Tag Archives: Nutrition

I spent a few months as a client of Good Measures, and wanted to share my experience.

The short version is that Good Measures is a great service, especially for bariatric surgery patients who do not have easy access to a Registered Dietitian (not a Nutritionist) where they live.

For those not familiar, Good Measures essentially provides dietitian services over the internet. You track your food in their diary setup, and your macro- and micro-nutrients will be evaluated. The tools are available through the website or a mobile app. You get immediate feedback in the form of the Good Measures Index (GMI), a number from 0 to 100 that evaluates the quality of your food intake for the day.

Each client is also paired with a Registered Dietitian (RD) for individual meetings over the phone, up to once a week included in the monthly fee. The RD can make adjustments to your individual nutrient goals to better reflect your needs. For instance, mine ramped up my protein goal and decreased my carb goals as I am a bariatric surgery patient. During the weekly meetings, the RD gives suggestions for foods to expand variety or better address nutritional needs/goals. The website/app also gives meal/food suggestions including recipies from several sources, and you can choose which of those sources to use as well.

I read about Good Measures in the Bariatric Foodie blog and she reports that Good Measures requested her input to make their platform more helpful for bariatric patients. Her blog entry has a MUCH more detailed review of Good Measures, I recommend checking it out. I also found them to be very responsive to input about their product and services.

One of the challenges for the bariatric surgery patient is finding really good dietary information. Physicians don't tend to get a lot of training in nutrition during their schooling. What a bariatric surgeon knows about diet typically comes from his perceptions of the experiences of his patients, plus information he gets from his peers. As a nurse, I got more training in nutrition than most physicians, but it's still not anywhere near the level of training a Registered Dietitian has.

A word here about nutritionists, those we refer to on WLS boards as 'NUTs'. In my state, and probably most others, there is no required training, certification, or degree in order to call yourself a nutritionist. Literally anyone can hang a shingle and call themselves one. I would imagine some NUTs are great, somewhere. However, I've never met one. What I have gotten from NUTs include information copied straight from the American Dietetic Association, exchange diet information that's outdated, or some wacko fad diet that's all the rage. Oh, and they usually want to do blood tests on the order of several hundred dollars to inform me what I should eat based on my blood, and identify food allergies that are "sub-clinical". I'll spare you my rant on this quackery, since my use of the word 'quackery' should make my opinion plain.

Bottom line, in my honest opinion NUTs are rarely worth your time or money. If they are employed by a surgeon's office, they'll be handing out the same information to everyone with little to no customization for individual needs and no real critical thinking if asked a question outside the box. If they're in an independent office, expect a lot of billing for information you can easily get from the internet and most of it is likely bunk. Often, NUTs are all a bariatric patient has access to, and that's a problem.

I loved that Good Measures provides access to a RD instead of NUTs, and that they've made a concerted effort to improve their offerings for bariatric surgery patients. I found my RD very easy to talk to, and she was very helpful.

My only complaint is that I found their food diary program to be not quite as robust as MyFitnessPal, and a little less intuitive. I don't mean to say that their database is bad, it's actually pretty good, it's just not quite as robust as MFP. I believe that they're working on expanding their food database, and help is always available through email or phone with a helpdesk technician. It was not annoying enough to drive me away from the service. On the plus side, the food diary looks at more micro-nutrients (vitamins, minerals, etc.) than MFP does, and the GMI is a real benefit. Add that to the RD access, and the little gripes I have about their interface are minor.

In comparison to what consultations with an in-person run, it's an absolute steal. The costs when I was on the service were $39/month paid monthly or $29/month paid annually ($348/yr). While that's more than a Netflix subscription and might seem high, I found it absolutely worth it. Especially for bariatric surgery patients who don't have ready access to a RD, this service is indispensable.

There is one caveat I think I should mention. If you have not been released to a "full diet" by your surgeon, you need to continue with what he/she has prescribed. During that critical healing period, what your surgeon says should be what you follow, period. (I have an entire post dedicated to the subject here.)

I think Good Measures offers the most to bariatric surgery patients who are moving into maintenance and want to expand their diet while still focusing on quality nutrition and trying to avoid the weight "bounce" that's very typical for many patients. It might also be an excellent choice for those around a year out who may still be trying to lose weight, but are finding it harder and harder as the honeymoon period wanes.

I did drop my service after a few months, because all the stress of grad school and chronic illness flares during the winter left me without the energy or drive to spend the time and money on my dietary quality. I will probably pick it up again later when I'm actually ready to focus on the effort.

