What to Expect When You Reach Maintenance

 

When you have reached your goal weight or the desired weight you want to maintain, you have entered what we call “maintenance.” When maintaining your weight, you are engaged in a healthy lifestyle and must continue to follow the guidelines we have set for you for the rest of your life. This means following the 70% protein food-based and 30% vegetable food-based meal plan, three meals a day. You will always want to eat high quality proteins and vegetables at every meal. If you decide to introduce any additional complex carbohydrates into your diet, the addition must be done gradually and in small amounts while also increasing your physical activity.

Examples of complex carbohydrates include whole grains, brown rice, and whole grain cereals and pastas. Eating too many carbohydrates, especially simple carbohydrates, will contribute to weight regain. Simple carbohydrates are to be avoided or extremely limited in your diet. Examples include white bread, crackers, chips, ice cream, and candy of any type.

When you enter maintenance, weight gain can happen. An increase in what the scale reads is not a sign of failure. It is simply a signal that it is time to take action by closely following your diet and exercise routine.

The human body goes through many normal fluctuations in weight. The variables that affect what the scale reads include:

• Bowel movements
• Fluid loss or intake
• Menstrual cycles
• Hormones
• Time of day

An action weight is the highest weight that you will allow for you body. When you arrive at this weight, now is the time to take action and calibrate what you are eating to drop to a lower weight. Set an action weight and weight yourself. You will know when it is time to take action to prevent weight gain. When you see an increase on the scale, eliminate excess carbohydrates from your diet, increase your exercise, increase your hydration, and measure your food portions.

Weight gain alerts can be:

• Sugar cravings
• Weight increase
• Old habits returning
• Loss of exercise drive
• Feeling of less energy
• Emotional upset
• Drinking carbonation
• Loss of support
• Grazing continually

If you are experiencing any of these alerts, you should seek activities that uplift you, get some support, start exercising one hour each day, go back to the basics (70% protein, 30% vegetables with no carbohydrates), increase your liquids to 64 ounces or more per day, attend support group.

Dietary Guidelines
Proteins – meats and cheeses

• Cod
• Sausages
• Feta
• Mussels
• Kefir (liquid yogurt)
• Orange Roughy
• Yogurt
• Provolone
• Tofu
• Skim milk
• Salmon
• Edam
• Limburger
• Halibut
• Chicken
• Beef Jerky
• Swiss
• Havarti
• Brie
• Turkey
• Blue cheese
• Parmesan
• Ham
• Navy Beans
• Catfish
• Gruyere
• Haddock
• Pork
• Shrimp
• Eggs
• Red Snapper
• Ricotta
• Beef
• Re-fried Beans
• Trout
• Kidney Beans
• Lamb
• Muenster
• Crab
• Monterrey Jack
• Veal
• Scallops
• Fish
• Lobster
• Bacon
• String Cheese
• Venison
• Black Beans
• Gouda
• Canned Tuna
• Cheddar
• Canned Turkey
• Mozzarella
• Deli Meats
• Clams
• Oysters
• Romano
• Cottage Cheese
• Canned Chicken
• Pinto Beans

Vegetables
In maintenance you can now eat vegetables cooked or raw. Vegetables provide vitamins and minerals that your body needs to sustain optimum health. Vegetables are sources of vitamin A and C, folic acid, and potassium. These vitamins and minerals are essential in the regulation of bodily processes. Vitamin C increases the body’s resistance to infection and aids in healing. Potassium regulates heart function.

After eight weeks post-op, you may begin adding raw vegetables as tolerated. Try blanching them at first. Add the more fibrous vegetables last and then chew, chew, chew.

Be sure to eat green and yellow vegetables daily. Most vegetables are easy to prepare and inexpensive compared to most foods. You can eat them raw or cooked. Be creative in your choices. Try a new variety. Prepare it in a new way; serve it with a cheese sauce or flavored vinegar. You are getting the most out of the calories you consume when you emphasize vegetables in your diet. Plan your meals to include 30% vegetables. There are many varieties to choose from.

Can be eaten cooked or raw:

• Okra
• Rutabaga
• Sweet Potatoes
• Onions
• Beans (edible pod)
• Hearts of Palm
• Beans (shell)
• Mushrooms
• Turnips
• Squash
• Edamame
• Greens (salad)
• Artichokes
• Broccoli
• Water Chestnuts
• Jicama
• Cauliflower
• Asparagus
• Scallions
• Parsnip
• Cabbage
• Bamboo Shoots
• Eggplant
• Carrots
• Spinach
• Tomatoes
• Sprouts
• Leeks
• Cucumbers
• Garlic
• Beets
• Greens (cooking)
• Fennel
• Peas
• Artichokes
• Peppers
• Celery
• Sunchokes
• Brussels Sprouts
• Radishes

Foods to be cautious with:
When introducing persimmons, oranges, grapefruits, tangelos or tangerine sections, use caution and eat carefully as these types of foods are fibrous and could get stuck in the new outlet of your pouch causing pain and vomiting. Also, de-string your celery before eating.

