Endurance Athlete after RNY

[Guest guest]

I am currently working with a patient that had RNY in July 2007. She is 5'9 and

~190# right now. Her weight is up about 20# from her lowest, but has been stable

for the last year or so. She is currently training for a 1/2 marathon, running

25+ miles per week and taking a spinning class 3x per week. Her running will

increase as the race gets closer, up to 55 or so miles a week.

I am having trouble convincing her that she needs to eat more. She is upset

enough with her weight right now (and wants to lose at least 10#, if not the

full 20# she has regained). She won't let herself eat more than 1300 calories a

day, and maintains around 50g of protein daily.

To my knowledge, even though she is post-RNY her caloric needs are the same as

an endurance athlete now, with a focus on vitamins and staying hydrated. Does

anyone know otherwise? Do you know of any articles I can show her that state

this? I'm convinces she needs to eat more, not only for her current activity

level, but to lose weight also.

I'd appreciate any thoughts or input!

Thanks!!!

[Guest guest]

You are absolutely correct. Energy needs for an endurance athletes are the same regardless of s/p RNY. Specifically, she needs enough carbs to fuel her training. Endurance athletes need 5-7 gm CHO/kg BW/d to maintain adequate glycogen stores for training. Hydration with a carb-containing sports drink during training is recommended. This will provide the 30-60 gm CHO/hr recommended during training, important electrolytes, and hydration. This pt also needs to realize that training season is not the time for wt loss. It is impossible to simultaneously train for optimal performance AND have an energy deficit. Athletes are encouraged to adjust BW during their "off season."

You are also correct in your assumption that if she creates too great of an energy deficit (via food restriction and exercise) she will slow down her metabolism and hinder wt loss. Help her to refocus onto the bigger picture. I know the docs and most people around her are likely focused primarily on wt loss, but this can not be her sole measure of success. If her self-worth is hinged entirely on the number on the scale, she has a rough life ahead of her. Help her to recognize and celebrate all the other things she has and is accomplishing: any improved health parameters (BP, lipids, etc), and improved quality of life (easier to fit into theater/airline seats, easier to move her body, less SOB, improved physical endurance, etc). She has accomplished a lot and needs to give herself credit for this. I hope this helps some.

Sally Hara, MS, RD, CDE, CSSD Registered Dietitian, Certified Diabetes Educator Board Certified Specialist in Sports DieteticsProActive Nutrition, LLC Kirkland, WA (425) 814-8443 No diet will remove all the fat from your body because the brain is entirely fat. Without a brain, you might look good, but all you could do is run for public office. - Bernard Shaw

From: k.vavrosky@...Date: Wed, 17 Feb 2010 17:33:57 +0000Subject: Endurance Athlete after RNY

I am currently working with a patient that had RNY in July 2007. She is 5'9 and ~190# right now. Her weight is up about 20# from her lowest, but has been stable for the last year or so. She is currently training for a 1/2 marathon, running 25+ miles per week and taking a spinning class 3x per week. Her running will increase as the race gets closer, up to 55 or so miles a week. I am having trouble convincing her that she needs to eat more. She is upset enough with her weight right now (and wants to lose at least 10#, if not the full 20# she has regained). She won't let herself eat more than 1300 calories a day, and maintains around 50g of protein daily. To my knowledge, even though she is post-RNY her caloric needs are the same as an endurance athlete now, with a focus on vitamins and staying hydrated. Does anyone know otherwise? Do you know of any articles I can show her that state this? I'm convinces she needs to eat more, not only for her current activity level, but to lose weight also. I'd appreciate any thoughts or input!Thanks!!!