A Healthy Taste Of Fear

BRIEF ARTICLE OVERVIEW: Toe the line, taste the fear, and grab a new appreciation for life with an overdose of self-love thrown in. Plus Recipes… Broccoli Bacon Quiche & Lasagna Soup.

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Living Normal: My Father’s Song

BRIEF ARTICLE OVERVIEW: What does living normal mean to you? Over three years after bariatric surgery, WLS lifestyles magazine contributing writer/columnist, Maureen Boyd takes living life passionately to a new level. Experience a post-op world full of new found senses, healing reflections, a healthy lifestyle and the chance at Living Normal.

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Nurses Unite To Improve Healthcare For The Obese

BRIEF ARTICLE OVERVIEW: Bariatric nurses rally for safe ethical and equitable nursing practices for obese clients.

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Adversity To Empowerment: One Person Paying It Forward

BRIEF ARTICLE OVERVIEW: Choosing to pay it forward life coach Jeff Cadwell encourages his clients to “design” positive healthy lives.

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Rock Your World

BRIEF ARTICLE OVERVIEW: A knock at the door, who could it be? Vulnerability or opportunity ~ which one are you ready to answer?

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Put Me In Coach I’m Ready To Play!

BRIEF ARTICLE OVERVIEW: Move forward…achieve success…maximize your potential…let a life coach cheer you on.

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Open Discussion: Weight Loss Surgery & Diabetes

BRIEF ARTICLE OVERVIEW: Early studies show weight loss surgery has promising results effectively treating Type II diabetes.

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What’s In A Name?

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It was a beautiful summer evening in San Diego and I was at the 25th annual meeting of the American Society for Bariatric Surgery. This is the Society that your surgeon, bariatric coordinator, nutritionist and psychologist likely belong to. The Welcome Reception was on the patio of the Convention Center which offered a beautiful view of the Pacific Ocean with hibiscus flowers all around.

I noticed a lull at one of the bars, so I walked up to order a light white wine spritzer, and as the bartender was pouring, he glanced around to see who was listening and said, “What is this bariatric thing? What does it mean?” Feeling good that he probably asked me because I looked like the least intimidating person there, for an instant I considered telling him that bariatric is derived from the Greek word baros meaning weight. Nah! So I said, “It’s weight loss surgery.” His face lit up. “Now I get it!” He understood. What I didn’t share with him was that at that same meeting, the Society was likely changing its name to the American Society for Metabolic and Bariatric Surgery. That would have had his head spinning.

I have been attending the annual meeting since 2001 and there always seems to be something exciting going on, whether it is the FDA approving the LAP-BAND® in 2001, the controversy over laparoscopic surgery versus open surgery, or the initiation of the Centers of Excellence. This year the buzz was certainly the change of the name of the Society.

It is very unusual for an organization to change names and the American Society for Bariatric Surgery (ASBS) has lived with this name since 1983. So, why did the name change occur and what are the implications? Those answers came during the President’s address at the end of the meeting.

The outgoing President, Dr. Phil Schauer explained that a name change for the Society was necessary to reflect the changing role of bariatric surgery. The surgery does not just reduce weight. What it does, equally importantly, is to cure disease, specifically diabetes. A 2004 study of weight loss surgery patients by Dr. Harvey Buchwald, et al found that of 22,094 patients:

• Diabetes was eased or eliminated in 86% of patients
• High blood pressure improved in 78.5% of patients
• Sleep apnea improved in 85.7% of patients
• High cholesterol was reduced in 70% of patients

Additional studies have shown improvements in heart disease, asthma, and PCOS. These are facts deserving recognition. The name change helps to move the perception in the eyes of the public, the medical community and the insurance industry that bariatric surgery is for more than just for weight loss. The membership overwhelming approved the name change. I felt that I had witnessed a significant event in the history of bariatric surgery.

There is a quote from Dr. Henry Buchwald that I love. He said “There are eight to ten million people who are morbidly obese in this country, and we’re only operating on one percent to two percent of them. Treating that small of a percentage wouldn’t be tolerated if it was any other illness.” Hopefully with greater acceptance and recognition of the surgery as a legitimate procedure for the treatment of metabolic diseases such as diabetes, bariatric surgery will be available to more than just one to two percent of those who qualify. And, it is also hoped that along with this acceptance will come a relaxation of a weight standard so that even if someone is under a Body Mass Index of 40 or even 35 that surgery will be available if there is a medical need.

