How to Stay Fit While Traveling

When you are on the go it’s hard to make time to exercise. Even die-hard fitness buffs may find it hard to keep up with an exercise routine when traveling. The good news is that with a bit of planning and just pair of sneakers, it’s easy to get a work out in just about anywhere.

Here are some creative ways to stay fit while away from your home.

1. Most hotels have a fitness center or pool. Inquire before your trip so you pack the right exercise attire. If a fitness center is not available consider walking the hotel halls. Think of it like swimming laps – just stay out of housekeeping’s way!
2. Watch an exercise DVD, a cable television exercise show or load up your computer with your favorite workout programs. With just a few feet of space, you can work out in your room. Even 30 minutes of exercise can help you stay on track and feel good.
3. Explore the area you are visiting. Look for walking trails, or safe streets to get in a walk or a jog. If you are in a new location, check with the hotel concierge or consult a trusted local source to find out some interesting and safe places to go. Always obey local traffic laws, and think about bringing someone with you.
4. Check out a local gym. Sometimes it’s fun to get out of your element and try a new class with a new instructor, or different group of people. Many gyms offer day or weekly passes so you can sweat it out even while away from home.

Do you exercise while traveling?

Ready to Get Healthy in 2013 and For Good

Join Penn Medicine's weight-loss surgery team for a free, informational session about weight-loss surgery at Penn. 

Meet weight-loss surgeons from Penn, and learn what weight-loss surgery is right for you. 

Winter Workouts: How to Stay Warm and Safe

Staying warm and dry while exercising in cooler temperatures may be challenging, and ice and snow can be treacherous, but just because it is winter doesn’t mean outdoor workouts need to stop.

Here are some tips to help you continue your workout through the winter months.

Select the Right Clothes

Staying dry is essential. Clothes specifically designed for cold weather wick away moisture from the body to keep you dry and warmer. For the layer that goes against your skin look for “moisture wicking” on the label, as well as machine washable materials. Avoid 100% cotton, it holds sweat and can lead to chills, muscle tightness and discomfort.

Wear Light Layers

Layers are important because if you get too hot, you can take some things off to cool down. Over your long sleeve moisture-wicking shirt, wear a fleece or wool pullover for insulation. Add an outer layer that will repel water and block wind.

Use Reflective Gear

Since days are shorter, and it might be dark when you work out, make sure to wear easy- to- see colors and other reflective gear that can help drivers see you in the dark. There are reflective vests that are mesh, so as not to add weight and bulk that can be seen hundreds of feet away and offer 360-degree visibility. Flashing lights on bikes are another way to gain more visibility and ensure you can be seen even when you are working out in the dark.

Cover Your Head and Ears

Most heat escapes the body from the head. Hats can keep in heat, but look for hats made with moisture-wicking materials so as not to keep your head too sweaty. Headbands that cover the ears are also a great way to keep your head warm, without getting too sweaty.

Keep Hands and Feet Warm

Protect your fingers and toes from frost bite. Wear thin glove that can be layer inside heavier lined gloves or mittens. Thermal socks are another essential winter workout item.

Indoor Alternatives

Be sensible in really nasty weather, do your workout indoors. This is a great time to cross train and try a new activity. Many gyms offer memberships on a month-to-month basis, which is a good opportunity to try a new class, start a weight training routine or try a new activity.

Ready to Get Healthy in 2013 and For Good? 

Join Penn Medicine's weight-loss surgery team for a free, informational session about weight-loss surgery at Penn. 

Meet weight-loss surgeons from Penn, and learn what weight-loss surgery is right for you. 

25 Ways to Say "No, Thank you."

High calorie food and drinks are usually in an abundant supply at holiday gatherings. If you are trying to eat healthier, control your calories, or recently had weight-loss surgery and can only eat small portions, finding gracious ways to say “no” to family members, friends or co-workers offering food and beverages can be challenging.

Start with a direct, “No thank you!” In case that does not work here are 25 more ways to respond to holiday “food pushers”.

