Penn Metabolic & Bariatric Surgery Program

Penn Metabolic & Bariatric Surgery Update

Monday, November 23, 2015

Meet Dr. Ian Soriano, Surgeon at Penn Bariatrics

Ian S. Soriano, MD, FACS, FASMBS is a Clinical Assistant Professor at Penn Medicine, specializing in gastrointestinal (GI) and bariatric surgery. He sees patients at Penn Medicine Washington Square.

Though a recent addition to Penn, Dr. Soriano has been practicing bariatric surgery in the Philadelphia area since 2008. We had the chance to sit down and chat with him about his experiences.

Why did you choose to be a bariatric surgeon?

Dr. Soriano in 2005
I actually struggled with weight myself. I was almost two hundred pounds when I was in residency. I lost my weight through diet and exercise, but I know how hard it was and I wanted to make a difference for people who are struggling.

When I was in surgical training, bariatric surgery was relatively new. Open surgery was most common, and I saw a couple of significant issues with it; but then at the same time I started seeing advanced laparoscopic surgery and its benefits, so I sought out additional training for laparoscopic bariatric and gastrointestinal surgery, which I have been doing since 2007.

Also, over the past three years, I have applied the benefits of robotic surgery to my practice and currently offer the option of robotic sleeve and gastric bypass procedures to my patients.

What do you typically discuss with a patient during your first meeting?

When we first meet, besides asking the usual medical questions, I like finding out what their motivation is to have the surgery. It is a big motivator if they have something tangible to aim for at the end. It is a long process; it takes anywhere from three to six months to get through the process before you can actually have the surgery, so I like to remind them why they are doing it in the first place.

What advice would you give to a person considering weight-loss surgery?

Dr. Soriano running the 2012 Philadelphia Marathon:
He achieved his goal of finishing the marathon in under four hours.
The most important thing is not to make the decision to have the surgery until you’re fully dedicated to the process, because it’s not an easy journey. It requires a lot of hard work on the patient’s part, and we are here to guide them. The minute that they leave our office, everything is in their hands. So they need to be really dedicated to the process; everything else follows after that.

What makes bariatric surgery different from other areas of medicine?

After surgery, patients are entering a new phase of life that is a big change from where they were before. It really makes a difference in their over-all quality of life. They’re gaining back lost years of life. Many patients celebrate the day of surgery as a second birthday, similar to undergoing organ transplant surgery for some patients.

We also follow our patients for as long as possible  – unlike most general surgery patients who are only seen for a couple of visits after surgery – so we really get to know them.

What else is important to know post-surgery?

The people who are successful are usually the ones who make time for follow-up. As for the patients who struggle, I wish they would come in and call more often. This happens because they are struggling with the weight loss after surgery. They feel like they’re failing and don’t want to disappoint their surgeon – so they don’t call and don’t follow up. The reality is it would actually benefit them so much more to call or reach out, and they should feel comfortable doing so.

What makes the Bariatric Surgery program at Penn Medicine different?

The Penn Metabolic and Bariatric Program has an amazing team of passionate and dedicated surgeons, physicians, nurses, dietitians and psychologists who are leaders in their field, as well as an excellent support staff from Penn Medicine who supports the program exceedingly well. It provides the necessary tools, both for physicians and patients to be successful. There are a lot of support groups and resources both online and off-line available for patients. Physicians are easily reachable.

With Penn Bariatrics, you get the expert care from surgeons who are the best in their field, but you don’t feel like you’re lost within a huge system because the surgeons are locally based at the hospital where you see them – giving you a cozy, personal experience. I think that’s important in bariatric surgery because patients need support and guidance.

I’ve stayed in the Philadelphia area because I love the city and I love taking care of the people here  – it feels like home.

Meet Dr. Soriano and the Penn Bariatric Surgery Team

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

Thursday, October 29, 2015

Shawn’s Story: Why I Chose Weight-Loss Surgery

Shawn Truppo lost 137 pounds with bariatric surgery. Here, he shares his struggles with weight loss and what he learned from his experience.

My name is Shawn Truppo. I am 32 years old, a Social Studies teacher in Trenton, NJ and married with a two and a half-year old and an eight-month old.