Barbara Thompson is the author of Weight Loss Surgery; Finding the Thin Person Hiding Inside You, and co-author of Weight Loss Surgery for Dummies which can be found at her patient web site www.WLScenter.com. Her free newsletter is available at www.wlscenter.com/E-Newsletter.htm. Check out her blog at WeightLossSurgeryBlog.net.

WLS Lifestyles - www.wlslifestyles.com - Copyright 2007

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Living Normal - Going Up

BRIEF ARTICLE OVERVIEW: What does living normal mean to you? Over three years after bariatric surgery, WLS lifestyles magazine contributing writer/columnist, Maureen Boyd takes living life passionately to a new level. Experience a post-op world full of new found senses, healing reflections, a healthy lifestyle and the chance at Living Normal.

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Tax Deductions & Obesity Surgery

BRIEF ARTICLE OVERVIEW: Ellen Bell discusses and identifies eligible and non-eligible obesity disease related tax deductions.

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Love Song to My Post-Op WLS Body

BRIEF ARTICLE OVERVIEW: Sing a song of comfort and joy unto your new body. Practice, believe and live its gently healing words.

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The Three Types of Abdominoplasties

BRIEF ARTICLE OVERVIEW: Dr. Katzen, reviews the three latest abdomen reduction/abdominoplasty procedures.

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A Tale of Two Tricias

BRIEF ARTICLE OVERVIEW: With food no longer ruling her life, Tricia Calme-Nelson, makes better choices and learns to love herself.

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Don’t Hide In Your Winter Coat

BRIEF ARTICLE OVERVIEW: No matter what your religion or traditions, holiday eating habits can get out of control. Decide to break the cycle and join the winners circle.

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Why We Don’t Do, What We’re Supposed to Do

BRIEF ARTICFLE OVERVIEW: Afraid to leave your comfort zone? Apply five real life solutions to conquer your fear.

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My Friends and Family Seem to Prefer the Old Me

BRIEF ARTICLE OVERVIEW: Humbly go forward with the new you; changes and all …do not compromise personal development to please others.

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My Story: A Family Legacy

BRIEF ARTICLE OVERVIEW: Leigh Marrisett comes across as a force to be reckoned with. At an imposing five feet, ten inches tall, clad in a uniform for her work as a deputy probation officer in a residential lockdown facility, she exudes confidence and purpose.

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Observations From An Obesity Overcomer: My Secret History

BRIEF ARTICLE OVERVIEW: WLS Lifestyles contributing writer/columnist, Kimberly Taylor, doesn’t mind ruffling some feathers now and then. Using her keen observation skills she covers a variety of topics concerning obesity. Her messages are clear, concise and in her opinion need to be heard to be overcome. Her overall focus serves to encourage, inform and support those striving to maintain a healthy lifestyle

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Creating a Bariatric Kitchen: A Trip Through the Supermarket

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As the winter months slowly move along, recognition of the post-holiday food “hangovers” are a necessary evil. Many bariatric surgery patients are struggling with having “strayed” during the end of the year celebrations. Many speak about getting caught up in the sentiment of the holiday season which often is an excuse to tempt fate by eating sweets and high fat foods. As bariatric patients, we don’t view holiday indulgence as a deal breaker, only a reminder to recapture the spirit and focus of the commitment to smart food choices within a healthier lifestyle. This is the perfect time to clean out the kitchen cabinets, and your home, of edible holiday gifts (we like to call it “contraband”) or other items that are still hanging around including liquor, desserts and candy or chocolates and surround yourself with resources and opportunities to guide you back to a feeling of control, and mastery over your food choices and eating habits. All of us, bariatric or not, could benefit from smarter, healthier eating.

Now that you have been introduced to the idea of the bariatric kitchen, and all the tools that support a user-friendly food plan, perhaps we can widen our focus to include a trip to the supermarket. Aside from being bariatric patients, we are members of family systems and work environments that are affected by our food choices and behaviors every single day. A trip to the market can be an opportunity for greater variety of foods choices and combinations which benefits everyone.

It can be helpful to have a mental picture of the supermarket prior to entering an actual store. Picture how the store is set up: When you enter, where do you begin? Are you in the produce section? Now imagine the different areas and what they have to offer. Doesn’t it seem that the fresher, perishable items are on the perimeter, or back walls, of the market? Produce, fruits, salad bar, meat/poultry/fish, whole grain breads and dairy areas are on the outside sections of the store.

