Whether you’re having weight loss surgery, have had surgery, or are trying to lose weight by other methods, we all know that it is no simple task. Many factors are involved in the process of weight loss as well as weight maintenance. In fact, many find the challenge of maintaining their weight just as difficult.
Although there are many strategies recommended to help with weight loss and maintenance, I plan to focus on two of them: changing what you eat and incorporating behavioral adherence.
As we know, the number of calories we consume plays an important role when it comes to losing weight. However, what we often don’t realize is that the types of food we choose may have more significance.
According to researchers at the Harvard School of Public Health, consuming low-quality foods, such as processed foods like potato chips, sugar-sweetened beverages, processed meats and unprocessed red meat, refined white grains, refined sweets, and desserts is associated with weight gain.
These researchers followed over 120,000 healthy men and women for 12 to 20 years and found that the lower quality foods were linked to weight gain over a 4-year period (the participants’ weight was measured every four years during the study). In contrast, the higher quality foods such as whole grains, vegetables, and fruit, healthy fats and yogurt were associated with weight loss and maintenance.
More weight gain occurred with a decreased intake of the higher quality foods and less weight gain with a decreased intake of the lower quality foods. While calories continue to play a role in weight loss and maintenance, the researchers found that focusing on overall dietary quality was more important. Bottom line, whole foods contain more fiber,“ usually have fewer calories keep you full longer and burn more as your body works to break down the food.>
On the other hand, highly processed and sugary foods and beverages don’t keep you full as long, usually contain more calories, and are already partially broken down, hence the word “processed.”
Healthy Eating With The „Healthy Plate“ Concept
For many of my weight management and weight loss surgery patients, I use the Healthy Plate concept when meal planning with them for weight loss and maintenance. The Healthy Plate that we use in our office is similar to the USDA’s MyPlate as well as the Harvard School of Public Health’s Healthy Eating Plate. All three follow healthy eating guidelines; including building healthy eating styles, choosing from a variety of foods, and focusing on high quality, nutrient-dense foods. This includes eating at regular intervals and not skipping meals, which can lead to overeating later.
The main concepts of the Healthy Plate method are to eat more vegetables, including lean proteins with every meal and snack, limit the amount of starches or grains overall while selecting whole grains, and drinking low-calorie or no-calorie beverages, such as water.
It is also important to limit eating out to special occasions. Individuals tend to eat more and eat higher calorie foods when eating“ out>. If you do dine out, try to choose meals that follow the Healthy Plate guidelines. Ask for an extra serving of vegetables and half the amount of starches. Ask for a to-go box before you eat the meal and place half in the box to save for another time.
Patients who have had weight loss surgery can also use this method, but with some modifications due to the smaller stomach size and surgical procedure.
General Guidelines For Weight Loss Surgery Patients
Based on individual progress, tolerances, and procedure
(Serving sizes are the same as below.)
Protein (animal and plant sources)
- Should be the first food finished during a meal or snack
- 3-4 ounces or ½ cup at a meal
- Start with cooked and then progress to raw
- Up to 3 servings per day
- Start with skinless and then progress to all fruits
- Up to 2 servings per day
- Should be the last food eaten
- Up to 3-4 servings per day
Added Healthy Fats
- Drink water as your primary fluid source; tea or coffee is okay too
- Avoid the sugary beverages
General Guidelines Using The Healthy Plate Method*
- ½ your plate should consist of non-starchy vegetables
- Include dark-green vegetables ( broccoli, asparagus, zucchini, leafy greens), red and orange vegetables (red peppers, tomatoes, carrots), white and yellow vegetables (onions, cauliflower, yellow squash) – choose from fresh and frozen
- Serving sizes: ½ cup cooked and 1 cup raw, 2 cups raw leafy greens
- ¼ of your plate should consist of animal and/or plant proteins
- Have protein at every meal and snack