After four to six weeks you may add fruit once or twice per week in an amount no larger than one strawberry. Fruit helps to regulate your bowels. Fruit is a natural sugar and may cause diarrhea and the “dumping syndrome” in some Gastric Bypass patients. It can also contribute to slower weight loss or to weight gain. Therefore, you may choose to not include fruit in your food plan. Your daily vitamin and your vegetables supply the vitamins you need.

Soups
Strain the soup. Eat around pasta and potatoes.

• Bean
• Lentil
• Vegetable
• Chicken Vegetable
• Vegetable Broth
• Chili
• Broccoli
• Cheese
• Bean and Ham
• Chicken Broth
• French Onion
• Turkey Vegetable
• Split Pea
• Beef Broth

Condiments
Use condiments, seasonings, herbs, and spices to add flavor without adding fat.

• Mustard
• Ketchup
• Light Mayonnaise
• Light Yogurt
• Greek Yogurt
• Salsa
• Lime Juice
• Lemon Juice
• Light Salad Dressing/Vinaigrette
• Light Sour Cream
• Light Cream Cheese
• Salt/Pepper
• Spices
• Low Sodium Soy Sauce
• Vinegar

Snacks
These do not take place of your main meals. Eat recommended protein-based snacks if you’ve increased your exercise for the day or your blood sugar is low. We discourage other types of snacks as they lead to old habits of constant eating (grazing) and eating foods that are not in your food plan.

• Beef Jerky
• Turkey Jerky
• String Cheese
• Cheddar Cheese
• Cottage Cheese
• Deli Meat
• Vegetables
• Hard Boiled Eggs

Grains
Carbohydrates such as grains and starches are high in fiber. They are also high in calories. Weight loss surgery patients receive their fiber through eating vegetables and meat. During weight loss, do not eat bread, pasta, rice, cereals, crackers, chips, tortillas, and potatoes.

Beverages
Water is the beverage of choice. Exclude fruit juices from your food plan. They are high in calories, can cause diarrhea, contribute to weight gain, and can induce the “dumping syndrome” in some Gastric Bypass patients. For the reason we recommend that you don’t drink them. They also contain natural sugars or artificial sweeteners. It’s important to stay away from liquids or foods that contain these added sweeteners, as they can increase your cravings for sugars and slow down your weight loss.

Drink 64 ounces of fluid each day. It is essential for good health, proper weight loss and to improve your energy level. Refrain from drinking fluids during your meal or for thirty minutes before or after your meal.

Because the surgery has dramatically reduced your stomach size, consistent fluid intake is vital to avoid dehydration. Always have recommended beverages with you and take small sips frequently. Let the liquid stay in your mouth for a few moments before swallowing, this insures you don’t drink air which can cause gas.

If you experience any symptoms of dehydration such as dry skin, dry mouth, dark urine, or very little urine output, increase your liquid intake. If dehydration persists after preventative measures have been taken, contact our office and speak with your surgeon’s medical assistant (801) 268-3800.

Primary Beverages

• Water
• Filtered water
• Tap water
• Bottled water
• Ice water
• Ice cubes
• Shaved ice
• Water flavored with a splash of lemon, lime, or orange

Secondary Beverages
(to be consumed on a limited basis only)

• Herbal teas
• Crystal light
• Tomato juice
• Carrot juice
• Skim milk
• Buttermilk

Milk and Dairy Products
Skim milk is an excellent source of calcium and vitamin D. These vitamins help to keep your bones and teeth healthy. Following surgery, you may experience an intolerance for milk products, or lactose intolerance. To combat this intolerance, try eating yogurt in varying amounts, then advance to skim milk. If problems persist, try taking Lactaid or Dairy Ease which are enzymes that help digest milk or avoid dairy products all together.

Medical Follow Ups/Annual Blood Work
To monitor your nutritional health after weight loss surgery, it is required that you have certain blood tests drawn annually. Your family physician or our office can order them one or two weeks before your annual visit. Please go fasting 6 hours prior to blood draw. The tests you need are as follows:

• Comprehensive metabolic panel (K90.9)
• Lipid profile (E78.0)
• CBC with diff (D50.9)
• Vitamin B12 level (D51.9)
• Thiamine Whole Blood (Frozen sample) (E51.9)
• Folate (D52.9)
• Vitamin D; 25 hydroxy level (E55.9)
• Hemoglobin A1c (E11.9, E13.9)
• DS (all of the above plus): Vitamin A level (E50.9)
• DS (all of the above plus): Protime (D68.9)

Mail or fax a copy of these test results to our office. The test will be reviewed by your surgeon and placed in your chart. Fax number (801) 268-3997.

 

For helpful hints on back to nutrition basics: some guidelines for life click here.
For helpful tips on protein, click here.
For more information on the lifestyle of a bariatic patient, go here.
For helpful tips for healthy nutrition, go here.

Find more answers to Frequently Answered Questions here.

 

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124