You may notice that the middle aisles are filled with pasta and rice mixes, boxed cookies and crackers, cereals, candy, soda and canned foods. However, there are also nutritious and wholesome foods in the aisles too, i.e. canned veggies, nuts, soy products; the point is to be a savvy shopper and make the best possible selections for your ongoing even success. If weight loss surgery patients can accommodate the needs of their families, as well as themselves, everyone will benefit from alternative food choices that are simple, tasty and require little effort.

Weekly food shopping should be interesting and challenging when looking for creative and flavorful foods to add to your own list of favorite bariatric foods. Specialty stores, organic markets, farmers markets and creative menu planning are key elements in maintaining interest and enjoyment in the long-term post-operative bariatric experience. So, go and explore your markets in a new light with an eye toward creativity. I imagine you might be pleasantly surprised by creating new recipes and snacks that may rekindle your commitment and motivation to a healthier, bariatric lifestyle!

More easy and healthy, creative snacks to have at home or at work:

• Fiber rich cereal to top fat-free yogurt
• Sugar-free gelatin with fat-free whipped topping
• Celery/carrots/peppers with a chickpea/hummus dip
• Sugar-free ice pops
• Winter fruits such as clementines and tangerines
• Part skim string cheese
• Edamame (Japanese soybeans)
• Whole grain bite size crackers
• Peeled cucumber slices with a fat-free yogurt dip/yogurt cheese

Lori Sperling Nevins, MSW, LCSW, is a clinical social worker and Bariatric Program Coordinator, with New York Bariatrics. She assisted Dr. William Homan, along with Valerie Ross Homan, LCSW, in developing a holistic team approach to pre-operative surgery preparation. Her team prepares bariatric patients for surgery and maintains patient follow-up in a supportive medical, nutritional and psychosocial aftercare program meant to maximize surgical outcomes.

WLS Lifestyles - www.wlslifestyles.com - Copyright 2007

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The Many Faces of Denial

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Bonnie sought help to stop a 25-pound relapse. She had bypass surgery five years ago at the weight of 380 pounds. Four years after the surgery she hit a low of 160, and after two skin removal surgeries she was proud of her new look. But, in the past year she began to graze on bread, cheese, popcorn and wine, attributing this to a spike in anxiety. As a 60-year old elementary school teacher, she was under pressure to take courses to receive new certifications. The stress of teaching and studying left her feeling overwhelmed.

She described the initial post-surgery period as magical, discontinuing meal planning or tracking, eating small amounts, feeling satisfied, rarely feeling hungry. At the point when she was wearing normal size clothes, a kind of cockiness set in. As the work pressures mounted she felt less joy from teaching and told herself: “what is wrong with rewarding myself with some snacks?”

Bonnie used a variety of rationalizations and justifications to explain the return to old excessive eating patterns. Among them were: Keeping a food diary is tedious, so I’ll do it in my head instead of on paper. I know I’m out of control, but I’ll start dieting on Monday. I deserve a reward – look at all the aggravation I have to put up with. I’ll just have a little in order to keep from feeling deprived. If any of these thoughts sound familiar, you may have to confront your use of denial – a serious threat to long-term success.

The Nature of the Problem

Initial discussions with Bonnie were designed to cultivate respect for the reality of her problem. Several principles were emphasized:

1. Her problem was more about food than it was about weight. If weight loss is to be maintained, she had to change her fundamental relationship with food. Eating needs to shift to the role of nourishment, and not be in the role of reward or escape from stress.

2. The food problem is lifelong, not temporary. For the rest of her life her job is to keep food in the new role. Losing weight doesn’t create the option to “click off.”

3. The food problem is relapse prone and compulsive. High-risk eating situations need to be anticipated or avoided. Keeping snack foods in her classroom is a set up. Telling herself that popcorn is an innocent safe snack can be the start of grazing on it all day long.

4. There is a lifestyle connection to compulsive eating. Bonnie’s lack of intimacy and support in her life made her more likely to use food as a substitute for companionship.

In time Bonnie began to accept the many forms of denial she was using. The following are some illustrations of the common faces denial can have…

Experimenting with Control

Relapse often is set up by what is called, “apparently irrelevant decisions,” small choices that seem innocent at the moment, minimizing the risk they may pose. One of my clients bought cookies she thought she didn’t like, but felt she needed to have for the weekend guests. She did not see them as a threat to her control, because she preferred other types of cookies, thinking, “if I have one or two, no big deal.” But having them in the house created urges. She began to graze on them and eventually had the whole bag, learning that control may mean keeping the environment free of temptation.

