Remind yourself that you chose to adopt and live a healthier lifestyle. While I know it is a struggle (believe me), this means giving up your old eating habits and beginning to work on a healthier relationship with food. My personal mantra in times of struggle is “Food is fuel”. I myself am an emotional eater and tend to want to eat my emotions at times. It is an on-going internal battle but as long as I stay aware of when, what and why I am eating it helps me to make better choices. After doing this for 6 years, I can honestly say that meal planning is a big key to staying successful!

Make careful menu selections by paying attention to the descriptions on the menu

• Deep-fried, pan-fried, basted, batter-dipped, breaded, creamy, crispy, scalloped, Alfredo, au gratin or in a cream sauce = high in calories, unhealthy fats and sodium

“Undress” your food

• Be aware of calorie- and fat-packed salad dressings, spreads, cheese, sour cream
• Ask for a grilled chicken sandwich without the mayo

Don’t be afraid to special order

• Ask for steamed veggies or a side salad instead of an unhealthy side and make sure to ask they be served without the sauces
• If your food is fried or cooked in oil or butter, request to have it grilled, broiled or steamed

Watch portion size – share or bring a portion home

• When possible, order from the kids menu
• Remember you are looking for your entire meal to be around 1 cup in size (which looks like about the size of a tennis ball)

Avoid beverages with calories

• Drink water with lemon or unsweetened iced tea
• Stop drinking 30 minutes prior to eating and up to 30 minutes after your meals. If you drink with your meals you are “washing” your food down and not allowing yourself to feel full causing you to eat more.

Eat mindfully

• Pay attention to what you are eating and savor each bite. Make sure to chew 1 bite per minute for 20 minutes
• Be mindful when you are almost feeling full and lay down your fork

As a general rule of thumb, I try to avoid any kind of bread products. This includes buns, thick pizza crust, white bread, flour tortillas to name a few. If you do eat bread choose either sprouted or whole-grain. Make sure to take the top slice/bun off. Remember the terms you want to look for on a menu are grilled, low-fat, steamed, roasted, and baked and don’t forget to avoid sauces! When choosing a salad try to go for the vinaigrettes, oil and vinegar or low-fat dressings. Try and avoid creamy dressings or those high in sugar like honey mustard. Remember the big picture! Moderation is the key, but planning ahead can help you relax and enjoy your dining out experience without sacrificing good nutrition or diet control.

Until next month,
Mary

1. Pick a specific activity, eating habit, emotional response, behavior, exercise, etc… that you want to tackle.

• “I want to lose 2 pounds a week for 8 weeks.”
• “I want to go to the gym for 30 minutes on Monday, Wednesday and Friday.”

2. Make your goal measurable.

• “I keep a log of my weight. I weigh myself on my scale in the nude at 9am every Sunday.”
• “I track my workouts on a calendar log sheet.”

3. I will hold myself accountable.

• I will pick an accountability partner, coach, or mentor to monitor my activity.
• I will give them permission to do two things. First, I will allow them to privately critique my progress even if it means being kindly disciplined or reminded why I am goal setting. Second, I will allow them to encourage me and build me up as I work diligently (not perfectly) towards my goals.

4. My goals are adjustable.

• “If my leg breaks, I will eat healthful to promote healing and hold off the weight loss until I am healed.”
• “If my car breaks down, I will get a ride with my friends.”

5. Set an action to achieve the goals.

• “I am going to do the above by eating 1400 calories per day using meal replacements, scheduled eating times and an adequate protein menu plan.”
• “I am going to achieve the above goal by packing my gym clothes and driving right to the gym on my way home on those three days each week for eight weeks.”

6. Set realistic physically and emotionally healthy goals.

• “I am going to stand up to previous failures with weight loss, set 1 to 2 pounds weight loss per week for eight weeks and keep a positive outlook on my progress.”
• “I am not an athlete and I will set a 30 minute exercise time three days a week to start for eight weeks.”
• “I will increase the amount of non-exercise physical activity during the day at work by walking around 10 minutes every hour of the day.”

