Observations of a Weight Loss Physician Assistant and Dietitian

By admin on March 23, 2009 at 2:12 pm

I have been fortunate to assist Dr. Kim for the past 8 months and I have been doing lap band fills for a little over a year now. I have also been a nutritionist for the past 9 years. I have noticed some things that I want to share.

1. A really tight band does not equal greater weight loss, it usually means more problems.
2. If you can’t eat solid, hard to digest foods, your band is too tight.
3. If you think how tight the band is, or the “restriction” it gives you will help you make healthy food choices, think again.
4. Soups and salads use to be diet foods, but are not band friendly.
5. Eat meat or other protein, dairy, veggies, fruits and then grains and in that order to plan your meals.
6. Chips, cookies, high calorie liquids and other fun foods always go down.
7. There are four parts to successful “banded” weight loss: 25% exercise, 25% nutrition, 25% behavior medication and 25% proper band tightness. Three of those, or 75%, is all about you and 25% is the band. In other words believe more in yourself, than you believe in the band.
8. The band was invented to reduce appetite and restrict portion sizes of healthful foods. Changing your eating habits and fitness is still your responsibility.
9. Being “banded”, having a bypass or gastric sleeve are all equally effective, with different rates of weight loss. Each of the surgeries depends on you to make them work.
10. That little voice inside your head telling you that you can’t, needs to be strangled.
11. Always fidget and dance, or whatever keeps you moving.
12. Exercise might not be fun or a part of your lifestyle, but…………….
13. If you restrict your calories, your body will lower your metabolism, your only defense is exercise.
14. Losing weight by yourself is like to building your own rocket to fly to the moon, you need more help than you are willing to admit. Make sure you have a support group.
15. Patience is the missing ingredient in any weight loss program. Progressive slow weight loss is how the band works best.
16. Mr. Spock on Star Trek was thin because he had no emotions
17. As you get smaller, you need fewer calories and will depend more on exercise to maintain your weight, which means you still have to figure out how to enjoy number 12 and 13.
18. Appetite and hunger are difficult to understand, have you figured out the difference?
19. Exercise is……ok I’ll stop already, refer to 12, 13 and 17
20. Last, but not least, tell yourself that you are confident, effective and motivated thousands of times per day, because the average number of times a day a person alludes to pending weight loss failure is often much greater.

David Kellenberger, MPAS, RD, PA-C

Metabolic and Bariatric Surgery
Nutrition and Dietetics

Posted in Ask the dietitian | 3 Comments

Sample Meal Plans

By admin on March 13, 2009 at 2:13 pm

Menu Planning with Exchange Lists

Well balanced meal planning is often a difficult task. As you may know, most Americans do not eat at least 5 servings of fruits and veggies each day. We often think of fried foods, burgers and fries, lasagna, spaghetti and meatballs, sandwiches and other staple American foods as “the only things I know to eat”. The meal plans below point out a way to plan meals based on the “Exchange Lists for Weight Management” produced by the American Diabetes Association and American Dietetic Association.

People often want to be told what to eat, but inevitable go back to eating what they are familiar with, tastes good and is convenient. So instead of giving you a fish, I will attempt to teach you how to fish, by sharing with you a basic method for determining what is in the foods you eat. It always helps to use foods labels or count Weight Watcher® points, but you can also use exchange list too. Exchange lists are helpful because you can exchange any food within a category for another and it will have the same nutrient composition. For example, a small apple will have the same calories, protein, and fat as let’s say 17 grapes, 4 fresh apricots or a small banana. So here is the formula and some sample menus. For a full reference please visit: http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/fd_exch.htm

Exchange List based on the American Dietetic and Diabetes Associations

Starch = 80 calories, 3g protein, 1 gram fat, 15grams carbs, look for starches
with more than 3-5g of fiber per serving
½ cup of cooked cereal, grain, or starchy veggie such as corn and peas
1/3 cup of cooked rice or pasta
1 ounce of bread or 1 slice
1 ounce of snack foods (may also be fatty)

Fruit = 60 calories, fiber and protein varies
1 small fruit
½ cup canned or fresh fruit unsweetened
¼ cup of dried fruit

