I've just seen a surgeon for an initial consultation about getting a bypass and he was positive and set me on the track for it. My first appointment with the dietitian is tomorrow and I'm scared to death.

I've had very negative experiences with dietitians for a very long time now. I've been overweight since I was very young, so I have been interfacing with dietary consultants from the age of 10 or so. It always seemed to go the same -- the dietitian was rigid. When I tried to explain about my inability to swallow certain foods or how stress and tiredness from my life circumstances meant that food prep was too hard, I got the same 'tough s***' response. One was also a personal trainer and pushed me so hard I ended throwing up after one gym session, and feeling faint on the treadmill at another (I was fourteen at the time, and didn't realise that this was bad for me).

I'm worried that this dietitian will be the same -- that there will be no flexibility and no understanding or sympathy for my issues. From my initial reading and discussion with the surgeon, there is a low-carb/high protein diet recommended on the bypass. This is the diet I feel good eating at the moment, but sometimes my circumstances mean that things slip up.

For example, when I wake up in the morning I'm too groggy to brace myself to eat 300g of yhogurt and fruit/nuts (what I need to feel full currently) -- so I need to add in a couple of slices of toast so I don't feel like I'm forcing food down my throat. And if I'm just off a stint of nightshifts and seriously sleep deprived, the best I can do is a microwave curry from Marks and Spencers.

I have a hope that some of that would go away after the surgery -- because it would be possible to actually feel full after 100g of yhogurt and a bit of fruit and nuts (or less? more?), and not need to eat again for another four hours. But I don't feel guilty for having slices of toast and things like that, after all my diet has been a /lot/ worse over the years and I've finally found a balance between whats healthy and what's do-able that it's taken me so long to find.

Terrified the dietitian is only going to hear that I still have some carb in a day, and not hear that I've improved that massively from eating pancakes and syrup when I wake up, McD's for lunch and a Chinese for dinner, and tell me I can't get surgery.

Are my fears warranted? Has anyone else had a 'not listening' experience with dietitians associated with WLS? I'm really really scared she'll be like the others.

Edited June 8, 20188 yr by JayCat

Obviously every dietician is different, so telling you about my first dietician visit isn't that helpful, but I'll do it anyway in the hopes that it will help calm your anxiety.

The dieticians who work with bariatric clinics come into the room knowing that their patients will have some... let's say, quirky eating behaviors. At my first visit with the dietician, she talked to me a little bit about my current habits (and was totally non-judgmental about it), and gave me a few goals to work on for the next visit: try to focus on portion sizes (not caloric values), start taking a daily multivitamin, and foremost, start working on increasing my protein intake: 80-100g of protein a day.

The next time, we talked about how it was going -- I'd done well about 50% of the time, and not so well the other 50% of the time; but I'd made progress on the protein and was experimenting with other changes. This time, she gave me a caloric target that was lower than I was used to, but not brutally low; and she challenged me to add some more veggies to my day. She wasn't picky about how I got there or what I chose, she just wanted me to work toward that goal.

My point is, there's probably nothing about you that this dietician hasn't encountered before, and probably s/he won't be aiming to scold you or impose rigid guidelines. S/he will be looking to get you moving in the right direction. S/he will probably be interested in getting a sense of what kind of caloric reduction it takes to get the weight coming off, if only a little. S/he will probably want you to get more protein (you'll be hearing a lot of that.) My dietician also gave me a weight loss goal for the months before surgery -- mine was about 10% of my weight, an amount that is very doable in the time frame (even accounting for a spell of false starts) but still something I'd have to work toward.

You'll still have to be open to doing some things differently, and trying some stuff you might not have thought you'd be ready to try. I have been stunned to discover that I'm actually kind of fond of a green smoothie in the morning -- my formula is raw baby spinach, a few frozen peach slices and pineapple chunks, a little water to "smoothie-fy" it -- but here I am, making murky green beverages every morning right before I head to work, and kind of missing them when I don't. But I'm also still eating two eggs and a strip of bacon for breakfast most mornings, sometimes a slice of toast or half a grapefruit as well, and my dietician seems not to have any problem with that. (She'd probably suggest turkey bacon, but I'd rather just not than sub in weird, failed facsimiles.)

Again, my dietician won't be the same as yours, but if you're working with bariatric specialists, this dietician will probably be aware that few of us can change radically overnight. I think they're also aware that if the rigid, punitive approach to diet worked, there would be no need for bariatric surgery.