1. Thank you, but I already ate.
2. It looks delicious, but I’m already too full!
3. Looks too good to eat!
4. Thank you, but I am trying to eat healthier.
5. Thanks, but I’m getting a jumpstart on my New Year’s resolutions!
6. I don’t have any room on my plate.
7. I worked out earlier, and am trying to stay on track tonight.
8. I’m saving my calories for _____ (insert other food).
9. I’ll have some later!
10. I’m so proud of my weight loss; I’m going to stay on my diet plan!
11. Did you know I’ve already lost 25 pounds?
12. I just had some of your amazing ________(insert other food) and it was great!
13. I’ve been cooking myself all day; I need a break from food!
14. I’m so close to my goal!
15. I have a weigh-in tomorrow, and I’m on my best behavior tonight.
16. I have to drive (for drinks).
17. I’ve already tried a bite of everything.
18. I’m allergic to that ingredient.
19. For some reason, I’m not that hungry!
20. I ate some when I got here.
21. I filled up on veggies earlier.
22. No thank you, but I’d love that recipe!
23. I’m good, thanks!
24. I’m trying to pace myself, but thank you!
25. No thanks, but my husband/wife/partner/friend would love to try it!

Can you add any creative ways to say, “No, thank you!” to food or drinks you do not want to eat?

5 Ways To Relax Right Now

The practice of yoga calms the mind by providing a deep feeling of relaxation and balance. Did you know that the very basics of a yoga practice can be done during your “everyday” life at any place or any time?

When you find yourself caught up in the hustle and bustle this holiday season, give yourself the gift of “instant yoga” by practicing these quick and simple techniques…anywhere…anytime:

Staying Grounded During the Holidays: 5 Easy Ways to Take Yoga off of the Mat

Standing Pose

The next time you are in the middle of a busy mall and feel overwhelmed by the crowds, take a few second to ground yourself by standing with your feet hip’s distance apart, relaxing your shoulders and fixing your gaze straight ahead. Take a few release breaths in through your nose and out through your mouth. This will reset your body and mind to allow you to continue with the remainder of your shopping.

Alternate Nostril Breathing

If holiday shopping gives you a headache, try inhaling and exhaling through each nostril by closing off one nostril and breathing in to a count of 8 and exhaling out of the other nostril to a count of 16. Do a few rounds of this ancient yogic breathing practice slowly for relief of stress and anxiety.

Shoulder Rolls

When lines at the cashier drive you crazy and cause stress, draw your attention to your shoulders and take a nice, long inhale bringing your shoulders up to your ears, circle them back and down. While you are at it, circle your neck around a few times while inhaling and exhaling slowly. You will feel a renewed sense of calm.

Lion’s Pose

Are those office parties making you tired of talking, smiling and socializing? Go to a quiet place and try this pose by opening up your mouth wide and sticking out your tongue. Making the sound of a roaring lion helps, too. Sounds funny, but this ancient pose is a great release for the facial muscles and really helps if you have been doing a lot of talking.

Meditate

The best way to get through the holiday season feeling happy, healthy and whole is starting each day with a few minutes of meditation. Just sitting silently with your eyes closed at any point during your day is very helpful to keep yourself in balance. Remember, it doesn’t have to be for a long period of time…even just one minute of silent meditation in the midst of a busy holiday season will go a long way!

Fern Nibauer-Cohen is the associate director of program development in the department of radiation oncology at Penn Medicine. She received her certification to teach yoga from Yoga On Main in Manayunk, PA and has completed the level one certification of the “Teaching Yoga to Cancer Patients Program” from Integral Yoga. We'd like to thank Fern for contributing to the Penn Weight-loss Blog.

The Unexpected Benefits of Being Fit

Bruce Sachais, MD, PhD, is an associate professor of pathology and laboratory medicine at Penn Medicine. In December 2010, he attended an informational session and decided to have weight-loss surgery. His Roux-en-Y gastric bypass surgery was performed at Penn by Noel Williams, MD. In this article, he discusses his struggle with weight, and why even as a physician, losing weight alone has been challenging. 

Read more about how Bruce lost 121 pounds. 

Nineteen months ago, I underwent gastric bypass surgery at Penn, a place that I know and love since I have worked there for the past 16 years. The most common question I get, after people realize that it is me (at least for those that have not seen me in a while) is how it feels and has it changed my life? Well of course it has, and for the better!

But, how does losing over a third of your body weight after being obese for most of your life change your life?

In so many ways.

First and foremost, I can again wear my wedding band; something I had not been able to do for over a year. What a wonderful feeling!

I have much more energy than I can remember ever having as an adult - energy for everything I do. I even appear more animated and enthusiastic when speaking with people, which had apparently been lost due to shortness of breath over the years. What an unexpected benefit.