7. Set a specific time in which to complete your goal.

• “I will complete my weight loss and exercise goals in 8 weeks!”
• “If for some reason I accomplish less than desired results, I will rebuke feeling as though I failed and repeat steps 1 through 7.”

Download a Goal Setting Worksheet

There is a chill in the air and some department stores have already moved the Halloween merchandise out of the way, to make way for Santa and the reindeer.

So, it’s time to think about how to handle yourself with all of the tempting treats of the upcoming season… Here are a few ideas around Holiday Parties

• Have a light healthy meal or snack to take the edge off your hunger before you go to a party.
• Make just one trip to the party buffet.
• Don’t hang out near the food. Socialize a distance away. This will help prevent unconscious nibbling.
• When you arrive at a party, avoid rushing to the food. Greet people you know- conversation is calorie-free! Get a beverage and settle into the festivities before eating.
• Hold your glass in the hand that you normally eat with to make finger foods less accessible.
• If you’re bringing a dish to share, make it healthful and delicious. That way you know there will be one thing you can munch on without racking up calories too fast.
• Have an accountability partner that will slap your wrist when you reach for too much.
• DON’T go it alone!

Over this holiday weekend, plan to spend (or eat) extra calories, just like you plan your budget. If you know you’ll eat more on a special occasion, you need to bank the calories before and afterward. And get up earlier on Thanksgiving (for example) and go for a long walk or bike ride, thus allowing yourself more in The Bank.

A Sweet Shake Alternative

Vanilla Shake Powder with GV Orange Early Rise Sugar Free Powder mixed tastes like Orange Sherbet (real sweet) for a shake alternate.

Liquid Chocolate Covered Cherry

You will need the following

• 1 cherry/dark cherry sugar free jello
• 7 to 8 of the cherry pomergrante ice cubes (hey thicker the better right?)
• 8oz of skim milk, if you prefer less you can
• Any one rounded scoop of the lovely Bari Essentials Chocolate Protein Powder

Combine all of these into the mixer, depending on your mixer I suggest the Ice Crush on HIGH first to make sure all the cubes are nicely crushed, then blend for about one minute, and finish it frappe style.

This could be an “ice cream” like treat!!

Another option is a “variety” shake with a scoop of vanilla BariEssential in decaf chocolate truffle flavored coffee.

Hair loss after bariatric surgery is very common and very stressful. We all want to achieve great weight loss results and still have great hair. The hair loss associated with bariatric surgery is called telogen effluvium and has to do with the normal hair growth cycle. It usually starts abruptly and very seldom lasts longer than 6 months. Human hair has a two stage growth cycle. The growth phase is called anagen and 90% of our hair follicles are in this phase at any given time. The resting phase is called telogen, which lasts about 1 to 6 months, with an average of 3 months. About 5-15% of our hair is in the resting phase at any given time. It is also known that telogen effluvium has to do with stress to the body and hormonal changes that can occur. Due to the stress more hair follicles can enter into the resting phase. This is important because the hair in the resting phase at the time of surgery is most likely the hair you will shed. This is why your hair sheds between 1 to 6 months after surgery (usually about3 to 4 months). When the hair starts to grow again the old hair follicle is released and you lose hair. Sometimes the hair comes out before new hair grows, yikes!

So in summary, this type of hair loss is a diffuse shedding of hair as it relates to the normal hair growth cycle. It is common in men and women and all races. It occurs a little more frequently in women typically after child birth and can also happen to infants after the first month or so of life. (1, 2)

Why does this happen in people who have bariatric surgery? The most common reasons are:

• Surgery, acute illness, trauma
• Chronic disease such as liver disease or any chronic debilitating disease
• Hormonal imbalance such as hypothyroidism
• Crash dieting, low protein intake, anorexia, chronic iron deficiency
• Heavy metal toxicity
• Medications such as beta-blockers, excess vitamin A and anticoagulants (1)

So, what we have here are a few things that may be affecting people with hair loss. It starts with surgery, a very low calorie intake and possibly low protein intake. Then you add any illness along the way, an underactive thyroid, iron deficiency, or genetics and you get hair loss of about 5-15% of your hair follicles. Other nutrients implicated in hair loss include zinc, biotin, folate, vitamin B-6 and essential fatty acids. (2) If no deficiency of these nutrients exists, then they will likely be of little use.