Good luck!

Well, you are absolutely going to need to change how you eat, there isn't any way around that fact mate. Post surgery you are going to have to focus on what you need first. Proteins, water, the "good for you stuff", carbs are almost dead last. You need *SOME* carbs, but there are better places to get them from than breads. Just be honest with your Nutritionist, about everything, including your fears about your Nutritionist. No one here was eating perfectly before surgery... and no one here is eating perfectly after surgery, we've just gotten a LOT better.

There are plenty of "do-able" healthy options. You don't *NEED* Toast, you want it, carbs are addictive and can be hard to shake, but you CAN do it. Post surgery you *might* not have any cravings, you *might* not be hungry a lot, you *might* be a lot of things. You won't know until after you have the surgery. But for me, cravings still exist, but I can control them and not cave in to the easier food just because it's easier. I still get hungry here and there, not too much, and certainly not as much as before, but it's there in some aspect and I've read lots of people do end up getting a full hunger sensation back a year or so down the line, some never do.

Seems you need to battle convenience more than anything. You don't need to divulge but, I can't thing of any reason where food prep is not possible... you just have to find something that works for your situation. Some folks cook a weeks worth of food on the weekend so they don't need to worry about prep the rest of the week. Me, I don't bother personally, there are plenty of quick, easy options that are within my post-op food guidelines.

Be ready for some major changes, they really need to happen. So don't go into this with the mentality that the surgery is going to have to work around you, you are going to have to work around your surgery.

10 minutes ago, Matt Z said:

No one here was eating perfectly before surgery... and no one here is eating perfectly after surgery, we've just gotten a LOT better.

^^this

42 minutes ago, JayCat said:

I've just seen a surgeon for an initial consultation about getting a bypass and he was positive and set me on the track for it. My first appointment with the dietitian is tomorrow and I'm scared to death.

I've had very negative experiences with dietitians for a very long time now. I've been overweight since I was very young, so I have been interfacing with dietary consultants from the age of 10 or so. It always seemed to go the same -- the dietitian was rigid. When I tried to explain about my inability to swallow certain foods or how stress and tiredness from my life circumstances meant that food prep was too hard, I got the same 'tough s***' response. One was also a personal trainer and pushed me so hard I ended throwing up after one gym session, and feeling faint on the treadmill at another (I was fourteen at the time, and didn't realise that this was bad for me).

I'm worried that this dietitian will be the same -- that there will be no flexibility and no understanding or sympathy for my issues. From my initial reading and discussion with the surgeon, there is a low-carb/high Protein diet recommended on the bypass. This is the diet I feel good eating at the moment, but sometimes my circumstances mean that things slip up.

Quite frankly, I hope your dietician doesn't have a lot of sympathy. What you need is good and honest information and no slack. Because I promise you, your pouch won't give you slack when you go to eat something sweet and end up dumping. Don't stress about it, don't eat things you cant swallow, but that doesn't give you the go ahead to eat crap either. If you go through this surgery with these types of excuses or reservations and if you don't toughen up... you won't succeed. This is a HARD thing to do. You don't want excuses to ruin it for you.

1 hour ago, NobodyYouKnow said:

Obviously every dietician is different, so telling you about my first dietician visit isn't that helpful, but I'll do it anyway in the hopes that it will help calm your anxiety.

The dieticians who work with bariatric clinics come into the room knowing that their patients will have some... let's say, quirky eating behaviors. At my first visit with the dietician, she talked to me a little bit about my current habits (and was totally non-judgmental about it), and gave me a few goals to work on for the next visit: try to focus on portion sizes (not caloric values), start taking a daily Multivitamin, and foremost, start working on increasing my Protein intake: 80-100g of protein a day.

The next time, we talked about how it was going -- I'd done well about 50% of the time, and not so well the other 50% of the time; but I'd made progress on the protein and was experimenting with other changes. This time, she gave me a caloric target that was lower than I was used to, but not brutally low; and she challenged me to add some more veggies to my day. She wasn't picky about how I got there or what I chose, she just wanted me to work toward that goal.

