Article By: Rachel Ignomirello, MS, RDN, CSOWM, LDN
Rachel Ignomirello is a Bariatric Dietitian and Board-Certified Specialist in Obesity and Weight Management.
I wear a lot of hats as a bariatric dietitian: nutrition counselor, educator, support group moderator, clinician, and sometimes even patient service support! Bariatric patients undergo life-changing surgery, which can be a stressful time for them. Complaints do happen, and these are the most common ones I hear from my bariatric patients.
1) This liquid diet is so hard!
If you’ve never had to do 2-4 weeks of liquids, you have no room to talk. When patients complain about their liquid diet, it’s because it’s hard! Offer them more variety in allowed brands, flavors, and textures. Through educational visits, the patient should understand that pre- and post-op diets have medical purposes: liver prep and safe healing. Help the patient remember their “why” for surgery, and it may make these hard times seem more temporary.
2) I hate my vitamins!
Bariatric vitamins have drastically improved in taste and texture over the last few decades, but some patients still struggle with them. Vitamins may make patients feel nauseous, so encourage them to take their bariatric supplements with a meal or to take them before bed to minimize or alleviate nausea. There are many bariatric vitamin companies out there, so help patients find a brand, flavor, and formulation that works for them and their lab work.
3) I have zero energy!
During the initial period of rapid weight loss, lower energy levels may be normal until patients are able to increase their protein and fluid intake. Bariatric patients can experience long-term fatigue if they are dehydrated, not getting enough calories or protein, or have a vitamin or mineral deficiency. While low energy may be common, it should always be checked and addressed.
4) My tastes are changing!
After bariatric surgery, taste changes are a frequent phenomenon but can benefit the patient. Most patients report a heightened sensitivity to sweets and/or a decreased tolerance of fried foods. Those changes may help the patient avoid sugary and greasy foods. If the patient is not tolerating their sweet protein shake, they may benefit from using an unflavored protein powder or a savory protein supplement instead. If the patient is struggling with protein food taste changes, help them find different protein sources or more variety through seasonings and sauces.
5) I don’t have time [to cook, exercise, etc.]!
It can be difficult for patients to start prioritizing themselves, but patients must learn how to manage their time and priorities for better success. Offer patients time management and delegation tips. Meal planning and prepping become a lot easier the more you do it and will prevent the classic “what should we eat” question at home. When it comes to exercise, there is nothing wrong with shorter workouts. Research has proven that short, intense 20-minute workouts can have a beneficial effect on health. If you do something, it’s better than nothing.
6) I'm losing my hair!
Post-operative hair loss is a common fear for bariatric patients, especially female patients. Hair can be an important component of self-image, and the thought of losing it can be distressing. Rest assured, I’ve never seen any patient go bald because of surgery. Let patients know that hair shedding should not continue for more than 6-9 months as long as there are no nutritional deficiencies. The shedding happens because of “telogen effluvium,” which is an alteration in the normal hair cycle, from the stress of rapid weight loss. I often discuss tips for disguising hair shedding and will re-focus patients by congratulating them on their healthy lifestyle.
7) Your wait times are so long!
As a provider, this is something that can be difficult to balance. If the patient spends too much time in the waiting room, it is often because of the extra one-on-one time the patients receive. It can provide more attention and focus for the patient, but it may worsen productivity. If availability is filling up, that may even be a discussion for more dietitians on staff. Patients must also be considerate not to constantly reschedule, cancel, or no-show since that can push back availability for others.
8) No one understands what I’m going through!
If the patient does not have a strong support system with friends and family, they may feel isolated in this journey. Most programs offer bariatric support groups to help, and many patients connect to other patients on social media. Patients sometimes come to me with their own preconceptions of a dietitian. “How do you know what I’m going through?” Comments and reactions like that are not really about us, but rather a patient who is trying to be heard. Even though I specialize in bariatric nutrition, I have not had the surgery. But do patients only choose a cardiologist because the provider had a heart attack? No. Do patients only choose an endocrinology office because everyone there has diabetes? No. Dietitians may not always struggle with weight management themselves, but we are trained professionals to help guide patients through their bariatric journey. We aim to live a healthy lifestyle with moderation and balance ourselves, and that is exactly what I want for my patients.
Complaints are almost impossible to avoid, but there are ways to help pacify the situation. Empathize with the patient and acknowledge their frustrations. As they speak, be mindful of your body language. Listen by nodding instead of interrupting. Work together on a solution OR just let them vent. At the end of the day, we must remember all the hard work our patients are doing. Be in their corner and help them through their grievance.