by Dave Fouts
Dave Fouts is the corporate chef for Western Bariatric Institute (www.westernbariatricinstitute.com) and Imetobolic. You can visit www.chefdave.org for free recipes, grocery shopping planning lists, weekly meal planners, and more.
“Eating out saves time and works well within my schedule.” I challenge this statement all the time; however, there are pros and cons to eating out. If a patient thinks that driving to the restaurant, waiting to order, waiting for your food to be served, then waiting to pay saves you time, not to mention the drive back, I’m not convinced. Aside from the time factor, when dining out, most restaurants are not taking the needs of your patients into consideration. Most foods are high in calories and portion sizes can be overwhelming. I’m not totally certain that all restaurants who claim to have light or low calorie dishes are being truthful. This can cause your patients to hit plateaus and even gain weight. However, the pro to eating out is that it can be a time saver if you have a place that has quick, healthy, already prepared foods, such as a Whole Foods Market or a Boston Market. These foods are made to meet the needs of the health conscious and are normally prepared in a way that gets the customer in and out in less than five minutes. The key is keeping one’s hands out of the food until he or she gets home. Also, the food that is already prepared costs less than going to a restaurant in most cases, but is still priced high for the convenience.
Dietary Compliance Issues
Kitchen management is a huge problem when trying to get your patients to eat the appropriate meals. The common excuses range from, “I don’t have enough time” to “I don’t cook.” These excuses are fingernails to a chalkboard. Patients must take control over what they are eating in order to secure their success within their weight loss surgery program. Time management in the kitchen, just like anything else, is a learned skill.
Defining where, when, what, and how will give your patients the tools they need, as well as provide confidence in their abilities to make good decisions. In most cases, food is the most challenging part of your program for patient adherence. I travel all over and have seen many great patient programs, but in most cases, kitchen management is not on the “Top Ten” list for discussion. As a chef, I believe that these life-management strategies in the kitchen are essential for bariatric patient success. Getting your patients on track and keeping them there should always start with lessons in their own kitchens.
The where is the kitchen, the crucial point in the home that most patients choose to ignore. This is seen as a place to make dirty dishes and waste time. “I don’t eat a lot” is a phrase I hear on an hourly basis. To that I say “Not true.” A patient may not eat like he or she used to, but patients do eat what their bodies need. Every meal needs to count! The kitchen is used to store all the nutrients and micronutrients that the bariatric patient’s body needs to stay healthy and fit. The kitchen should be viewed as their personal health food store. I often say my kitchen is a lot closer than the local GNC. In my kitchen, because of kitchen management, it takes only two minutes to walk in and get what I need versus 30 minutes to drive to where I would need to go buy it. The kitchen is great for making to-go orders as well as dining in, and the mood can be set to the patient’s personal liking.
When refers to the patient’s need to schedule in meal preparation and meal time. Between taking the kids to school, work, going to the gym, and getting the oil changed in the car, scheduling for meals is never a top priority. What I find self-defeating is that people spend thousands of dollars to lose weight, but when it comes to time management and food planning, they drop the ball. Meal planning should always come first. Time management is different for many people. If a patient works the night shift, then he or she is scheduling meals for 7pm to 7am; this differs for those who work during the day. Regardless of schedule, within defined times meal planning should take place. How do I teach time management to bariatric patients? I advise all patients to plan their meals for the whole week, and this can be done in one hour. Start off with seven breakfasts, then move on to the same planning for lunch and then for dinner, with extra meals if deemed necessary by the surgeon. In the beginning, this may take a little longer than an hour, but as meal plans are set, the patients can use previous meal plans to modify and assist in the making of new ones. Scheduling is very important and needs to be managed to fit each person’s lifestyle. An ER nurse has a different day every day, whereas an office person normally has lunch the same time daily.
The ER nurse needs to prepare and plan for more hands-on meals at work (i.e., cheese cubes, meat wraps, cut veggies). The office person can plan to eat leftovers, which can be heated from last night’s dinner.
What refers to the foods, beverages, and anything consumed by the patient. The food and how it is prepared determines the time a patient will be in the kitchen. With this in mind, there are practical tips you can share with your patients that will help them develop better habits for what they choose to eat.
All grocery markets offer a variety of foods. Foods can be purchased whole fresh, chopped fresh, frozen, and canned. Price can be a factor, but in most cases, it’s the time management factor that keeps patients from cooking for themselves. Fresh is always better than frozen. In most cases, frozen is better than canned. When shopping, choose foods that can be prepared or used quickly. Purchase the onion already diced rather then the whole onion. Most produce departments offer already chopped and sliced foods. This simplifies the process so that all the patient has to do is open a lid and cook. Prep time before a meal can take up to 50 percent of the time in the kitchen. By eliminating the prep, the cook time is cut in half. Choose raw meats that are already cut up. Most stores will cut the meat up for the customer if needed. Most delis have already prepared meats that have been cooked. For example, rotisserie chicken can be used for chicken salad or in fajitas. Most prepared frozen meals are either high in fat, sodium, calories, or all of the above.
When looking for the perfect frozen meal, I recommend teaching your patients how to read the dietary labels. Have a list of frozen meals that the dietician has pre-approved. Not only does this give the patient guidance, but it also makes shopping easier. It is recommended that the patient make his or her list before going to the store, and then not stray from that list once at the store. Shopping for only what is on the list not only saves time but also money, and ensures that the patient is only stocking the planned healthy foods that should be stocked in the kitchen.
The how is the preparation used to save time cooking or preparing the food once in the kitchen. When cooking food, thinner cuts are better because they cook faster. If a thick cut is used, I suggest using a slow cooking method, such as a crock pot. When preparing foods that require no cooking, such as cheese, raw vegetables, and already prepared lunch meats, keep them bite size. Use low-fat salad dressing to add more flavor.
When, where, what, and how are all questions that should be reviewed with your patients. It can be tough enough for patients to adjust to all of the lifestyle changes they must adopt, and many times they feel pulled in different directions when they re-enter their everyday lives after weight loss surgery. Often, the time shortcut comes in the areas of meal and food selection, causing diet to automatically be a potential problem area for many. But good nutrition and healthy eating are easily within everyone’s reach regardless of time restrictions, provided that patients have the right resources and guidance. The end result of encouraging your patient to eat well at home leads to a healthier patient.
Category: Patient Management Perspective