The good news is that you can count on the hair returning unless you have a chronic illness or genetic reason for the hair thinning. The following suggestions are the best advice I can give anyone with telogen effluvium, now that we know what it is.

• Relax and don’t worry. It is natural hair loss of 5-15% of your hair due to the stress of surgery and weight loss. It rarely lasts more than 6 months. It grows back.




• Visit your primary care doctor to be evaluated for any illness or non-nutritional reason for hair loss such as thyroid disease or other chronic illnesses.




• Follow our dietary prescription which calls for limited calories and exceptional diverse protein intake on a daily basis. DO NOT add a lot of protein and increase your calories so much that you sabotage your weight loss. Obesity kills, not a little hair loss!




• Take a bariatric specific multi-vitamin with adequate B vitamins, folate, zinc and biotin. Don’t forget your B12 and calcium citrate with vitamin D supplements.




• Avoid excessive vitamin A and high dose zinc supplements they are both potentially harmful.




• Add iron if you are iron deficient based on your lab findings in consultation with your healthcare provider.




• Consider adding an additional B-complex. The B vitamins are not generally toxic and the extra B vitamins with biotin may help keep your metabolism running smoothly.




• Eat fish rich in omega three fatty acids several times a week or supplement with fish oil supplements in consultation with your healthcare provider.




• Consider discussing minoxidil drug therapy with your healthcare provider as a possible means to grow or thicken hair. This drug has not been shown to stop the process of telogen effluvium, but given that it stimulates hair growth it may have some benefit. (2)

References:

1. Jacques J. Micronutrition for the Weight Loss Surgery Patient. Edgemont, PA: Matrix Medical Communications; 2006
2. Hughes E. CW. Telogen Effluvium. Website. http://emedicine.medscape.com/article/1071566-overview. Updated 12/17/2010. Accessed 8/4/2011

Here are a few helpful tips to help you stay on the straight and narrow:

• Make sure you’re drinking the full daily number of protein shakes. (Optifast, 5 a day mixed with water; BariEssential, 4 a day mixed with skim milk.) I recently heard of a patient who complained that he was very hungry on the liquid diet. When asked how many shakes he’d had that day, he replied…”Two.” If you deprive yourself of the daily required amount, you’re setting yourself up for failure and temptation.




• Drink lots of liquids in addition to the protein shakes. Fill yourself up with water, and feel free to enjoy unsweetened tea or coffee as well. Crystal Light (or a comparable store brand) will be your best friend during these weeks! Drink up! (But nothing with calories, carbonation, or alcohol.)




• Try adding sugar-free popsicles (caution: check sugar/carb content to ensure that they’re truly “sugar-free” and not “no sugar added…two very different things) or sugar-free jello as a treat. You can even make Knox Blox out of the sugar-free jello by decreasing the water by half…makes them more chewy and substantial, and you can cut them in squares for portable snacks.




• Enjoy a cup of low-sodium Swanson’s Chicken Broth each day to break up the sweetness of the diet. Even someone with a deadly sweet tooth can grow weary of sweetness all day every day.




• Give yourself some variety by creating new flavors. Be creative and have fun (without adding extra calories). Here are a few suggestions:
• Add vanilla, almond, coconut, or mint extract to any of the basic powder mixes.
• Add any flavor of Crystal Light to the vanilla, strawberry, or chocolate. You’ll probably need to add extra water or ice to off-set the added sweetness.
• The protein drinks are best when very cold and shake-like. Try making ice cubes out of coffee (Frappucino, Baby!) or various Crystal Light flavors and add to the shakes. Some patients have had great success with sprinkling in some sugar-free jello powder too. Just remember, adding a sweet ingredient may necessitate adding extra water or ice or it might be too sweet.
• Let us know if you create a recipe that’s especially good….and please share on Facebook!
• If you’re using BariEssential instead of Optifast, keep in mind that it’s not as sweet. Some patients like that, and others feel like it needs a little sweetener…and that’s fine. Add a packet or teaspoonful of your favorite (i.e. Sweet ‘N Low, Truvia, Splenda, etc.) if you like.