1 Cup Fat free/low fat milk = 90 calories, 8grams protein, 0-3grams fat, 12grams carbs
1 Cup Reduced fat 2% milk = 120 calories, 8grams protein, 5grams fat and 12 grams carbs
1 Cup Whole milk = 150 calories, 8grams protein, 8grams of fat and 12 grams of carbs

Nonstarchy veggies = 25 calories, 2grams of protein and 5 carbs
½ cup cooked
1 cup raw

1 ounce Very Lean Meat = 35 calories, 7grams protein and 0-1gram of fat
1 ounce Lean Meat = 55 calories, 7grams protein and 3grams of fat
1 ounce Medium Fat Meat = 75 calories, 7grams protein and 5 grams of fat
1 ounce High Fat Meat = 100 calories, 7grams protein and 8grams fat

Fats = 45 calories and 5grams of fat
1 teaspoon of regular margarine or veggie oil
1 tablespoon of regular salad dressing

Sample Meal Plans

Now that you have the exchange list in mind, you can substitute any foods you like in the menus below. If you don’t want an egg, then eat an ounce of turkey breast slices. The calories really never change as long as you exchange foods within the same category.

800 Calories:
Starch 2 (160) Dairy 3 (240) Protein 5 (175) Veggie 3 (75) Fruit 2 (120) Fat 2 (90)
About 55-65 grams of protein
Breakfast: 1 protein 1 egg
1 dairy ½ cup cottage cheese
1 fat 1 tsp of margarine

Lunch: 2 protein 2 ounce of turkey lunch meat
1 dairy 1 yogurt
1 veggie 1 cup raw, ½ cup cooked carrots
1 fruit 4 apricots
1 starch 1 ounce of whole grain crackers

Dinner: 2 protein 2 ounces of fish
1 dairy 1 ounce reduced fat cheese
2 veggie 1 cup sautéed zucchini
1 fruit 1 small apple
1 starch 1 small baked sweet potato
1 fat 1 tsp of margarine

1200-1400 Calories:
Starch 4 (320) Dairy 3 (240) Protein 6 (210) Veggie 3 (75) Fruit 3 (180) Fat 3 (135)
For 1400 calories add an additional Starch and milk or add fruit and more protein, whatever you want as long as it is about 200 calories more.
About 65-75 grams of protein

Breakfast: 1 protein 1 ounce of sausage with <5g of fat per serving
1 dairy 1 ounce of reduced fat cheese
1 starch 1 slice extra crisp whole wheat toast
1 fat 1 tsp of margarine

Lunch: 2 protein/2 starch 1 cup of chili with beans and very lean hamburger or turkey
1 dairy/1 fat 1 ounce of regular cheese
1 starch 6 saltine-type crackers
1 veggie ½ cup green beans made with chicken broth and bacon flavoring
1 fruit 17 small (3oz) grapes

Snack: 1 dairy 1 cup fat free or 1% milk

Dinner: 3 protein 3 ounces of lean pork or chicken
2 veggie 1 cup of cooked broccoli
1 fruit 1 small apple
2 starch ½ cup of corn and ½ cup of green peas
1 fat 1 tsp of margarine

Let’s see what happens if we use the exchange lists to calculate someone’s meals has eaten on a typical day. This menu may be similar to a day you have eaten. The plan represents a breakfast many feel is healthy, a typical lunch at a pizza joint and a country style dinner with friends and family.
Calories/Protein/Fat
Breakfast: 1 cup oatmeal with 2% milk and 2 tables spoons of brown sugar 300/8/5
1 cup of orange juice 120/0/0
4 slices of bacon 180/8/20

Snack: 1 pack of pretzels (1.5 ounces) 80/2/1

Lunch: Individual pan pizza any brand 700/20/25
1 small salad with lettuce, tomato and dressing 135/0/15
20 ounce cola 200/0/0

Dinner 1 fried chicken breast and 1 leg 625/42/45
1 cup of macaroni and cheese 270/14/12
¼ cup of coleslaw 50/1/1
½ cup of fried okra 160/0/15
20 ounces of sweet ice tea 160/0/0

The grand total is 2,980 calories, 95 grams of protein and 139 grams of fat. That leaves about 300-330 grams of carbs too. The average person will not eat this all the time, but frequently. This diet truly represents the “Western Diet” that we have all come to know all too well. It is the diet of cancer promotion, high blood pressure, diabetes, metabolic syndrome, obesity and numerous other conditions.

