To Snack or Not to Snack…That Is the Question

by Sharon Zarabi, RD, CDN, CPT
Ms. Zarabi is the Bariatric Dietitian at Lenox Hill Hospital, New York, New York.

Introduction
From apples to oranges, Cheetos® to 100-calorie snack packs, protein bars to protein shakes, there is no shortage of snack items from which to choose these days. Many patients are confused because they read through their education packets and are informed in seminars that they must have three fixed meals per day following weight loss surgery, which contradicts preceding weight loss tips of six small meals throughout the day. Patients come to me frantically looking for answers. Research has actually proven that healthy snacking may be beneficial to weight loss as opposed to the eating pattern of three meals a day.1,2

What Constitutes a Snack?
A snack, defined by the Random House dictionary, is “a small meal eaten between regular meals.”3 Maybe the sandwich didn’t quite cut it and you still feel the need to have that treat to top it off. Or the “ I need something sweet” craving hits at 4pm.4 Perhaps breakfast was early and you’re starving at 10AM. These types of cravings and subsequent habits are hard to deny for anyone, much less the weight loss surgery patient, for whom food is often a source of comfort. This type of behavior snacking must be addressed in all weight loss surgery patients in order for them to succeed after surgery, to maintain good health following surgery, and to avoid the need for revision.

Different Types
Snacks can also be regarded by their quality and composition. High-quality snacks are those composed of high nutrient value, representing a good source of vital nutrients, such as carbohydrates, protein, or unsaturated fats.5 You might see these food items as part of the New Food Guide pyramid—(www.mypyramid.gov)—examples include fruits, vegetables, and proper servings of complex carbohydrates. These healthy choices are preferable to the low-quality snacks that account for most packaged items, which are low in nutritive value and higher in calories, including candies, cookies, and chips.6 In this case, it is what you eat, not when you eat, that is the issue, and the pyramid reflects the types of “snacking” that we should all encourage in our patients.

Snacking: Good or Bad?
Some surgeons may object to snacking due to the fact that it may promote grazing behaviors. As bariatric health professionals, we hope that the surgery will break old habits; therefore, suggesting only three fixed meals daily can be subjective.7 A second reason surgeons may avoid suggesting snacks is because many Americans equate snacking to packaged items. Keep in mind that 22 pretzels supply as much as 150 calories, a 2oz brownie can contribute as much as 400 calories, and a 99-cent bag of potato chips can provide 300 calories, all with very little nutrient value. This does not mean that 100-calorie snack packs are the way to go, as they contain simple sugars, which do nothing to satiate hunger.

Patient Education
Educating patients is crucial for optimal postoperative success. It is important for postoperative patients to follow up with their dietitians and learn how to incorporate snacks into their meal plan while avoiding exceeding total calories for the day. Total calorie needs vary depending on a patient’s height, current weight and adjusted body weight, age, gender, and postoperative date. As long as a patient is below his or her maximum caloric intake for the day (based on the patient’s basal metabolic rate [BMR]), which is the amount of calories needed for survival, it is safe to add 200 to 300 calories from snacks per day in between meals. I commonly recommend eating every four to five hours to prevent uncontrolled blood sugars and feelings of hunger.8 Eating the right foods in the right combinations can help keep the belly satiated and thus control the amount of total calories ingested by the end of the day.

Power Nutrients
The two power nutrients that work synergistically include fiber and protein. Protein is necessary in the diet to carry out the work of the living cell by serving as enzymes, receptors, transporters, and hormones. Protein is essential to build, repair, and maintain body tissues and immune function. Fiber, on the other hand, is an indigestible component of plants found mostly in complex carbohydrates, such as oats, barley, bran, skins of fruits, and vegetables. Not only do they take longer to digest, helping you to stay full longer, but also add bulk to stool to help keep you regular—your stomach will thank you.

Conclusion
I recommend consumption of three fixed meals per day in conjunction with two high-fiber, high-protein snacks in between to prevent overeating at mealtime, and especially recommend precluding late-night snacking. Typically when a person goes for long hours without eating, in an effort to diet or “watch” what he is she is eating, he or she makes up for what is not consumed in the early hours of the day by ingesting more calories at night. Sound familiar?

To keep their snack calorie intake in check and get the most nutrition out of foods, patients should choose snacks with more than three grams of fiber and less than 10g of sugar, in addition to high-protein content. Such power snacks may be easily obtainable if pre-planned, brought from home, or found at local delicatessens—even the nearest foodmart as businesses have been catering to health-conscious snackers.

Wise snacks include the following, which are high in protein, high in fiber, and approximately 200 calories each:
• 4oz lowfat cottage cheese and fruit
• 2oz of sliced turkey on multigrain English muffin
• 8oz protein shake with 1/2 cup fiber cereal
• Small apple with 1oz mozzarella string cheese
• Baby carrots with 1tbsp hummus
• 1 cup lite yogurt with berries
• 1tbsp peanut butter on one slice of light 100-percent whole wheat bread.

Happy Snacking!

References
1. S Drummond, N Crombie, T Kirk. A critique of the effects of snacking on body weight status. Eur J Clin Nutr.1996;50:779–783.
2. DK Dodd. Snacking, aversive imagery, and weight reduction. Percept Mot Skills. 1986;62:313–314.
3. Random House Dictionary. Available at: www.dictionary.reference.com/browse/snack.
4. Toornvliet AC, Pijl H, Hopman E, Elte-de Wever BM, Meinders AE. Serotoninergic drug-induced weight loss in carbohydrate craving obese patients. Int J Obes Relat Metab Disord. 1996;20:917–920.
5. S Drummond, T Kirk, A de Looy. Snacking: implications in body composition and energy balance. British Food Journal 1995;97(5):12–15.
6. Wurtman J, Wurtman R, Berry E, Gleason R, et al. Dexfenfluramine, fluoxetine, and weight loss among female carbohydrate cravers. Neuropsychopharmacology. 1993;9:201–210.
7. J Warde Kamar, M Rogers, L Flancbaum, B Laferrere. Calorie intake and meal patterns up to four years after Roux-en-Y gastric bypass surgery. Obes Surg. 2004;14(8):1070–1079.
8. Barbara J. Rolls, Liane S. Roe, Amanda M. Beach and Penny M. Kris-Etherton. Provision of foods differing in energy density affects long-term weight loss. Obes Res 2005;(13):1052–1060.

Address for correspondence:
Sharon Zarabi RD, CDN, CPT,
Lenox Hill Hospital,
110 East 59th Suite 8A,
New York, New York 10022;E-mail: [email protected].

Category: Nutritional Considerations in the Bariatric Patient, Past Articles