Slim and Satisfied

by Cheryl Winters

If you’re like some people who have had an ostomy, eating is probably a lot more fun now than it was before your surgery. But you may also have noticed that with this increased enjoyment have come some unwanted pounds.

If so, join the club. It’s quite common for people to gain weight after having an ostomy, says Carmen Lee, MS, RD, CNSD (certified nutrition support dietitian) at the University of Miami. And the weight gain isn’t always just because of their renewed appetites, she says. “Along with enjoying their food again, many people who have had an ostomy are apprehensive about exercising and so they aren’t as active as they used to be,” Lee says. “With decreased activity levels and increased eating, weight gain is sure to happen.”

But the good news is that it doesn’t have to happen, the experts say. By following these simple guidelines, you can have your healthy appetite and healthy weight, too.

Get healthy first

If your ostomy surgery has been fairly recent—within about 6 weeks—you should talk to your doctor or CWOC nurse before starting on any weight-loss plan, says Linda Alexander, MSN, CWOCN, at Boston Medical Center. “You don’t want to deprive your body of any nutrients while you’re healing,” she says.

Make your calories count

This means avoiding foods with lots of empty calories from sugar or fat such as candy, soda, and chips. It also means avoiding the drive thru at your local fast-food restaurants whose offerings also tend to be high in calories and fat.

Know that size matters

Many restaurant meals also can be simply too large to be included in an effective weight-loss program, Lee says. “These aren’t normal size meals, so don’t think that the more food you’re getting, the better.” If you do eat out, be smart and take some of these behemoth “bargain” meals home to be eaten later, she says. This way you will be getting a good deal.

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How Weight Loss Affects Your Stoma Whenever you gain or lose weight, your abdominal contours change, and you may have problems with your ostomy appliances. “If pouching doesn’t fit the way it used to, see your CWOC nurse; you may need to be refitted,” says Carol Coker, ARNP, CWOCN, of UM-Jackson Memorial Hospital in Miami, FL. Even a gain or loss of 5 to 10 pounds can cause problems. Here’s what to watch for: Leaking New pressure areas Any change in your skin or stoma Change in pouch-emptying frequency

Don’t skip meals

Just as you shouldn’t overeat, you shouldn’t under eat, either, Lee says. Skipping meals only sets you up for overeating later, she notes, and it can put you at risk for watery stools and gas, too.

Consider mini-meals

Perhaps the best way of all to reduce the risk of overeating at any one meal is to eat “mini-meals,” Lee adds. “Especially for people who’ve had ileostomies, eating six smaller meals a day instead of three large ones helps you digest and absorb food better,” she says. Mini-meals may also aid weight control by keeping your body burning calories more evenly throughout the day. Just be sure your mini-meals consist of a wide variety of foods rich in nutrients, Lee notes.

Be careful of raw veggies

Does your weight-management diet include salads and raw fruits and veggies? According to Claudia Mueller, MS, RD, LD, colorectal dietitian at the Cleveland Clinic Foundation, people with an ostomy should avoid raw fruits and vegetables for the first 6 weeks after their surgeries, although cooked versions are fine, except mushrooms and corn. Raw fruits and vegetables may be reintroduced into the diet gradually after this 6-week period, she says.

“The majority of ostomy patients should be able to eat raw foods, provided they chew extremely well,” Mueller says. “If someone does get a blockage, it’s probably because they aren’t chewing thoroughly.”

If you have an ileostomy, check with your physician or dietitian before you eat corn, popcorn, or nuts. No matter what type of surgery you had, you should always avoid foods that cause you discomfort, diarrhea, painful gas, or allergic reactions.

Drink plenty of liquids

If you do need to “fill up” to curb your appetite, do it with liquids — water being best. Carol Coker, ARNP, CWOCN, of UM-Jackson Memorial Hospital in Miami, FL, recommends that people with an ostomy should drink six to eight 8-ounce glasses of water a day, unless you are under fluid restrictions by your primary care physician for a medical condition. People who have had an ileostomy may also want to consume sports drinks to help replace electrolytes (important minerals) lost through the stoma. Not all beverages get a green light, however: Experts recommend avoiding sodas and fruit drinks that offer lots of empty calories in the form of sugar.

Be active

Get your doctor’s approval first, of course, but once you do, try to get some exercise every day, and as soon after your surgery as possible. (You should be up and walking while you’re still in the hospital, in fact.) Once you’re home, try to take a walk every day, indoors or out. Other easy exercises to try are weight training using light ankle and wrist weights for toning, swimming, bicycling, and playing golf. Remember to start out easy, however, and not to push yourself. And if you do have any discomfort, stop until you can have a talk with your nurse or doctor.

Beware of fad diets

What about trying one of the many quick weight-loss programs dominating the best-seller lists these days? Our experts weren’t comfortable with fad diets or any diet that restricts what you eat for an extended period of time. “All of these diets that people follow for just a few weeks are fine, but most dieters don’t stay on them for long,” Lee says. “And once they go off the diet, they go back to their bad eating habits and gain the weight back. You have to find a plan that you can stay on for the rest of your life, and that involves rethinking the way you eat. The bottom line: Eat a well-balanced diet of healthy foods.”

Cheryl Winters-Tetreau is a freelance writer and former contributing editor to Prevention^®.

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The Lowdown on Low-Carb Diets Interested in trying one of the low carbohydrate diets that now are all the rage? Claudia Mueller, MS, RD, LD, colorectal dietitian at the Cleveland Clinic Foundation, suggests sticking to a modified plan that allows 9 to 10 servings of carbs a day. “I don’t recommend a severe carbohydrate restricted diet that encourages rapid weight loss because a diet like this can run the risk of causing dehydration and electrolyte imbalance. But a modified approach is okay.” Be sure to check with your doctor and dietitian before you start a low-carb diet or any other restricted eating plan, Mueller adds. Because of the severity of the changes in your body, high-protein diets that are severely restricted in carbs must be followed while under your physician’s care. Regular monitoring of your medical condition is mandatory for your safety to manage any side effects and prevent complications.

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