• Exercise is great, obviously, but be careful about adding extra exercise to your schedule during the liquid diet. If you’re burning additional calories, you may get hungrier. Try walking each day or doing some strength-building work each week to keep your strength up (and give you a running start after surgery recovery); however, this is probably not the time to sign up for that Kick-Boxing or Zumba class you’ve always wanted to try, or to train for a 5K. Wait till you’re fully recovered after surgery…then GO FOR IT!




• Ask your family members to assist you. Perhaps they’ll join you on your liquid diet, or at least eat healthier while you’re on it. Either way, ask them to throw away junk food and items that will tempt you…or at least HIDE them…out of sight, out of mind!




• Provide support and accountability for yourself. If you’re tempted to “fall off the wagon”, call a friend who will encourage you, or call our office and get a pep-talk from a staff member. You can do this, and YOU ARE WORTH IT!

So you think you can cheat? In all seriousness, keep in mind that it is vital that you stay on the 800 calorie-per-day liquid diet prior to surgery. Not only will the weight loss give you a running start for your post-surgery weight loss journey, but your liver must shrink in size to ensure a safe laparoscopic procedure. If your liver hasn’t shrunk (i.e. you’ve been cheating on the liquid diet), Dr. Kim may not be able to perform your surgery. This alone should encourage you to follow the prescribed liquid diet TO THE LETTER. Don’t risk losing the opportunity that many of you have looked forward to for months or years.

Your surgery is the proverbial “carrot dangling from a stick in front of you.” This pre-surgery diet is different from any other restrictive diet you’ve tried previously. After this liquid diet, your procedure will give you a life-changing tool that has brought enormous success to so many Dr. Kim’s patients. You can look forward to lower weight, less joint pain, discontinuation of medications, added mobility, more confidence and overall well-being…a chance to live your life again. Now isn’t that worth a few weeks of liquid diet? ABSOLUTELY!!

Arby’s
Grilled chicken ceasar salad

Burger King
Chunky chicken salad

Chick-fil-a
Char-grilled chicken garden salad

McDonald’s
Chicken McGrill with out Mayo

Wendy’s
Grilled Chicken Sandwich

Taco Bell or Taco Casa
Re-fried beans (frijoles)

This is just a suggestion of some healthier options when you are on the run and shouldn’t be a daily habit….

Recipe

• 2 tablespoons olive oil
• 1 medium onion, chopped
• 1 red bell pepper, ribs and seeds discarded, chopped
• 1 jalapeno , ribs and seeds discarded, chopped
• 2 cloves garlic, minced
• 3 cans (15 to 19 ounces) black beans, drained and rinsed
• 1 quart reduced-sodium chicken broth
• Freshly ground pepper, to taste
• Make-Ahead Salsa or store-bought salsa and sour cream and chopped, fresh cilantro, for garnish

Serving size 1/2 cup:
Estimated 100 calories, 2 grams of fat, 8 grams of protein

Directions

Heat the oil in a large saucepan over medium heat. Add the onion, bell pepper and jalapeno. Cook, stirring occasionally, until the vegetables soften, about 3 minutes. Add the garlic and stir until it gives off its aroma, about 1 minute.

Stir in the beans and broth. Bring to a simmer over high heat. Reduce the heat to medium-low and partially cover the pot. Simmer for 30 minutes. During the last 5 minutes, stir in the sherry, if using.

In batches, transfer the soup to a blender, process until smooth, and pour the puréed soup into a large bowl. (If you have an immersible hand blender, you can puree the soup right in the pot.) Season the soup with salt and pepper.

Serve the soup hot, with bowls of the salsa, sour cream, and cilantro passed on the side so each person can add whatever toppings they like.

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

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.

David Kellenberger, MPAS, RD, PA-C

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.

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

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

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