Meet Karen Coyne, CRNP

Karen Coyne, CRNP, is a nurse practitioner and part of the Penn Metabolic and Bariatric Surgery Program team.

It’s also likely she’s one of the first people on the team to meet new patients when they start their weight-loss journey at Penn.

“That first visit can be two to three hours long,” says Karen. “I tell patients to bring a book! The visit is very thorough, and patients meet a nurse practitioner, dietitian and surgeon one the same day.”

At that visit, Karen learns more about patients embarking on their journey.

“I discuss with them their medical history, habits and any other conditions they may have that may affect their surgery,” she says.

“A lot of the people we meet don't know what they are getting in to, or they have a lot of questions,” says Karen. “We inform patients a lot about the procedure, testing required, and what will be needed of them throughout the process. We try to make solid recommendations and suggestions to help prepare them for weight-loss success.”

What do you like best about what you do?

It’s gratifying to see significant co-morbidities and disabilities improve after losing a significant amount of weight with weight-loss surgery. I enjoy interacting with patients and having the opportunity to educate patients.

What is your favorite healthy food?

I like multi-grain bread toasted with peanut butter for breakfast.

Favorite tips for weight loss and/or keeping off weight?

• Small, frequent sensible snacks throughout the say to keep hunger in check
• Incorporating as much activity as possible into everyday routines

Best advice for weight-loss?

Listen to the team.

More about Karen

Favorite food: Asian
Favorite exercise: Walking
Favorite sports team: I don’t follow sports.
Last book you read? South of Broad by Pat Conroy
When I get down time I like to….chill.

Let Penn Help You Lose Weight For Good

Penn can help you lose weight.

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia. There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.

Join Us for a Free Weight-Loss Surgery Information Session in February

For many people trying to lose weight, taking the first step can be the most difficult part of the process.

Whether it’s getting out of the door to head to the gym, or deciding to choose a healthier option at mealtime, once you take that first step, it can be easier to gain momentum toward a healthier lifestyle.

Weight-Loss Surgery Information Sessions at Penn Medicine

Choosing to have weight-loss surgery is not an easy decision, but learning all of the facts is easy with Penn’s free weight-loss information sessions.

At a weight-loss information session, you will learn about the various options for weight-loss surgery and meet with the surgeons and clinicians who will help you every step of the way.

Mark your calendars for the following information sessions at Penn Medicine in February

• 2/3 at 6 pm: Penn Presbyterian Medical Center
• 2/5 at 6 pm: Perelman Center for Advanced Medicine
• 2/10 at 6 pm: Perelman Center for Advanced Medicine
• 2/12 at 6 pm: Pennsylvania Hospital
• 2/13 at 7 pm: Penn Medicine Valley Forge
• 2/15 at 10:30 am: Penn Presbyterian Medical Center
• 2/17 at 6 pm: Perelman Center for Advanced Medicine
• 2/19 at 7 pm: Penn Medicine Radnor
• 2/20 at 7 pm: Penn Medicine Bucks County
• 2/24 at 10 am: Pennsylvania Hospital
• 2/25 at 11 am: Perelman Center for Advanced Medicine
• 2/26 at 7 pm: Penn Medicine Cherry Hill

Lose Weight at Penn Medicine

Learn about weight-loss surgery in Philadelphia and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.

Super Bowl Eats: Spicy Roasted Butternut Squash and Apple Soup

By Danielle Rosenfeld, RD, LDN

This Super Bowl Sunday, why not kick it up a notch with a hearty butternut squash soup? It’s a great alternative to chili, loaded with nutrition and has just enough spice to get you warmed up for the big game.

Butternut squash has a sweet, nutty taste similar to that of a pumpkin and tastes awesome roasted and blended into a soup. Butternut squash contains approximately 60 calories per cup and is packed with fiber, potassium, vitamin A, and vitamin C. I like to add cannellini beans to the soup to boost the protein content and add another layer of flavor and texture.

This recipe is great because it is incredibly simple to make and incorporates a beautiful balance of flavors between the cinnamon, cumin and cayenne pepper. To make this soup even more fun, add a whole wheat grilled cheese “crouton”. See recipe below.

