Hilary Rounds earned her bachelor's degree at Colorado State University and completed her post-graduate work through the VA Healthcare System in San Diego, California. Hilary is accredited by the Academy of Nutrition and Dietetics for Nutrition Counseling and Education, as well as through the National Academy of Sports Medicine for Personal Training. Hilary has also done consulting and assessment work in nutrition and exercise. As a Registered Dietitian, Hilary specializes in health coaching and outpatient issues including bariatrics, weight management, and diabetes
- What got you started?
- Misconceptions about WLS
- Frustrations patients have
- Habits to be successful after Bariatric Surgery
- What are some reasons WLS patients don't succeed?
- How to deal with a weight loss plateau?
- Exercise after Weight loss surgery
- Habits of successful bariatric surgery patients
- Strength training and weight loss surgery
- Keto diet and bariatric surgery
- Helping someone out of a plateau
- Fear of re-gaining the weight after weight loss surgery
- Long distance cardio and fueling after weight loss surgery
Geof: 00:00 What got you started to where you are now?
Hilary: 00:04 So, um, well first of all in college, I was studying to do like exercise science and that kind of stuff, but then took a nutrition class and got really interested in nutrition. So I decided to go that route and then in my internship because to be a Dietitian you have to do an internship after you graduate from college and then take a test. But in my internship I worked with a Dietitian, that worked with with weight loss surgery patients and was very inspired by them because just seeing them get their lives back and be able to do things that they hadn’t done in a long time and all that kind of stuff. I’m really made me like working with this population.
Geof: 00:00 When you talk to people about weight loss surgery, whether it’s somebody who’s wanting to go into it or just somebody that you talk to, they talked about, you talked about weight loss surgery, some of the misconceptions that you get around that. So what do you see most often?
Hilary: 00:15 So I think, um, a lot of people think it’s the easy way out. Like the weight loss surgery was just going to force you to eat a certain way and you’re going to lose weight no matter what. That’s not the case. Um, it is. We educate quite a bit that it is just a tool and it’s only as good as you use it because if you don’t use it and you don’t follow kind of the guidelines, then it’s not going to work. You know you still have to make healthy choices and exercise and take care of yourself. So I think that’s probably one of the biggest misconceptions is just that you don’t have to put in the work cause you certainly do.
Geof: 00:51 Yeah, I, yeah, I see it a lot. Is that, um, that was the misconception I see alot too. [inaudible].
Geof Shuford: 00:00 What are some frustrations that you see when it comes to talking to your patients?
Hilary Rounds: 00:05 Um, I mean, I think right after surgery there’s not a lot of frustrations because I think people really follow the rules. They follow the plan because they want to be successful. So they kind of follow everything to a T. I think about six months out then maybe some old behavior starts thinking back in and then that’s where, you know, finding the motivation for them still because their motivation changes along the way when they first have surgery, their motivation is to like get off medications, be able to move easier after they’ve lost a good amount of weight those things they’ve already achieved. So kind of pushing themselves to keep finding new motivators along the way. So that’s a common thing I see around that time. And then between like year one and year two, it’s being around I think other people living kind of normally that they kind of forget what rules they should be following because they do kind of feel just like everybody else, even though they have smaller portions still and all that, they kind of creep up a bit and again, that motivation is a huge factor in their success.
Geof Shuford: 01:12 What do you do for …I mean, how do you get people back on track? I mean the six months …
Hilary Rounds: 01:17 so then I think they had to dig a little deeper of why it’s important for them to still work towards what their goal is and all that kind of stuff. Even though they’re feeling a lot more comfortable. So for them it’s just finding, you know, why are they still working to get there? For some people it’s why I do feel pretty comfortable, so it might take them a little longer to find that and be more invested. For others it’s, you know, I still want to achieve this and this and this. So it’s just rethinking about what their motivation is. So it really comes from them. For some people it’s more internal. For some people it’s I want to fit in to this pair of jeans still and go back to my old wardrobe that I have. And so it’s different kind of for everybody. Sometimes it’s even certain activities will talk about, um, you know, if they wanted to go hiking, I know you’ve mentioned that some of the time, like going and doing a 14’er or had people do marathons and iron man. So sometimes those are their motivators to kind of keep them moving forward too.
Geof Shuford: 02:19 usually it takes a little bit for them to get to the point where they want, they start thinking that activity is something you can do and maybe I guess it is sort of, it takes a while to get to that point.