Maintaining a High Risk Lifestyle

A client was one of four good friends who lived in different cities in the United States. Once each quarter they reunited by picking a city to visit, with the principle activity being a week of sampling new restaurants. He came to accept that this food-based “hobby” of his was contradictory to his stated goals of losing weight and keeping it off, and eventually replaced it with golf lessons and volunteer activities. Good intentions and high motivation can be trumped by a hazardous lifestyle.

Complacency/ Overconfidence

Often relapse is triggered by a kind of cockiness that comes from success. After a significant weight loss, clients may justify a shift of priorities. “My family needs me more now. With my weight down 50 pounds it will be OK to spend less time planning meals.” Imagine that with every positive behavior (a meal plan, an exercise session) it is as if you took a brick and cemented it to the previous brick. In the end, with each successive pro-health action you build a wall that stands between you and compulsive eating. Recovery, then, is the commitment to engage in all the necessary actions that maintain a wall of separation between you and your compulsive potential. If, through over confidence or a shift in priorities, you discontinue the healthy strategies, down comes the wall. You and food are now enmeshed, and your eating spins out of control.

Rationalization

A client who was more than 100 pounds overweight minimized his food abuse with various justifications. “I just eat too much while watching television I don’t use food; I just like the taste of it. Why deprive myself of my only pleasure after a bad day? I’ll start a diet eventually anyway.”

These are examples of “addictive logic” – an inner voice that says, “it’s OK” whenever there may be some hesitation or questioning of the compulsive cycle. This type of thinking effectively builds a protective wall around the food use, wards off challenges or threats to its existence, and enables it to be acted out in the moment and into the future.

The Failure to Self-Diagnose

Imagine that successful weight control is something that rests on a table of strong legs and a sturdy top. The table is built from an honest and accurate understanding of the problem and related treatment strategies. This consists of the core principles I worked on with Bonnie: The problem is food, not weight. It is chronic, relapse prone, compulsive and lifestyle related. Embedded in the problem is the tendency to wear blinders, to deny these essential truths, and therefore to deconstruct the table on which recovery is built.

Webster defines addiction rather broadly as a condition of having given oneself up to a habit. While there may be some debate in the professional community, as to whether compulsive eating is an addiction, in my clinical experience I have found it to be, at minimum, “addictive like.” The self destructiveness of addiction often doesn’t make much logical sense, and begs the question: what keeps an addiction going? Denial breathes strength and life into addictive behaviors by leading to a lack of attention, dismissing the nature of the problem and what is needed for recovery. This can never be the platform for success, and must be confronted with a supportive, educational, and persistent approach. Be willing to do what Bonnie did. By recognizing denial, you are empowered to let it go.

Lee Kern, MSW, LCSW, is the clinical director for Structure House, a residential weight loss facility in Durham, NC. Kern leads the post-bariatric surgery program. Designed for patients following weight loss surgery, the program offers surgery-focused medical assessments and personalized eating and relapse prevention plans. For information, visit www.structurehouse.com or call 800.553.0052.

WLS Lifestyles - www.wlslifestyles.com - Copyright 2007

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3-Step Process To Create A Better Reality

BRIEF ARTICLE OVERVIEW: It’s really only a hop, skip and a jump to believing the impossible. A satisfying life awaits you in only 3 simple steps. Use your imagination to picture your new life.

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The Importance of Behavior Modification and the Role of Personal Accountability

BRIEF ARTICLE OVERVIEW: Proactive efforts put forth a good defense against “old” relapse behaviors. Seize control of the post-op healing process path and emerge with a greater sense of self awareness. Draw a roadmap to recovery mapping out well-informed choices for the road ahead.

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Observations From An Obesity Overcomer: For the Love of a Child

BRIEF ARTICLE OVERVIEW: WLS Lifestyles contributing writer/columnist, Kimberly Taylor, doesn’t mind ruffling some feathers now and then. Using her keen observation skills she covers a variety of topics concerning obesity. Her messages are clear, concise and in her opinion need to be heard to be overcome. Her overall focus serves to encourage, inform and support those striving to maintain a healthy lifestyle

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Book Review: Weight Loss Surgery - Is It Right For You?

BRIEF ARTICLE OVERVIEW: No longer considered mysterious or extraordinary, weight loss surgery is gaining more and more popularity. This is a must have comprehensive resource and reference book for weight loss surgery patients, their families and friends. So go ahead and get the straight scoop to help you make a more informed decision.

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My Story - A New Life, A New Outlook

BRIEF ARTICLE OVERVIEW: Released from physical and mental pain, Cynthia Shyne faces the world with an entirely new outlook after weight loss surgery.

