RE: Evidence-based guidelines on snacking

[Guest guest]

We work to make a clear distinction between planned, healthy snacks and snacking and then tailor it to the patient with feedback from them in regards to hunger level and amount eaten at meal compared to nutrient needs. I find that bypass folks will not get adequate protein/calories if only eating 3 times per day in the early stages. I find often the band folks get too hungry between meals, then eat real fast and vomit if snacks are not permitted. There is little research on any eating recommendations specific to bariatrics and to say that weight management stuff doesn't apply really gets under my skin because until there is more evidence in bariatrics we have to use what we know applies to weight management!! I encourage you to provide examples of times that a snack is appropriate and important in bariatrics and educate your co-workers and patients about those times.

My two cents

uraged in post-op bariatric patients? I understand why grazing is an issue, but I'm trying to figure out what evidence is out there to discourage snacking. The ADA evidence analysis library supports snacking for the adult weight management population due to research that has linked a decreased risk for obesity...I would think these guidelines could be applied to bariatric patients as well.Has anyone come across any actual reserach or studies on eating frequency in the bariatric population? I was planning on discussing how to incorpoarte pre-planned protein snacks for our bariatric support group this week, but was informed by our bariatric coordinator that our program does not support snacking and that snacking guidelines for the general population cannot be applied to bariatric patients.What is everyone else recommending in regards to eating frequency/meal patterns for bariatric patients? Also, what resources or evidence are you using to support your recommendations?Thank you, Chase, RD, LDFort Worth, TX

[Guest guest]

We, also, recommend "no snacking."

Once a patient has reached their goal weight, I may add back a "mini-meal" in addition to the 3 regular meals. But I srictly avoid the "snack" word, teaching them to divide their day into breakfast - time to drink fluids - lunch - time to drink fluids - dinner - time to drink fluids. If theywill truly adopt philosophy, it will go a long way towards their success, making clean break from old snacking/graving/unconscious eating patterns.

From: nicole.chase12 <nicole.chase12@...> Sent: Tue, March 2, 2010 11:50:43 AMSubject: Evidence-based guidelines on snacking

Why is snacking discouraged in post-op bariatric patients? I understand why grazing is an issue, but I'm trying to figure out what evidence is out there to discourage snacking. The ADA evidence analysis library supports snacking for the adult weight management population due to research that has linked a decreased risk for obesity...I would think these guidelines could be applied to bariatric patients as well.Has anyone come across any actual reserach or studies on eating frequency in the bariatric population? I was planning on discussing how to incorpoarte pre-planned protein snacks for our bariatric support group this week, but was informed by our bariatric coordinator that our program does not support snacking and that snacking guidelines for the general population cannot be applied to bariatric patients.What is everyone else recommending in regards to eating frequency/meal patterns for bariatric patients? Also, what resources or

evidence are you using to support your recommendations?Thank you, Chase, RD, LDFort Worth, TX

[Guest guest]

I agree with , especially bypass patients (but also some band patients) cannot meet protein or nutrition needs with only 3 very small meals, especially in the first year. I spend a lot of time talking about appropriate snacking and the importance of moving from typical American snack foods to healthy protein and fruit based snacks. I wish there was a better word than snack but I have not come up with one! Any ideas?

Diane Olson MS RD CDE UW Health Bariatric Surgery Program University of Wisconsin Hospital and Clinics (608) 265-1718 dolson3@...

-----Original Message-----From: [mailto: ] On Behalf Of Laschkwitsch, :LPH Weight Management InstituteSent: Tuesday, March 02, 2010 2:51 PM Subject: RE: Evidence-based guidelines on snacking

We work to make a clear distinction between planned, healthy snacks and snacking and then tailor it to the patient with feedback from them in regards to hunger level and amount eaten at meal compared to nutrient needs. I find that bypass folks will not get adequate protein/calories if only eating 3 times per day in the early stages. I find often the band folks get too hungry between meals, then eat real fast and vomit if snacks are not permitted. There is little research on any eating recommendations specific to bariatrics and to say that weight management stuff doesn't apply really gets under my skin because until there is more evidence in bariatrics we have to use what we know applies to weight management!! I encourage you to provide examples of times that a snack is appropriate and important in bariatrics and educate your co-workers and patients about those times.