Spicy Roasted Butternut Squash and Apple Soup

Ingredients

• 1 lb. butternut squash, cubed
• 1 small yellow onion
• 1 small apple, peeled (I prefer honey crisp or McIntosh)
• 1 tbsp. olive oil
• 4 cups low sodium chicken stock (or vegetable stock)
• 1/8th tsp. cayenne pepper
• 1/4 tsp. ground cumin
• Fresh ground black pepper
• 1/4 tsp. cinnamon
• 1, 16 oz can white cannellini beans
• Toasted pumpkin seeds and pinch of grated Parmesan (to serve)

Directions

1. Preheat oven to 425 degrees F.
2. Cut the butternut squash, onion, and apple into 1 inch cubes. Place on a sheet pan and toss with olive oil and a pinch of freshly ground black pepper. Roast for 35-45 minutes, tossing occasionally, until very tender.
3. Meanwhile, heat the chicken stock to a simmer. When the vegetables are done, put them through a food mill or food processor to puree. Add some chicken stock, if needed.
4. Once vegetables are pureed, add to the large pot with chicken stock. Add cayenne pepper, cumin, cinnamon and a pinch of salt and pepper. Stir well to combine.
5. Add 1 can of white cannellini beans to simmering pot.
6. Cook for 10 minutes and serve with 1 tsp. toasted pumpkin seeds and a pinch of grated Parmesan cheese.

Whole Wheat Grilled Cheese “Croutons”

Make a grilled cheese sandwich with two slices of “light style” whole wheat bread, one slice of American cheese and 1 tsp. Smart Balance spread to coat the pan. Cook until crisp and cheese is melted, slice into quarters and serve 1 crouton per soup bowl. Enjoy!

Penn Medicine Can Help You Lose Weight

Let Penn Medicine help you lose weight. Learn about weight-loss surgery and if weight-loss surgery at Penn is right for you at a free information session.

Register for a weight-loss surgery information session here.

How I Fit it All In

Chiara Gravell had a sleeve gastrectomy at Penn Medicine with weight-loss surgeon Noel Williams, MD, in 2011. Since then, she’s lost more than 150 pounds, and has gone from being obese to completing triathlons. In this blog, she discusses her strategies for fitting everything in. 

Fitting it all in!

Once people (myself included) figure out that weight-loss surgery is just a tool, then a ton of practical questions come flooding out, most of which revolve around - how can I do this? How can I fit everything in? How can I fit in the protein, exercise, work, taking care of my family, doctor appointments? I can’t do this!

Just before surgery, people ask me, “Chiara, HOW AM I GOING TO FIT IT ALL IN”? I calmly reply, “You aren’t. Or at least not right away. ”

I didn’t for a while, but eventually it works out. I wish someone had told me that. I was so filled with anxiety, trying to get everything in and failing. Eventually I just stopped getting upset about it and simply did the very best I could.

Water: However, if I am honest, I didn’t get all 64 oz. of water into my body on a regular basis for at least four (4) months. I tried every day and did my best every day; however some days, I just couldn’t force down all of the water which was recommended. I did, however, always make sure that I was progressing in the right direction.

Protein: Same thing with protein, it was six (6) months before I consistently day in and day out was able to get in 60g of protein. The protein at first gave me horrid heartburn, so I had to experiment with different types of protein that I could tolerate. The first few months after surgery include a lot of experimentation, on what works and what doesn’t. My taste buds had changed and I had no idea how a little bit of food (I mean ridiculously small amounts) would affect my body.

Work: I was lucky, when I had the surgery, I worked from home. So I was able to return to work quickly. I could do this because if I needed to, at lunch I could lay down for an hour. I didn’t have a commute, so I always came to work fresh of energy. I also had my own kitchen with everything I needed right down the hall. This was a huge advantage. I didn’t have to plan my food and pack it and try to get everything in at work and then have something not be tolerated and need to leave work for a bit. I could do all of that in the privacy of my own home, usually while I returned emails and listened on conference calls. Not everyone will be as lucky as I was, so it’s important to plan appropriate time off from work.