Hilary Rounds: 02:31 Yeah. So it’s kind of adjusting to their new lives. They are not bound to just what they were doing before and now they can do all these different things. So they’re not used to that. So it’s just thinking of it in a different way and kind of experimenting with things.
Geof: 00:00 What have you seen when it comes to clients habits that have been successful with the tool?
Hilary: 00:05 I think the people that are most successful are the ones that really do make it a lifestyle change, you know, so by that time it’s not difficult anymore because they’re so used to their new routine. Um, so I think that’s probably the best advice is the more people can work on that early on, kind of the rules of the tool and the more successful they will be later on because then they don’t have to put so much work into it. The people that struggle I think are the ones that never really embraced that. And it was always kind of a challenge and they never really adopted those lifestyle changes.
Geof: 00:39 There’s people that will say, well, the tool, the rules don’t really work for me. I’ve modified them a little bit. How do you speak to that a little bit in terms of just, you know, like Hillary said, I should do x, but that just doesn’t work for me.
Hilary: 00:54 Um, I, if I start doing something different and it’s working well for them, then I would maybe be OK with it as long as it’s still, they’re getting all their protein in other fluids still then I’m not real picky about it. But usually what I see as the ones that aren’t following the rules have a more difficult time. I’m telling him to do it and I do tell people that it’s more of a guideline for them too. So it’s not like set in stone, like you must do this, like one of the rules, you know, we don’t like protein drinks after six weeks post op because you should be getting your protein from your foods. But I always tell people, you know, if you’re somebody that has protein drink for breakfast every day and you’re losing weight and you’re being successful, I’m probably not going to give you too hard of a time.
Geof: 01:43 I think some people think a meaner than you really are, right?
Hilary: 01:45 Yeah. So not a mean person.
Geof: 00:00 What have you seen as sort of the top reasons, uh, that, that aren’t successful with surgery or what, what are your top reasons for that?
Hilary: 00:07 So the ones that aren’t really using the tool, so if you’re like grazing, if you’re drinking a lot of your calories, those you can eat around your bypass or a sleeve or whatever procedure you had. So it’s kind of like you never had anything. So I think those are kind of bad behaviors that sabotage people. Um, that’s why we try to have the more structured meals and have you not drink with your meals. Those types of things is based around that to use your tool to its fullest advantage.
Geof: 00:41 I’d figured out the shortcuts.
Hilary: 00:44 I always tell people, you know, will tell you how to cheat because I don’t want you to discover it and think that you found some. Right. It’s like a little kid like, oh my gosh, I can get away with this. Like, no, we can tell you how do you, how to do that, but why would you want to? Because you had this procedure to help you.
Geof: 01:03 Right? Yeah. I guess that’s what I was saying is I sort of figured, but just listening to people and hearing how they changed, I was like, that’s, that’s sort of the way that the short cut around that
Hilary: 01:14 so you can do it, but why? How successful it’s going to be a. yeah, that’s my all. I always encourage people to ask me why you know, why we have certain rules or why would we do it that way? Because then they understand the reasoning behind it and how it works versus us just telling them, you should do this, this, and this.
Geof: 01:35 It’s better if you understand that. That’s true.
Geof: 00:00 The one that I see a lot of with weight loss, a lot of times people come across the plateau and there’s typically there’s one in that first six weeks post op and then there are others along the way. What are some of the factors that come in to those plateaus and is there a way to get through them other than just waiting.
Hilary: 00:22 So a true plateau is four weeks of no weight loss, no inches lost, like basically you haven’t seen any change in a month, so that’s why I usually encourage people, you know, they can weigh themselves once a week, but tracking by the month, if you haven’t seen any success in a month, then yeah, your in a true plateau. Otherwise you know what we see in the first six weeks as you might see a stall of like a week or two and that’s just your body kind of catching up where it’s sort of adapting to the fewer calories and figuring out what’s going on and then it’ll start picking up again and then along the way that can happen. That’s pretty regular, but that just as long as you’re following the rules, you’re getting your protein in. You’re not skipping meals than that will pick up again the plateaus usually it’s for three reasons, one of three reasons, so it could be that your carbs have kind of snuck back in there and you’re getting a little bit more comfortable and a little bit more relaxed, so maybe you’re not getting as much protein too. So that’s one common thing. Another one is if you have a change up your exercise in a while because you don’t weigh as much, you’re not burning as much calories just doing your everyday I’m like walking around and your everyday functions so that kind of evens out and that can cause a plateau. So bumping up the exercise a bit. And then the other thing we see is sometimes people have really ramped up their exercise and they’re not fueling their body enough. So that’s where if you know you’re doing everything right, you’ve tracked your carbs, tracked your protein, and everything’s on track and you have changed over your exercise where you recently and you’re still stuck, then that’s where we would probably look at calories to see do we need to add more calories to fuel your workouts? And so those are Kinda the three common reasons people hit a plateau.
