This past week I had the opportunity to spend time at a weight loss center, wound clinic, and also in medical telemetry and ICU. I am sure you all have heard of weight loss surgeries (more appropriately called bariatric surgeries) by now and while it may seem like a quick and easy fix… it is far from that. Even though the majority of these surgeries are preformed laparoscopically, no surgery comes without some risk. At this particular center the surgeons performed three different bariatric surgeries: Laparoscopic Adjustable Gastric Banding (LABG), Laparoscopic Sleeve Gastrectomy, and Roux-en-Y Gastric Bypass (RYGB).
What is the role of an RD when it comes to bariatric surgeries?
Bariatric surgeries all require a dramatic lifestyle change. Dietitians are responsible for conducting an initial nutritional screening to ensure that the client is suitable for surgery. If the patient is not willing to change their diet then they will not be allowed to undergo surgery due to the danger it could cause. Dietitians are also used to explain and educate the patient on the bariatric diet prior to surgery and participate in follow-up appointments with patients as needed. Here is just a brief overview of some of the dietary changes one must undergo after surgery.
Advance diet as tolerated from clear liquids to puree/soft foods to solids post surgery – this typically takes at least one month.
Eat slowly – it should take 20-30 minutes to finish a meal!
Always sip liquids, NEVER chug! You should drink about 1 oz. every 15 minutes.
Chew slowly and thoroughly before swallowing
Avoid sugary foods to prevent “Dumping Syndrome”
Limit fat intake – fats slow the digestion process which can lead to nausea
REMEMBER the stomach can only hold a few tablespoons immediately after surgery and will eventually hold up to 0.5-1 cup so you will need to eat less
Drink at least 64 oz. fluid to prevent dehydration
Do not drink fluid with meals – stop drinking 30 minutes before eating and wait until 30 minutes after to drink again
Always eat your protein food first to make sure your protein intake is adequate
Tolerance of dairy (lactose) may be altered so substitute a lactose-free dairy if needed
What does a typical menu look like for the first month after surgery once you are discharged?
I ran across this video today and based on my interest in PCOS I found it particularly interesting. This is a doctor who shares his background and speaks to surface a new hypothesis that obesity might be a coping mechanism and not the main issue in some people. He admits how he lacked empathy and was very judgmental to overweight individuals in the past. This is an amazing video that is a great eye opener to everyone, especially healthcare providers.
In lieu of September being Childhood Obesity Awareness Month I wanted to look at the big picture of childhood obesity, as well as the entirety of obesity as a National epidemic.
Shocking New Trends for Obesity
A recent report released new findings that if changes are NOT made and the current trend continues, 39 states will have obesity rates soaring above 50% by 2030. Keep in mind that is only the number of adults who are obese (BMI >30) and does not include those who are only considered overweight (BMI between 25-30). This is a HUGE problem for America. Think back to 20 years ago. No state had obesity levels above 15%, yet in 20 years all 50 states could have obesity rates above 44%. 13 states would have obesity rates above 60% with Mississippi tipping the scales with 66%. Colorado would reign of being the “skinniest state” but it’s obesity rates would increase from today rate of 20.7% to 45%. Although they would still have their “bragging rights,” 45% is nothing to be proud of. Since my recent move from Colorado to West Virginia where the obesity rate is currently 32.4%, earning them the title of the 3rd most obese state, the difference was beyond obvious. I cannot imagine seeing those rates more than double in the next 20 years — something needs to change! Click here to view an interactive map with state-by-state data on the current and projected obesity rates for 2030. Currently, roughly 2/3 (66%) of all adults are overweight or obese, which translates to only 33% of adults in America being at a healthy weight. Nation-wide obesity levels total 35.7% of the US population. Obesity is now a nation-wide epidemic and not just concentrated in the South.