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Bariatric Advantage Founder Still Tuned In To The Needs Of Patients

BRIEF ARTICLE OVERVIEW: Tune in and turn up the volume to a unique post-op weight loss surgery forum lends long term support to patients. Tom Kinder continues to raise the bar reaching higher levels focusing on behaviors, needs, issues and concerns surrounding patient care after bariatric surgery.

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Does Your Insurance Carrier Have An Exclusion In Your Policy For Bariatric Surgery?

BRIEF ARTICLE OVERVIEW: Check your insurance policy frequently avoiding weight loss surgery denial due to an exclusion or non-coverage policy change. Exhaust all surgery options before throwing in the towel and never, never give up. Usually there are other possibilities to consider before tossing all hope away of ever having bariatric surgery.

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Living Normal - A Day In The Life Of The Physically Fit

BRIEF ARTICLE OVERVIEW: What does living normal mean to you? Over three years after bariatric surgery, WLS lifestyles magazine contributing writer/columnist, Maureen Boyd takes living life passionately to a new level. Experience a post-op world full of new found senses, healing reflections, a healthy lifestyle and the chance at Living Normal.

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And the Oscar for “Best Actor in a Supporting Role in a WLS Drama” Goes to…

BRIEF ARTICLE OVERVIEW: All leading “stars” need to be supported. If you are a supporting actor in a weight loss surgery drama your support will not be optional. Study your part, become familiar with your role. Set the “stage” for success. And the Oscar goes to… Step up, don’t be shy lay claim to your hard earned award.

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Success

(How do you know when you have succeeded?)

BRIEF ARTICLE OVERVIEW: If you see it, you can believe it. It may be hard to do but conceptualize yourself thin. Achieving success is a state of being; living success is a state of mind. And don’t be surprised one day when you least expect it someone calls you, yes you, petite or small.

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Mission Nutrition

BRIEF ARTICLE OVERVIEW: Leading weight loss surgery nutrition educator Dr. J. Jacques outlines her philosophy, using this as reinforcement in her belief that every patient should have a basic understanding of post-op nutritional care. Inadequate follow-up care contributes to unreliable compliancy rates, making it hard to identify certain post-op maladies. Patients and physicians working together can make a difference and provide the necessary motivation to better health and a life well lived.

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Supports Really Can Make A Difference!

BRIEF ARTICLE OVERVIEW: Put yourself first, allow others to help you. Seek out strong support systems within the bariatric community.

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The Well Stocked Bariatric Kitchen

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In bariatric programs nationwide, the issues of healthy food options and creative eating are constant topics of discussion. We know that bariatric patients face tremendous challenges in the new post-operative adjustment period, as well as the long-term recovery period. As bariatric professionals, we encourage our patients to set up their bariatric kitchens to reinforce a commitment to an overall change in lifestyle and eating habits. Remember, bariatric surgery is a tool, not a magic bullet, which should be used to lose weight, keep it off and maintain healthy choices that lead to better habits for a lifetime. If you set up your bariatric kitchen in this manner, it will help you reach these goals!

The bariatric kitchen/pantry can be a blueprint for bariatric patients who are looking for food staples to keep around the house and use in various combinations. The idea is to set up your kitchen and home environment for weight loss success by having these foods and tools readily available. If you open the refrigerator and kitchen cabinets after a long, hard day and bariatric friendly foods are not there, inevitably you will be faced with food choices that are not conducive to proper bariatric eating. The result is a failure to follow the established eating plan, because “nothing else was available.” The alternative we suggest is to be PROactive rather than REactive by setting up a well-stocked bariatric kitchen. Avoid the “open the fridge and see what’s there” trap by having ample supplies of high nutritional value, but low calorie foods available to help you stay on track. Proper preparation can help to prevent straying from the meal plan, which ultimately leads to a decreased rate of weight loss, or even the dreaded weight regain.

Convenience also plays an important role in everybody’s daily life. Creative food combinations and nutritious meals and snacks that travel easily, or can be eaten at home with minimal preparation is key for most of today’s bariatric patients. These may include canned, frozen or individually packaged foods for times between supermarket trips when fresh food supplies in the house are limited. Remember, a properly stocked bariatric kitchen starts with a good grocery shopping list. Use the list of suggestions below to stock your bariatric kitchen.

