Question 2
When patients were asked how to improve the gastric bypass pre/post surgery process, 11 patients (14%) suggested “sustained dietary supervision” such as cooking classes and group support. What other ways can a gastric bypass program provide additional nutrition support for their patients before and after surgery?
posted by Anonymous @ 6:55 PM
28 comments
28 Comments:
I think that monthly information sessions and ongoing preoperative and post-operative support groups would be extremely beneficial. Monthly sessions would cover a wide-variety of nutrition topics in addition to lifestyle education, such as how to over-come weight-loss barriers or how to refrain from developing disordered eating patterns. If individuals do not have the time to attend monthly sessions or support groups, an online program that provides patients with support and long-term follow-up might also be beneficial. The fact that users of an online program would not have to meet face to face might help to keep patients all the more honest about how they are really doing.
It sounds like the pre-surgery visit with the RD primarily focused on what to do after the surgery. Taking the time to have several pre-surgery visits that helped improve their habits now would be a great start. Working on obvious problem areas (ie. eating out 5x/week or high intake of soda) before the surgery and getting them to improve these months before hand can help improve confidence in making changes after the operation as well as possible induce some weight loss before even having the procedure.
Anna, I love the idea of monthly sessions in a group setting. That is often seen for other nutrition related health issues like bypass, diabetes, and COPD, it makes complete sense for bariatric patients to meet like that as well. The online option for those that can't attend is also a great idea. There are so many ways to make sure the participants feel like they have control of their eating habits and weight loss goals, not the other way around, that RDs can use to our advantage.
I agree with the previous two ideas (increased frequency of pre-op meetings and the online support) – great ideas! I definitely think monthly support groups are essential for long-term success. This is another opportunity for patients to connect with others who are experiencing the same issues. As we know this patient population is at an increased risk for development of vitamin / mineral deficiencies. Therefore, all patients post gastric bypass should have lab work completed every six months and every year after surgery. This may provide further opportunity for face to face interaction with the physician and RD. Furthermore, a monthly newsletter from the "bariatric RD" may be beneficial for reinforcement regarding tips for preventing complications, etc.
Another thought going with Anna's idea - blog or even Facebook support for younger obese / bypass patients. This could be monitored by an RD.
A gastric bypass program could set patients up with peers who has gone, or is going through surgery themselves. This way, patients would have each other to rely on in between meetings. They would be able to share tips, and what has worked/hasn't worked for them. The RD's contact information would be readily available to group members, but having someone that has personally gone through the same surgery, may give them a better sense of motivation and commitment.
I think that using cooking classes and support groups are both great ways to provide nutritional support, but like Anna said, it may be necessary to hold these meetings on a more frequent basis. Providing the patients with additional nutrition information such as dining out tips, grocery shopping tips, portion size education, etc. on a regular basis would help the patients to stay on track. I also think it would extremely important for the MD and/or RD to be readily available to the patients should they have and questions or problems.
I think Rachel W's idea of a blog or facebook group/page is really good. Younger patients are needing this type of surgery, and those are currently their chosen avenues of communication. These communication avenues are gaining popularity with older populations as well. With an RD monitoring and responding to to the online posts, questions could be answered in the fastest way possible.
I agree with Rachel W that having some sort of online communication that is monitored by an RD would work well for this population. It would provide these patients with an easy way to have their questions answered outside of their normal sessions. I also think Meredith’s idea of having a peer to rely on before and during the surgery process is a great idea. This would allow the patients to share experiences and tips amongst each other, which may lead to increased self-motivation and higher success rates.
Rachel, I think that a monthly newsletter would be an excellent idea. This could be distributed via e-mail or posted on a blog where patients could comment and ask questions. I also love the additional suggestions regarding online support for the younger generations.
I think having a bi-weekly or monthly nutrition education class would be beneficial. Sometimes hearing things once or twice is not enough to ingrain the information so that they can actually practice healthy eating and exercise behaviors. Having a cooking class is a great way to improve the pre/post surgery process, but maybe even having the patients themselves do a guided group grocery shopping to learn what types of foods to buy/stay away from and then following through with the cooking class. It would also be nice to have an online support blog or email thread so that the patients can keep in touch and ask questions with one another.
I think doing a support group of some kind to get individuals a chance to be in contact with people who are going through the same thing they are. It would provide an opportunity for the individuals to learn from each other as well as from a counselor of some kind to provide guidance.
Anna
You are dead on with the addition of the internet for added education and support. If there was something set up for them to use as an ask and answer this would be a great way for them to get good information fast and to be a secure and legitimate place for nutrition information.
In order to improve the gastric bypass surgery process, there should be monthly meetings or activities to provide additional nutrition support. These meetings should start pre-surgery and continue after surgery. In addition, there could be some kind of website or blog for those who are unable to make the meetings and/or need extra support in the meantime.
