Bariatric Athlete Nutrition
Lea Crosetti, RD, CSSD
www.BariAthletes.com
September 22nd 2012
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Objectives
• Review bariatric and sports nutrition guidelines
• Identifying the variables when combining bariatric and
sports nutrition guidelines
• Learn how to address and motivate the athlete through
their transformational barriers
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Bariatric Surgery
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Nutritional Changes Post Bariatric
• Minimal caloric intake
– Restrictive and malabsorption
• Minimal carbohydrate intake
– Dumping syndrome
– Expansion
– Reduces protein intake
EVERYTHING IS REDUCED!
VERY CATABOLIC!
• Minimal fluid intake
– 1-3oz fluid at a time
– Hold fluids 30 minutes pre
and post meals
• Vitamin and mineral
deficiencies
– Malabsorption and reduced
intake
– Noncompliance with
supplements
Allis, Blankenship, Buffington, Furtado, Parrott. Surgery for Obesity and Related Diseases. ASMBS
Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. 4 (2008) S73-S108
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Athletes
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Sports Nutrition Guidelines
• Maintain neutral or positive calorie balance
– +500-1000kcal for muscle building
• Increase carbohydrates to meet the energy
demands of workouts
– 5-13g CHO / kg
• Increase fluids to meet sweat losses
– ~1L/hr
• Adequate vitamin and minerals
– Fe, Ca, Zn, K, Vitamin D, E, C, B12, Folic acid
Rosenbloom CA, Coleman, E. Sports Nutrition: A Practice Manual for Professionals,
5th ed. SCAN dietetic practice group, American Dietetic Association (in press).
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Disconnect Between Bariatrics
and Sports Nutrition Goals
• Bariatric Nutrition Goals
– Low carb, high protein
– Low calorie diet
– Small volume meals
• Sport Nutrition Goals
– High carbohydrate diet
– High calorie diet
– Large volume meals
There are NO set guidelines for bariatric athletes!
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Common Complaints When Trying To
Follow One Or The Other
• Follow Bariatric
Guidelines
– No energy!
– ‘Hit the wall’ or ‘bonk’
• Follow Sports Nutrition
Guidelines
– GI distress or dumping
syndrome
– Vomiting or stomach pain
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What Are Their Goals?
• To finish?
• To PR?
• Achieve healthy
weight?
• Develop new lifestyle
to avoid weight
regain?
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Things to consider when working with
this population
• Sports Nutrition:
– What type of event do they plan on doing?
– Individual preferences
• Bariatric Nutrition:
– No 2 patients are the same
• Different surgeries
• Different surgeons
• Different time post op
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Considering the Spectrum
1 month post op
Bariatric
Nutrition
5k
3 years post op
Sports
Nutrition
Ironman
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Leave the Numbers Out
• There are no standards!
• Everyone’s anatomy is
different
• Great opportunity to
reconnect with hunger /
fullness levels
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Tapping Into the Right Energy Source
• Training the body to rely more on its own energy
stores (fat tissue), which reduces calorie intake
during training
• Goal is to reduce calorie consumed per hour
during training and race
• This is ideal for bariatric athletes who can’t
consume large amounts of simple sugars during
events
Seebohar. Metabolic Efficiency Training.; Teaching the Body to Burn
More Fat. 2009
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Periodized Workouts
• Training philosophy that is done in cycles, with each cycle having
its own goal.
• Cycles vary in volume and intensity, allowing you to build and
prevent injury.
• Each cycle is broken up into weekly cycles that will have gradual
builds and then a recovery week.
• Periodized training allow for an aerobic
base to be built early in the season
while more sport specific and
higher intensity workouts the closer
the event becomes.
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Periodized Nutrition
• If volume and intensity changes so should
nutritional intake
• The composition of meals change because of the
different energy systems being used
• Fat can be a primary fuel source for lower
intensity workouts
• Carbohydrates are primary fuel source for higher
intensity workouts
Seebohar. Nutrition Periodization for Endurance Athletes: Taking
Traditional Sports Nutrition to the Next Level. 2005
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Basic Everyday Guidelines
•
•
•
•
Eat balanced meals throughout the day
Plan to have a meal, snack or shake every 2-4 hours
Should be a mix of carbohydrates and protein
Volume of meals and snacks depend on type of
surgery, how far out from surgery, and type of activity
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Pre Workout Nutrition
• Something easy to digest and best tolerated
• Make sure there is both protein and carbohydrates in it,
preferably low in fat
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During Workouts
• May not be needed
– depends on workout intensity and duration as well as the
conditioning of the athlete
– 1 hr or more will likely need carbohydrate and electrolyte
repletion
• Smaller more frequent dosing to prevent high sugar load
• Usually whey protein
– Protein mixed with carbohydrate tends to have better results
during and helps with recovery
– Try to avoid fructose as it is less tolerable among most athletes
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Sports Nutrition Products
• Drinks, Bars, Gels, GUs, Shot Blocks
– Infinite drinks, Cliff bars, Shot Blocks
• Hydration and Electrolytes
– NUUN, Salt Sticks
• Find one the one that is best tolerated
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Post Workout Nutrition
• 45 minute to 2 hour window for best repletion
• Post workout nutrition is key for recovery, strength
building, and improved performance during next workout
• Carbohydrates and protein mix
– Typical sports nutrition: 4:1 ratio
– Bariathlete appropriate: 2:1 ratio
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Who are you working with?
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New perceptions
• Weight loss driven
– Vs performance driven
• Food is now fuel
– Breaking emotional ties to
food
– No “good”/”bad”
• Exercise is no longer
punishment
• Establish rapport
– Not the food police!
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How they see themselves
• They still see themselves as overweight
– Body dysmorphia and poor body image
• Really hard for them to acknowledge themselves as
athletes
– Athlete as an image vs trait/behavior
– Definition: a person trained or gifted in exercises; a
participant in a sport, exercise, or game requiring
physical skill.
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Triggers and Barriers
• Taking injuries personally and motivating them to
stay on track
• Mentality to do it all right now
• Knowing past triggers and saboteurs
• Identifying new coping strategies
• Remember their journey
– Remind them how far they have come
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Key Points To Remember
• You are working with people with very individualized
needs
– Assess surgical and athletic status
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•
•
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Focus on balancing daily meals and snacks
Help them find what products may be right for them
Adjust for individualized tolerances
Always be a major contributor to their support system
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CONTACT INFORMATION
LEACROSETTI@BARIATHLETES.COM
877-66-FUEL4YOU
TWITTER.COM/BARIATHLETERD
FACEBOOK.COM/BARIATHLETES
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