Geof: 02:21 Usually you see that break when they make one of those changes.
Hilary: 02:24 Yup.
Geof: 00:00 So in terms of exercise, uh, what are some of the things you would advise against and to the other side of that, I guess what, what would you like to see more of your patients do more of if anything?
Hilary: 00:12 I mean as long as they’re safe and they just kind of start slowly and build up as appropriate then there’s nothing really I advise against, you know, do what you enjoy. the thing I would like to see them do more of our finding activities that outside of the gym or that they just enjoy doing because I think people get kind of in that Rut of just doing the same thing all the time. So just experimenting with different activities and seeing if there are things that they enjoy now that they didn’t know that they’d never enjoyed before, just because they’re less, less weight.
Geof: 00:00 For your patients that are really successful and what have you noticed to be sort of the common habits?
Hilary: 00:05 Um, I think it’s just exercising regularly, kind of following the guidelines. So aiming for their 10 to 15 grams of protein every three hours. not overdoing the carbs and not more than 15 grams of carbs per meal. and aiming for mostly protein and produce at their meal. so not doing a lot of the grains and so just getting the most nutrient rich foods they can with their smaller portion sizes. And I think including the exercise component is kind of one of those things that keeps them going. So that’s usually what we see, you know, kind of after the six month mark is the people that really embrace that they tend to be a little bit more successful.
Geof: 00:00 I always advise strength training when I talk to potential clients or people that have that have come out of surgery and sometimes you’ll get people talking about the strength training and there’s a hunger that comes with that. What would you advise when it comes to the strength training because it uses so many more calories, but people are on these restrictive in terms of the amount they can eat. How do you advise that?
Hilary: 00:18 So I usually warn them first before they start ramping up their strength training that they probably will be hungrier and that’s OK, but to kind of help, it could be two things. It could be that, yeah, they’re hungrier, but as long as they’re doing more dense proteins, they’re still feeling like they can make it through their workouts and they feel good and all that kind of stuff. And that’ll kind of help the hunger, you know, just to feel more satisfied. So it denser proteins like chicken or fish or those types of things. And then more produce more fruits and vegetables, um, can help with that. And then if they’re feeling like they can’t make it through their workout, then that’s where we might supplement with like a protein drink or something like that.
Geof: 01:05 I always say maybe eats an apple slice or something 30 to 45 minutes before. Is there something else that you would think would be better?
Hilary: 01:13 Yeah. So usually I would recommend something similar, but I would recommend the protein and the carb just tell him the snack that they had before their workout to make sure that they do incorporate some carbs with it. Um, and then if they need something during their work out, you know, doing a little bit of diluted like G2 or something because they might actually need a little bit of sugar. And then I’m a little bit of the electrolytes depending on what they’re doing. And then planning to have another one of their snacks or meals right after their workout.
Geof: 00:00 This is an interesting one that I came across, just it’s about the Keto diet where it’s a very low carb, high fat, high protein diet and see I’ve seen or I’ve seen conversations of posts or weight loss surgery clients really embrace it. How do you feel about that?
Hilary: 00:19 So I don’t recommend it because I think we do still want some carbs in the Diet and we don’t necessarily want to do really high fat choices. try to choose healthy fats when they can and we do have some patients that like to do the Keto diet and that’s fine and we’ll do a modified version of it so it does kind of fit into the plan. So I’m not against it, but I wouldn’t recommend it to anyone.
Geof: 00:46 What would you, I mean, I guess I’m just curious now is sort of how would you modify it a little bit for someone who’s gone through the bariatric surgery?