Exercise: Then came exercise, which I struggled with for about nine (9) months. I had the added excuse that my husband’s cancer came back about six weeks after my surgery, so I had to take care of him through another round of chemo, and a rare lung infection during the first 6 months after my surgery.

How to fit it all in? 

Once exercise came back into my life after surgery, I needed to figure out how to work, take care of my family, and work out. For me, I always needed a race to train for. If I had a race then I would have to train, if I had to train I would have to work out. I needed to keep it simple. Plus I have this wonderful disorder called “race sign-up disease.”I love to sign up for races! But, I HATE training for races, it is a vicious cycle I use to trick myself into exercising.

Once I became a race addict, that marked one year after surgery. It took me one year to figure out how to fit it all in. My schedule was planned and very well executed. Work out then work, then cook then church or friends or family commitments. It worked for me. I know how important exercise is and make sure to keep it a priority in my life.

Now, I have a new job. I have a commute and I have to travel and when the holidays come around… AHHHH!!!!

For the first time since I figured out how to get it all in! I have had to relax and be kind to myself. I have to settle for four or five days of working out versus six or seven. I have to plan my meals a week in advance and shop for that food and pack my lunch and snacks and sometimes dinner. I have to work out after work, which means that I don’t get home until about 9 pm. It is different. I am sure I will figure out a plan that works for me soon. Until then I am “trying to fit it all in” as much as humanly possible!

My mantra is, don’t worry if you can’t get it all in right away. Try and try again, until you come up with a routine that works. That is what I do, and when life changes, I change the routine until I get it all in again. Then life changes again. Since life always seems to change, I will have to be kind to myself, and not beat myself up when I fail, because that won’t help. However trying one day at a time, I will eventually get it all in again!

Penn Medicine Can Help You Lose Weight

Penn can help you lose weight. Learn more about weight-loss surgery at Penn, and what weight-loss surgery is right for you at a free information session.

Register for a free weight-loss surgery information session here.

Susan Lost 138 Pounds with Penn Medicine

Susan Tapper was always, as she says, a “chubby person.”

“I spent my entire life dieting or binging,” says Susan, who is now 61. “It affected my relationships, my work, my emotional well-being. And, as I got older, my physical condition.”

At 283 pounds, Susan’s body was in pain. Suffering from severe osteoarthritis, Susan had one hip replaced, and needed the other replaced as well. However, her weight kept her from scheduling the surgery and she was living in pain.

But there was another surgery on her mind – Roux-en-Y gastric bypass.

“I’d been researching the surgery for years, and looking for a long time at bariatric programs in the area,” says Susan. “When I met Dr. Korus at Penn’s bariatric program, I knew Penn was the right place for me.”

Susan had gastric bypass in August, 2010, and her weight started coming off.

“Yes, the weight comes off, but it’s not easy,” she says. “I work at it every single hour of the day. When you first have the surgery, you are so motivated and it’s easier to stick with the program. But after a few years, when things start to get back to normal, it can be more challenging.”

To date, Susan has lost 138 pounds. 


To combat cravings and stay on track, Susan puts protein first.

“I keep high protein foods with me at all times,” she says. “Not everyone does this, but it works for me.”

Susan also combats a scenario a lot of people can relate to – night eating.

“One of my biggest issues is night eating. I have to tell myself that the kitchen is closed at 8 pm,” she says. “I also do something to get out of the kitchen area, like read or move around to get through the craving.

While Susan still suffers from osteoarthritis, she walks, swims or does exercises she can do while sitting down.

“This is my life, and that reward is so wonderful,” she says. “I wear a size 10, I can fit in airline seats and move around so much easier. The benefits outweigh all the work that goes into losing weight.”

Practical Advice – And What I Eat

“You can't avoid food,” says Susan. “It’s a matter of making the right choices.”

For Susan, breakfast usually means Kashi protein cereal or egg beaters and sometimes a piece of 7-grain toast with cheese. A snack might be a protein bar, or an apple with PB2.

