Angie Britt shares her experience of learning to eat after weight loss surgery.
Since having weight loss surgery in 2014, Angie Britt has become accustomed to the question: “What can you eat?” People tend to think that her post-weight loss surgery diet is highly restrictive, and that she “can’t” eat certain foods or at most restaurants. Before her surgery, Britt thought the same thing.
“I’m not going to get to eat food for the rest of my life,” Britt thought.
What Britt has found over the past six years is that she “can” eat anything, and that there are in fact many healthy, post-weight loss surgery diet-friendly options. Rather than thinking about what she can or can’t eat, Britt prefers to think in terms of what she should eat.
Britt, the Supervisor of Patient Service Operations for the Weight Loss Surgery Program at Washington University School of Medicine in St. Louis, has learned several lessons in the six years since her surgery. From how to pace yourself while eating to the best way to stick to a diet when life presents unexpected situations, she shares her tips for eating after weight loss surgery.
“I eat five small meals a day,” Britt says. “I don’t ‘snack.’ I don’t eat three meals and two ‘snacks.’ For me, that word means foods high in carbs, loaded with calories.”
While the food a patient eats is an important element of their postoperative diet, Britt also acknowledges the psychological impact of language. She avoids words like “snack” because they are associated with foods she should not eat.
She also discourages patients from using the word “cheat.”
“If you cheat yourself after surgery,” Britt says, “that’s who you are cheating: yourself.”
Having “cheat days” or “cheat snacks” is counterproductive to Britt, because these words suggest “getting away with something.”
Learning How to Eat Again
After weight loss surgery, the area of the stomach is smaller and requires less food to feel full. While this makes sense logically, smaller portions can appear too small. If a patient is accustomed to seeing larger portions, the newly reduced size of their meal might be startling.
“Using a smaller plate helps with the perception,” Britt says. Psychological aspects of eating, such as the amount of empty space on a plate, can play a larger part in dieting than patients might expect. “We have a relationship with food,” she says, “whether we realize it or not. When you operate on the stomach, that relationship changes.”
As part of that changing relationship, Britt also has a process for eating that ensures she gets the necessary nutrients before feeling full. On her plate, the food is separated by category: protein, green vegetables, starchy vegetables. During a meal, she travels around the plate, starting with her protein and ending with the higher carb vegetables. “Most of the time,” she says, “I don’t make it to the end of the plate before I’m full.”
Adapting to the Unexpected
The team of nutritionists and dietitians in the multidisciplinary Weight Loss Program help educate patients on what and how to eat, but life is full of unexpected situations. Britt says that, with proper education and attention to nutritional value, patients can stick to their diet even when they forget to bring their lunch or have to eat in an unfamiliar setting. While she suggests planning meals and bringing high protein, low carb food, she also understands that there are times when a person will forget to do these things.
“The education our registered dietitians and nutritionists provide is so important,” Britt says, “because it equips you to adapt to the unexpected.”
Can You Eat Fast Food?
Fast food tends to have many options that do not fit the high protein, low carb suggestions for a post-weight loss surgery diet. Burgers and fries are high in carbs and calories, and are typically served in portions larger than the patient is recommended to eat.
“You aren’t going to be stopping at a drive through every day,” Britt cautions. She acknowledges that, for some, the occasional trip to a fast food restaurant might be unavoidable. “We try to help our patients make better choices when they do get fast food.”
Rather than a large meal including a hamburger, French fries and a soda, Britt recommends ordering something grilled. If there is no grilled option, Britt encourages patients to select the sandwich with the highest protein and remove the bread to reduce carbs. “See if there is an option that is wrapped in lettuce instead of bread,” she suggests.
These small adjustments make it possible for patients to fit the occasional, infrequent fast food stop into a hectic schedule without completely derailing their diet.
Beware the Buffet
Going out to eat with family or friends can be challenging when dieting, but Britt has found ways of reducing the stress so that she can still enjoy these outings.
