I was hard at work in my newest (to me) Bariatric Clinic the other day when a difficult phone call came through.
“I had surgery 9 months ago…and I STILL can’t eat anything.”
For the next 30 minutes, the patient and I walked through several scenarios to pinpoint what was going on.
I asked her a long series of questions so I could get the full picture. For some of you, this may resonate.
- I hate protein. I can’t stand the thought of any meats.
- I never eat three meals a day. I can’t stand the thought of it.
- I don’t have trouble with water. I can drink just fine.
- It feels like I eat the same 3 foods. (In her case – cottage cheese, apple sauce and beans)
- My family is worried about me.
- I’ve tried every protein shake out there and I just can’t STAND them.
She wasn’t being rude to me. She wasn’t being difficult. She was just exhausted. Worn out. Frustrated. Beyond discouraged.
These are the phone calls that dietitians/nurses/doctors cannot take personally. It’s time to just keep talking.
As we talked, I had a few notable bells go off in my head that helped me know what direction to go to. Here’s what was going on in my mind:
- She hates protein and especially meats. I wonder how big her bite sizes are.
- She can’t stand the thought of eating. Sounds like she’s developed a food aversion (more explanation on this to come)
- Water goes down just fine. This isn’t a structural issue. Her issues are more with food than at unexplained times of the day with unexplained pain.
- She’s become very limited to three SOFT textured foods. Now I REALLY think her bites are too big. Soft foods go down much easier.
- Her family is worried. I should be too. It’s time to listen because those who know her best are concerned. This also leads me to ask questions about how much she weighs – and how much she wants to weight. (In this case, she had lost 10 pounds more than she was wanting to and felt too small. Now I needed to focus on not only better nutrition in her diet, but also a way to increase her healthy calories for some weight re-gain).
- Protein shakes are out. Don’t push them anymore. Allow her to take them off the table and turn her attention to success with foods.
With this much information, it was now time to go through different foods and ask her what she was open to eating. Once again, I couldn’t take it personally when she shouted “NO!” before I got the words out of my mouth. She has been struggling with severe food aversions.
Aversion: a strong feeling of dislike, opposition, repugnance, or antipathy
When someone has struggled with food for 9 months (or more…or less) but has continued to push through every day only to feel sick, nauseated, in pain, etc….the aversion only becomes worse. We all have this in some regard. If you think of a time you got sick on something as a kid and never ate it ever again (ravioli for me. UGH). It takes a LOT of patience to recover from a food aversion, and this patient will unfortunately have a bit of a road to get past the mental block of her food aversions.
So I began going through some protein based foods that were softer in texture because I knew more solid proteins were out of the question at this current time.
- Egg Salad? I hate eggs!
- Tuna Salad? Yeah…maybe.
- Chicken Salad? Probably.
- Low-fat cheese? Yes, I can definitely do cheese.
- Greek yogurt? It’s been a while, but I can try it again.
- Flakey fish? Depends. Sometimes the smell makes me gag.
- Dark meat chicken? Thigh, leg or wing meat? Yes! I can do dark meat but can’t stand white meat.
We were on to something.
At this point I discussed with her the issue of bite sizes.
It seemed to me, this patient took what she felt was a small bite size after surgery. The trouble was, it wasn’t as small as her pouch needed it to be. When she ate more solid textured foods, meats in particular, even when she chewed it really well…that whole bite of food was going down into the pouch at one time, hitting her pouch HARD and feeling very heavy. This made her feel sick and she began to dislike meat. Fast forward 9 months later and she can’t stand the thought of any meats.
To illustrate this better…below is a membership video I made using a highlighter marker. I think it’s a great way to think about the importance of how you eat your foods!
The patient agreed with me. She was very surprised when I told her to keep her bites the size of a pencil eraser and agreed with the description I shared above about too large of bites.
I recommended she focus on soft proteins, using much smaller bites, and putting the focus back on eating protein at 3 meals each day. After she has 2-3 weeks of these foods going well and is beginning to gain confidence, I did encourage her to graduate back to more solid proteins for better variety in foods and for quality protein intake in her diet.
Then we had to talk about weight re-gain. She needs more than 3 meals a day and she needs (quality) high fat, high nutrition foods in between meals. I recommended she snack on nuts and olives because those sounded good to her and they are packed with healthy oils. High fat = increased calories for weight gain but healthy fat = much better for her heart and overall health.
So we had a plan.
She was to focus on the list of soft proteins we discussed and add high calorie snacks in between meals. Continue with her water intake and her vitamins. Keep a very detailed journal and call me in two weeks. I also recommended she set herself up for success with meal times. Eat at home. Eat at the table. Dim the lights. Put on music. Make it a very relaxing and peaceful place with little distraction so that she could a) stay calm as she focuses on healing from a food aversion and b) focus on how she is eating her foods.
I hope this brings encouragement to you. If you are a post-op patient and you find yourself struggling with foods on any level, I’m glad you came by my website. Take a look around. Send me an email (email@example.com). Look into a membership. Feel encouraged. You are not alone and I am here to help!
All my best,