Conflict disclosure: I was not compensated in any way for this review. I paid full price for my Good Measures service, and was not asked to make this post by anyone.

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So for the past few weeks I've been struggling with how intuitive eating does or does not fit with weight loss surgery.  I don't have a healthy relationship with food to start with, so I'm admittedly at a disadvantage.  We grow up with certain foods being labeled as "bad" and "good", and some foods being held out as "treats".  Someone I know posted this week, "Treats?  What are we, dogs?"  It certainly made me think about how our society programs us for unhealthy attitudes about food.  I want to get away from that.

I agree that intuitive eating is a healthy approach to food.  Do I want chocolate cake?  If so, I should eat chocolate cake.  Thinking that I can't have the cake, or that it's forbidden or "bad" increases the likelihood that I'll binge on it.  Checking in with my body about what it wants and needs is certainly a good approach.  Food is not a moral issue.  Food is not good or bad, it's just food.

Most of the WLS community is sold on low-carb eating, many advocate a ketogenic diet.  The discussions on the boards frequently label anything with carbs as "bad" even including fruit and starchy vegetables.  Anyone discussing eating bread or rice is quickly informed that those foods have no place in our diets during the weight loss phase.  I find that kind of labeling problematic.  Especially given that I cannot eat low-carb.  Going into ketosis makes me incredibly ill for weeks, where most people get over the "carb flu" after 2-3 days.  So carbs are part of my diet, though I do try to eat mostly whole grains, fruits, legumes, etc. for my carbs and limit refined flour and sugar products.  But occasionally I want half of a bagel with cream cheese, dammit.  I refuse to start labeling food as "good" or "bad" just because everyone else does.

My sleeve actually is helping with part of the intuitive process.  My newly rearranged tummy has definite ideas about what it likes.  If I eat too much sugar, too much fat, too fast, or don't pay attention to when I'm full, I physically feel very bad.  Certainly reinforces the whole "listen to your body" thing.  My tastes have changed, and I'm having to re-learn what foods I do and don't like.  I am trying foods I would never have tried before this whole process started, as well.  Definitely steps in the right direction, I think.

Then there's the "have to" pressures.  I "have" to eat a certain amount of protein every day.  I "have" to drink a certain amount of water every day.  I feel pressure to eat vegetables and fruits, even the ones I don't like because they're healthy for me.  There are days I don't want another protein shake, or another chicken breast, or whatever.  There are days I just don't feel thirsty and the water just tastes awful.  Because I don't have much of an appetite anymore, if I practice completely intuitive eating, I can subsist on shockingly few calories and little hydration for several days before I'd feel the need to eat or drink more.  That doesn't seem healthy, but is it good to force myself to eat or to eat something I just don't want?  Is that any healthier?

Sometimes we have to hold our nose and take medicine that tastes awful.  There is a school of thought that food is medicine, and we should essentially hold our nose and eat what is healthy for us even if we hate it.  That school of thought is what has made me miserable for most of my life around the so-called "need" to eat vegetables.  While I see the logic, it's just not going to work for me.

So what am I supposed to do about the protein requirements and the fluid requirements?  My therapist asked me last time what the consequences were for not meeting the minimums.  If I don't drink enough fluids, I get migraines to start with, and other issues also arise.  So in order to stay healthy, I have to drink whether I want to or not.  All I can do is add flavorings to my water to make it more palatable.  With the protein, I suspect that missing a day here or there isn't a problem, but on an ongoing basis I'll start losing muscle mass.  So it's best if I strive for the protein goal every day in order to stay healthy and active.

As with so many things in life, I think that there's just no black and white answer.  I need to find ways to get all of my needed macro nutrients into my diet, most days anyway, to keep moving toward a healthier place.  Forcing myself to eat things I just don't want however, is going to push me back into an unhealthy relationship with food.  The best answer I have come up with so far is to start thinking of every food option for these macro nutrients so I can give myself options.  Like having different flavorings available to make the water more enticing, I need to have different options available all the time for my protein to give my tummy and taste buds plenty of variety to choose from.  Maybe the message my body is trying to send me is "enough with the freakin' protein shakes!!" and it's not about the protein per se because hummus or a nice bowl of lentils could meet the protein needs without forcing myself to drink another shake.  Maybe I'm just not listening ENOUGH to my body, even though I'm doing much better with it.

Food for thought.  (Pun completely intended.)