Posted in Ask the dietitian, Recipes, Uncategorized | 2 Comments

Acai Berries

By admin on February 27, 2009 at 2:06 pm

Many people are talking about the popular berry called Acai. It is a palm berry of the Amazon and is rich in nutrients called phytochemicals or plant chemicals. Plants such as Acai get there colors from compounds that protect them from damage from the sun. In our bodies we are also at rick for damage from the sun, metabolism of chemicals and the aging process. Acai has been touted to reduce hunger, increase metabolism and boost the immune system. Well here is my take. I performed PubMed (a huge government research database) and the International Bibliographic Database of Dietary Supplements (IBIDS) and did not see any original human studies that show Acai will help you lose weight or feel full. That’s the bad news, but the good news is that the berries do possess very strong antioxidant properties. They also contain fiber and carbohydrate, which may promote fullness. A number of vitamins and minerals in the berries are used to produce energy in the body and help support a healthy immune system. Research on the fruits according the studies I saw, were concentrating on better understanding how the berries color pigments work as antioxidants in the body and if they may help control, kill or otherwise reduce one’s risk for cancer. So here’s to the acai berry of the Amazon and all power foods such as broccoli and other cruciferous veggies, colorful fruit such as blueberries, almonds, walnuts and to a plant based diet. All the disease fighting ability we may ever need is in the foods we eat. To lose weight, remember no matter what power foods you add to your diet, calories count. Energy in and energy out. Always combine your acai berry juice with a brisk walk or other activity to live a strong healthy life.

David Kellenberger, MPAS, RD, PA-C

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Dallas Fort Worth Weight Loss Surgery Tools

By admin on February 22, 2009 at 8:51 pm

REALIZE mySUCCESS (TM) is an internet-based program and self-accountability tool developed for patients with the Ethicon Realize Band. In an attempt to enhance patient accountability, long term weight loss success, patients with a Realize band have access to a Web-based tool that tracks post-operative goals, customize plans and monitor their weight loss progress. In a recent observational study, about 3,800 people who had a Realize band and used REALIZE mySUCCESS (TM) were studied to see if the program helped them lose more weight and keep up with all forms of accountability needed to be successful with adjustable gastric banding surgery for weight loss. The results indicated that people who were frequent users (> or = to 1 x week) lost statistically more weight at 2 months, 4 months and 6 months than people who were infrequent users (< 1x/week). People who logged on and kept track of themselves lost about 46% of their excess body weight at 6 months, this was 10% more than infrequent users. Let’s say you want to lose 100#, you would lose about 46 pounds by six months with more frequent self-accountability. Also the study found that almost 90% of people using the program were still participating, so staying involved in your care is key to meeting your long term weight loss goals.

One of my greatest concerns is that people tend to put all their eggs in one basket when they have a gastric band placed from Realize or Lap Band. Imagine if you will that four pillars are holding up a building. One pillar is behavior modification, one is fitness, one is diet composition (calories, protein, etc…) and the last is a properly tightened band. Each of the four pillars provides 25% of the strength of the building. If you rely too heavily on one pillar or completely ignore one, the building will crumble. For gastric banding this is very true, if you rely on the band to be tight, but do not exercise or engage in healthful eating behavior or try to eat small amounts of less than healthful foods, your building will crumble. The next time you think you need a fill ask your self whether or not your building is sturdy and if you are truly utilizing all the tools needed to realize your success. Your band does not need to be super tight to eat a variety of foods per day to make it to about 900 to 1400 calories and go for a 30 minute walk. So here’s to living fresh.

Posted in Ask the dietitian, Lap Band | Comments Off

Lose it for iPhone

By admin on February 17, 2009 at 6:21 pm

Lose it” for iPhone

We have a new weapon in the war against the bulge. Lose it, an application made for all you iPhone and iPod Touch users out there is a wonderful tool that can be used to develop a calorie budget, keep track of what you have eaten and track calories burnt in exercise. Reviewed by over 2600 users, it gets about 4 stars for functionality and best of all it is free. Yes free.

