Greetings!
As the nation's obesity rates rise, we can expect to see more people turning to weight loss surgery. This newsletter provides some guidelines for you to help those who have had weight loss surgery assure an adequate and appropriate dietary intake in our health care communities.
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Weight Loss Surgery Nutrition Guidelines |
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Most diet manuals in long term care don't include a "post bariatric surgery" diet. How are we meeting the nutritional needs and individualizing the nutritional care of this special group with specific dietary needs? Here are some of the concerns for the patient with a history of weight loss surgery:
- There is no standardized diet; regular menu/portions will not work for this resident
- Possible wound healing issues
- Problems with tube feeding
- Difficulty in meeting protein needs
- Would the Heimlich work in a choking situation?
- Incomplete medical history - will we even know they had weight loss surgery?
- Malnutrition and malabsorption will follow them to the facility
- Malnutrition may impact healing and recovery of future surgery or fractures
- How will we handle the dementia resident?
- How do we care plan their special needs?
When assessing the nutritional needs and developing a nutritional plan of care for a resident who has had weight loss surgery, it is helpful to know what kind of surgery they had. The Roux-en-Y (gastric bypass) procedure will have different long term dietary adjustments than the laparoscopic adjustable gastric banding (lap band) procedure.
Patients who have had Roux-en-Y may experience abdominal pain and pressure and dumping with intakes of regular volumes of food on our LTC menus. General dietary guidelines for residents who have had Roux-en-Y surgery include:
- Consume nutrient dense fruits, vegetables and whole grain high fiber foods
- Limit starchy vegetables
- Choose mono and polyunsaturated fats
- Eat protein rich foods with at least 20 grams of protein per meal or 60-90 grams/day
- Avoid concentrated sweets
- Don't drink with meals; stop fluids 30 minutes-1 hour before a meal
- Consume 64 oz. daily of calorie-free/non carbonated fluids between meals
- Don't graze; eat 3 meals per day and avoid snacking
- Maintenance diet should consist of about 1 to 1 ½ cups of food per meal
- Take small bites, eat slowly and chew thoroughly
- Take a multivitamin/mineral supplement daily
Many patients who have had Lap Band surgery have problems with vomiting and reflux. Some general dietary guidelines for these residents include:
- Eat 3 small meals and 2 planned snacks/day
- Consume at least 60 gm protein/day
- Eat protein first, then veggies
- Drink 48-64 oz. of water/day; no carbonated beverages
- Avoid liquids 30 minutes before or after meals
- Choose 2 servings low fat dairy/day
- Choose high fiber foods
- Avoid concentrated sweets in foods and beverages
- Choose reduced fat foods and condiments
- Avoid soft breads
- Problem foods may be pasta, rice, bread, beef
- Stop eating at the FIRST sign of fullness
- Take a liquid or chewable multivitamin
- Take a chewable calcium supplement
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Read the History and Physical and additional diagnoses of admitted residents. If residents have a history of weight loss surgery, discuss it with the resident and find out their specific dietary habits. Check for intolerances and try to adjust their dining plan to more closely match their usual pattern and help them stay on a healthy plan while in the health care community. You may need to educate nursing, activities and dietary staff on their adjustments for timing of fluid intake and portion sizes.
Click here for more information about bariatric surgeries.
Click here for more diet information post bariatric surgery.
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| Dear Dietitian |
As surveyors look toward culture change in dining programs, they will also look at usual and customary dietary habits being honored for individuals. We all need to consider this when planning nutritional care of our residents. Thanks for doing your part in individualizing care!
Have a happy and healthy Thanksgiving!
Judy Morgan, MBA, RD
RDNews Editor
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Registered Dietitian Newsletter
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