A well stocked bariatric kitchen has the proper tools at hand:

• Measuring spoons and cups
• Food scale
• Individual food storage containers of various small sizes
• Ice cube trays for freezing small portions
• Snack size zipper lock bags
• Plastic eating utensils for travel/work

A well stocked pantry has:

• Canned tuna (or pouches) in water, canned lump crabmeat
• Canned chicken
• Seasoning blends (i.e. Mrs. Dash)
• Apple cider and/or balsamic vinegar
• Artificial sweetener (i.e. Splenda, Equal, Stevia, Sweet n’ Low)
• Light or low-fat mayo, mustard
• Low calorie, low-fat salad dressings for seasoning and marinating
• Individual sizes of packaged fruit packed in juice
• Canned vegetables
• Canned diced tomatoes, jarred tomato sauce, salsa
• Canned beans/legumes (garbanzo, kidney, black, red, fat-free refried)
• Low sodium broths and soup bases (chicken, beef, vegetable, seafood)
• Whole grain, high fiber, high protein pasta
• High fiber, protein rich hot cereal packets (i.e. oatmeal, multigrain, farina, oat bran, etc.)
• High fiber, high protein cold cereal
• Whole grain crackers (such as WASA, Ry-Vita, Kashi, low-fat Triscuits)
• Crystal Light, Diet Snapple and other low calorie beverages or powder mixes
• Carnation Instant Breakfast, no sugar added
• Pre-made diet gelatin cups, diet pudding cups

A well stocked bariatric freezer has:

• Individually frozen shrimp in a bag
• Skinless chicken breasts or tenderloins
• Lean chopped meat frozen in small snack size zipper top bags
• Sugar-free ice pops, sugar-free fudge pops
• Bags of frozen fruit pieces (no sugar added) for smoothies and snacking, either bought already frozen, or freeze your own sliced banana, berries or grapes to add to yogurt or cereal

A well stocked bariatric refrigerator has:

• Pre-washed and cut fruits and vegetables (try the supermarket salad bar for variety)
• Yogurt and yogurt smoothies (small containers, low-fat, artificially sweetened)
• Part-skim ricotta cheese
• Low-fat or fat-free cottage cheese (small containers)
• Low-fat cheese wedges/mozzarella “string cheese” sticks (i.e. Laughing Cow brand, Polly-O brand)
• Pre-shredded low-fat cheese blends to boost flavor and protein of foods
• Deli sliced turkey, ham or chicken breast
• Fresh eggs, hard boiled eggs and egg substitutes
• Pre-cooked grilled chicken or turkey strips
• Skim and 1% milk
• Assorted pre-washed and cut salad green blends
• Low-calorie salad dressing/spray dressings
• Imitation Butter in spray form (such as I Can’t Believe it’s Not Butter)

Be creative…

Need some creative, healthy easy combinations for meals or snacks? The challenge is to keep food choices creative and flavorful; inspiring your taste buds is crucial in order to keep you interested in healthier food choices.

• Romaine lettuce leaf wrapped around 2 slices deli turkey with mustard or low-fat salad dressing
• 4 oz. fat-free yogurt with 2 oz. fresh berries and 1 Tbsp. fiber rich cereal
• Part skim mozzarella stick wrapped in sun-dried tomato slice or roasted red pepper (not packed in oil)
• 2 oz. seared tuna steak with low-fat dill sauce (fat-free yogurt, capers, dill and lemon juice)
• Laughing Cow low-fat cheese wedge spread on multigrain WASA cracker
• 2 oz. fat-free milk, 2 oz. fat-free yogurt, 2 oz. fruit of choice a few ice cubes, sprinkle sweetener to desired taste and pulse in blender.
• Freeze half of small banana or 10 frozen grapes
• Hot cereal (one packet) mixed with water or skim milk, artificial sweetener and fresh fruit. Or try hot cereal add vanilla extract, artificial sweetener and cinnamon.
• 3 oz. grilled chicken over salad greens and low-calorie dressing of choice, lemon juice or balsamic vinegar.

Lori Sperling Nevins, MSW, LCSW, is a clinical social worker and Bariatric Program Coordinator, with New York Bariatrics. She assisted Dr. William Homan, along with Valerie Ross Homan, LCSW, in developing a holistic team approach to pre-operative surgery preparation. Her team prepares bariatric patients for surgery and maintains patient follow-up in a supportive medical, nutritional and psychosocial aftercare program meant to maximize surgical outcomes.

Denise Addorisio, RD, CDN has been a registered dietitian for over 25 years, and has devoted the last decade of her career to weight management. She joined New York Bariatrics as the Bariatric Program Dietitian while it was in its infancy and maintains a private practice there. She also is an Adjunct Professor of Nutrition at SUNY Westchester Community College.