Air travel is less uncomfortable as I can fit in the seat. So is going to the theater, as most theater seats (at least for live theater) are quite small.

My health is much better. All of my medical issues are either resolved or much improved. I guess the one exception to this is that my family still thinks I am crazy, perhaps even more so given my increased energy these days.

I don’t have to worry about walking around. In fact, I look forward to it. Before my surgery I would have problems after about 5 minutes, but now I can walk for over an hour. I can even run a little and have started a running program. My friends are shocked as I was never athletic at all. I even played in a charity softball tournament with my wife and younger daughter, who are real softball players. I can’t say I did well, but I did play and contributed to the team’s effort, - and had fun.

While these may not seem like major accomplishments for people that have been able to maintain a healthy weight and lifestyle most of their lives, they are significant to me. I feel that I have my life back.

Get Your Life Back

Whether it's playing with your kids, managing health conditions, or getting back to feeling like you, get Penn help you meet your weight-loss goals.

Join us for a free information session about weight-loss surgery at Penn. There, you'll be able to meet with Penn weight-loss physicians, and learn about your options in weight-loss surgery.

Join us for a free information session today.

Beneficial Bacteria: All About Probiotics

Danielle Rosenfeld, MS, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses probiotics, a “buzz word” in the food industry.

Beneficial Bacteria

Probiotics are “good” bacteria similar to organisms that occur naturally in the digestive tract. The digestive tract needs a healthy balance between good and bad bacteria for optimal health. Believe it or not, there are more than 100 trillion good bacteria living in the human body, many of which reside in the digestive tract. There are numerous strands of probiotics that have been linked to a variety of health benefits when administered in large enough amounts.

Why Take Probiotics

A study conducted at Stanford University School of Medicine examined the effect of probiotics in post-operative Roux-en-Y gastric bypass surgery patients. After three months, the participants who had taken a daily probiotic supplement had higher average weight loss and enhanced absorption of vitamin B12. In addition to these findings, probiotics, particularly lactobacillus acidophilus, may facilitate lactose digestion in lactose-intolerant individuals, a common problem for post bariatric patients.

Food Sources of Probiotics vs Supplements

Probiotics are found in cultured dairy foods such as yogurt and kefir. The number of active cultures found in foods varies greatly, depending on the type of bacteria and food processing. Certain processes to prolong shelf life, such as pasteurization in yogurt, can kill off some of these beneficial bacteria. Look for yogurts that have a “Live and Active Cultures” seal, as these contain approximately 22 million active cultures in a typical 8-oz serving. Additional food sources include pickled vegetables, sauerkraut and dark chocolate.

Supplements generally contain a much more concentrated supply of probiotics, providing 100 million to 1 trillion active cultures per dose. When shopping for probiotic supplements, look for one with many species of lactobacillus, such as L. acidophilus or bifidobacteria, as strains of these probiotics have been shown to improve digestion and have an extensive safety record for use in the generally healthy population. There is no specific dose recommendation and products should be used according to the manufacturers’ recommendations.

The Weight Loss Surgery: What To Expect Before Surgery

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses what to expect before weight-loss surgery to ensure long-term success.

“A journey of a thousand miles must begin with a single step.” Lau-tzu, Chinese Philosopher (604 BC – 531 BC)

For individuals contemplating weight-loss surgery this statement certainly rings true.

The path to a healthier weight actually begins well before the actual surgery date. The pre-surgery journey starts by attending a bariatric surgery information session. At this session potential candidates learn about the bariatric surgical procedures, the benefits and risks of surgery, essential diet and lifestyle changes and what the weight and health criteria are to qualify for weight-loss surgery.  A member of the bariatric team is available to answer questions and schedule an initial consultation with one of our bariatric surgeons.

At the initial consultation your health, diet and weight loss history will be reviewed by a surgeon, dietitian and a nurse specializing in weight loss surgery. A plan for your pre-operative evaluation and nutrition education is created. Completing the series of pre-operative clinical and laboratory tests are the next steps in your journey to weight-loss surgery. A sleep study, psychological evaluation and medical specialist consultation are also required. All of these procedures and visits may take several months to complete.

During this time it is important to attend monthly medical weight management appointments and start taking steps toward a healthier diet and lifestyle. Keep a food and activity diary to help establish regular eating and exercise habits.

The goal before surgery is to put into place positive behaviors that will help you succeed after surgery.