My two cents

uraged in post-op bariatric patients? I understand why grazing is an issue, but I'm trying to figure out what evidence is out there to discourage snacking. The ADA evidence analysis library supports snacking for the adult weight management population due to research that has linked a decreased risk for obesity...I would think these guidelines could be applied to bariatric patients as well.Has anyone come across any actual reserach or studies on eating frequency in the bariatric population? I was planning on discussing how to incorpoarte pre-planned protein snacks for our bariatric support group this week, but was informed by our bariatric coordinator that our program does not support snacking and that snacking guidelines for the general population cannot be applied to bariatric patients.What is everyone else recommending in regards to eating frequency/meal patterns for bariatric patients? Also, what resources or evidence are you using to support your recommendations?Thank you, Chase, RD, LDFort Worth, TX

[Guest guest]

I agree that their nutrient needs cannot usually be met on only three small meals a day (at first, if not long term). My philosophy is to teach "Eat real food, three times a day and then use protein supplements for b/t meal snacks, if hungry or as needed to achieve protein goals." I think this makes it more "black and white", food is for meals (even if they occasionally choose chips or cookies) and supplements are for "supplementing" the meals. The protein shakes and bars tend to really fill them up, so they don't want more to snack on. I also think it helps them include more plant food in their meals if they are not so focused on getting all of their daily protein goal met on these three meals alone. That, too, is a good thing.My two cents worth. Simler, MS, RD, Manager for Weight Loss Surgery and Osteoporosis ProgramsValleyCare Health System925-416-6712 >>> "Olson Diane L" <dolson3@...> 3/2/2010 3:15 PM >>> I agree with , especially bypass patients (but also some band patients) cannot meet protein or nutrition needs with only 3 very small meals, especially in the first year. I spend a lot of time talking about appropriate snacking and the importance of moving from typical American snack foods to healthy protein and fruit based snacks. I wish there was a better word than snack but I have not come up with one! Any ideas? Diane Olson MS RD CDE UW Health Bariatric Surgery Program University of Wisconsin Hospital and Clinics (608) 265-1718 dolson3uwhealth (DOT) org -----Original Message-----From: [mailto: ] On Behalf Of Laschkwitsch, :LPH Weight Management InstituteSent: Tuesday, March 02, 2010 2:51 PM Subject: RE: Evidence-based guidelines on snackingWe work to make a clear distinction between planned, healthy snacks and snacking and then tailor it to the patient with feedback from them in regards to hunger level and amount eaten at meal compared to nutrient needs. I find that bypass folks will not get adequate protein/calories if only eating 3 times per day in the early stages. I find often the band folks get too hungry between meals, then eat real fast and vomit if snacks are not permitted. There is little research on any eating recommendations specific to bariatrics and to say that weight management stuff doesn't apply really gets under my skin because until there is more evidence in bariatrics we have to use what we know applies to weight management!! I encourage you to provide examples of times that a snack is appropriate and important in bariatrics and educate your co-workers and patients about those times. My two cents uraged in post-op bariatric patients? I understand why grazing is an issue, but I'm trying to figure out what evidence is out there to discourage snacking. The ADA evidence analysis library supports snacking for the adult weight management population due to research that has linked a decreased risk for obesity...I would think these guidelines could be applied to bariatric patients as well.Has anyone come across any actual reserach or studies on eating frequency in the bariatric population? I was planning on discussing how to incorpoarte pre-planned protein snacks for our bariatric support group this week, but was informed by our bariatric coordinator that our program does not support snacking and that snacking guidelines for the general population cannot be applied to bariatric patients.What is everyone else recommending in regards to eating frequency/meal patterns for bariatric patients? Also, what resources or evidence are you using to support your recommendations?Thank you, Chase, RD, LDFort Worth, TX

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[Guest guest]

We do recommend 3 meals and 2 snacks at our center. We discuss the difference b/w snacking and grazing.

