Nutrition Managemen tof the Bariatric Patient: Rosemary Mueller, MPH, RD, LDN, Advocate Weight Management and Emily Schumann, MPH, MS, RD, LDN, Advocate LGH and Bariatric/ Metabolic Center September 26, 2014 Breaking Down Barriers
Dec 24, 2015
Nutrition Managementof the Bariatric Patient:
Rosemary Mueller, MPH, RD, LDN, Advocate Weight Management and
Emily Schumann, MPH, MS, RD, LDN, Advocate LGH and Bariatric/ Metabolic Center
September 26, 2014
Breaking Down Barriers
Objective One: Understand the barriers
that bariatric patients’ face related to nutrition and weight management
Objective Two: Recognize the various
types of patients and how to best address their nutrition and weight management needs
Objective Three:
Learn key tips for improving your patients’ nutrition compliance and success at your facility or practice
Objective 1: Barriers to Nutrition Recommendations
Variable Stages of Change
Nutrition Myths & Mixed messages
“Do something different and the weight stays off.” Ex.,
raw food, gluten-free, eat based on your blood type, most
current T.V. celebrity’s advice – whatever is popular at
the moment.
“Just take a diet pill, tea, herb, colon cleanse, etc.
and you will safely control your appetite and burn
unhealthy fat without dieting.”
“You can diet and not exercise and still keep the weight
off.”
Common Denominator: Sense of shame or failure over repeated diet attempts and inability to maintain weight loss
“I really don’t eat that much..just don’t understand why I cannot lose more…must be my thyroid.”
Denial is an ineffective way of coping with painful emotions and embarrassment
about body size and weight.
Minimizing and Distortion
Portion Distortion: “What is there, I eat, and what is there is not necessarily what I need to eat.”
Objective 2: Addressing Different Types of Patients
Type of Patient Description Best Diet Approach
The Rule Follower Follows all instructions to a “T”
Give sample meal plan and/or encourage specific changes
The Just Gets It Understands concepts- can understand moderation and is reasonable with choices
Ask questions to find an area of improvement (diet recall) to help pt recognize need for change
The Know-It-All Does not follow directions, gives up easily, claims they have tried everything, nothing works
Encourage small change first and explore desires to make changes
The Firecracker Excited about changes, easily motivated, does well at first, then back to old habits
Encourage 1-2 changes at a time and follow up often.
Open-Ended QuestionsAssessment Phase:
What are your health concerns?
How do you see your food affecting your health?
How does your day go with respect to food?
How do snacks fit in?
Could you describe what your house is like at dinner time during the week?
After Providing Information/Advise:#59):
What is your response to this handout/information/suggestion?
How do you see using this information?
What are your thoughts?
How might your life be different if you were to do this?
Patient Expresses Motivation to Change:
What steps are you ready for?
What do you see as your next steps?
Where do you want to go from here?
What do you see yourself doing this week?
After planned action:
How might you do that?
How do you see yourself doing this at home? During the weekdays?
What could get in your way? What else?
© 2011 Molly Kellogg, RD, LCSW www.mollykellogg.com
Objective 3:Most Important Nutrition Tips to Tell Patients
Key Tips
Frequent, smaller meals- 5-6/day
Protein at each meal to assist with satiety and sensation
of fullness
Track your intake
Mindfulness and learning to discern hunger and fullness
cues; slowed eating speed
Key Tips
Rethink your drink
Adequate fiber through vegetables, fruits, whole grains
Refer to a dietitian
Food journaling: facing facts
Sample Food Journals
Time Food Item(s) Portion Size Length of Meal (Goal 25-30 mins)
Name:_________________________Date: __________
Dietary Log:
So why don’t our patients journal their eating and exercise?
It is self-confrontational.
It takes some time and effort.
It destroys “magical thinking” and makes one accountable
for changes in weight.
Some patients are embarrassed to share this with their
dietitian or other health professional.
Keys to overcome this barrier: Encouragement
Accountability for journaling
Non-judgmental evaluation by health professional
Specific and personalized recommendations
Application: Patient Presentation Frank, 44 year old male with arthritis in knee causing
mobility issues. Family history of heart disease. Pt
reports knows he should probably lose weight but he likes
food too much and can’t stand “all that healthy stuff”.
He says he knows you are going to tell him to eat less
and more things that taste like grass. Weight has been
gradually increasing over the last 10 years.
Application: Patient Presentation Susie, 53 year old female with DM, HTN, BMI: 48 has tried
Phentermine, Cranberry cleanse, and currently taking
Garcinia Cambodia extract that she heard about on Dr. Oz.
Has tried over 25 diets but only ever lost 5-8 lbs and gains
back weight plus some. Pt feels she doesn’t eat that much
food during the day (only eats breakfast and dinner) so
doesn’t understand why she can’t lose weight.
Our Role as Health Care Providers
Our Objective: Restore hope, assist as change agents Let patients know you care
Speak/inform/educate with frankness regarding
nutrition/health risk
Frequent visits- accountability is key
Speak/inform/educate with respect about nutrition
behaviors that need to change
Correct myths/distortions and provide guidance and tips
for incorporating appropriate health behaviors
Summary Understand where patients might be coming from and
barriers they have or will face
Recognize that each patient is different
Ask open-ended questions and permission
Provide key tips to help them with behavior changes for
weight loss
Refer to other professionals
References: 1. “Transtheoretical Model of Behavior Change”, James
Prochaska, Ph.D.
2. Kellog, Molly. (2011). Counseling Tips for Nutrition
Therapists Series 2011. Tip #108: Forming Effective Open
Questions. Retrieved from
http://www.mollykellogg.com/archive11.html#108.
Questions?