• Eat at least three meals a day.
• Limit foods that are high in fat and sugar.
• Eat whole not processed foods focusing on lean protein and fiber containing products.
• Increase your activities of daily living and start a “dedicated exercise program.”
• Focus on losing weight.
• Stop smoking, patients must be smoke free for at least 2 months before surgery.

Get Weight-loss Support

Attend a bariatric support group.

Encouragement and support are essential for success. The support group provides the opportunity to interact and ask questions of our professional staff as well as patients who have had surgery.

One of the last steps in the pre-operative journey is attending the diet instruction class to reinforce the details of the post-operative diet progression.

Our team will help you take this pre-operative journey one step at a time!

Healthy Recipe: Chunky Vegetarian Chili

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, shares with us a delicious and healthy alternative to traditional chili. 

This quick, meatless chili is full of fiber and protein, low in fat, and delicious enough to please meat-lovers. Make this meal ahead of time and pack it in a thermos or microwave-safe dish for easy lunches during the week.

Chunky Vegetarian Chili

Yield: 8 servings (serving size: 1 cup)

Ingredients

• 1 tablespoon vegetable oil
• 2 cups chopped onion
• 1/2 cup chopped yellow bell pepper
• 1/2 cup chopped green bell pepper
• 2 garlic cloves, minced
• 1 tablespoon brown sugar
• 1 1/2 tablespoons chili powder
• 1 teaspoon ground cumin
• 1 teaspoon dried oregano
• 1/2 teaspoon salt
• 1/2 teaspoon black pepper
• 2 (16-ounce) cans stewed tomatoes, undrained
• 2 (15-ounce) cans black beans, rinsed and drained
• 1 (15-ounce) can kidney beans, rinsed and drained
• 1 (15-ounce) can pinto beans, rinsed and drained

Preparation

1. Heat the oil in a Dutch oven over medium-high heat.
2. Add onion, bell peppers, and garlic; sauté 5 minutes or until tender.
3. Add sugar and remaining ingredients, and bring to a boil.
4. Reduce heat, and simmer 30 minutes.

Nutritional Information

Amount per serving
Calories: 257
Calories from fat: 9%
Fat: 2.7g
Saturated fat: 0.3g
Monounsaturated fat: 0.5g
Polyunsaturated fat: 1.2g
Protein: 12.8g
Carbohydrate: 48.8g
Fiber: 14.2g
Cholesterol: 0.0mg
Iron: 4.5mg
Sodium: 876mg
Calcium: 150mg

Recipe from Cooking Light, December 2003

Fiber Sources and Eating Fiber After Weight-loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses fiber, sources of fiber, and how to add fiber to your diet after weight-loss surgery.

Fiber

If you are trying to lose weight or maintain a healthy weight, a high fiber diet is an essential part of your program. Not only do high fiber sources like fruits and vegetables tend to be low in calories, but the fiber they contain slows digestion, which helps to keep you feeling full. For example, an apple is more filling than apple juice because of the fiber it contains. Additionally, foods that contain fiber often take longer to chew, giving you time to realize that you are satisfied on a smaller portion. A high fiber diet has also been linked to other health benefits including lower blood cholesterol levels, better blood sugar control, and bowel regularity.

Types of Fiber

Dietary fiber is found only in plant foods, including fruits, vegetables, legumes, whole grains, nuts and seeds. Functional fiber is a newer term referring to isolated fiber that is added to foods.

Sources of Fiber

The number of food products on the market advertising added fiber has grown significantly in the past few years as food manufacturers have tuned in to our desire for higher fiber foods. Added fiber can now be found in everything from yogurt to soups. Inulin is the most common functional fiber being added to foods and can be found in a food product’s list of ingredients. Keep in mind, foods that naturally contain fiber are the best source of fiber because you’ll benefit from other nutrients in the food like antioxidants, vitamins, and minerals. Functional fiber has not been shown to have the same benefits as dietary fiber, and foods fortified with fiber tend to be overly processed and really just glorified junk food.

Adding Fiber to Your Diet After Weight-loss Surgery

After bariatric surgery, it can be difficult to obtain adequate fiber from foods due to much smaller portion sizes, so taking a fiber supplement or using foods with functional fiber may be beneficial. Aim for consuming 14 grams of fiber for every 1000 calories that you eat.
Tips for adding more fiber to your diet:

• Add more fiber gradually, a week or two at a time. Adding fiber too quickly can cause gastrointestinal symptoms like bloating and gassiness.
• Spread out your fiber intake throughout the day rather than loading up in one sitting.
• Eat whole fruits instead of juice.
• Use beans as a source of both fiber and protein.
• Make all of your grains whole grains. Look for cereals with at least 5 grams of fiber per serving and breads and crackers with at least 3 grams of fiber per serving.