Shawn with his wife before bariatric surgery
I spent my 20s on the seesaw of weight loss and gain. I tried both the fad diets and tried-and- true methods, all with the same results. I would go to the gym every day for six months, lose 50 pounds and then gain back 55. Adkins for eight months: drop 45 pounds, gain back 50. Weight Watchers: 50 down, 50 up. Every few years the gain and loss would repeat, but the trend line remained the same: Every two years, the scale would push 10 pounds higher.

Between college and my 30th birthday I went from a top weight of 230 to 285. It wasn’t until my son turned one and my wife and I had a second child on the way that I finally decided I needed to change for good. That brought me to the Penn Bariatrics Program.

I chose Penn because of their reputation for excellence and the thoroughness of their program. Other possibilities I researched did not have the same the rigorous testing and pre-surgery guidelines as Penn. While it seemed like endless hoops to jump through beforehand, I firmly believe it was the preparation before bariatric surgery that made this a successful journey for me.

I began to diet two weeks before surgery, which coincidentally was the day after Thanksgiving – my goodbye kiss to gluttony. The Friday after Thanksgiving I weighed in and was shaken to find myself heavier than ever, at 302 lbs.

December 10, 2014 was surgery day. People ask me all the time, “Were you scared?” I can honestly answer that I was not. I was far more scared of the fact that in my immediate family there were a collective three heart attacks, two bypass surgeries and a half-dozen stents, and I was much heavier than any of them ever were.

My surgery went perfectly, and I was awake and carefully walking within four hours; however, the next weeks and months brought even better results.

In six months to the day, June 10, 2015, I reached the end of my weight loss journey: coming in at 165 pounds. I had lost 137 pounds. My 2XL clothes all went in the donation boxes, and I now am able to fit into mediums. My pants went from a 44 to a 30, jackets from 52 to 40, and I am off cholesterol medication for the first time in seven years.

Shawn today
I managed to do this by following every word of advice from the Penn team. I treated this time as if it was my last chance to change, as it probably was. I watched my calories, ate protein and even began running. I will never claim that it was easy, but it was just easy enough that someone that had failed all his life to be healthy was finally successful.

Weight-loss surgery is not for everyone. It is an incredibly personal decision that only you can make for yourself. Although they have all changed their tune now, there was not a single member of my family that supported my decision to have this surgery. Their opinions ranged from “just don’t give up when you diet” to “you’re way too young to do that.” Nevertheless, I knew myself, and I knew what I needed. I don’t have a single regret and would encourage anyone to learn about the program for themselves.

If you're interested in learning more about weight-loss surgery at Penn, sign up for an information session.

Monday, October 26, 2015

Halloween Treats that Won't Scare Your Stomach

Maria Kotwicki, registered dietitian with Penn Bariatrics, shares her favorite healthy Halloween recipes for you and your family.

With candy everywhere you look, it can be a challenge to stay on track during Halloween. However, eating healthy doesn’t mean missing out on fun, festive treats. These delicious snacks will make your Halloween a howling success.

Spooky Spider Deviled Eggs

Serves 12


6 hard-cooked eggs, peeled
3 tbsp low-fat mayonnaise
½ tsp ground mustard
1/8 tsp salt
1/8 tsp pepper
Whole black olives, to turn the eggs into spiders


  1. Cut eggs lengthwise in half. Slip out yolks and mash with fork.
  2. Stir in mayonnaise, mustard, salt and pepper. Fill whites with egg yolk mixture, heaping it lightly. Cover and refrigerate up to 24 hours
Per Serving: 83 calories; 5 grams total fat; 6 grams of protein; 1 gram of carbohydrates

Monster Mouths 

Serves: 2


2 green apples
4 Tbsp peanut butter
Handful of almond slivers


  1. Cut apple into quarters; remove core. Cut each quarter into 4 slices.
  2. Spread 1/2 teaspoon peanut butter on one side of each apple slice.
  3. Insert almond slivers, extending slightly over peel of slice, for teeth.
  4. Top each with remaining apple slice, peanut butter side down, to make smiling mouth.
Per Serving: 165 calories; 5 grams total fat; 4 grams of protein; 25 grams of carbohydrates