My point is, there's probably nothing about you that this dietician hasn't encountered before, and probably s/he won't be aiming to scold you or impose rigid guidelines. S/he will be looking to get you moving in the right direction. S/he will probably be interested in getting a sense of what kind of caloric reduction it takes to get the weight coming off, if only a little. S/he will probably want you to get more protein (you'll be hearing a lot of that.) My dietician also gave me a weight loss goal for the months before surgery -- mine was about 10% of my weight, an amount that is very doable in the time frame (even accounting for a spell of false starts) but still something I'd have to work toward.

You'll still have to be open to doing some things differently, and trying some stuff you might not have thought you'd be ready to try. I have been stunned to discover that I'm actually kind of fond of a green smoothie in the morning -- my formula is raw baby spinach, a few frozen peach slices and pineapple chunks, a little Water to "smoothie-fy" it -- but here I am, making murky green beverages every morning right before I head to work, and kind of missing them when I don't. But I'm also still eating two eggs and a strip of bacon for Breakfast most mornings, sometimes a slice of toast or half a grapefruit as well, and my dietician seems not to have any problem with that. (She'd probably suggest turkey bacon, but I'd rather just not than sub in weird, failed facsimiles.)

Again, my dietician won't be the same as yours, but if you're working with bariatric specialists, this dietician will probably be aware that few of us can change radically overnight. I think they're also aware that if the rigid, punitive approach to diet worked, there would be no need for bariatric surgery.

Good luck!

Thank you very much for your encouragement -- When talking to the surgeon he said that the dietitian was very different to the NHS weight loss dietitians I was previously interacting with. I just know that if I feel like she doesn't care about my story enough to understand why I'm not still on my 800 cal a day 'so hungry I can't remember a name' blood sugar diet -- because I relapsed into junk.

My average (on a good day) daily diet looks like this currently

Morning -- yhogurt with teaspoon of honey or maple, cinnamon or allspice, toast and fruit

Lunch -- Ham salad, big on the mayo.

Dinner -- chicken and some veg.

I'll snack on nuts and things. How far do you think I'll need to deviate from that to get to where I need to be? I'm hoping she doesn't give me a weightloss goal of 10% -- that's almost a kilo a week for me, given that the surgery is meant to be about 10 weeks away.

My NUT was great. I know everyone has different experiences though. I had to do a year of NUT visits as a pre req. I lost almost 60 lbs. She helped me really get ready for what to expect after surgery and to cut out of foods and drinks that I wouldn’t be able to have any more.
Just tell your NUT about your fears right at the beginning. Mine didn’t give me much sympathy, which I actually really appreciate since this is a huge life change. I’m glad she really prepared me for what was coming.

1 hour ago, AshAsh1 said:

Quite frankly, I hope your dietician doesn't have a lot of sympathy. What you need is good and honest information and no slack. Because I promise you, your pouch won't give you slack when you go to eat something sweet and end up dumping. Don't stress about it, don't eat things you cant swallow, but that doesn't give you the go ahead to eat crap either. If you go through this surgery with these types of excuses or reservations and if you don't toughen up... you won't succeed. This is a HARD thing to do. You don't want excuses to ruin it for you.

I think sympathy might mean something different to what I understand it as? I expect sympathy, as I would if any person had heard my story, but I don't expect that to change what advice she gives me? I work with birthing mothers and I have sympathy for them, it doesn't mean I would offer each one a GA and a c-sec because that would be detrimental in the long-term, if not satisfactory in the short term.

I am not expecting her to tell me that "an occasional slice of cake won't be a problem". Frankly, it already is that's why I'm in this mess. I just want her to be flexible (within the limits) of the pre-op diet and work /with/ me rather than order me about like I'm coming to her with normal weight issues.

My NUT is wonderful and I still see her post-op. I choose to do that so I have accountability. She calls it like it is but she is able to deliver that message in a way that I can accept. She also answers ALL my questions ad I have a lot!

1 minute ago, SleeveinIL said:

My NUT is wonderful and I still see her post-op. I choose to do that so I have accountability. She calls it like it is but she is able to deliver that message in a way that I can accept. She also answers ALL my questions ad I have a lot!

That's the kind of experience I want. I have no illusions about the type of diet I need for the rest of my life -- I just need her to realise that my body hasn't got that 'leg up' or 'tool' yet that it will have when I have the surgery.

On 06/08/2018 at 16:00, JayCat said:

I think sympathy might mean something different to what I understand it as? I expect sympathy, as I would if any person had heard my story, but I don't expect that to change what advice she gives me? I work with birthing mothers and I have sympathy for them, it doesn't mean I would offer each one a GA and a c-sec because that would be detrimental in the long-term, if not satisfactory in the short term.