Talk to your program registered dietitian for more tips on how to get enough fiber in your diet.

Vitamin D – Are You Getting Enough?

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses vitamin D, and how to tell if you’re getting enough vitamin D. 

Vitamin D is essential for the absorption of calcium and building and maintaining strong bones. Individuals who do not get enough vitamin D may develop soft, thin, and brittle bones, a disease called rickets in children and osteomalacia in adults.

Vitamin D is also required for the healthy functioning of muscles, the nervous system, and the immune system.

This essential nutrient may also play a role in the risk of developing many chronic diseases such as diabetes, hypertension, autoimmune disease and some forms of cancer.
How can you make sure you get enough vitamin D?

Vitamin D is unique among the nutrients required for good health because it can be made by the body when our skin is exposed to sunlight. When the ultraviolet – B (UV B) radiation of the sun penetrates our uncovered skin, vitamin D synthesis is triggered.

How much sunlight is too much or too little?

It is hard to say.

The amount of sunlight needed to make enough vitamin D depends on a number of factors:

• Time of day: For the sun’s UV B rays to adequately penetrate the skin the sun must be directly over head.

• Your location: Individuals living in more northern latitudes, where the sunlight is less intense, may not synthesize vitamin D in the winter months. But vitamin D synthesized during exposure at other times of the year can be stored in the liver and fat.
• How much of your skin is exposed: The more skin surface area exposed, the shorter the time needed to meet your vitamin D needs.
• How easily you get sun burned: The melanin pigmentation of dark-colored skin prevents UV B light penetration and limits vitamin D synthesis. Darker skin needs more sun exposure, lighter skin less time in the sun is needed to produce vitamin D.
• Factors that block UV rays: Sunscreen, with a SPF of 8 or more, will block the vitamin D – producing UV rays.

According to the National Institutes of Health, less than 30 minutes of sun exposure (without the use of sunscreen) twice a week to arms, legs or back is sufficient to maintain adequate vitamin D levels.

Getting Vitamin D Without the Sun

When sun exposure is limited it is important to include good food sources of vitamin D (e) in the diet or to take a supplement. Fish liver oils are the best sources of vitamin D. Fatty fish, such as salmon, tuna and mackerel are also good sources. Foods of animal origin contain vitamin D3 or cholecalciferol.

Most of the vitamin D in our diet comes from fortified milk and breakfast cereals. The milk supply in the United States is fortified with approximately 100 IU vitamin D per 8 ounces. Some brands of breakfast cereal, orange juice, yogurt, margarine and soy beverages contain added vitamin D. Food labels do not list vitamin D unless the food has been fortified.

Vitamin D from planted-based foods is in a different form called vitamin D2 or ergocalciferol. Vegetables are poor sources of vitamin D. Some mushrooms, however, contain vitamin D2. The amount of vitamin D2 in these mushrooms can be increased by exposing them to UV light. A dried ground mushroom powder containing 600 IU of vitamin D per teaspoon is now available and can be added to food to increase dietary vitamin D.

How much dietary vitamin D is needed for good health?

According to the Institute of Medicine1 during the first year of life infants require 400 International Units (IUs) per day. Infant formula is fortified with vitamin D. Since breast milk is not a good source of vitamin D, breast-fed infants require a daily vitamin D supplement.

The requirement for vitamin D increases to 600 IU for children one year of age and older and for adults up to 70 years. To maintain healthy bones, the vitamin D requirement goes up to 800 IU in adults 71 years and older.

Over the counter vitamin D supplements are available in a range of doses. Both ergocalciferol and cholecalciferol are effective in raising vitamin D levels. Taking a large amount of vitamin D can be harmful so it is recommended that you check with your health care professional before beginning a vitamin D supplement. The safe upper limit for vitamin D is 4000 IU/day (for children 9 years and older and adults). Vitamin D is also found in most multivitamin supplements and calcium supplements. Be sure to include these sources of vitamin D when calculating the total amount you are taking daily.

