after surgery with the restrictive size of the stomach and the, sometimes violent, reactions to the “wrong” foods. That’s why it works. I don’t think people are truly prepared for the lifetime of restriction that comes with surgery; it’s not easy, but it’s strict regulation of food intake which is something that some people really struggle with.

Anyway, I loved the idea of giving this diet a shot. I’d like to be able to provide concrete, experienced guidance to my patients. For instance, I’ve already learned that these protein shakes are not cheap! So, the three of us are trying the Pre-Op diet this week for 5 days starting tomorrow! I went grocery shopping this morning, and to be honest, the contents of my cart made my stomach turn a bit. I am a “real food” RD. I don’t like the idea of replacing actual food with protein shakes and bars. I keep Luna bars and Kind bars on hand as snacks, just in case I have to go too long between meals at work or on the road, but I opt for whole food whenever possible. I recognize that these are first world issues, but this will not be easy. Today, I bought two different kinds of ready-to-drink protein shakes, yogurt drinks, some Jell-O, low-fat soup, and broth. I also bought sugar-free gum, because I KNOW that I will need something to chew. I have some unsweetened soy milk at work, as well as a couple no-sugar, stevia-sweetened beverages. Needless to say, my other half is not thrilled about this adventure, as he knows I am grumpy when I’m hungry…

Oh lordy, wish me luck!

I’ll check in daily to document the process with photos of my “meals.” Guess I need to work through some of my solid food leftovers tonight!

Have you ever done something to be able to relate to people a bit more? One of my friends tried a diabetic insulin pump (with saline instead of insulin) to understand what some patients with diabetes go through! I tried the SNAP challenge earlier this year, which aims to demonstrate just how hard it is to live on a food stamp budget. That was an eye-opening experience. I’d love to hear if you’re done anything similar.

Stay tuned for updates!

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