21 September, 2019
It is very common for people to gain weight following stoma formation. There are many reasons for this such as:
- Increased absorption of nutrients and better food tolerance (mainly Ulcerative colitis patients)
- Reduced intake of low calorie foods like fruit and vegetables to control stoma function
- Reliance on starchy, ‘stodgy’ food to bind stoma output
- Changes in body image
- Alterations to relationship with food
Unfortunately, gaining significant amounts of weight following stoma formation can increase the risk of complications such as hernias and of course, as with the rest of the population, an unbalanced diet leads to an increased risk of diabetes, heart disease and some cancers. This can lead to well-meaning healthcare professionals and perhaps friends and family drawing attention to these risks and encouraging weight loss.
Sometimes, a useful analogy is to compare having a stoma to being given a pet to look after that you don’t particularly want. The pet has to go everywhere with you, either permanently or temporarily. The better you care for the pet, the easier it is to look after and the happier you feel. The more you reject it and don’t care for its needs, the harder it is to manage and the less friendly it becomes.
Looking after your stoma by taking care of your health is so important, but this can be very hard to do if you have struggled to accept your stoma. Unfortunately, weight loss is never easy and it is further complicated for many people with a stoma, by the need to regulate output through dietary changes that tend towards a less balanced diet. Everyone with a stoma has a different experience of eating from the reason for stoma formation to the length of bowel remaining, other medical conditions and our individual food culture. There are very few foods that suit every ostomate. While many people with a stoma can eat everything and anything, lots of people find that there is a long list of foods that don’t agree with them. This can lead to feelings of isolation and those ostomates can feel judged by those who can eat freely.
This means that designing healthy eating information for people with a stoma is really tricky! It also means that for many people, standard means of weight loss, for example, weight management groups, booklets from GPs and online information is inaccessible and can cause people to feel like they might as well not even try.
A different approach (applicable to all) is to consider the reasons why you’re eating and focus less on what you’re eating. The foods we choose and the reason we eat them is very often not “because it’s healthy and I am hungry”. The reason we’re eating is often because we’re bored, unhappy or stressed. Eating works temporarily under these circumstances because it lights up the reward centre in our brain, making us feel good. Unfortunately, if you are trying to manage your weight, especially if you are trying to manage your weight because the doctor told you have to, you will often experience guilt associated with eating the ‘wrong’ foods which can lead us to feel like a failure and, often, to eating more.
The way to manage this is not to download a more restrictive diet or buy a new diet book or to ask your next-door neighbour how he lost weight and copy him. The best way to understand your eating behaviour is to understand why you’re eating. Try keeping a journal of what you eat and write beneath each entry “I ate this because…”.
This is not an exercise in self-judgement but a way of understanding your eating behaviour better. If you’re regularly writing “I ate this because I was bored” you might want to try and find a hobby or a creative outlet that gives you that stimulation you’re looking for from food. Try colouring or doing crosswords while you’re watching the TV, it might help to distract your mind and boost your happy hormones.
If you’re writing “I ate this because I am unhappy” it is time to address the reasons for the underlying unhappiness. It might be that you need to get some professional help and your GP would be a great place to start with this. It might be that you know the causes of your unhappiness and you can begin to address them, either way, the over-eating is as symptom of your distress, not the cause. It is the underlying issues that need to be tackled.
If you find you are often writing “I ate this because I was stressed” it’s time to find new stress management strategies! There are some great ideas online including controlled breathing and meditation. Obviously in an ideal world you will also reduce the causes of stress in your life but of course, that isn’t always possible.
If you often find that you’re eating something because you’re on the run and you can’t find anything healthy to eat, it would be a good idea to try and plan ahead a bit for your day and maybe stock up on healthy food and snacks you can keep with you.
Gentle exercise, even just stretching can light up the same reward centre in your brain as food does. Chatting with a friend on the phone or watching funny videos will also help. Creativity and hobbies do the same thing. There are plenty of healthy behaviours that we can do that can displace some of the overeating.
The most important thing to remember is that you already know everything you need to about how to lose weight. There are no secrets. The diet industry will always be waiting to sell you a new weight loss method or supplement. We buy into a new diet hoping that we didn’t know what we should have been eating before when really the solution is in understanding why we are eating.
Once you have understood and developed some strategies to overcome the reasons for over eating, think about the basics. Try to have plenty of fruit and vegetables and lean protein. If you find that vegetables affect your output, try choosing vegetables from the lower fibre list. Snack on fruit when you can or try peanut butter on oat or rice cakes. Rice cakes can be a great way to thicken output without giving a lot of extra calories.
Remember that weight gain is always a symptom of a problem and not the cause of our problems. Healthcare is currently set up in a way that treats weight gain as THE problem without finding real solitons to the causes for weight gain.
By Sophie Medlin, Dietitian, City Dietitians