Why is it important to track calories? Well good question young grasshopper. Calories represent the energy trapped in the foods we eat. Calories come from carbohydrates, fat and protein which our bodies convert these nutrients into heat. Each and everyone of us needs a certain amount of calories each day to run our metabolism to repair tissue, make DNA, keep our cells healthy and happy. Theoretically, we could eat donuts all day and lose weight eventually. Yes, Yes, I know that donuts aren’t healthy, but what if you needed 2,300 calories each day to walk, talk, type, drive, breath, think; I think you get the point. If you ate 1,200 calories worth of donuts you would lose weight. However, you would also turn into a jelly donut, because you would be starving your body’s cells of vital vitamins, nutrients, essential proteins, fats and healthy carbohydrates. So here’s the point. If you can control the amount of calories you eat and eat the right amounts of fats, carbohydrates, fats, minerals and vitamins, you would effectively lose weight and keep your cells healthy and happy.

“Lose it” an iPhone application helps you do that and quick. You can track what you have eaten on the fly in your phone and get instant feedback on how well you are doing. It is a great tool. The other thing is that it doesn’t matter what diet you like to eat. You can eat fast foods and healthier foods or follow a specific diet like “South Beach”. It is really up to you what you eat. Remember healthy and happy cells means reducing your risk for cancer, diabetes, high blood pressure and heart attacks or other blood vessel diseases. Combine a healthy well-balanced diet with power foods, daily fitness and a calorie tracker and aim for an initial 5 to 10% weight reduction. Good luck and live fresh.

David Kellenberger, MPAS, RD, PA-C

Posted in Ask the dietitian | 1 Comment

A New Year, Not Another Diet

By admin on January 15, 2009 at 6:25 pm

Hello again everyone and happy new year!

Each and every year millions of Americans resolve to improve their health, lose weight and exercise at the beginning of the year. Unfortunately, we start out motivated, but the motivation to continue a “diet and exercise plan” for many of us fades after a few months. Most will experience some weight loss and improved energy, but as the stresses of our lives return and old eating habits pounce on us, we begin to lose confidence and self-esteem in our ability to make lasting changes.

The sad truth of most “diets” is that they do not necessarily consist of what or where we like to eat. They also ask us to track portions, calories, fat grams, carbs and many other things that are sometimes difficult to do. The benefit of such dietary and exercise programs is that they attempt to hold us accountable to what we eat, how we eat, when and where we eat and so on. Accountability is a big part of lifestyle change isn’t it. It is often difficult to stay accountable to everything you put in your mouth no matter how motivated you are.

We really are all committed to improving our health and wellness. We are committed to losing weight, but our motivation weans over time, our old lifestyles are corrupted by many years of the “American style of eating and living” and accountability is tedious and difficult to maintain. This is why we experience a 90-95% failure rate of diet, behavioral and exercise to maintain weight loss.

On the positive side, people all across the country do lose weight and keep it off, they exercise 60-80 minutes a day, stay accountable, eat healthful foods and other things, but what about the rest of us, the 90% of us, who feel miserable about ourselves when we fail to persist in our efforts. It isn’t because we are not committed, it isn’t because we don’t care or lack will power. Sure doctors and dietitians tell us that eating a well-balanced diet with healthy carbohydrates, fiber and protein will help us feel full longer and keep weight off. But what about the irresistable pull of the almighty french fry. Also known as the multi-billion dollar advertising campaign of the high calorie, high fat, refined, processed, but tastes o so good American junk food industry screaming at us on a daily basis. Seriously, what’s up with those sinnfully delicious Red Lobster commercials and what is authentic Mexican food? Do people in Mexico really sit around to lunch and dinner each day and eat 1,500 calories and 60 grams of fat worth of greesy enchiladas, ground beef and chips?

Bariatric surgery is the solution for thousands of people each year in the ongoing battle to lose weight, treat numerous chronic health conditions and improve a sense of self-confidence and accountability that is not found elsewhere in the diet industry. Bariatric surgery including the Lap Band System, Realize band, laprascopic gastric sleeve resection and laprascopic R and Y gastric bypass, are life changing, medically necessary procedures of great value. Surgery affords many people in need of a perminant accountablity system, an enhancement if you will of your ability to eat mindfully, with purpose and restraint. To enjoy maybe for the first time, weight loss that has a success rate opposite of a regular diet, about 90% of people losing weight and keeping it off. Yes there are costs, but the costs are often associated with success and not failure as with conventional diets.