Hilary: 00:53 So instead of just doing any kind of high fatwe would try to aim for the healthier fats. Um, so they could still do the high protein and high fat low carb, which is fine because we say no more than 15 grams of carbs per meal, but they don’t necessarily have to have 15 grams of carbs per meal. So it’s really not that far off. I would just kind of tweak like the type of fat that they’re using or trying to aim for something that’s not going to raise their cholesterol. And because we do see that sometimes in patients if they’re doing too many high saturated fat and protein options, then sometimes instead of having that weight loss, um, make their cholesterol go down, sometimes we’ll see it go up and then we take a closer look at it.
Geof: 01:41 How do you see the Keto Diet? This is just more general in terms of exercise itself. From my perspective, I always think having such a low carb diet has, drives up less energy, but I’m not, I don’t know if I’m valid on that one.
Hilary: 01:56 It may in the beginning and your body kind of shifts and you will use a different fuel source. So then people feel fine. So that’s another thing that I usually ask them, cause everybody’s a little bit different is, you know, have they noticed a difference in their energy levels? Can they exercise, you know, do they hit a wall during their exercise? So then if so, then maybe the Keto diet is probably not a good fit for them. Whereas other people I’ve had, they have more energy than ever and want to do everything. So I think it’s just the individual. But usually we try whatever diets people want to do. Um, you know, we never recommend a diet per se, but if there’s certain things people want to try, then we’ll let them try it. We just try to make sure it’s safe for them to experiment with it if they want to.
Geof: 00:00 All right, so here’s your, uh, a math problem question. Let’s say you have a patient of yours, it’s six months out and hasn’t seen any change in about three weeks to like a plateau of three to four weeks and say she’s eating six to 800 calories a day. What would you suggest for her?
Hilary: 00:18 So I would always start with food journals so I to have them journal their foods for at least a couple of weeks, kind of see if there’s anything that stands out because we always go to macronutrients first. So see how her protein as fitting in, how her carbs are, make sure she’s still into the 10 to 15 grams protein or the 15 grams, carbs. And then if all that’s going well then we would look at calories. So then based on how much exercise she’s doing, if she’s only getting six to 800 calories, would probably try to bump it up by a couple hundred calories and then see what happens over the next week and then kind of go from there. So it’s sort of like collecting data. I always tell people with food journals is we have to collect this data to see how their body reacts to things because 600 to 800 calories might be fine for some of our patients and then for others they mean quite a bit more. So sometimes that’s where sort of take the bmr with a grain of salt after surgery. But that’s where I would look is are they on the lower end of kind of average or are they on the higher end and then sometimes we’ll base how many calories will increase at a time based on that. They did have, I had one guy once who was following everything to a t and was exercising like crazy and he was just stuck. and he was eating probably about a thousand calories a day and he wasn’t. It was probably like nine months out from surgery. So that’s pretty typical. But when we looked at his BMR, it was like 2200. We increased to 1300 and he dropped five pounds like right away. So sometimes I know it doesn’t make sense to patients, but sometimes you do have to increase your fuel source so that your body can burn it while you’re working out instead of conserving it.
Geof: 02:11 Yeah, sometimes I noticed that it’s difficult for people to want to eat more.
Hilary: 02:15 What? How are we going to lose weight if I do that? It doesn’t quite work that way. calories in calories out is not. It’s not what it seems.
Geof: 02:27 I feel it’s a generational thing. Like the eighties and nineties, there was that low fat, you know? Then there was the low carb, but it was never don’t eat a lot and you’ll lose weight. And I think people have a hard time getting over that.
Geof: 00:00 The large percentage of people have gone through the weight loss surgery have a fear of gaining weight. What advice you give to those people?
Hilary: 00:06 I think that’s everybody’s worry is that, that this isn’t going to work. They’re not going to lose weight or they’re going to regain it back. Um, and we do see a lot of weight regained. Not a lot like they don’t regain a lot of it back, but we do see some and for some people it’s because they have this unrealistic idea of what weight they needed to be at. So they’re trying to kill themselves, trying to get there. Then they find out it’s not so realistic, so they bounce back a little bit and then that’s kind of where they’re more comfortable. So that’s one scenario. And then, um, what we usually recommend is as you’re losing weight to always have a ceiling weight, um, so really that amount that, so maybe five pounds above where you are now, have, if you ever hit that number, it’s time to come back in, get reengaged, come to a support group or review class something because something has changed and you may not realize what it is, but maybe you just needed a refresher of kind of the guidelines or um, you know, maybe we need to take a closer look at what’s going on. So to catch it early versus waiting until you’re 20 pounds up that 30 pounds up. Um, the other thing that I always see or people tell me is, well, I knew I needed to come back in, but I wanted to get some of the weight off before I came back in. And I always tell people we’re not judging you. We are looking at us more as like objective. We’re really looking at where you are now and where you’re trying to be and how we can get you there. Like, we don’t expect you to be perfect all the time. Nobody’s going to yell at you for gaining weight back. Just come in sooner rather than later because usually, um, that’s all it takes, is just kind of a reminder and a refresher and um, that’s pretty typical. So just allow yourself that, you know, you’re going to bounce around a little bit. So I always tell people kind of live in the gray like you can’t be so black and white because. And just know that we’re here to help because we do see that all the time. Like that’s pretty hard. I always remind people that they always have the tool. So even if they’ve gotten completely off track, they’ve not been using it for years, you know, if they just start following the guidelines again, usually it will start working for them again. So that’s the good news.
