Abstract

A well-balanced diet with dense nutrition is a very important aspect of healthy weight loss for people that have undergone lap band surgery. Lap band surgery is one of the most popular bariatric weight loss surgeries available to qualified patients. There are strict criteria for people receiving this surgery, like BMI higher than 35 after diet and exercise failed to produce significant weight loss. There are many risks associated with this procedure and strict diet has to be followed after to avoid malnutrition. Lap band procedure is not always successful. Many patients go back to old dietary habits and fail to lose weight. A proper teaching plan with coping skills can avoid these common issues.

   Teaching plan- Diet after Lap Band Surgery

  Patient interviewed, CM, had lap band surgery in April of 2018. She decided to undergo this procedure as she was unsuccessful to reduce her weight by diet and exercise alone. She was also pre-diabetic and suffering from joint pain and bulging disc. Understanding the risks, she underwent the procedure hoping for significant weight loss. A year and a half later, the patient was only able to lose 45 pounds. Her BMI is still 45.5. She recently had an Anterior Cervical Discectomy with Fusion between C4-C5, so her ability to exercise is postponed till recovery is complete. Patients diet while in hospital was less than desirable. Patient’s family would often bring outside food for her. McDonalds and Taco Bell were her favorite. Knowing that lap band surgery success can only be achieved through change  in one’s diet, student nurse decided to create a teaching plan to help the patient with healthy weight loss plan.

                                                        Assessment of the Patient

 CM underwent multidisciplinary counseling before the surgery, but already forgot the majority of the information given to her. Preoperatively, all patients receive total medical evaluation and an extensive training from many disciplines including dieticians, psychologists, and bariatric surgeons (Khoraki, Moraes, Neto, Funk, Greenberg, and Campo, 2018). The patient was under the care of a dietician for 4 months after the surgery and was making great strides. Unfortunately, the insurance only covered certain amount of follow up meetings and the patient slowly reversed to her old eating habits.  Long term weight loss outcomes are much more promising in Europe and Australia centers for lap band surgery due to the fact that long-term port-operative management and follow-up factors, life -style and supportive environment are available to the patient as long as they need it to reach their goal. Patients family prefers to dine in restaurants and often attend many family gatherings with potluck style food service. She voiced her frustration with her limited results from the surgery and wanted to clean up her diet to lose weight. .  Exercise regime was also unattainable as patient was suffering from painful herniated disc in her neck and painful joint pain due to the excess weight.  She spoke to her husband and son and convinced them to join her in following a healthy diet.

                                                   Method of Implementation

  The patient was eager to learn new coping skills and voiced readiness to learn different ways to reach her goal weight. The student nurse chose to introduce the patient to a phone application called MyFitnessPal that helps users with choosing healthier options and educating them about the nutritional value of each meal. Database is one of the largest available and contains majority of store-bought foods and many restaurants menus with detailed nutritional values. The patient can easily access it on her phone and add her food choices into her daily intake file. The application is very user friendly, mobile and has many interactive and educational videos. Another method the student nurse implemented was teaching the patient to keep their food journal. Entering her food intake and how those  meals made her feel is an important step towards better health.  The student nurse suggested that the patient joins a social media groups offering  support for people following lap band or other types of weight loss surgery. The support from other patients that are dealing with the same daily obstacles to lose weight makes the journey less lonely. Furthermore, bariatric patients could experience number of nutrition and dietary challenges that can impact short-and long- term weight and their bodies homeostasis. The student nurse also educated the patient about “grazing”. Grazing is an excessive snacking which can jeopardize long-term weight loss if not minimized (McCrice and Don Paul, 2015). Grazing is often triggered by social or psychological circumstances. These could include eating when stressed, bored, emotional, and in association with activities such a watching television, performing computer work, or attending social events (McCrice and DonPaul, 2015). Being present in the moment when eating will help the brain get important cues from the stomach when it gets full to avoid mindless overeating. It takes 15 to 20 minutes for the brain to register that there is a food being ingested and hunger being satisfied. In those 15-20 min many people are able to overeat and ingest too many calories in one sitting. Slower eating and longer chewing of the food leads to earlier realization of fullness and stopping before excessive calories are ingested. Patient understood and implemented this suggestion at her following meal with a great success. She also stated that once she recovers from the disc replacement surgery and her doctor clears her for full activity, she will start an exercise regime to aid her weight loss. Having proper tools, support and education help will make any weight loss journey successful.

                                                                Evaluation

 Patient demonstrated proper use of the application on her phone for two days and kept her journal updated with detailed entries about her food choices and how the food made her feel.   She feels confident and optimistic in her newfound skills and believes it will help her on her journey to lose weight and get healthier. She found many people who have undergone the same type of surgery on social media platforms. They helped her find local dietician who specializes in helping bariatric patient stay on track before and after surgery. She also found support from her family. They decided to start eating healthier to prevent any health issues in the future and help the patient lose and keep the weight off long term.

References

Khoraki, J., Moraes, M. G., Neto, A. P. F., Funk, L. M., Greenberg, J. A., & Campos, G. M. (2018). Long-term outcomes of laparoscopic adjustable gastric banding.The American. Journal of Surgery, 215(1), 97-103. doi:http://dx.doi.org.ezproxy.library.csn.edu/10.1016/j.amjsurg.2017.06.027

McGrice, M., & Kathlene, D. P. (2015). Interventions to improve long-term weight loss in patients following bariatric surgery: Challenges and solutions. Diabetes, Metabolic Syndrome and Obesity, 8, 263-274. doi:http://dx.doi.org.ezproxy.library.csn.edu/10.2147/DMSO.S57054