I am not expecting her to tell me that "an occasional slice of cake won't be a problem". Frankly, it already is that's why I'm in this mess. I just want her to be flexible (within the limits) of the pre-op diet and work /with/ me rather than order me about like I'm coming to her with normal weight issues.

Ok, fair enough. I think everyone in the healthcare field should come up with a plan that the patient can be successful with.

Ok so I’m in the states but so far I have seen 3 nuts 2 within a bariatric program and one privately and here’s the thing about bariatric nuts they work with ppl like us daily so your nut should have compassion but also no nonsense for bad behavior once you are under their care because frankly this is life or death it’s not a matter of like dislike heck I’m the pickiest eater alive and I can stick to it so if you need recipes I got you if you need to vent I got you ok

My NUT is so sweet you can eat her like pie. But having said that, she looked at what I was eating and gave the honest truth about it. So brace yourself, sometimes the truth hurts. She also worked with me to find winning solutions for my situation. I work a very demanding job, have financial issues, and family issues including taking care of a disabled person. Ham salad heavy on the mayo? I just don't think that will fly... but I could be wrong.. maybe its okay for your body and situation. I know my Nut has me making ham roll ups for lunch. That is where I take several thin slices of ham, a slice of real cheddar cheese (not the processed kind) and roll it around shredded lettuce, tomatoes, cucumbers or other salad type veggies.... its sooooooooooo yummy. (I'm in the pre - pre op phase, not the liquid diet phase yet). I can even dip it in ranch dressing (the regular kind not the low fat kind) if I want to but here it the key, I had to let the carbs go.... even the low carb breads and wraps. She told me if I couldn't do that then she would have to find another plan for me. So a good NUT will find what works for you but you have to be willing to at least try what they suggest and report back the honest truth on what you are and are not doing so they can know what adjustments to make. I reported back my fruit servings and it was way too many so they changed it and now I'm losing again. You have to open yourself up, put the past in the past and look at this as a new journey. Be willing to at least try and if you find yourself choking or whatever document it and go back so they can adjust. But just try.

I hope everything went well for you today at you appointment. I was really nervous the first appointment too.

So JayCat, how did it go?

@NobodyYouKnow

I've avoided posting for a while because I was thoroughly disappointed and upset with my appointment -- I left in tears.

Half way through telling my dietary story the dietitian stopped me and, from my perspective, seemed to act like they'd heard the whole thing. Truth be told I had much more to say and felt like if they'd taken the time to really consider these things they'd then have gotten a much better picture of who I am and my particular struggles with food and how to progress from there.

But they didn't do that. The dietitian proceeded to tell me exactly what I couldn't eat, followed by counter-productive information specifying that I could eat the foods they'd just told me not to eat. They then proceeded to show my the size of plate I'd be eating off of after the surgery like it was a big revelation (smaller plate size is the FIRST thing you read about on the google result that comes first for googling bariatric surgery for me). This was followed by the dietitian stating incorrect information about muscle/fat metabolism in regards to long term fasting, and present to me a leaflet with the information detailed information on what they want me to eat.

However, the information presented to me was a 1000 kal diet big on the protein. If I was able to stick to this diet long term I would not be getting surgery?? I have no problems with the types of food they want me to eat but am concerned with my ability to hold up the quantities long term WITHOUT surgery. I also note that while reading the leaflet to me, they kept on pointing out vegetarian options even though I'd previously mentioned I eat meat. Not a big deal, but it felt like twisting the knife a little because I knew already the dietician wasn't listening to me.

All in all, I don't have a /huge/ issue with what they have asked me to eat. But, I think if the result of an hour long consultation was going to be 'eat 1000kal of a 3:3:1 protien:carb:fat diet' irregardless of what I said, it could've been a 15 minute appointment instead. Instead I went in expecting to be listened to and considered instead of brushed over, ignored, and quite frankly, patronized (I already knew a lot about diet and what the post surgery diet would be like. None of the information was new to me.)

I would appreciate it if people were sensitive in replying to me I am still quite hurt by the consultation.

EDIT: to clarify though, I am doing exactly what they told me to do and have every intention of following it to the best of my abilities. I've come too far to get stopped in the road by a bad dietitian.

Edited June 12, 20188 yr by JayCat