Rachel, I agree with you that a blog could be facilitated by an RD. This would be a great way for people who need extra support between meetings to get answers to questions, recipes, and other resources.
There are so many ways to provide additional nutrition support for patients after surgery: Support groups, weekly or monthly seminars, continuing education-type articles, podcasts or vlogs with RD's and MD's, quarterly visits with an RD, educational sessions on DVD, there really are so many possibilities.
Meredith- I didn't even think of facebook... An app could be developed for the iPhone as well!
I think the summary of the article pretty much answered this question. I think everyone's ideas on group support are great but I feel that continuous consultations with an RD to work individually with these patients would be very beneficial both pre and post surgery. The article mentioned that the patients met with the RD 4 times in the first year and 1 or 2 times in the next 4 years. I think these numbers should be increased to 6 consultations in the first year along with the monthly meetings and blogs mentioned by everyone else and 3-4 times in the years following that. I think that the number of meetings could be individualized depending on the progress the patient is making. Plus, that means more work for dietitians and there's nothing wrong with that!!!
I think the ideas regarding facebook and a blog are great. A lot of times people don't feel comfortable going to meetings or they don't have the time in their day so these are excellent ways to keep the patients connected to an RD and others going through the same process. However, it was mentioned that this would be more for the younger patients but I think this would be very helpful for the older patients too because everyone has facebook and are blogging now-a-days including my 78 year old grandparents so I think this is great for all ages!
Support groups could be even more helpful if cooking classes and physical activities happened as a part of these support groups. Having a support group where activities concerning diet, exercise, and emotional support components (5K runs, cooking classes, nutrition talks, group talk sessions, ice skating parties, etc) would be a more comprehensive approach to achieving and maintaining a healther weight status.
Creating online forums as well as real life meetings would increase the inclusiveness of such support. I think it's important to have professionals in counseling, nutrition, and physical activity to answer questions and separate fact from fiction.
Anna Taylor
To provide additional nutrition support, can provide access online or by phone to an RD who can answer questions they might have. The program can also send out daily e-mails or texts message with words of advice and support. They could have weekly or biweekly meetings to just meet and talk, have weigh-ins, or do demos and other things like that.
I agree with what most of you said, especially regarding using the internet as a resource. I also think it is extremely convenient, but that also makes me wonder how much it would help. I think there is sometimes more accountability when a person shows up to a meeting or a group to weigh in or asks questions or watch demos than going online, where a person can just not sign on or lie about their weight loss. I think having both options available to participants would allow them to reap the most benefits.
I think the internet support groups are a great idea as well as monthly sessions to stay updated, motivated and on track with their main goals. Reiterating and gradually introducing these individuals to more information will help them stay focused and knowledgable on what is neccessary to achieve and maintain their goals. Preparing the individual undergoing surgery with more pre-op sessions seems appropriate to illustrate the importance of their efforts post-op as well as to inform them of various resources previously mention to help them along the way.
I think having follow up meetings every month with an RD and maybe some peers that have recently had bypass surgery would help them deal with the lifestyle changes and any problems they are all having with adhering to the diet changes.
Sarah U
I really like how Meredith and Sarah G. mentioned facebook groups and iphone apps! That is a great way to reach the younger people who are having this procedure done.
Sarah U.
All great ideas girls...I think that support groups are a great idea so that patients have other people to talk to who are going through similar challenges as themselves. To supplement that though, I think one-on-one sessions with an RD at least once a month are essential. That way, patients can get into things that are specific to them or can open up about more personal things they may not be willing to discuss in a group setting. From my recent experiences with complications of bariatric surgeries at Memorial Medical Center, nutrition follow-up with these patients is absolutely essential. Although many programs out there are great, some are not so fantastic and will give the surgery to anyone who comes along and can pay the price. Unfortunately, this leads to some life threatening situations, many of which can be avoided with some nutrition intervention.
I think that there is a great variation among bariatric surgery centers. Some centers have large amounts of after care while others have almost none. In the centers that I have seen, yearly visits with an RD for the rest of life post surgery and monthly support groups seem to be the standard after care. I feel like that is sufficient after care for the bariatric center. I do believe that the support groups could implement different events like a cooking class if their specific population desired it.
All of your suggestions are good ones, but I think it is important to remember that we cannot actually follow the guidelines and lose the weight for our patients. While I believe that complete after care is important, I also think it is important that patients seek out multiple ways to have a healthy lifestyle. There are healthy cooking classes in other facilities, there are meetings at gyms and health food stores. It is important to diversify in order to have a complete lifestyle. Meeting with an RD once a year with support groups monthly should be enough to make sure the patients are using good information.
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