Mostly, the surgery itself has life changing qualities. Eating slower, restricted portions, feeling full quickly, having less desire to eat in the first place. With this permanent kind of accountability, one is free to explore opportunities to increase leisure acitivity, possibly pain free or at least greatly reduced, free to explore new healthier recipes without having to worry. Is the scale going to go down to show me I am a success? Success comes with a price. The price of having surgery is a new you and permanent accountability partner. Bariatric surgery is a tool that initially changes your anatomy, then your physiology and appearance; ultimately what is changed goes beyond the physical. For many it changes their lives so much it…………… I can’t truly say what it does. It is beyond me and I am humble enough to tell you I may never understand the “spiritual” side to such a life changing experience. As a challenge for this year. Finish the sentence I started and couldn’t complete, tell someone of your own experience or take the opportunity to discuss starting your own adventure with bariatric surgery. Remember, it is a new year, but not another diet.

Yours Truly
David Kellenberger, RD, PA-C

Posted in Ask the dietitian |

Content vs Context

By drdkim on October 23, 2008 at 2:58 pm

Hello Everyone,

Thank you all for welcoming me into Dr. Kim’s practice. I have enjoyed meeting many of you at regular appointments or at the support group meetings. As you all know, I am a Registered Dietitian as well as a Physician Assistant, so I have the unique opportunity to help out with nutritional concerns regarding lap gastric bands and gastric bypass.

Today I just wanted to start out by talking about the concept of Content vs. Context. Over the next months and years we will talk a great deal about what to eat, how to eat, when to eat, anti-obesity foods, vitamins, minerals, etc. But that is all content; it is the nuts and bolts of nutrition and can be quite boring and technical. I realize that there is more to life than the grams of protein you eat during the day, there also exists the fact that our nutritional intake is affected by the context in which we eat.

I have seen numerous people who come to the office upset about the amount of “forbidden foods” they ate over the past month because they are stressed regarding having to care for ailing parents, difficult school exams, poor sleep, the economic crisis and other pertinent aspects of well, being alive. So, remember when we talk about whey protein isolates and the biological value of protein and their affect on your hair; we really need to take that content and place it within the context of our lives and remember to give ourselves the self-respect we deserve. Even the most skilled eaters, will experience difficulty at a party with a plethora of food.

A part from the emphasis we place on eating protein first to maximize weight loss and reduce losing muscle during rapid weight loss, we need to focus on eating a variety of fresh fruits, veggies, dairy and whole grains. In order to do that we will need to work together on developing skills that will help navigate the crazy world we live in and realize that effectively managing the context in which we eat is as important as the quality of vitamin supplement we take. Talk to you soon.

David Kellenberger

Posted in Ask the dietitian |

Claudia

By drdkim on October 10, 2008 at 8:50 am

Claudia,
This long after gastric bypass your hair loss is nutritional or metabolic disease. You need to increase your protein to 60 grams a day. Please call our office 817-285-8889 to schedule a nutrition consultation appt.
I would also like to get a ferritin level and add iron and zinc to your diet.

Posted in Ask the dietitian |

Ask Our Dietitian

By drdkim on September 12, 2008 at 10:06 am

Dr. Kim’s dedication to your success has motivated him to employ a new Physician Assistant. The unique benefit to all of us is that his new PA is also a registered dietitian. Please allow me to introduce David Kellenberger RD, PA-C.
Many of you have met him in the support group meetings, many others during office visits. I would like to share his educational background and experience with you so that you may feel confident that the information you receive from this blog is valid and will benefit you.
David’s Educational background includes a Bachelors Degree with honors in Nutrition and a Masters Degree in Physician Assistant Studies from the University of Florida. He did his internship in Medical Nutrition Therapy from Mass General/Harvard Medical School. He has served as a clinincal dietitian for North Florida Regional Medical Center for Obesity a bariatric center of excellence for two years. He has also worked in the area of research and development in nutritional supplements. Since 2007 he has worked as a Certified Physician Assistant for a Gastroenterologist/Internal Medicine group and General Medicine/Diabetes/Metabolism Clinic. As you can see for his young years he has accomplished a great deal and he is a delightful addition to our program. If that isn’t enough he is multilingual, speaking German and Spanish.
As you can see he has a wide range of experience and knowledge so you can feel very comfortable sending in your questions.

Posted in Ask the dietitian | 1 Comment