There's no other way to get 3 fruits in the day and adequate protein. The snacks we recommend are fruit and protein and a meal spacing of 3 1/2 to 4 hours apart.

Sanam Shahrokhinia MS RD

Cedars Sinai Medical Center

Los Angeles, CA 90048

From: Sandi Birch <foodycoach@...> Sent: Tue, March 2, 2010 2:46:51 PMSubject: Re: Evidence-based guidelines on snacking

We, also, recommend "no snacking."

Once a patient has reached their goal weight, I may add back a "mini-meal" in addition to the 3 regular meals. But I srictly avoid the "snack" word, teaching them to divide their day into breakfast - time to drink fluids - lunch - time to drink fluids - dinner - time to drink fluids. If theywill truly adopt philosophy, it will go a long way towards their success, making clean break from old snacking/graving/ unconscious eating patterns.

From: nicole.chase12 <nicole.chase12>BariatricNutritionD ietitiansSent: Tue, March 2, 2010 11:50:43 AMSubject: [bariatricNutrition Dietitians] Evidence-based guidelines on snacking

Why is snacking discouraged in post-op bariatric patients? I understand why grazing is an issue, but I'm trying to figure out what evidence is out there to discourage snacking. The ADA evidence analysis library supports snacking for the adult weight management population due to research that has linked a decreased risk for obesity...I would think these guidelines could be applied to bariatric patients as well.Has anyone come across any actual reserach or studies on eating frequency in the bariatric population? I was planning on discussing how to incorpoarte pre-planned protein snacks for our bariatric support group this week, but was informed by our bariatric coordinator that our program does not support snacking and that snacking guidelines for the general population cannot be applied to bariatric patients.What is everyone else recommending in regards to eating frequency/meal patterns for bariatric patients? Also, what resources or

evidence are you using to support your recommendations?Thank you, Chase, RD, LDFort Worth, TX

[Guest guest]

I agree with 's 2 cents. This is what our program advocates too.

From: Laschkwitsch, :LPH Weight Management Institute <KLaschke@...>Subject: RE: Evidence-based guidelines on snacking Date: Tuesday, March 2, 2010, 3:50 PM

We work to make a clear distinction between planned, healthy snacks and snacking and then tailor it to the patient with feedback from them in regards to hunger level and amount eaten at meal compared to nutrient needs. I find that bypass folks will not get adequate protein/calories if only eating 3 times per day in the early stages. I find often the band folks get too hungry between meals, then eat real fast and vomit if snacks are not permitted. There is little research on any eating recommendations specific to bariatrics and to say that weight management stuff doesn't apply really gets under my skin because until there is more evidence in bariatrics we have to use what we know applies to weight management!! I encourage you to provide examples of times that a snack is appropriate and important in bariatrics and educate your co-workers and

patients about those times.

My two cents

uraged in post-op bariatric patients? I understand why grazing is an issue, but I'm trying to figure out what evidence is out there to discourage snacking. The ADA evidence analysis library supports snacking for the adult weight management population due to research that has linked a decreased risk for obesity...I would think these guidelines could be applied to bariatric patients as well.Has anyone come across any actual reserach or studies on eating frequency in the bariatric population? I was planning on discussing how to incorpoarte pre-planned protein snacks for our bariatric support group this week, but was informed by our bariatric coordinator that our program does not support snacking and that snacking guidelines for the general population cannot be applied to bariatric patients.What is everyone else recommending in regards to eating frequency/meal patterns for bariatric patients?

Also, what resources or evidence are you using to support your recommendations?Thank you, Chase, RD, LDFort Worth, TX