Not only is obesity a huge health concern, it also could lead to an economic crisis. The amount of money spent towards health-care cost will skyrocket from the increased prevalence in diabetes, heart disease, and other comorbidites of obesity. This report projected that by 2030 America will see an additional 6 million cases of type 2 diabetes, 5 million cases of coronary heart disease and stroke, and over 400,000 new incidences of cancer that is directly related to obesity. These levels are already extremely high with 25 million Americans with type 2 diabetes, 27 million with chronic heart disease, 68 million with hypertension (high blood pressure), and 50 million with arthritis today. If obesity continues on the current trend we can easily expect to see an increase of 18 billion dollars each year, which does not account for a decrease in productivity!
Obesity is considered to be “one of the most challenging health crisis that this country has ever faced.” When we look at starting to “correct” this trend and being able to reduce obesity rates we need to be implementing and promoting small changes for adults. In America, weight loss is promoted as something that should be quick and easy and can be bought; in fact, permanent weight loss should be close to the opposite and should be looked at as a steady loss of 1-2 pounds a week. Increasing exercise, decreasing portion sizes, increasing fruit and vegetable intake, and decreasing high-calorie, low-nutrient foods could lead to the change in the trend of obesity that America needs.
When looking at future trends, our focus also needs to be towards preventing children from becoming obese and ultimately eliminated childhood obesity. Since 2010, the month of September has been dedicated to looking at childhood obesity and raising awareness. Today, nearly one-third of children and teens are either overweight or obese. Since 1980, the rate of childhood obesity has tripled! It has been suggested that this is the first time that children may have a shorter life span their parents. Think about how this can really impact America.
What caused the increase in childhood obesity?
Think back to when you where a kid or to what your parents told you about their childhood. Compare your activity levels and those of your parents with children today and you will most likely see a significant difference in activity levels and habits of children today. Thirty years ago, children walked to school, participated in daily physical education, spent recess being active, and ran around the neighborhood until dinner. Now-a-days children ride buses to school and are replacing their time that was once spent actively playing with playing video games, watching TV and chatting online. The average 8 to 18 year-old spends 7.5 hours each day using TV, computers, video games, cell phones, and movies. Physical education programs and after-school sports are being decreased and even eliminated in some schools to the point that only 1/3 of children are meeting the recommended daily activity levels of just one hour. Back in the day, more meals were home-cooked, less processed, and portion sizes were reasonable. Today, parents tend to be busier resulting in less home-cooked meals. Snacks were once consumed only once or twice a day and now one in five school-aged children consume up to six snacks a day! Portion sizes have increased up to five times larger than they were in the 1970’s. As Americans, we are now consuming 31% more calories than we were in the 1970’s, yet our activity levels have plummeted. Combine the lack of physical activity with the “fast food nation” our children are exposed to and the result is childhood obesity. It is shocking to find out that many children are unaware of where their food is even coming from and cannot identify the names of common fruits and vegetables. We are setting our children up for obesity, diabetes, heart disease, a shorten life span, decreased productivity, and decreased success rates. This needs to end! Children establish their habits and eating behaviors early on and need to have the proper education and resources to do so.
Childhood Hunger and Obesity
In America we tend to be fighting a double-edged sword when it comes to children and nutrition; obesity and hunger. Although, we tend to associate obesity with having more than enough access to food that is not always the case. One in seven low-income preschool aged children are now obese. One way to fight this epidemic is to look at the source. Most children are receiving meals through the schools and making those meals healthier, more nutritious, and more available can work to fight both ends of the spectrum. I will focus directly on school lunches and legislation involved childhood nutrition in a future blog post during National School Lunch Week, which is October 15-19th. If you would like to get more involved in helping fight against childhood obesity or learn more about it please check out the COAM at http://www.healthierkidsbrighterfutures.org and the Let’s Move initiative at http://www.letsmove.gov/learn-facts/epidemic-childhood-obesity. Are a student at West Virginia University or a resident of Morgantown? Check out what WVU and local programs in the area are doing to help fight against by clicking here.