1. © BariAthletes ® Bariatric Athlete Nutrition Lea Crosetti, RD, CSSD www.BariAthletes.com September 22 nd 2012

2. © BariAthletes ® 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

3. © BariAthletes ® Bariatric Surgery

4. © BariAthletes ® Nutritional Changes Post Bariatric Minimal caloric intake –Restrictive and malabsorption Minimal carbohydrate intake –Dumping syndrome –Expansion –Reduces protein intake 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 EVERYTHING IS REDUCED! VERY CATABOLIC! 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

5. © BariAthletes ® Athletes

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7. ® 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).

8. © BariAthletes ® 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!

9. © BariAthletes ® 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

10. © BariAthletes ® What Are Their Goals? To finish? To PR? Achieve healthy weight? Develop new lifestyle to avoid weight regain?

11. © BariAthletes ® 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

12. © BariAthletes ® Considering the Spectrum Bariatric Nutrition Sports Nutrition 5k 1 month post op 3 years post op Ironman

13. © BariAthletes ® Leave the Numbers Out There are no standards! Everyone’s anatomy is different Great opportunity to reconnect with hunger / fullness levels

14. © BariAthletes ® 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

15. © BariAthletes ® 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.

16. © BariAthletes ® 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

17. © BariAthletes ® 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

18. © BariAthletes ® Pre Workout Nutrition Something easy to digest and best tolerated Make sure there is both protein and carbohydrates in it, preferably low in fat

19. © BariAthletes ® 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

20. © BariAthletes ® 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

21. © BariAthletes ® 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

22. © BariAthletes ® Who are you working with?

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24. ® 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!

25. © BariAthletes ® 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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27. ® 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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29. ® Key Points To Remember You are working with people with very individualized needs –Assess surgical and athletic status 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

30. © BariAthletes ® LEACROSETTI@BARIATHLETES. COM LEACROSETTI@BARIATHLETES. COM 877-66-FUEL4YOU TWITTER.COM/BARIATHLETERD FACEBOOK.COM/BARIATHLETES CONTACT INFORMATION