Geof: 00:06 is always still there. One of my clients just said that. Then I went out and it told me it was still there when everything came back up.
Hilary: 02:41 where you’re supposed to do it, it’ll remind you.
Geof: 02:45 It’s kind of funny because I think it’s a great investment because it is not something that goes away
Hilary: 03:07 like diets . People spend thousands of dollars on diets that are short term and you have to eat special foods. Like you can’t live that. So yeah, that’s why I would recommend the weight loss surgery versus trying to do that if you have a significant amount of weight to lose because you almost get behind the cycle, you know, you’re so far behind that it’s really hard to change it around. So having a tool that sort of gets some of that weight off right away, then it, you just keep moving in that other direction.
Geof: 03:24 The exercise portion, I think people get frustrated because they can’t move anymore like they used to be able to and things hurt and uh, so they just give up on exercise which just makes it even worse. And especially if they liked it, it just makes the depression or whatever. They may start getting themselves into make everything bigger and then that surgery really does restart a lot of things.
Hilary: 03:46 Think about, I mean carrying around a hundred pounds, like a hundred pound backpack all the time. Everything you do. I probably wouldn’t want to exercise either.
New Speaker: 03:46 I wouldn’t even want like to stand up
Hilary: 03:58 Yeah. So I don’t blame them, so that’s why once that way is kind of lifted even a little at a time, it’s like, oh my gosh, I could do anything.
Geof: 04:09 Your clients go, holy crap. I can’t believe I used to be. I could never do that. So it’s kind of cool to see.
Geof: 00:00 So I talked about the strength training aspect of it, but a lot of people like to do more cardio, like longer distance bike rides or runs or stuff along those lines where the fueling is going to be more. Maybe especially during the fueling, it’s going to be more simple carbs, but I also have always wondered, especially if someone has gone through the bypass and you’re eating like a gel shot during a run. How does that have that…
Hilary: 00:24 Yea, to prevent that dumping so there’s a certain threshold for dumping syndrome. So usually and we have had a gastric bypass patients that have done marathons and they will use like the gels, but for one just like anybody doing a marathon experiment first and kind of see what works best along the way but and how often you need to be doing it and what feels comfortable, but because it is a little different for everybody, but usually they can do a gel and then wait a little bit because it will absorb pretty quickly and then they can move on and keep doing it. For other people, they’ll just do like a diluted sports drink instead of water. Along the way, and then that kind of sustains them, but yeah, usually they’re fine cause the threshold is about 15 grams of carbs. So some people are a little bit more sensitive but a lot of people can usually get away with that much. So usually that’s plenty to be able to keep going through our race
Geof: 01:22 and then the feeling before, I don’t think I’m not a big carb fuler before
Hilary: 01:27 Ususall, Well and again, you know, usually your adapt, your body adapts to whatever fuel your giving it so you can kind of retrain your body so they do just fine. Um, so they’ll have a little bit of carbohydrates with their protein so remember if they have straight carbohydrates they’re going to absorb it quickly. The protein’s gonna Kinda help them use it longer and then um, they may have to have, you know, something along the way or just right after they’re done. So the timing of it is kind of individual. So we work a lot with them on that when they’re training for those things. But yeah, it can be done. We’ve had people do iron mans and all kinds of stuff. So
Geof: 02:08 it’s not that much different than really any other kind of life.
Hilary: 02:11 Exactly. And you can do pretty much the same thing other athletes do. You just start with that or kind of ease into that and kind of see how. And then we can adjust it based on what symptoms they’re feeling or energy levels they’re feeling.