WLS Lifestyles - www.wlslifestyles.com - Copyright 2007

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How to Feed Your Hunger Without Gaining Weight

BRIEF ARTICLE OVERVIEW: It’s not uncommon to find the hungry feelings and the urges to eat creeping back in after weight loss surgery. But amazingly losing weight doesn’t have to mean going hungry. In fact, learning to feed your hunger is one of the most powerful things you can do after bariatric surgery. Hunger has many forms, and it’s not all about food. Be mindful about hunger and feed it in satisfying ways.

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Raymond and Damon - The Story of Two Super, Super, Super, Morbidly Obese Men

BRIEF ARTICLE OVERVIEW: It does not discriminate, its victims are: young, old, rich, and poor. Obesity knows no boundaries. Two super morbidly obese men use modern technology supporting one another through the ups and downs of weight loss surgery. They have made it past some tough times and are eager to help others battle their weight struggles. Walk a mile in their shoes to discover hope, courage and strength.

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Keep Off The Weight You’ve Lost Forever

(An Inspiring Moment with Stacey Halprin, Author, Motivational Speaker, Actress, Overcomer)

BREIF ARTICLE OVERVIEW: Stacey Halprin faces her challenges head on. Stacey reflects on the last five years of her life about compulsive eating, body image and how changing thoughts and behaviors can help achieve long-term weight loss success.

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The Food Diary: The Lifestyle Connection

BRIEF ARTICLE OVERVIEW: Post Weight Loss Surgery (WLS), an exciting time filled with happiness, joy and hope. Those are some of the feelings you expect to happen after WLS. But when post-op relapse occurs it can be frustrating. Jan decides its time to make a lifestyle connection as she chooses to make a complete turnaround and stop undermining her success.

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The Importance of Having the Right Tools

(Post-Op)

BRIEF ARTICLE OVERVIEW: Destination: Unknown. There is no magic carpet ride smoothly guiding you into the weight loss surgery journey future. A timely arrival and gentle ride depends on identifying all available post-op tools. Once you have established that you are using the right tools, praise and acknowledgement will be yours.

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Lap-Band Surgery: Bridging the Gap

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Obesity has now reached epidemic proportions, not only in North America but also globally. According to the Centers for Disease Control, it is now estimated that more than two-thirds of Americans are overweight, and nearly one third are obese.1 The consequence of this increase is a dramatic rise in the major health conditions associated with obesity. Obesity has been shown to contribute to the development of numerous life-threatening or disabling disorders including coronary heart disease, hypertension, type 2 diabetes mellitus, hyperlipidemia, degenerative joint disease, and obstructive sleep apnea.2 An estimated $45 billion is spent annually in the United States treating diseases associated with obesity. Most researchers and physicians are now beginning to realize that obesity is a real disease that needs an effective solution.

Significant weight reduction in the morbidly obese has been demonstrated to improve or reverse co-morbid illness, while benefiting psychologic, social, and economic well-being.3 The treatment, however, requires an intervention that is both effective and broadly acceptable. Unfortunately, conventional medical therapies have proven ineffective in achieving even modest weight loss long-term unless it is maintained permanently.4 In the severely obese (BMI>35), this weight loss is insufficient to solve the medical, physical, and psychosocial problems of their obesity. The only methods available that can achieve major and sustained weight-loss are surgical (fig. 1… see pdf version of article to view chart).

Bariatric operations have been shown to produce sustained weight reduction with improvement or resolution in most obesity- related co-morbidities.5 As a result, the number of bariatric procedures performed has risen exponentially over the past decade, approaching 200,000 annually. It is estimated that more than 140,000 Roux-en-Y gastric bypass procedures were performed in 2004 alone. Despite bariatric procedures being available, in one form or another, for more than 50 years, they are still used by only a small fraction of those who suffer from the problem. This limited use of bariatric procedures is attributable to several factors. These operations are generally perceived as highly invasive with significant risks and adverse effects. This along with the irreversibility of the stapling procedures has resulted, not surprisingly, in relatively few patients willing to accept these options. Furthermore, the Roux-en-Y gastric bypass is considered one of the most complex and technically challenging laparoscopic procedures performed by general surgeons requiring additional specialized training and a long learning curve.6 These facts, despite modifications in technique to reduce complications, have continued to foster concerns among patients, as well as referring physicians.