Symptoms of vitamin D deficiency in adults include osteomalacia, causing bone pain and muscle weakness. Vitamin D deficiency can be determined by checking the concentration of 25-hydroxyvitamin D in the blood. If a deficiency or insufficient amount is found, a prescription form of vitamin D is required. It takes several months to treat vitamin D deficiency.

Food sources of Vitamin D2

Foods containing Vitamin D and International Units (IUs)/serving

Cod liver oil, 1 Tablespoon 1,350 IU
Salmon, sockeye, canned, 3 ounces 715 IU
Dole Portobello Mushroom Powder, 1 teaspoon 600 IU
Mackerel, Atlantic, raw, 3 ounces 547 IU
Swordfish, raw, 3 ounces 474 IU
Sardines, canned, 2 ounces 150 IU
Tuna, light, canned in water, 3 ounces 40 IU
Egg, 1 large (vitamin D found in the yolk) 40 IU

Foods Fortified with Vitamin D

Milk, skim, reduced fat and whole, fortified, 8 ounces 115 - 124 IU
Yogurt, fortified, 8 ounces 120 IU
Margarine, fortified, 1 Tablespoon 50 IU
Orange Juice, fortified, 1 cup 100 IU
Fortified, Ready to eat cereal ¾ - 1 cup 40 -100 IU

1. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.
2. U.S. Department of Agriculture, Agricultural Research Service, 2011 USDA National Nutrient Database fir Standard Reference, Release 25. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndl


NOTE: While time in the sun is good for vitamin D production, it does increase the risk of developing skin cancer so it is prudent to wear protective clothing and sun screen with an SPF of 8 or more when in the sun for any length of time. Anyone with a history of skin cancer should avoid the sun exposure and protect themselves from UV rays.

Healthy Chicken Salad Recipe

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, shares with us a healthy and low-calorie recipe for chicken salad.

This chicken salad recipe offers a different take on a traditional salad. Enjoy this chicken salad with whole-grain crackers, spread it on whole-wheat bread for a sandwich, or scoop on a bed of salad greens. Sweet apples and raisins strike a delicious balance with the fragrant curry. Put leftovers to use and chop leftover chicken from dinner to incorporate into this quick salad.

You can also use store-bought rotisserie chicken for great results.

 

Curried Chicken Salad with Apples and Raisins

Ingredients

• 1/4 cup low-fat mayonnaise
• 1 teaspoon curry powder
• 2 teaspoons water
• 1 cup chopped skinless, boneless chicken (about 4 ounces)
• 3/4 cup chopped apple (about 1 small)
• 1/3 cup diced celery
• 3 tablespoons raisins
• 1/8 teaspoon salt

Preparation

Combine mayonnaise, curry powder, and water in a medium bowl, stirring with a whisk until well blended. Add the Grilled Lemon-Herb Chicken, chopped apple, celery, raisins, and salt; stir mixture well to combine. Cover and chill.

Nutritional Information

Amount per serving
Calories: 222
Calories from fat: 22%
Fat: 5.4g
Saturated fat: 0.9g
Monounsaturated fat: 1.7g
Polyunsaturated fat: 2g
Protein: 17.5g
Carbohydrate: 26.9g
Fiber: 2.5g
Cholesterol: 50mg
Iron: 1.5mg
Sodium: 731mg
Calcium: 30mg

Source: Barbara Seelig Brown, Cooking Light, August 2005

307

Susanne is a 20-something nurse who had lap-band surgery at Penn in 2012. In this blog post, Susanne discusses her lifelong struggle with weight, and the decision she made to have weight-loss surgery at Penn.

You can read more about Susanne on her blog, Read Purl Before Swine. 


Few people feel good about themselves in winter - especially in January when you are acutely aware of the softness that has developed around your middle. Those aren't merely "love handles," they're the red flags calling "FOUL" on all those naughty plays you've been executing at the dinner table.

They're the extra pounds that have been accumulating since the first pass of your hand through the bowl of candy intended for trick-or-treaters, right on through Thanksgiving pie, Christmas cookies, and New Year's Eve champagne cocktails.

In January of 2011 I found myself at my doctor's office for a check-up only to receive a fright that might have been better reserved for Halloween. The scale was clearly not correctly calibrated. Surely, I was not 307 pounds. That was a number usually reserved for contestants on The Biggest Loser!
307 is not a "whoops I ate too much this holiday" number. 307 was the culmination of 20 years of bad eating habits, of consoling myself with sugar and fat, of eating in secret, of 2 attempts at Weight Watchers and countless other fad diets, and plus-sized clothing.

