RE: poor wt loss

[Guest guest]

Hello

I have a pt who I am working with who only lost 5 pounds in the last 3 weeks

and is approximately 2 month post op. She was very tearful and is mourning the

loss of food. She used to be able to consume 2500 - 3000 kcal and still

maintain her weight before surgery. Per diet records she is consuming on

average 800 kcal and 40 gm protein (Some days much less then this). She is only

doing one protein drink a day and I encouraged her to increase this to 3 per

day. She again became very tearful and reported she would rather eat then drink

protein drinks. Discussed the protein bars by Resource (opti fast) My question

is - In my limited experience with bariatrics I have had only 1 other pt who had

slow wt loss at first and was doing a poor job getting adequate protein and once

that resolved there was much improvement. Do you think this too is her issue?

Her activity is very minimal due to her extreme obesity, however she has been

able to increase that somewhat from where she was before. I would appreciate

any tips. My heart goes out to this lady - she is very discouraged. Thanks in

advance.

Tull RD LD CDE

[Guest guest]

,

Her fluids might be third spacing due to insufficient protein intake. Two months post-op is a time for healing and repair. Good advice to up her protein drinks to three/day. Increase activity as able. Weight plateaus can occur early out as well. Plateaus can be expected with someone who lost a tremendous amount of weight intially (i.e. first three weeks or so). She'll get over the hump. Don't let her get discouraged.

Kate Alie, M.S., R.D., L.D. Director of Nutrition Services Medabolix 600 Way

Northgate Business Park

ton, WV 25311 (304) 347-4313 (304) 347-4316 (fax)>From: "Tull, " <Tull@...> >Reply- >< > >Subject: RE: poor wt loss >Date: Mon, 13 Sep 2004 14:03:23 -0500 > >Hello >I have a pt who I am working with who only lost 5 pounds in the last 3 weeks and is approximately 2 month post op. She was very tearful and is mourning the loss of food. She used to be able to consume 2500 - 3000 kcal and still maintain her weight before surgery. Per diet records she is consuming on average 800 kcal and 40 gm protein (Some days much less then this). She is only doing one protein drink a day and I encouraged her to increase this to 3 per day. She again became very tearful and reported she would rather eat then drink protein drinks. Discussed the protein bars by Resource (opti fast) My question is - In my limited experience with bariatrics I have had only 1 other pt who had slow wt loss at first and was doing a poor job getting adequate protein and once that resolved there was much improvement. Do you think this too is her issue? Her activity is very minimal due to her extreme obesity, however she has been able to increase that somewhat from where she was before. I would appreciate any tips. My heart goes out to this lady - she is very discouraged. Thanks in advance. > > Tull RD LD CDE > > > Check out Election 2004 for up-to-date election news, plus voter tools and more!

[Guest guest]

- Continue to encourage her. If she is tolerating solid foods have her eat 5-6 small high protein meals/day vs additional pro drinks. Has she tried to add sugar free pudding to her protein drink to make high pro pudding, this usually works very well. Make sure she is not consuming too many calories with liquids between meal. Encourage her to do chair exercises and to move as much as possible. Tell her to hang in their, it will come off!!!

Good luck, Cheryl

-----Original Message-----From: Tull, [mailto:Tull@...]Sent: Monday, September 13, 2004 2:03 PM Subject: RE: poor wt lossHelloI have a pt who I am working with who only lost 5 pounds in the last 3 weeks and is approximately 2 month post op. She was very tearful and is mourning the loss of food. She used to be able to consume 2500 - 3000 kcal and still maintain her weight before surgery. Per diet records she is consuming on average 800 kcal and 40 gm protein (Some days much less then this). She is only doing one protein drink a day and I encouraged her to increase this to 3 per day. She again became very tearful and reported she would rather eat then drink protein drinks. Discussed the protein bars by Resource (opti fast) My question is - In my limited experience with bariatrics I have had only 1 other pt who had slow wt loss at first and was doing a poor job getting adequate protein and once that resolved there was much improvement. Do you think this too is her issue? Her activity is very minimal due to her extreme obesity, however s! he has been able to increase that somewhat from where she was before. I would appreciate any tips. My heart goes out to this lady - she is very discouraged. Thanks in advance. Tull RD LD CDE

[Guest guest]

Is she only on protein supplements right now at 2 months post-op? If

so, that could be a reason why she is not losing weight. In the

ADA's " Nutritional Impications of Bariatric Surgery, Perspectives of

Practitioners " by week 8, patients are transitioning to moist and

mushy foods (3 oz protein food at each meal (tuna, cottage cheese,

fish, eggs, pureed chicken) and protein drinks are weaned. The

surgeon that proctered our surgeon when we first started told me that

his patients usually start to cheat at about 3 weeks post-op so he

urdges his RD's to start them on yogurts, eggs, high protein oatmeal

(Bariatrix is what we use). I also let them start trying about 1/2

cup of skim milk with the knowledge that they might not tolerate it.

If they do, I urdge them to mix sugar free CIB with it. I hope this

helps. If your program allows it, I would start giving her something

other than protein drinks. She might need to have a psych consult

too. That is part of our protocol within 1-2 months post-op. A friend

of mine who is a bariatric RD told me that sometimes patients don't

lose weight post-op because they are not meeting the protein goal or

even eating enough period. I think your patient REALLY needs food.

, RD, CD

Memorial Weight Loss

and Bariatric Surgery Center

>