“Dinner could be turkey, fish, chicken, yogurt, cottage cheese or cheese sticks and crackers,” she says. “I like crunching something sweet like frozen yogurt ‘squeeze’ tubes. Or, I will have a piece of dark chocolate or nuts in the evening. For me it's easier to eat the same things over and over again. I don't like to vary my meals and snacks too much!”

Susan also offers advice for others.

“Get to know yourself. For some people that is hard. This has to be about you. Pay attention to when you are hungry or thirsty. Don't beat yourself up if you feel like you failed. Learn what works and what makes you feel good. Make the effort to handle the challenges that occur and pay attention to what you eat. If you don't recognize your old eating habits, you will gain the weight without question.”

Finally, Susan adds:

"I was glad that I made the decision to have the surgery with Penn. Going to my first support group run by the nutritionist Karen Buzby, I was confident that Penn was the right place. I felt immediately comfortable with the people and the relaxed atmosphere. It has been important to me as part of my success and as part of my ability to keep the weight off, to attend the meetings and talk with people who have had the surgery or who are about to have the surgery. That group gave me the confidence to have the surgery."

Let Us Help You Lose Weight For Good 

Penn Medicine can help you lose weight.

Learn about weight-loss surgery in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good. Register for a free information session today.

Meet Penn Dietitian, Danielle Rosenfeld, RD

Danielle Rosenfeld, MD, RD, LDN, is a registered dietitian and clinical nutrition specialist at the Penn Metabolic and Bariatric Surgery Program.

Danielle works closely with people before and after weight-loss surgery at Penn to ensure they are getting their required nutrition, vitamins and minerals as they embark on their weight-loss journey.

And, just as important, Danielle teaches patients how to eat well.

“I’ve always been passionate about nutrition, and I find it incredibly inspiring to help others create change in their diets and lives,” she says.

We recently caught up with Danielle to learn more about her, her favorite advice for healthy eating and what advice she offers people who have had weight-loss surgery at Penn.

What do you like best about what you do?

I enjoy interacting with patients and seeing significant changes in them over time. I hope that I can inspire others to follow their goals, and love helping them along the way.

What is your favorite healthy food?

Apples! I love them – especially when they are season. My favorites are honeycrisp and mutsu.

Favorite tips for weight loss and/or keeping off weight?

Eat a fiber-rich breakfast! It’s so important to feel fuller longer and keep hunger at bay between meals. Chia seeds are also helpful in keeping you feeling full for longer.

Finally, don’t skip meals. It will backfire on you and could ultimately make you eat more.

What do you wish people knew about weight-loss surgery?

I hope that people are realistic about their own weight-loss outcomes. People lose weight differently, and it takes a lot of work – even after having surgery. I want people to know that it is still important to change their lifestyles and exercise more. It’s important to still adhere to diet recommendations to prevent complications and possible weight re-gain.

Best advice for weight loss?

Don't give up! It’s a marathon, not a sprint. Set realistic goals, and stay on track to meet them.

Some of Danielle’s Favorite Recipes

• Healthier Gluten-Free Oatmeal Chocolate Chip Cookies
• Chicken Escarole Soup
• Colorful Quinoa Grecian Salad

More about Danielle…

Favorite movie: Julie and Julia
Favorite food: Apples and almond butter
Favorite place to vacation: Turks and Caicos
Favorite exercise: Running and Pure Barre
Favorite type of music to work out with: Dance and Hip-Hop
Favorite sports team: Go Giants!
Favorite TV show: Homeland
Last book you read? Everything is Illuminated by Jonathan Safron Foer
Favorite drink: Water with lemon
Do you play sports? I play tennis, ski and run – but all for fun!
Do you play an instrument? Nope!
When I get down time I like to….Try a new recipe!

Let Penn Help You Lose Weight For Good

Penn can help you lose weight.

Learn about weight-loss surgery in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia. There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.

The Dreaded STALL

Chiara Gravell had a sleeve gastrectomy at Penn Medicine with weight-loss surgeon Noel Williams, MD, in 2011. Since then, she’s lost more than 150 pounds, and has gone from being obese to completing triathlons. In this blog, she talks about stalls, plateaus and how she deals with them. 

