Bariatric Debate: Counting Calories

Even dietitians don’t agree if counting calories after bariatric surgery is the best approach

A question was asked to a group of dietitians

One of my favorite resources as a dietitian is to be a part of the Academy of Nutrition and Dietetics and furthermore to be a part of the Weight Management practice group.

As a member of the practice group, I am on an of dietitians who focus on weight management counseling and several who practice bariatric surgery nutrition.

This past week an email went out with a simple question:

“I was wondering what is the average amount of calories a person can consume on a daily basis post Gastric Sleeve or Bypass.”

After a few days went on, I noticed her email had fourteen replies. I always knew this was a hot topic for bariatric patients but seeing dietitians discuss it was so fascinating to me!

What is the benefit to counting calories after weight loss surgery?

In an effort to maintain privacy because I didn’t ask all of these dietitians if I could share their thoughts, I’ve instead decided to discuss the overall thoughts on those in favor of calorie counting and those opposed.

For those who did recommend calorie counting, the most common reasons as to why they give calorie guidelines:

As dietitians we are to support patients in their goals, not force them to do things our way. If they insist on having a calorie number and we don’t give them one, they will go find the number somewhere else and it may not be a great source.

Most dietitians actually agreed that calorie counting can lead to obsessive thoughts and disordered eating. However, they understand patients are really wanting a number and they would rather give a number than have their patient not come back and instead go to a Facebook group for information that is not personalized from a nutrition expert (a registered dietitian).

Dietitians were a little varied on how many calories they do recommend! The original question regarding “how many calories a day post Sleeve or Bypass” was hard to answer because there are so many variables to consider.

Why would a dietitian not recommend calorie counting?

Again, the comments were pretty polarizing on which approach to take whether to give a number or not give a number but mostly everyone agreed that calorie counting as a whole wasn’t the best approach.

For the dietitians who were not in favor of giving a calorie based diet, this was the primary reason:

Bariatric surgery has the benefit of improving hunger and fullness thanks to hormonal and physical changes. Patients would be better set up for lasting success if they focused on quality over quantity and used mindful eating to identify natural stopping points.  It’s an opportunity to normalize food in their lives instead of counting calories.

I was really excited to hear from Narmin Virani RDN, CSOWM, who has been using an Intuitive Eating model for bariatric surgery patients and has been writing a paper on what they have found. Here is an excerpt from her email:

{Quote continues} “especially once the appetite starts increasing, after 6 months post-op. This leads to getting back into the ‘restrict-binge’ cycle that caused patients to gain weight over years of dieting pre-surgery, messing with their minds, and ultimately leading to weight regain.”

Narmin went on to share about the Intuitive Eating Model she uses with pre and post-op patients. She also gave me permission to share the poster of her presentation at the 2019 ASMBS Conference. (Below)

“We have been using the Intuitive Eating model pre and post surgery to foster a healthy relationship with eating to facilitate better weight loss maintenance and physical/mental health outcomes long term, adapting the IE approach to meet nutritional needs and prevent malnutrition in the initial weeks/months postop.

I also agree that while there is no evidence on protein needs after surgery, we do recommend approximately 60 grams a day postop.  Even though this is not evidence based, we find that giving protein recommendations does not lead to the level of maladaptive eating behaviors as calorie numbers do, as calorie numbers limit the amount of food patients can eat, while protein numbers don’t do this, and protein recommendations can be integrated more flexibly, and be helpful in preventing protein-malnutrition post-op.”

Intuitive Eating and Bariatric Surgery

This is likely a precursor for a separate blog regarding Intuitive Eating, but as a way to connect and showcase the work Narmin is has done, here is a quick summary.

Intuitive eating is the practice of focusing on your body’s natural hunger and fullness cues and making you the expert of what your body is signaling instead of focusing on diets and numbers to tell you how much to eat.

Sidenote: I love that the header includes the phrase “healthier relationship with food” as this has been the theme of our current Get Focused Challenge!

Click on the image to view the PDF version.

For More on this topic

If this brings up more questions for you on what you should be eating after surgery, you may be interested in my video courses library.

My approach to post-op nutrition is to focus on a ratio of protein to vegetable and listen to fullness cues on where to stop. It’s different than the approach of set portion sizes and focusing on numbers but many patients find freedom in keeping it more simple.

You can find out more in my video course How to Success After Gastric Sleeve or How to Succeed After Gastric Bypass. The first lesson is free and the remaining lessons are for active members to the website.

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