Hi,

Has anyone ever experienced the Nutritionist and PA are in agreement on food/shakes, and the Psych Therapist disagreed with them regarding food/shakes.

I am at the beginning stages of my journey, about 3 months in. I have lost a total 15 lbs. I go swimming ever night. I explained to the nutritionist and PA that I am super hungry after swimming. They have to eat small protein before swimming, then eat my dinner as planned, If that doesn’t work add in a shake or more protein. The drs office wants 3 meals a day but they are okay with protein snacks or non carb veggies/fruit snack


The Psych therapist was completely against this and was very adamant about just doing 3 small meals a day, no snacks no extras etc.

A therapist is not a nutritionist. I would go with what my PA and nutritionist think over what a therapist tells me to do with regard to protein and food intake.

Personally, if they are also in the same practice I would let the nutritionist and PA know that the therapist is dispensing other advice, it is confusing to patients, and they need to sort it out within the practice.

I agree. The PA and the nutritionists would be the experts in this case and they agree. I would disregard the other advice and it couldn’t hurt to let they all know that they are offering conflicting advice.

Psychologist involves the mind... They Typically have no training or education on nutrition... Especially a nutritionist who specializes in weight loss surgery.

2 hours ago, berryboo97 said:

the Psych Therapist disagreed with them regarding food/shakes

LOL, yes.

It's not a bug, but a feature ... in a way. The medical side of things look at your physical structure. The psychologist understands how obesity impacts you mentally, socially, and devises (if they're good) a way for you to accept yourself and work positively towards change.

I've enjoyed both sides once I became my own (and honest) patient advocate. My therapist is right that our worth really isn't determined by our weights; that we should eat until we're not hungry regardless of weight, and that the biggest gift you'll give yourself is making peace with the negative self-image.

The medical team is right there's a diet that works with surgery.

That being said: it's becoming increasingly settled science that going hungry - as in hungry-hungry, not 'mmh I'd like some ice cream' - has profound hormonal, mental, physically negative effects. You should not go hungry. And that's where you as your own patient advocate comes in.

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EDIT: I'm sorry, I'm an idiot. And so is your psych! I'll leave the above for general thought sharing, though.

I thought the psych said eat and the medical team said don't eat. . Your medical team has it right here, and that's the same position your psych should take. I bet they're just telling you that because they don't want to give you advice that extends beyond their field of expertise (that being said, "hunger" as a state of being should be part of a bariatric psychologist's field of knowledge).

Edited February 8, 20224 yr by Guest

I agree with listening to the medical personnel. However, ask them WHY they are giving you these directions. Once you have surgery, you need to be aware that "grazing" (unplanned snacking, eating too frequently) can cause you to not loose much or regain your weight, because you're constantly re-filing your stomach as soon as there's room, and usually with not healthy food. Also, most people think exercise burns a lot more calories than it does (most calorie counters are completely wrong on how many calories you will burn and overestimate it), so eating because you've exercised is not always the right response.

but... you will never last in your life long journey if you ignore your hunger. I never lost my hunger after surgery and had to eat 5-6 times a day because I could only eat a little at once.

I agree that you should tell the doc/pa/nutritionist that not everyone is on the same page!

My dietitian doesn’t agree with my surgeon. When I brought up the conflicting info with the surgeon he hold me to smile and nod in my dietitian appointments and do what he suggests anyway.

Since my surgeon is much more knowledgeable about what works with my messed up digestive system, I go with his advice.

Thank you everyone.

I agreed to listen to the drs and Nutritionist. My biggest concern with the psych that this would be the reason she would not clear me. She has seemed to steep in the role of a nutritionist. I almost wanted to switch therapist

The reason why is because swimming burns a lot of calories. I’m not just floating or gentle swimming, I am either treading water or doing aerobics. The faster I go the more resistance I have. And it’s not just I want something to eat, it is hunger. I can try to drink water, but it’s almost like I begin to feel faint or sick like from nit eating. So then I just grab anything. If I know it is there I can have a plan to make sure it’s healthy, or sit the protein a side before it gets that bad.

The therapist has no business telling you what to eat, that's the domain of the nutritionist or PA. Listen to them.

9 hours ago, berryboo97 said:

Thank you everyone.

I agreed to listen to the drs and Nutritionist. My biggest concern with the psych that this would be the reason she would not clear me. She has seemed to steep in the role of a nutritionist. I almost wanted to switch therapist

The reason why is because swimming burns a lot of calories. I’m not just floating or gentle swimming, I am either treading Water or doing aerobics. The faster I go the more resistance I have. And it’s not just I want something to eat, it is hunger. I can try to drink water, but it’s almost like I begin to feel faint or sick like from nit eating. So then I just grab anything. If I know it is there I can have a plan to make sure it’s healthy, or sit the Protein a side before it gets that bad.

Yes, swimming does make me hungry too, but it doesn't burn as many calories as you might think. The estimates given are based on weight, but your weight doesn't cause you to exert much extra energy in the pool, so they are overestimated that way. Plus, because these calorie estimates are always way too high, that's more than the usual amount of "bonus" calories it says your burning vs what you actually are.

I do agree that having a plan for what to eat post-swimming is much better than just grabbing anything.

Did the psychologist say she wouldn't approve you for surgery? I would just smile and nod and say you agree with her. Normally, I say to take these psychologist evaluations seriously, but it sounds like this might be an exception.

I hope you are able to get your surgery! I haven't gone back to swimming since my surgery, even though I can. I just keep making excuses, so good for you!

The psychologist basically has a checklist of things to evaluate you on. One of them is snacking between meals. They don’t want you to do it, period. If your nutritionist approves of the evening snack, I would just smile and tell the psychologist that you don’t eat after dinner. Otherwise, they may not approve you for surgery.

Normally I’d say don’t lie to a medical professional but she’s really doing stuff outside her scope of practice sooooo I’d tell her that her advice has worked like a charm and you aren’t snacking at all. And follow your nutritionist and md advice.