Fortunately, the introduction of the adjustable gastric band may provide a way to bridge the gap between the impotence of conventional medical therapies and the fears of traditional surgical therapies. The Bioenterics LAP-BAND® System (Inamed Health, Santa Barbara, Calif.) was approved by the Food and Drug Administration in the United States in June of 2001. Since its introduction, the The LAP-BAND® System has gained increasing popularity as a safe, effective, yet less invasive surgical weight-loss procedure. It provides effective, long-term weight loss, unlike conventional medical therapies, but without the risk associated with that of the Roux-en-Y gastric bypass.7

The LAP-BAND® System is an adjustable silicone band that when placed around the upper portion of the stomach, creates a very small gastric pouch. The pouch created subsequently holds less food thus causing the patient to feel full faster for longer periods of time. Unique features of the LAP-BAND® System are its adjustability and reversibility while also providing a decreased risk of morbidity, mortality and malnutrition. Systematic reviews have also shown comparable weight-loss of the LAP-BAND® System compared to the Roux-en-Y gastric bypass long term (fig. 2… see pdf version of article to view chart). Because of its safety and effectiveness, some authors have even begun recommending the Lap-Band System as the primary procedure of choice for morbid obesity and recommending the Roux-en-Y gastric bypass only in cases of unsuccessful or failed gastric banding.8 This would especially be true in those individuals potentially at higher risk, such as the elderly and adolescent population.

Regular follow-up in banded patients is critical however. Patients are typically seen every 4-6 weeks. As the patient loses weight, small adjustments to the band are periodically required to maintain the appropriate level of restriction. This typically necessitates that the patient be seen more frequently. Moreover, there is a slower initial weight loss associated with the LAPBAND ® System compared to the Roux-en-Y gastric bypass. These facts, however, do not detract from its overall benefits.

Because of its overall safety, and the fact that it is less invasive, the LAP-BAND® System procedure is well suited to be performed on an outpatient basis. As a result, ambulatory surgery centers specializing in bariatric surgery are becoming ever more popular and are springing up across the country. They have the benefit of offering services that are catered specifically to the obese patient including nutritional education, support groups and physical therapy. These services are instrumental in providing the morbidly obese patient with a comprehensive aftercare program that ultimately results in improved care and better long-term results, as far as weight-loss is concerned.

Hopefully, because of its several positive attributes, the LAP-BAND® System will potentially be able to overcome the community’s resistance to bariatric surgery. This along with the potential cost saving for outpatient services will ultimately lead to increased utilization by the community, as well as increased acceptance by commercial insurance carries.

REFERENCES

1. Prevalence of overweight and obesity among adults: United States 1999-
2. National Center for Health Statistics Web site. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/obese/obse99.htm.
3. The Practical Guide: identification, evaluation, and treatment of overweight and obesity in adults (NIH Publication Number: 00-4084). National Heart, Lung, and Blood Institute and the North American Association for the Study of Obesity. October 2000. Available at: http://www.nhlbi.nih.gov/guidelines/ obesity/practgde.htm.
4. Changes in co-morbidities and improvements in quality of life after LAPBAND placement. J.B. Dixon and P. E. O’Brien. The American Journal of Surgery 2002; 184: 51S–54S
5. The development of the surgical treatment of morbid obesity. M. Deitel and S. Shikora. Journal of the American College of Nutrition 2002; 21, Vol. 5: 365-371
6. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med 1991; 115:956–961.
7. Does establishing a bariatric surgery fellowship training program influence operative outcomes? R. Gonzales, L.G. Nelson, M.M. Murr. Surgical Endoscopy Jan 2007; 21: 109-114.
8. Laparoscopic adjustable gastric banding in the treatment of morbid obesity. P.E. O’Brien and J. B. Dixon. Archives of Surgery 2003; 138: 376-382.
9. Laparoscopic gastric banding as a universal method for the treatment of patients with morbid obesity. Korenkov M., Kneist W., Heintz A., Junginger Th., Obesity Surgery, 14, 2004; 1123-1127.

Matthew St. Laurent, MD is a native of Houston, Texas. He became interested in the field of Bariatric surgery while serving as Chief of Surgical Services for the 5th Medical Operations Group in the United States Air Force. He furthered his training in Laparoscopic Adjustable Gastric Banding and has performed over 1,200 Bariatric procedures. Dr. St. Laurent is one of the most experienced Bariatric surgeons in the Houston area and is currently a surgeon partner with Journey Lite of Houston. Journey Lite focuses on the special needs of obese patients in facilities designed to enhance the patient experience and provide quality outcomes in a nurturing, patient focused comprehensive program.

WLS Lifestyles - www.wlslifestyles.com - Copyright 2007

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