Ruben Cardona plans to spend Christmas in his loft in East Downtown with his partner.
“I’ve been so eager to decorate this year I put up all my holiday stuff up even before Thanksgiving,” he said.
Cardona’s tree is decorated and covered with lights, and his stockings — for humans, as well as his dogs Ramsey and Bug — are hanging. Instead of visiting family, Cardona, 28, will schedule Facetime and telephone calls to stay connected.
“We decided to do our holidays apart,” he said.
In some ways, staying separate will make Cardona’s celebration easier this year. A few months ago, he had a gastric sleeve procedure. After weight loss surgery, diets and portion sizes are restricted, making Christmas dinner trickier to navigate.
“It’s my first holiday season with this surgery,” he said.
Since most Christmas parties are canceled this year because of COVID-19, Cardona can stick to his prescribed post-surgery diet. He can control how much he eats and when he sits down for a meals.
Cardona has also committed to making smart choices, like subbing mashed cauliflower for mashed potatoes and forgoing the wine this holiday season.
These decisions are less difficult to make without holiday parties and family meals.
According to the American Society for Metabolic and Bariatric Surgery, 252,000 bariatric procedures were performed in the U.S. in 2018. At Baylor College of Medicine, where Cardona is a patient, about 160 weight loss procedures are performed annually.
“A lot of patients get concerned,” said Rachel Griehs, a dietician at Baylor College of Medicine, has been working with Cardona. “When they get together with friends and family, there’s food all over. It’s a challenge for them.”
Cardona’s bariatric surgeon at Baylor Dr. Juliet Holder-Haynes said patients are often worried about managing meals after the procedure – especially for their first holiday.
“For patients who have bariatric surgery, there are a lot of concerns about food in general,” she said. “Holidays and public events can be stressful.”
It can be difficult to explain to your mother why you can’t try her specialty this year – or why second helpings are out of the question, she said. “It can be awkward when they can only have small amounts of food.”
Punch and champagne are often off limits, which can be confusing to friends who want to celebrate over a toast.
“They can’t do it like they used to, and that can cause a lot of stress,” Griehs said.
She explained that after a gastric sleeve or bypass surgery, a patient’s stomach is literally smaller.
“They can’t always eat certain things, and they won’t be able to overeat,” Griehs said. “We’re changing their anatomy and their stomach. You almost have to treat their stomach like it’s brand new.”
Even munching on something dry like turkey or too sweet like a Christmas cookie can make them sick, she added. Not only are certain foods off limits but portion size is crucial. Eating too much of a food — even one that’s typically safe — can lead to vomiting.
Starches can be too heavy for a weight loss patient. “They can be heavy, like a lump in the stomach,” said Griehs, who recommends patients stick with protein. “Keep that food to the smallest portion. Eat everything else first.”
That means, after the Christmas ham and a vegetable, a spoonful of mashed potatoes or stuffing can suffice.
Dumping syndrome – diarrhea, nausea, cramping or light-headedness caused by rapid gastric emptying – is common when patients eat sugar or drink during a meal.
“Foods that don’t sit in the stomach, literally dump,” Griehs said. “For some people, they can eat barbecue sauce and that happens. For others, it’s a piece of cake. There’s nothing you can do about it. You just have to go through it, and it’s almost like food poisoning.”
Staying away from dessert, alcohol and carbs can help post-operation individuals feel better. Still, a new dish can pose a problem, simply because patients do not know how they will react to certain ingredients.
“Eat the stuff you know you can eat,” Griehs said. “Be aware of ingredients in dishes. Maybe bring a dish you know that you can eat.”
In addition, she tells patients to eat slowly and chew food well. Drinking water and eating also must become separate occasions.
“You cannot eat and drink together,” she said. “It creates a lot of pressure on the stomach. Then you would feel bad for a couple of hours.”
She also suggests using a saucer instead of a plate to limit portion size – and to bring baby silverware to force small bites of food.
“If they have one bite too many, they will get sick,” Griehs said. “They don’t want to get to that point.”
Michelle Stacker, 51, underwent the procedure in May after hypothyroidism caused her to gain weight even though she ate healthy and exercised. Weight loss surgery seemed like the solution. Already, she’s lost 60 pounds. Now she enjoys running around with her grandchildren in the park.
“Having this surgery changed my life,” said Stacker, who lives in The Woodlands. “I feel so good. I wake up, and I’m not aching. I wake up, and I’m not hurting.”
Still, adjusting to her diet has its challenges. Her once-typical salads don’t sit will in her stomach any more, and she can only take a couple sips of her beloved daiquiris before placing them back in the freezer for later. She often drinks protein shakes instead of meals to help with her nutrition.
During the holidays, she plans to cook stuffing, cake and other favorites for her family.
Stacker will be eating with baby silverware to control her portions. She also has to be careful not to take in too much air, when she drinks water.
Stacker said the extra effort is worth is.
“This year, I’m feeling joy that I attribute to the surgery,” she said. “I don’t feel sick. I’m active, and I get to play with my grandchildren.”
Some patients will want to limit their calories to a holiday party – and restrict what they eat the rest of the day or even skip some meals. That’s a bad idea, Griehs said. It can lead to over-eating and chewing too fast.
“A lot of people will go all day without eating and then be ravenous,” she explained. “I tell people to eat light but be sure you eat. You want to stick to your regular schedule of eating.”
Still, Griehs said to remember that each holiday get-together lasts only a day. If an individual overeats or has a dessert, it’s not the end of the world.
Patients often worry about gaining back the weight they lost with surgery, Griehs explained.
“There’s a honeymoon phase after the operation when they can lose weight no matter what,” she said. “That doesn’t last forever. Their appetite starts coming back, and if they haven’t changed the way that they think about food, they will likely go back to old eating habits.”
Dr. Holder-Haynes agreed. “One bad meal is not going to cause you to have weight gain,” she said. “It’s a pattern of behavior that leads to weight gain. One Christmas meal won’t sabotage you.”
She advises patients to remember why they had the surgery in the first place, when they get frustrated about their diets during the holiday.
“Before surgery, your relationship with food had to change,” she said.
Holder-Haynes also suggests that patients have a game plan. “Plan what you’ll eat, and picture what your plate will look like,” she said.
Cardona said that both Holder-Haynes and Griehs consider him a patient for life, not simply during the surgery.
“If you have any questions, they tell me to feel free to reach out,” Cardona said. “I’ve done that, and I enjoy it.”
They have both been clear to him that weight loss is a process.
“This is going to be a lifelong thing,” he said. “This is something I have to work for. I want to keep this going. I’ll set new goals, and I’ll keep moving forward.”
Cardona’s surgery was at the end of August. Four months later, he now weighs 206 pounds, down from 287 pounds.
He’s become extremely aware of what he can eat and when. Already, he feels healthier. Before his surgery, even walking his dogs would hurt his feet and back.
“But now I feel like I have more energy and can withstand walking longer and farther,” he said. “My dogs are very appreciative.”
Maybe the holidays shouldn’t be all about food anyway, he added.
“We’re so used to holiday get-togethers and food,” Cardona said. “It’s not about the food and gifts. It’s about the holidays.”
In Christmases past, Cardona’s holiday gatherings often centered on the food; after dessert, everyone left. That’s changing, as he and other family members have opted for weight loss surgery.
“Food hasn’t been the center of our gatherings anymore. It’s about bringing ourselves to the table instead,” Cardona said.
Lindsay Peyton is a Houston-based freelance writer.