Success Habits of Weight Loss Surgery Patients:

How medical providers can help their patients be a success story

Megan Keesee, RD LDNRegistered DietitianDuke Center for Metabolic and Weight Loss SurgeryDuke Raleigh Weight Loss Surgery

What is success?

ASMBS defines ‘successful’ weight loss as ≥50% of excess body weight

Excess body weight = pre-operative weight –ideal body weight (BMI =25)

Why do we need help?• One study by Stanford University School of

Medicine showed 49% of bariatric surgery patients are lost to follow up– Lost to follow-up: missed 12 month post-op appointment

and never returned to clinic afterwards

• Another study showed typical follow-up rates for GBP patients are in the range of 60% to 80%

• Patients who attend all scheduled follow-up appointments experience greater long-term weight loss than those who do not

What are the Success Habits?

• Healthy Eating (following bariatric nutrition guidelines)

• Exercise• Self-Care• Accountability

Healthy Eating Behaviors• Eat every 3-4 hours • Focus on protein, fiber,

and heart healthy fats– Protein first to ensure

fullness and maintain lead body mass

• Hydration– 64+ ounces per day– Avoid sugar-sweetened

beverages• Limit high fat and high

sugar foods

Healthy Eating Behaviors Continued• Eat slowly and chew well• Separate fluids from food• Plan ahead

– Meals, snacks and supplements

• Keep a food journal

ExerciseResearch shows…• Consistent exercise leads to a 4.2% lower BMI

• Moderate intensity exercise leads to a 5.7% greater excess weight loss

• People who become active after surgery lose more weight than inactive patients, suffered from less depression and anxiety, and had higher scores in general health– "active" defined as at least 200 minutes per week of

walking or other moderate or vigorous exercise

Exercise Continued3 components:• Cardio or Aerobic Exercise

– Walking, running, swimming, biking, dancing, rowing, boxing, aerobics class

– Recommendation: 150 minutes moderate intensity and 75 minutes vigorous intensity

• Strength Training Exercise – Body weight, dumbbells, machines at a gym, resistance

bands– Recommendation: at least 2 times per week

• Stretching– Stretching, yoga, Pilates

Self Care• Realistic expectations

– Let go of perfection • Positive self-talk

– Avoid the ‘all-or-nothing’ mind-set • Handle emotions with out food

– Exercise– Breathing exercises– Reach out for support

• Measure small successes and non-scale victories – Exercise longer?– Clothes fit better?– Able to do more?

Accountability• Goal Setting

– Behavior focused– SMART goals (Specific, Measurable, Attainable, Realistic,

Timely) • Attend scheduled follow-ups

– 2-3 weeks, 3 months, 6 months, 1 year, and annual visits• Seek Support

– Support groups– Friends/family– Therapist– Personal Trainer– Nutrition Counseling

How Can You Help?• Ask and engage in conversation• Express empathy • Non-weight bias• Give positive reinforcement and recommendations• Encourage…

– The success habits and goal setting– Utilize resources

• Technology• Support groups• Blogs/Recipe sites• Local gyms and wellness centers

– Follow up with the bariatric team

References• Azagury, Dan, et al. “Loss to Follow-up after Bariatric Surgery: Are Lost

Patients Doing Better or Worse?” Surgery for Obesity and Related Diseases, vol. 12, no. 7, 2016, doi:10.1016/j.soard.2016.08.264.

• “Benefits of Bariatric Surgery.” Www.asmbs.org, American Society for Metabolic and Bariatric Surgery, asmbs.org/patients/benefits-of-bariatric-surgery.

• Cummings, S., Isom, Kellene A. Pocket Guide to Bariatric Surgery, 2nd Edition. Academy of Nutrition and Dietetics; 2015.

• Fielding, G. A., & Ren, C. J. (2005). Laparoscopic adjustable gastric band. Surgical Clinics of North America, 85, 129-140. doi:10.1016/j.suc.2004.10.004

• Gould, Jon C., et al. “Impact of Routine and Long-Term Follow-up on Weight Loss after Laparoscopic Gastric Bypass.” Surgery for Obesity and Related Diseases, vol. 3, no. 6, 2007, pp. 627–630., doi:10.1016/j.soard.2007.07.005.

• Johnell, Patrice. “Characteristics of Bariatric Surgery Patients.” Florida State University Libraries , 2009, diginole.lib.fsu.edu/islandora/object/fsu:181803/datastream/PDF/view.

• Ramnarace, Cynthia. “Exercise Before and After Weight-Loss Surgery.” EverydayHealth.com, 20 Nov. 2008, www.everydayhealth.com/weight-loss-surgery/weight-loss-surgery-exercise.aspx.

Thank you!

Megan.Keesee@duke.edu