Preoperative Bariatric Nutrition Followup Sample Reports
Preoperative Bariatric Nutrition Followup Sample Report #1
LAST SEEN BY REGISTERED DIETITIAN: MM/DD/YYYY.
DIAGNOSIS: Morbid obesity with surgical preference for the lap band. Surgery is not booked.
INITIAL WEIGHT: 243 pounds.
WEIGHT LOSS GOAL: 15 to 20 pounds.
PRESENT WEIGHT: 246 pounds with an increase of about 2 pounds since last meeting.
HEIGHT: 64.5 inches.
BMI: 41.5.
BEHAVIOR SKILLS GROUPS: Enrolled.
EXERCISE: No structured exercise; however, she does have a treadmill at home and stated she is going to start today. We reviewed the importance of a goal of the eventual 30 minutes 5 days a week.
CHANGES IDENTIFIED: The patient reports really making no changes since last nutrition visit and having a difficult time during the holidays, eating cookies and other “junk” food.
FLUIDS: Reports drinking 1 coffee in the morning with cream and Splenda, water and Crystal Light. We reviewed the importance of staying adequately hydrated and drinking 64 ounces daily.
FOOD RECALL: Note that the patient reports eating “junk” all day and being “bad” around the holidays. She is very vague in her food recall. She reports not eating breakfast, sometimes not eating lunch or having a bagel, sandwich or pizza. Dinnertime is generally protein, a vegetable or takeout subs. Snacking in the evening is her difficult time, and she tends to eat crackers, popcorn and chocolate. We discussed this at length.
ASSESSMENT: The patient is a (XX)-year-old morbidly obese female who present today for a preoperative bariatric nutrition followup. Overall, the patient appears to be struggling since initial consultation.
She reports having a hard time around the holidays and really not making any changes since last meeting. We reviewed the importance of eating 3 meals per day, prioritizing protein and then balancing the protein foods with fruits and vegetables.
She tells me today that she wants to start a low-carbohydrate diet and is somewhat resistant to eat fruits, vegetables and whole grains. We reviewed the importance of an overall healthy diet, including fruits, vegetables and healthy carbohydrates. The patient has not had her eating disorder evaluation as discussed last time with the nurse practitioner, and she was encouraged to have this evaluation done prior to meeting with the nurse practitioner in March.
We encouraged her to begin structured exercise and she is aware of her 30 minutes 5 days a week goal. She will also increase her fluid intake to about 64 ounces. Upon fully reviewing all of the diet and exercise goals discussed at the last nutrition visit, it is apparent that the patient is struggling to make lifestyle changes consistent with postop success such as meal structure, menu planning, behavior modification and consistent cardiovascular exercise. The patient may further benefit from completion of the goals listed below as she continues to prepare for gastric banding surgery.
GOALS:
1. Consume 3 meals a day, 7 days a week, spaced 4 to 6 hours apart.
2. Measure and weigh protein to a goal of 20 grams or 3 ounces at every meal.
3. Prioritize protein at all meals.
4. Continue to wean off of high sugar foods such as cookies, cakes, etc.
5. Snack only when physically hungry and choose only a fruit or protein.
6. Format meals as 20 grams/3-4 ounces of protein plus fruit and/or vegetable and minimal amounts of starch.
7. Practice waiting between meals to consume fluids.
8. Increase fluids to a minimum of 64 ounces daily, noncaloric, noncarbonated, and noncaffeinated.
9. Begin structured exercise working up to a goal of 30 minutes 5 days a week.
10. Work on preop weight loss goal of 15 to 20 pounds prior to surgery.
11. Meet with eating disorder specialist prior to meeting with nurse practitioner in March.
12. Work on eating slowly, cutting food into bites and chewing food well.
13. Call with any questions or concerns between now and next nutrition visit.
FOLLOWUP: Appointment booked for March.
TIME SPENT: 30 minutes.
Preoperative Bariatric Nutrition Followup Sample Report #2
LAST SEEN BY REGISTERED DIETITIAN: MM/DD/YYYY.