One of the biggest complaints I had, and also hear from others right after surgery is, why am I not losing weight consistently? Why is the scale not moving??

Let’s face it, right after surgery the scale goes down a lot. It is FUN to get on the scale and watch it go down, and down and down…. However the scale will stop or stay the same or - heaven forbid - go up a pound or two for a day, or even a week.

Weight loss after weight-loss surgery is not a consistent “3500 calories out equals one pound off the scale.” Well not at least immediately. It took me a long time to realize this. Intellectually, I understood. I mean just because I burned 3500 calories more than I took in my body would not release that weight immediately. I was like a petulant child, constantly watching the scale weighing myself daily and on some days more than once a day… I wanted it NOW. I’ve done 3500 calories worth of work, take it off NOW! Sort of like a baseball game I ran all four bases put up one point on the scoreboard! Unfortunately it does not work this way… at least it didn’t for me.

How Weight Loss Worked for Me After Weight-Loss Surgery

My weight loss went something like 30 pounds in the first month. That did not equate to one pound a day like I wanted, it was five pounds the first week, then two pounds a day for the next three days, then no pounds for 3 days, then 5lbs. As you can see it was crazy. My emotions went nutty. Happy, sad, frustrated, confused… it was all there, and all tied to what the scale said. I had to stop weighing every day. I started weighing myself only once a week.

The second through six months the scale went down consistently however not the same amount. Lots of people wake up on weigh day and are two pounds down every week. I would go down, then stay the same, then go down. It is like my body would only release five pounds at a time and hold everything up… then release another five pounds. It was annoying and frustrating. I was eating what 500 to 750 calories a day and working out and I should be down!!! I am still obese… when am I going to be THIN???

That was my real question, when would I wake up and poof! See I was thin! The answer varies for everyone. For me it was 18 months before I “looked” like a “normal” weight person.

Today I am over two years out of surgery and my body still does the holding on thing…. I recently broke a stall that had me in its grips for three months. YIPPEE!!! I was dancing around the bedroom very excited!

How to Get Through a Weight-Loss Plateau

The best advice I can give for a stall, is BACK AWAY FROM THE SCALE!

Do no weigh more than one time per week. If you weigh once a week you will pretty much every week go down a bit. Please if you have more than two weeks of the same weight or similar weight, then try weighing once per month. The scale can mess with my head. I needed to use it only as a tool to equate measurements for others. (ie. doctor’s offices, insurance companies… my hubby when he asks how much weight I've lost…)

Other strategies that helped me during stalls:

• Take your measurements – This last stall , I released two inches from my hips and a half an inch from my waist.
• See how your clothes fit – It is an oldie but goodie it will tell you if you are going up or down. If your clothes are lose you are going down.
• Keep very good track of food - The app I use to track my food and exercise will show, yes, I have eaten fewer calories, I have burned more calories, and then if I am patient the weight will release when my body is ready.

The dreaded stall is a certainty after weight-loss surgery. How I dealt with it was totally up to me. I continually choose to use the scale as just one tool and be patient. (Well most days, lets face it I still want it NOW!!! But alas… I am an adult and need to learn to wait my turn. ☺)

Lose Weight at Penn Medicine

Penn can help you lose weight.

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.

Happily (and Healthfully) Ever After

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses minerals, vitamins and supplements you should take after weight-loss surgery.

After bariatric surgery it is essential to take multivitamins and mineral supplements to make sure these important dietary micronutrients are in adequate supply to maintain good health during weight loss.

During a conversation with a patient, a newlywed who recently returned from her honeymoon, I was pleasantly surprised to learn she brought her vitamins to her wedding and took them during the reception! That’s one organized bride who added "Take your supplements" to her wedding day  to do list. Success after weight-loss surgery requires this type of commitment to developing positive diet and lifestyle habits to ensure healthy weight loss!

To review the latest vitamin and mineral requirements after gastric bypass and sleeve gastrectomy, refer to the list below. These recommendations are from the American Association of Clinical Endocrinologists, the Obesity Society, and American Society of Metabolic and Bariatric Surgery's 2013 Clinical Practice Guidelines.