- Choose from both animal and plant sources: animal sources (chicken breast no skin, lean ground turkey, seafood, eggs); plant sources (legumes/lentils, tofu and other soy products, nuts and nut butters, seeds)
- Avoid processed meat, bacon, and limit red meat and cheese
- Serving sizes: 3-4 ounces of animal protein, ½ cup legumes/lentils, 1 cup tofu, 1 oz nuts, 2 Tbsp nut butter, 1 egg
- ¼ of your plate should consist of whole grains and/or starchy vegetables
- Choose whole grains over refined (whole wheat bread, whole wheat pasta, whole wheat tortillas, quinoa, barley, brown rice, corn tortillas, whole grain cereals)
- Serving sizes: 1 slice bread, ½ cup pasta/rice/quinoa/barley/cooked oats, 6” tortilla
- Starchy vegetables consist of corn, peas, potatoes, winter squash (limit white potatoes)
- Serving sizes: ½ cup corn/peas, small sweet potato, ¾ cup winter squash
- Fruit is great with breakfast, on the side of a lunch or dinner meal, or part of a snack
- Eat different colored fruits similar to the colors of the rainbow – choose from fresh and frozen
- Serving sizes: one small fruit, ½-1 cup sliced fruit
- Can be part of any meal or as part of a snack
- Choose low-fat or fat-free milk or Greek yogurt (plain is best and then add fruit to sweeten)
Added Healthy Fats
- Choose healthy unsaturated fats such as olives and olive oil, canola oil, avocados and avocado oil, nuts and nut butters (we also include nuts and nut butters in the protein group)
- Serving sizes: 1 tsp oil, 1/8 avocado, 1 Tbsp oily dressing, 1 tsp mayonnaise
- Drink water as your primary fluid source; tea or coffee with little sugar is okay too
- Avoid the sugary beverages
*The number of servings from each food group is based on each patient’s nutritional requirements
Incorporating behavioral adherence is also important for weight loss and maintenance. Adherence can include sustainability of a particular eating pattern, decreasing feelings of deprivation, and self-monitoring. Researchers in Australia at the Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, found that participants, in several studies they reviewed, lost more weight when they stuck to the prescribed diet longer. They found that participants adhered better when the intervention diet was similar to their own eating pattern. They recommend that dietary interventions be flexible, individualized, and easily adapted to a person’s dietary preferences. This also includes allowing yourself to indulge sometimes and not completely eliminate any food that you will eventually want to eat again. Eventually, the feeling of deprivation may take over, leading to binging on that “forbidden” food, followed by feelings of guilt.
Judith Beck, Ph.D., in her book The Diet Solution: Train Your Brain to Think Like a Thin Person, reminds us that it is better to learn how to eat a “forbidden” food in healthy moderation and with mindful attention, without feelings of guilt afterward, than to totally eliminate it. Self-monitoring, or self-regulation, includes keeping a food diary.
Using a food diary has been shown to be a strong predictor of behavior change as well as maintaining the behavior over the long run. Don’t worry if your food diary is not perfect. The value of the food“ diary> is also to increase awareness of what and when you are eating, to keep you motivated, and help you stick to your eating plan.
Therefore, when developing a meal plan for yourself, it is important to choose a healthy plan, but also one that you find easiest to stick with in the long run.
- Eat less processed, refined, and sugary foods
- Have protein with every meal and snack – including animal and plant sources
- Enjoy more non-starchy vegetables
- Eat more whole grains
- Eat more unsaturated fats and cut back on saturated fats
- Eat regularly and don’t skip meals
- Stick to a plan that is realistic and sustainable for the long run
- Keep a food diary
For more information:
Mozaffarian, Dariush, et al. “Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men.” N Engl J Med (2011) 364(25):2392-404.
Gibson, Alice A., and Amanda Sainsbury. “Strategies to Improve Adherence to Dietary Weight Loss Interventions in Research and Real-World Settings.” Behavioral Sciences 7.3 (2017): 44.
ABOUT THE AUTHOR
Natalie“ buntzen ms rd> is a registered dietitian for St. Joseph Heritage Healthcare, Center for Health Promotion in Santa Ana, California. She works with weight management and weight loss surgery patients. Her background includes teaching nutrition and food safety classes, and working with a variety of patients including those with eating disorders, diabetes, gestational diabetes, heart disease, post surgical weight loss and weight loss needs.