It was also the result of taking high doses of steroids for 6 months after being diagnosed with an auto-immune kidney disorder that had come out of left field earlier that fall. My physician was minimally empathetic, telling me that individuals were capable of managing their weight while on steroids and that I could hardly use my medication regimen as an excuse. Devastated seems too soft a word for the feelings I had at the time. Rock bottom feels appropriate though cliche.

A Struggle

I didn't consider it an option to remain at that weight. As a nurse, I knew all too well that I was already at risk for any number of lifestyle-related illnesses: hypertension, diabetes, cardiac disease, sleep apnea and on. I also knew that I felt out of step with all of my friends who enjoyed active lives that included running marathons and hiking. I felt that I might as well be standing at the bottom of Mt. Everest without any climbing gear.

I was 25 years old and had gotten myself into a royal mess.

I had considered bariatric surgery almost 2 years prior to this incident in my doctor's office but my insurance coverage at the time was not covering any of the available procedures. In my disappointment, I talked myself out of the option and told myself that I would lose weight the "natural" way. The "natural" way has always been considerably difficult for me. I would put in a great deal of effort in changing my eating habits, reducing my calories, and sweating at the gym for very little reward. One pound here, another there, but there was never any dramatic decrease in pounds. Eventually, I would become discouraged eating so little food, counting every calorie, and agonizing over whether or not I could get away with 30 minutes at the gym or if I should push myself for a full hour.

Maintaining a very strict diet was hard at 25 when socialization is focused mainly on food and alcohol. No one wants to go out with friends and sip water. In February, I started my first nursing job and more or less put my weight struggles aside. I was able to stop taking the steroids later that spring and a minimal amount of the weight came off without any intervention, but I was still hovering between 290 and 300. In August, I had a frank discussion with both my primary care doctor and my kidney specialist. We discussed bariatric surgery and I felt ready to pursue the option, especially now that I had an insurance carrier that was willing to approve the procedure.

Preparing to Change for Good

I decided that the laparascopic gastric band was the most appropriate surgical option for me. I found the staff of the bariatric surgery clinic at Penn Medicine to be extremely encouraging and supportive of my choice. I spent 9 months with them before the procedure. I might have much preferred to get the results I craved right away but I now appreciate the months I spent going to the support group meetings, improving my knowledge of nutrition and exercise, and the thorough medical assessments needed to ensure my health and safety.

My surgery was completed in May 2012 and I am learning to use this new tool that I have to manage my weight. It felt like such a relief to know that I now had help in achieving my goals. It is still difficult to change my habits and behaviors but my changing shape and increased endurance motivate me to continue to live a healthy and active lifestyle. It has been exciting to fit into clothes that I hadn't worn in over a year and to buy smaller sizes from my favorite stores.

On a recent trip, I no longer needed a seatbelt extender on the airplane and I didn't feel that I was smothering my neighbors. I started a running program and marvel at my new capabilities in the gym. Even though the scale doesn't always show me dramatic results, I know that I have lost inches in places where I lost fat and gained muscle. For the first time, I am excited about continuing this weight-loss journey. I finally know that I am capable of success.

This winter, I look forward to feeling better about myself even after the holidays are over, to being in more pictures, and to bundling up because I am cold not because I am trying to hide my body.

Learn More About Weight-loss Surgery at Penn

Penn can help you lose weight, and get back to a healthier lifestyle.

Join us for a free information session abut weight-loss surgery at Penn. Meet Penn weight-loss surgeons, and learn what weight-loss options are available to you.

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Preventing Bone Loss After Weight-Loss Surgery

Danielle Rosenfeld, MS, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses bone loss, and how to prevent it while losing weight.

Bariatric surgery can result in excess body weight loss between 40 to 70%. It can also impact bone health, making the need for supplementation vital.

Recent studies are finding that significant and rapid weight loss is associated with increased bone damage. A 10% weight decline has been linked with a measured 1 to 2% bone loss at various sites. Bariatric surgical procedures can further heighten this bone turnover and associated bone loss.

What does this mean? Bariatric surgery patients are at increased risk for osteoporosis and bone fracture. Postmenopausal, lactose intolerant and vegetarian patients may be at even greater risk for osteoporosis. Why significant weight loss impairs bone health is not fully understood and likely involves numerous factors.

Preventing Bone Loss with Calcium and Supplements

Appropriate vitamin/mineral supplementation is essential in preventing bone loss.

