With obesity at an all-time high in the United States, it is easy to blame Americans' diet and lack of exercise. However, many other factors also may be at work.

"Most people who are obese or morbidly obese have tried repeatedly to lose weight through diet and exercise," says Susan Deno, a registered and licensed dietitian with Park Nicollet Bariatric Surgery Center. "Despite their best efforts, their bodies continue to hold on to extra pounds or quickly regain any that are lost. This may be due to their metabolism, genetics or how their bodies uses nutrition - it is hard to pinpoint a reason."

Nutritional counseling promotes healthy habits

For some people, the only way to successfully lose weight is by having bariatric surgery. "Some insurance companies require patients to undergo a period of nutritional counseling before they have surgery. Although not everyone appreciates mandated counseling, most patients see the benefit in developing the habits that ensure long-term success," Deno says. Patients are counseled to:

eat three meals a day.
have breakfast within two hours of waking up.
practice "mindful" eating, without the distraction of work or TV.
increase fruit and vegetable intake.
cut back on eating in restaurants.
shop regularly for groceries.
schedule time for preparing healthy foods.
avoid eating for reasons other than hunger.

"The reality is that many candidates will practice these behaviors before surgery and notice only minimal results or none at all," Deno explains. "But when they practice these habits after surgery, they will experience great success. They will eat less because of their reduced stomach size, and, if they have gastric bypass surgery - their bodies will absorb fewer calories, accelerating the weight loss."

Nutritional concerns following surgery

Patients who undergo surgery need to supplement their diet with a multivitamin, calcium, vitamin D and, sometimes, iron. "Now that they are eating less, they may not always get the nutrients they need from food," Deno explains.

People who have completed bypass surgery are at greater risk for nutritional deficiencies because their digestive tract absorbs less food. "For example, the lower portion of the stomach normally absorbs vitamin B-12, but because surgery bypasses it, people need special vitamin B-12 supplements that are absorbed under the tongue. Vitamin supplements and a nutritious diet help eliminate this concern," Deno explains.

Following surgery, she also counsels patients to:

chew small amounts of food to applesauce consistency.
drink eight glasses of non-sweetened, non-carbonated beverages daily (not with meals).
sleep a minimum of seven hours a night.
get some form of physical activity for at least 20 to 30 minutes nearly every day.

Help remains available

Deno emphasizes the importance of follow-up care for all patients. "We meet patients every six weeks that first year after surgery, offering them shopping guides and tips on how to make the right choices. We also encourage patients to visit us annually thereafter so we can help them overcome any challenges that interfere with their new, healthier lifestyle."

Sometimes little tips can make a big difference. "We may need to remind people to eat and drink at separate times. Because of the anatomical changes, stomachs empty faster when food and liquids are mixed, causing people to feel hungry sooner," Deno explains.

"Surgery is a huge investment mentally, emotionally and physically - for patients and their loved ones," she adds. "We encourage patients to take advantage of every opportunity for our team to provide help and support. Maintaining weight loss is not easy - even after surgery."