Multivitamin and Mineral Supplement

• Purchase a high potency vitamin containing 100 percent of daily value for at least 2/3 of the nutrients listed
• Dose: Two (2) multivitamins/day.
• Chewable multivitamin are recommended for the first two to three months after surgery. Do not use a “gummy–type” vitamin they usually do not have a complete array of the required nutrients.

Calcium Citrate Supplement (with Vitamin D)

• Purchase a supplement containing calcium citrate. This form of calcium is better absorbed after gastric bypass or sleeve gastrectomy surgery.
• Dose: 1200 to 1500 mg of calcium/day.
• Do not take more than 600 mg of calcium at a time.
• Pay attention to the serving size on the label. For calcium supplements the serving size maybe two pills instead of one.
• If you take iron supplements, do not take calcium and iron together; separate them by at least two hours.

Additional Vitamin D Supplement

• Total Dose: 3000 International Units/day.
• Add up the vitamin D in your two (2) multivitamins and in all of your calcium supplements. If the total amount of vitamin D is less than 3000 International Units - an additional vitamin D tablet is needed to bring your daily total to 3000 International Units.

Vitamin B-12

• Either a daily sublingual B-12 tablet OR a monthly B-12 shot is needed.
• The daily sublingual or “under-the-tongue” tablets or liquid should have at least 500 micrograms of vitamin B-12 per dose.
• A primary care physician can administer a monthly B-12 shot.

While some individuals find it challenging to comply with the daily post- surgery vitamin and mineral protocol making supplements a part of your daily routine, like the bride above, results in healthy weight loss (and hopefully happily ever after lifestyle!)

Lose Weight at Penn Medicine

Penn can help you lose weight. Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.

Healthy Recipe: Beef Daube Provençal

A flavorful and hearty beef and vegetable stew is the perfect cold weather meal for a family or company dinner.

This dish is easy to prepare and can be cooked at a low temperature in the oven or in a slow cooker. In the recipe below, turnips and squash can be substituted for carrots, or serve with mashed potatoes rather than noodles. A side green salad would complete the meal.

Beef Daube Provençal

Yield: 6 servings (serving size: about ¾ cup stew and ½ cup noodles)
Time: 40 minutes (hands on), 3 hours 15 minutes (oven), 5 hours (slow cooker)

Ingredients

• 2 teaspoons olive oil
• 12 garlic cloves, crushed
• 1 (2-pound) boneless chuck roast, trimmed and cut into 2-inch cubes
• 1 1/4 teaspoons salt, divided
• 1/2 teaspoon freshly ground black pepper, divided
• 1 cup red wine
• 2 cups chopped carrot
• 1 1/2 cups chopped onion
• 1/2 cup lower-sodium beef broth
• 1 tablespoon tomato paste
• 1 teaspoon chopped fresh rosemary
• 1 teaspoon chopped fresh thyme
• Dash of ground cloves
• 1 (14.5-ounce) can diced tomatoes
• 1 bay leaf

Preparation

1. Preheat oven to 300°.
2. Heat a small Dutch oven over low heat. Add oil to pan; swirl to coat. Add garlic; cook 5 minutes or until garlic is fragrant, stirring occasionally. Remove garlic with a slotted spoon; set aside. Increase heat to medium-high. Add beef to pan; sprinkle with 1/2 teaspoon salt and 1/4 teaspoon pepper. Cook 5 minutes, browning on all sides. Remove beef from pan. Add wine to pan; bring to a boil, scraping pan to loosen browned bits. Add reserved garlic, beef, remaining 3/4 teaspoon salt, remaining 1/4 teaspoon pepper, carrot, and next 8 ingredients (through bay leaf), and bring to a boil.
3. Cover and bake at 300° for 2 1/2 hours or until beef is tender. Discard bay leaf. Serve over noodles.
4. Note: To make in a slow cooker, prepare through Step 2. Place beef mixture in an electric slow cooker. Cover and cook on high for 5 hours or until beef is tender.

