Hi all. I had my surgery consult last week and will be doing 6 months of supervised weight management in preparation for the surgery (RNY bypass). The guidelines the nutritionist gave me for eating during this phase included eating 60-80 grams of protein per day and eating low fat. (Low carb was not included as a guideline but avoiding processed carbs, flour, sugar, etc. was.)

Could someone let me know the rationale for eating low fat, both during this time period and following the surgery? Up to this point, during periods in which I have been feeling my best, losing significant amounts of weight, and managing my blood sugar levels well (I have type 2 diabetes), I have eaten a whole-foods, low carb diet focusing on eating by hunger and satiety rather than counting calories, and my diet has been high in fat and protein. Not in fried foods and such, being that I wasn't eating things like french fries or breaded foods, but I was eating full-fat cheese or yogurt, for example--whole foods. The fat increased satiety and helped slow the release of glucose. It feels strange to me when I'm focusing on my health to buy non-fat or low-fat versions of foods that may have additives or other ingredients to compensate for the removal of fat, and so I'm struggling a bit. If I better understood why, then I wouldn't struggle quite so much.

Is it simply that a gram of fat has more calories that a gram of protein or carbohydrate, and the thinking is that low fat eating will lower calories? Or does fat promote sliding through the pouch? I thought dumping syndrome was more related to sugar/high carb foods, but perhaps I am wrong?

Thanks so much for any information!

Edited September 12, 20178 yr by brightfaith

I had that same question when I entered this process. I don't "believe" in eating low fat for exactly the reasons you mentioned (reduces satiety thus leading to more general eating, low fat foods have other additives and chemicals, they contort the food unnaturally to make them low-fat, etc.).

I pushed back with my doctor and nutritionist and finally got the explanation you guessed. The aim is to help keep overall calories down rather than being a problem with fat as a general macronutrient.

I have not made an effort post-op to limit my fat intake whatsoever. I'm not going out of my way to eat extra fat necessarily, but I'm ensuring that the proteins I eat are fully satisfying and filling with fats added as needed. I do strictly limit carbs. I've had great weight loss progress. I haven't had much trouble sticking to the food plan which I attribute to eating enough fat to keep me satisfied.

Good luck!! I'm 2 months post-op. It's hard work but SO worth it!

Some bariatric programs (and nutritionists/dietitians) are behind the times. They espouse old-guard views regarding dietary fat being the cause of weight problems and heart disease.

It's been proven that dietary fat doesn't make people fat. It's been proven that fat and cholesterol don't cause heart disease, yet some dietitians still preach tenets that are from a bygone era.

I eat full fat food; no low fat or non-fat here.

So glad to see this topic! I've been eating full-fat cottage cheese, as well as full-fat cheese as a sprinkled topping on my pureed foods. Sometimes I mix a small dollop of sour cream in. My skin and hair are so dry, and my calories are so low, I can't imagine any good reason to limit the fat in the small amount of food and calories I'm getting. It's not like I'm even close to 1000 calories a day -- how will dairy fat hurt me? Also, food tastes so much better with a little fat in it. I might as well not be utterly repulsed by what little I'm eating.

Ok, let's separate out the different time frames.

6 or more months preop: As referenced above, it's to keep calories in check and get some weight loss started. If you can control caloric consumption while eating fat, I don't see a problem with it.

Liver shrink diet: Needs to be a low fat AND low carbohydrate to be sure that liver has shrunken sufficiently to make a safe procedure.

Postop: Back to keeping calories in check. Ideal weight loss happens somewhere between 800-1200 calories for the year or two after surgery. The first couple months postop it's almost impossible to get "too many" calories. After that, you have to start watching.

I was never told low fat. I actually have trouble getting fat into my diet.

Pre op they told me to loose 3-5 kg, how I did it was up to me. Post up, for the first 6 weeks I was told to limit fat to 15g pr 100g and sugar to 8g pr 100g due to the risk of dumping. After that, I got cleared to eat anything I wanted. Trial and error to see what I could tolerate. Ice cream is a no go. The sugar/fat combination is just too high. But full fat cheese on it's own is not a problem.

Thank you so much to everyone who replied. I really appreciate it, and I feel much better about pushing back on the low fat guideline and choosing to eat full-fat foods. Thank you again!

I eat full fat dairy. Lean meats, but no low fat high sugar items , but my fat is very low because I do not just 'add fat' to things for the sake of adding fat,but I am doing just fine and feel satiated , I do not like low fat items because of the higher sugar. I was told to do low fat but I explained why this is not for me and they said that it was fine. My diet consists of lean meat and low starch veg just because thats what I like right now. I do not like the texture of fat on meat , never have.

On 13/09/2017 at 10:57 PM, brightfaith said:

Thank you so much to everyone who replied. I really appreciate it, and I feel much better about pushing back on the low fat guideline and choosing to eat full-fat foods. Thank you again!

I think you will have to see how your body tolerates it. Have an open mind. I have a friend who had RNY full fat items give her runny stools. , not sure why.

my personal philosophy (and i am NOT an anti-fat believer. saturated and monounsaturated are good for you). HOWEVER:

during the first 6 months after surgery, your body has more than enough fat to run on... from you!!! i'm just ending my first 6 months post-surgery (115lbs down) and i have purposely kept any kind of excess fat out. i haven't strictly avoided it, but for instance i get fat-free skyr (yogurt) and trim any visible fat off of meat. go light on the oils. again, the body is getting more than enough fat from your own stored fat cells. it is my personal belief that adding too much fat via diet will slow weight loss during this unique initial period.

once i reach my goal weight (new set point), i will make a conscious decision to up the fat content of my diet. because i will NEED more calories at that point, and my body will not have so much ample stores to draw from. so i'll go back to full-fat yogurt, generous olive oil, fattier cuts of meat, etc.

My NUT advised against no fat products and prefers if we don't use low fat. She said that no fat/low fat diets have been proven ineffective and unhealthy. I've been eating full fat since day 1 and have had no issues with it. The only thing I don't eat full fat is meat, I prefer very lean proteins.