“If I know I am going to a restaurant,” Britt says, “I look for their menu online beforehand.” Instead of going in blind and potentially making an unhealthy decision, Britt recommends planning your order in advance so there is no pressure in the moment. “That way, when everyone else has ordered, you aren’t sitting there trying to figure out what you should eat.”
She finds that most restaurants offer meals that fit her diet, and that she can often take enough leftovers for a second meal, because the portion sizes are so much larger than she is used to eating.
The all-you-can-eat buffet is one setting Britt warns patients to avoid. With unlimited options and so many unhealthy, high carb foods on display, the buffet presents a particular challenge for patients.
“I don’t like buffets,” she says, “because I tend to make bad choices. I want to try a little bit of everything.”
Britt recommends checking to see if the restaurant offers entrees that can be purchased separately—removing the danger of the buffet entirely—or sitting as far from the buffet as possible, which might reduce the temptation to make return visits after clearing a plate.
Every season has its share of family gatherings, from the barbecues and outdoors parties of spring and summer to the fall and winter holidays, and these gatherings often involve eating heavily. This can be a source of temptation for patients—especially if there are certain family recipes and traditional dishes that are staples of these get-togethers. While there are likely some unhealthy options at a family barbecue or holiday party, Britt sees these as opportunities to eat healthy while still having fun.
“The best thing to do is sign up for a dish,” Britt says. She encourages patients to bring something healthy, that they will enjoy and that others will also like to eat. Involving the other partygoers by bringing something that everyone will eat is one way to help reduce the stigma surrounding what a person “can” eat after weight loss surgery.
“One good thing about family functions is that there is almost always a protein,” Britt says. “There are vegetables that aren’t covered in gravy. If you have a favorite family dish that isn’t the healthiest, have a small portion and eat it slowly so that you can savor it.”
Following these tips can help patients navigate some of the more difficult moments they are likely to face after weight loss surgery without veering off course from their diet.
Adult Weight Loss Surgery Team, from left: Francesca Dimou, MD; Jayme Sparkman, ANP-BC; Ashley Waldrop, RN, CBN; J. Chris Eagon, MD; Shaina Eckhouse, MD; and Ashley Welborn, RN.
Advice for Patients
“Through the first year after having weight loss surgery, that’s your prime time for losing weight,” Britt advises. “The surgery is providing you the biggest part of the tool right then.”
While the procedure does make it easier for patients to lose weight, sticking to a healthy high protein, low carb diet is equally important. Committing to a diet can be difficult, but Britt underscores that investment in the diet is pivotal to success.
“A lot of times, patients will say: ‘Give me a list of what I should eat every day. Give me a meal plan,’” Britt says. The Washington University Weight Loss Surgery team at Barnes-Jewish Hospital does offer nutritional information, including meal plans and menus, but Britt stresses the importance of patient buy-in. “It has to be your decision. It has to be your idea. You have to be the one that buys into what it is that you’re making and eating.”
Britt loves to cook. She does not like relying on packaged or canned meals that are low in flavor. “Everything has to have a lot of flavor,” she says. This means that, for Britt, the post-weight loss surgery diet had to involve recipes she could cook and adapt to her own preferences.
Britt’s favorite meal is a plate of nachos. Typically high in carbs, nacho chips are not something a patient should eat as part of a post-weight loss surgery diet. Because she loves nachos, though, finding a healthier way of preparing the meal was important to the success of Britt’s diet. Her solution was to cut “carb balance” tortillas into triangles, toast them until crispy and use those as the base for her homemade nachos.
Angela Britt helps bariatric surgery patients understand the requirements of their diet, and how to succeed after weight loss surgery.
“The buy-in is yours,” Britt emphasizes. “If pizza is your favorite food, you need to find a way to make that pizza.”
Patients are not alone in this journey. Learning to eat differently is a challenge, and the program offers patients resources for the road ahead.
“Our team of dietitians and nutritionists helps educate patients,” Britt says. With registered nutritionists and dietitians, a responsive team of nurses and physicians, and patient support groups, the program is designed to give weight loss surgery patients all of the tools to succeed in their postoperative journey.