Weight-Loss Dieting When You’re on Dialysis 

If you are considering going on a diet to lose weight, you may wonder how that will work with your dialysis diet. As with most diets, losing weight on a dialysis diet can be challenging and take time to show results. If you diet in a healthy way by eating right, working with your renal dietitian and incorporating physical activity into your routine, you can lose the unwanted pounds and feel healthier. 

Why some people on dialysis want to lose weight

If you are overweight or obese and on dialysis, you may benefit from weight loss for the following reasons: 

• Better blood sugar control, if you have diabetes
• Better blood pressure control
• Decreased cholesterol and triglyceride levels
• Increase energy
• Qualification for a kidney transplant

How to start a weight-loss diet when you’re on dialysis

There are some things to know before you begin any weight-loss plan. When you’re on dialysis, talking with your dietitian and doctor about changes in your usual diet is important. Your dietitian can help you form a meal plan that keeps in mind both your dialysis diet and your desire to lose weight, while your doctor may suggest which exercise is best for you. Share with them what your goals are so that you receive accurate guidance for your weight-loss diet. 

The following are weight-loss diet tips for people on dialysis: 

Be aware of your shopping and eating habits

• Keep a food journal to record what you eat, your emotions and hunger level.
• Don’t skip meals; this often leads to overeating later on.
• Keep distractions at a minimum while you eat, i.e. turn off the television during mealtime.
• Avoid nibbling while preparing meals.
• Eat slowly.
• Refrain from grocery shopping when you’re hungry.
• Before grocery shopping, make a list and stick to it.

Exercise with your doctor’s consent 

• Start exercising slowly and build your way to at least 30 minutes a day.
• Choose an activity you enjoy, such as bicycling, swimming or walking.
• Invest in a pedometer to track your steps; try to reach 10,000 steps a day.
• Take the stairs instead of the elevator.
• Park farther away from store entrances so you get in extra steps when running errands.
• Ask about exercises you can do in your chair if you are unable to get up.
• Keep in mind that household chores, gardening and other everyday activities can be considered exercise, so talk to your doctor about what you do now and what else you may do to get more exercise.
• Track the calories you burn.

Reduce calorie and fat intake 

• Try different cooking methods. Use nonstick cooking pans or nonstick cooking spray. Also cook in ways that won’t add more fat to a meal, such as grilling.
• Choose lean cuts of beef, pork, lamb and veal. Trim the fat before cooking.
• Take the skin off poultry before cooking.
• Buy water-packed canned tuna, chicken or other meats. Buy low-sodium foods when available or rinse them under cool water to remove excess sodium.
• Substitute low-fat mayonnaise and salad dressing for the originals.
• If you use nondairy creamer, look for the one with the fewest calories.
• Select angel food cake, graham crackers, low-fat cookies and vanilla wafers, instead of cakes, pies, donuts or high-fat cookies.
• Use Equal^®, Splenda^®, Sweet ‘n’ Low^® or other sugar substitutes instead of regular sugar.
• Avoid frosted cereals or those with nuts and fruit; instead try Corn Flakes^®, Rice Krispies^®, puffed rice and other lower calorie cereals.
• Substitute fresh fruit and vegetables for high-fat snacks. Be sure to keep within your potassium allowance.
• Increase fiber intake to 25 grams per day. Ask your dietitian for tips on the best high-fiber foods to eat.

Be aware of your portion sizes 

• Measure or weigh foods until you get an accurate sense of serving sizes.
• Portions should be the right size; see the guidelines below.

• Buy single-serve or smaller packages if you are tempted to eat more than one serving.
• When eating out, share a meal or take half home.
• Use a meal plan to determine how many servings from each food group to include each day.

Reward yourself 

When you set reasonable goals and achieve them, reward yourself. Here are some suggestions: 

• Go to a movie.
• Buy a new outfit, book or CD.
• Take dance lessons.
• Have a bowling night with friends.

Difficulties when trying to lose weight on dialysis

Weight loss can be difficult. It takes time and dedication to achieve your weight-loss goals. The difficulties you may face are both physical and emotional. Here are some reasons why dialysis patients may be deterred from eating right and exercising.

Physical

Anemia

Some people with chronic kidney disease (CKD) who are on dialysis have anemia, due to low red blood cell count, which causes fatigue, shortness of breath and dizziness. Your doctor will develop a treatment plan that will help treat anemia. If you have anemia, ask your doctor to tell you when your blood count is high enough for you to exercise safely. 

After-treatment affects

Some dialysis patients who do in-center hemodialysis can feel weak after treatment and therefore lack the motivation to exercise. Sometimes this will last for only a few hours while others require a good night's sleep. Plan exercise after a post-treatment rest or exercise on non-dialysis days.

Peritoneal dialysis (PD)

People on peritoneal dialysis (PD) may have trouble losing weight because they absorb glucose (sugar) from the dialysis solution. The glucose taken in during dialysis can sometimes add up to as much as 500 calories per day. The best way to avoid weight gain while on peritoneal dialysis is by using dialysis solutions with the least amount of glucose. That means using more 1.5% and 2.5% (yellow) bags and fewer 4.25% (red) bags. If this results in the retention of fluid, work with your dietitian and PD nurse to determine the amount of salt and liquids you should eat and drink each day. 

People on PD usually have the time and ability to exercise, and this should be a part of your daily routine. Some people find it easier to exercise with an empty abdomen rather than one filled with fluid. This should be discussed with your PD nurse and physician. 

Adequate protein 

Reducing food intake usually cuts into the amount of protein eaten. If high-quality protein intake is inadequate while dieting, you may lose muscle mass and your albumin level may drop. Your dietitian can offer guidance to help make sure you eat enough low-fat, high-quality protein. Dietitians can also monitor your monthly labs to make sure your albumin is not dropping.

Emotional

Food choices

Sometimes people make poor food choices based on their emotional state and overeat when they feel down, hopeless or even happy and want to celebrate.

How to stay on track 

Remember that losing weight will not happen overnight and trying to make huge changes all at once can become discouraging. Set small goals that can turn into an overall big success. 

Talk with your dietitian about different meal plans that fit your goals and lifestyle. Your dietitian may also introduce you to frozen meals that cut cooking time but are low in phosphorus and potassium. Be sure to cut out unnecessary calories, such as high-fat and high-sugar foods. If you find yourself losing weight to be on the transplant list, this shows the healthcare team how committed you are to your health. 

People who are successful at losing weight usually adopt the following habits: 

• Keep a food diary
• Eat well-balanced meals
• Set realistic goals
• Include regular exercise

Let your healthcare team know that you are trying to lose weight. Your dry weight needs to be adjusted as you lose weight so the correct amount of fluid is taken out during each treatment.  

Summary 

Weight-loss dieting when you’re on dialysis can be an added challenge to the dialysis diet. Losing weight does not happen overnight and requires a lot of dedication. Gradual changes may help you achieve better results. The approach is not just a change in your diet, but a change in your lifestyle. Once you set realistic weight-loss goals, talk with your health care team about an individualized plan and making good habits as part of your routine. You may end up a weight-loss success story.