DIAGNOSIS: Morbid obesity with surgical preference for the gastric bypass. Her surgery is not booked at this point.
INITIAL WEIGHT: 294 pounds.
WEIGHT LOSS GOAL PRIOR TO SURGERY: 20 pounds.
PRESENT WEIGHT: 286 pounds with a weight loss since initial consult of 8 pounds. Per Dr. John Doe, he would like her to get down to 250 pounds prior to surgery, which is a total weight loss of about 36 pounds.
HEIGHT: 63.4 inches.
BMI: 49.9.
BEHAVIOR SKILLS GROUPS: Completed per patient.
EXERCISE: No structured exercise at this point. We reviewed the importance of working up and doing what she can comfortably tolerate as she does say she has asthma and atrial fibrillation, which limits her exercise during the day. We did discuss, also, a goal of 30 minutes 5 days a week and working up to this as tolerated.
CHANGES IDENTIFIED: The patient reports trying to watch her portions, trying to increase vegetables and decrease carbohydrates.
FOOD RECALL:
Breakfast: Either skips or has raisin bran with a piece of wheat toast and apple juice. On the weekends, she will occasionally have eggs or Egg Beaters with a light toast and apple juice.
Lunch: Tuna with light mayonnaise on a sandwich or, if she is at work, she will have meat, vegetable and trying to stay away from potatoes and starches, or she will have tomato soup and a grilled cheese.
Snack: Yogurt or string cheese.
Dinner: Pork, chicken, beef, prime rib, with applesauce and green beans.
Snack: Yogurt or cheese stick.
FLUIDS: She drinks Crystal Light Lemonade and iced tea about 2 quarts per day. She does drink coffee in the morning with cream and sugar and does drink apple juice as well.
HMR liquid diet, per Dr. John Doe. The patient will start this today and is going to be doing 5 HMR shakes 500 daily.
ASSESSMENT: The patient is a (XX)-year-old morbidly obese female who presents today for a progress check prior to bariatric surgery. She has completed her behavior skills classes and now she just needs to get some weight off prior to surgery. She has done a good job since last nutrition visit, losing about 8.3 pounds. However, per Dr. John Doe, she is to start HMR to get off about 36 pounds prior to surgery.
We talked about the HMR liquid diet in detail today. The patient is going to do the HMR 500, 5 shakes a day. We reviewed the importance of drinking adequate fluids, and she is going to consume greater than 64 ounces of her noncaloric, noncarbonated and noncaffeinated fluids.
We discussed the extreme importance of exercise and working up as tolerated to a goal of 30 minutes 5 days a week. We also talked about after surgery planning meals and trying to choose leaner proteins, more fruits and vegetables, limiting her starch intake. The patient was given HMR liquid diet materials and recipe ideas as well as information about ordering it online and ordering it from the pharmacy.
Upon fully reviewing all the diet and exercise goals set at last nutrition visit, it is apparent the patient is slowly trying to make lifestyle changes consistent with postoperative success such as meal structure, menu planning, behavior modification and consistent cardiovascular exercise. The patient may further benefit from completion of goals listed below as she continues to prepare for her gastric bypass surgery.
PATIENT GOALS:
1. Consume 5 HMR shakes daily.
2. Consume greater than 64 ounces of noncaloric, noncarbonated and noncaffeinated fluids.
3. Try to avoid solid foods in general. If hungry, have 1 extra shake.
4. Complete lab work with primary care physician in 2 weeks and have a followup appointment in 4 weeks, and she will also complete lab work at that point.
5. Increase exercise to a minimum of 30 minutes 5 days a week.
6. Work towards preoperative weight loss goal of about 36 pounds prior to surgery.
7. Call with questions or concerns between now and next nutrition visit.
Followup: Return visit with registered dietitian in 4 weeks for HMR followup. Also, follow up with primary care and have lab work completed there for initial HMR labs.
TIME SPENT: 30 minutes.