Serve with 3 cups cooked medium egg noodles (about 4 cups uncooked noodles)

Nutritional Information
Amount per serving:
Calories: 367
Fat: 12.8g
Saturated fat: 4.3g
Monounsaturated fat: 5.8g
Polyunsaturated fat: 0.9g
Protein: 29.1g
Carbohydrate: 33.4g
Fiber: 3.9g
Cholesterol: 105mg
Iron: 4.3mg
Sodium: 678mg
Calcium: 76mg

Recipe from: Lia Huber, Cooking Light OCTOBER 2013

Don’t Forget Your Fiber After Weight-Loss Surgery

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.

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 15 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. High-fiber fruits include raspberries, pears and figs.
• Use beans and lentils as a source of both fiber and protein.
• Make all of your grains whole grains and don’t be afraid to switch it up—try quinoa, brown rice, bulgar or faro. 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.

Ready for a Healthier Life?

Penn can help you lose weight.

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.

What’s Your Water Goal?

The water and food needs of those who have had weight-loss (bariatric) surgery, are just as important than before bariatric surgery.

Water is an important part of our lives because staying properly hydrated improves functions of the body. Every bodily function depends on water. Lack of adequate water intake can lead to dehydration, constipation fatigue, dry skin, decreased physical activity, and hunger. Proper hydration helps the body get rid of waste, and can help keep digestion on track.

But how much is enough?

The Institute of Medicine set general recommendations for women at approximately 2.7 liters (91 ounces) of total water—from all beverages and food daily, and men on average of approximately 3.7 liters (125 ounces daily) of total water. This includes all beverages – not just water.

Please note, those who have had weight-loss surgery should not drink caffeinated, carbonated or alcoholic beverages.

Only your doctor can tell you exactly how much water you need, but it’s a good rule of thumb to try to drink about 64 ounces of water a day. Initially after weight-loss surgery, a minimum of 50 ounces should be emphasized to prevent dehydration.

Do you find it hard to get in your water? Here are some tricks to make sure you’re getting enough.

• Get a good, reusable, dishwasher-safe cup you can take with you everywhere you go.
• Try drinking a glass of water if you have the urge to snack.
• Don’t drink fluids with your meals. Since most weight-loss surgery patients can only eat small amounts of food at a time, it’s important to get the nutrients from your food before you drink your water.
• Track your water so you know how much you’ve had throughout the day.
• Add lemon or some cucumber to your water glass for a refreshing, different taste.
• Play around with temperature. Some find that it is easier to tolerate cold beverages, while others prefer room temperature or warm water.

What are your tips to get all of your water in?

Ready for a Healthier Life?

Penn can help you lose weight.

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today. 

What is CrossFit?

Every now and then, there’s a fitness trend that seems to take over every morning talk show, conversation at the gym and TV ad. First it was Spinning, then Zumba. Now? CrossFit.

What is CrossFit?

CrossFit is a strength and conditioning exercise program that focuses on muscular strength, cardiovascular fitness and flexibility. Unlike other fitness programs, CrossFit is built on the theory that your body constantly needs change and challenge in order to get fit.

CrossFit Inc. describes its strength and conditioning program as “constantly varied functional movements executed at high intensity across broad modal and time domains."

The class, or session, is about an hour long and includes a warm up, skill development, and a workout of the day followed by stretching.

What Types of Exercises are Included in CrossFit?

CrossFit features a lot of the same exercises that might remind you of gym classes in years past. Things like burpees, lunges, squats and pull-ups challenge your strength and muscles by using your own body weight. CrossFit also incorporates cardiovascular drills like running, boxing, jump rope, and jumping jacks to get your heart rate moving.

Should You Take a CrossFit Class?

That depends. CrossFit is definitely not for everyone. Some professionals say CrossFit puts people at risk for more injuries. Others say it’s best suited for people who are already in an experienced exercise program. If you do take a CrossFit class, explain to the instructor you are new, and ask if there are any modifications of exercises in case you are not able to perform them.

CrossFit is challenging, but it is fun too! If you are able, and have cleared an exercise program with your physician, CrossFit may be a great class to incorporate into your current regime.

Ready for a Healthier Life?

Penn Medicine can help you lose weight.

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.