Calcium, the most abundant mineral in the body, is stored in the bones and teeth where it supports bone structure by making them strong and dense. After bariatric surgery, calcium absorption is less efficient and supplementation with calcium citrate + vitamin D is essential in order to keep bones strong and healthy. Proper supplementation includes 1500 to 2000 mg daily with no more than 600 mg at a time. Dietary calcium intake is also very important and patients should aim to consume low fat dairy foods and beverages in addition to supplements, up to 3 servings daily.

Taking a complete multivitamin/mineral supplement daily is also required after bariatric surgery as there are many other micronutrients, such as magnesium and vitamin D, which play important roles in bone health. Your surgeon might ask that you take additional vitamin D if your labs indicate you have a deficiency.

A recent study examined bone health at 18 months post gastric bypass surgery and found that there was prolonged bone turnover, which indicates that supplementation needs to be lifelong and not just in the immediate postoperative period.

Bottom Line

• Bariatric surgery patients need to be increasingly aware of bone health and take measures to prevent bone loss associated with rapid weight decline
• Combined dietary and supplemental calcium intake may be required to prevent bone loss during rapid weight loss
• Choose calcium citrate rather than calcium carbonate- this is the form that post-op bariatric patients can absorb
• Consume a diet rich in calcium
• 1 cup milk, 1 cup yogurt, and 2 oz cheese contain at least 300 mg calcium
• 3 oz canned salmon or sardines contain at least 200 mg calcium
• 1/2 cup cooked greens (kale, spinach, collards), ½ cup soybeans, broccoli, white beans contain 50 to 100 mg calcium.

• Follow vitamin/mineral supplementation regimen prescribed by bariatric team

When Will Power and Knowledge Aren’t Enough

Bruce Sachais, MD, PhD, is an associate professor of pathology and laboratory medicine at Penn Medicine. In December 2010, he attended an informational session and decided to have weight-loss surgery. His Roux-en-Y gastric bypass surgery was performed at Penn by Noel Williams, MD. In this article, he discusses his struggle with weight, and why even as a physician, losing weight alone has been challenging. 

Read more about how Bruce lost 121 pounds.

As a physician, I should know better. I understand the importance of healthy eating and maintaining a healthy body weight. I understand biochemistry; how the molecules in the food we eat are extracted and used for energy, building up our bodies, and how they are stored (mostly as fat) when we consume more calories than we burn. I understand the importance of regular exercise, not only for burning calories, but for keeping many of our body tissues, such as our blood vessels, is a healthy state (which helps decrease the risk of heart attacks and strokes). So if it were just a matter of knowing, I should have been thin and healthy, but I was not.

To become an academic physician, one who both cares for people and performs research to improve the ability of medicine to care for people better, I am used to doing things that are difficult. Many years of education and training, long hours in the hospital, fighting for funding to support my scientific ideas all take time, dedication and determination. So if it were just a matter of willpower, of trying harder, I should be thin and healthy.

The fact is, for some people, it is more than that. Knowing what to do and having the determination to do it is just not enough for everyone to lose meaningful amounts of weight over the long haul. It was not for me. That is NOT an excuse by any means, and I want to stress that both knowing and determination are required (even after weight-loss surgery) they were just not sufficient. It was when I finally came to terms with this, that I took a serious look at surgery as a means to finally achieve my weight loss and health goals.

Through the education and information provided by the doctors, nurses and dieticians at Penn Metabolic and Bariatric Surgery Program, I learned about what gastric bypass could offer me, and what it could not. As a physician myself, I read some of the primary scientific literature, which supported all I had learned from the program. I learned how gastric bypass (as well as other surgical options) was most likely the tool I needed to allow me the success I needed, and deserved, to become a healthier and significantly smaller man. I learned that after surgery, both the anatomy of my digestive track (stomach and intestines) and biochemistry (chemical reactions and signals in the body) that control digestion and hunger would change. It is a combination of these changes, with my knowledge of healthy eating and exercise habits, and my determination (will-power) that have given me my success (down 121 pounds from a high of 322 pounds) to date.

I have chosen to write this because I want others to know that it’s okay to ask for help; that knowing what to do does not always allow a person to be successful in life, and that weight loss surgery, at least for me, has been the additional piece of the puzzle to allow me to meet my weight loss and health goals.

My life has changed for the better in so many ways, but that is a story for another day.

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