Pumpkin Mousse

Serves 4


2 small packages of instant sugar-free vanilla pudding
2 cups of fat-free milk
1/2 teaspoon pumpkin spice such as cinnamon, nutmeg, etc.
15-ounce can of pumpkin
8 ounces of fat-free Cool Whip


  1. Make pudding first with the 2 cups of skim milk.
  2. Fold in the rest of the ingredients - spice, pureed pumpkin and Cool Whip.
  3. Serve!
Per serving: 100 calories; 5 grams total fat; 2 grams of protein; 13 grams of carbohydrates

These recipes are a great alternative to sugary candy and snacks. We hope you enjoy them at your next Halloween party.

Tuesday, October 20, 2015

Tricks for Avoiding the Treats this Halloween

Maria Kotwicki is a registered dietitian with the Penn Metabolic and Bariatric Surgery program. Here, she shares tips for a healthy Halloween.

Don’t be tricked by Halloween treats that try to disrupt your healthy habits. Although Halloween is often centered on sweets and candy, there are plenty of ways to make it more nutritious. Below are tips to help you navigate this holiday with confidence and pride.

10 Tips for a Healthy Halloween

  1. Manage your hunger. Pre-planned meals and snacks are a great way to keep you feeling satisfied and less likely to raid the candy bowl.

  2. Buy treats you do not like. If you prefer chocolate, buy gummies to decrease temptation. Also, try not to buy treats too early. The longer they are sitting around the house the more tempting they may be.

  3. Who says you have to give out candy? Consider fun alternatives, such as glow sticks, Halloween pencils, stickers, temporary tattoos, crayons or bubbles.

  4. Get moving. Get some exercise by making this Halloween a fun family event. Turn it into a workout by aiming to visit a certain number of houses or seeing who can climb the most stairs. Be sure to wear comfortable walking shoes!

  5. Focus on your favorite fall activities. There are plenty of fun fall activities that you can do in October that do not involve sweets.  Apple picking, hayrides, costume parades, pumpkin picking and carving Jack-O-Lanterns are activities the entire family can enjoy.

  6. Out of sight, out of mind. If you have candy sitting around your house after Halloween, stash it in the freezer.  Allow your children to eat a few pieces at a time.  Having the candy in the freezer makes it less accessible for everyone and will help with proper portion control.

  7. Save the date. Set a date for declaring your home free of Halloween candy. This is the day all of the Halloween candy will be removed from the house.

  8. Celebrate with support. If you’re pre- or post-weight-loss surgery at Penn Medicine, you can join us at an upcoming support group. The group can provide the extra support you need from others who are going through the same thing you are.

  9. Keep a positive perspective. If you make a mistake, stay positive. Weight loss and maintenance is a long‐term effort and one day will not make or break your weight-loss goal.

  10. Host a healthy Halloween party. Invite your friends and host a party with treats that you provide. Try out a new healthy recipe and enjoy the company of family and friends.
I hope you have a happy and healthy Halloween!

If you want to learn more about weight-loss surgery and its results, sign up for a free informational session.

Wednesday, October 7, 2015

Meet Ginger Strano, RD, Program Coordinator with Penn Bariatrics

Ginger Strano, RD
Ginger Strano, RD, LDN, is the bariatric surgery program coordinator at Penn Presbyterian Medical Center. As the program coordinator and a clinical dietitian, Ginger works closely with patients before and after weight-loss surgery to ensure they navigate smoothly through the process of preparing for bariatric surgery. Her clinical care experience, combined with her background in nutrition, make her a great addition to our Bariatrics team.

We sat down for a question-and-answer with Ginger to learn more about her and the program.

Can you tell us a little more about your role?

I’ve always enjoyed helping people, and this is a way I can do that. For many of our patients, bariatric surgery offers them a brand new life where they can do things they used to do or offer the ability to try new things they’ve always wanted. As the program coordinator, I work closely with our bariatric team to make sure our patients accomplish their goals & requirements needed to prepare for surgery. Nutrition is an important part of the before and after weight loss surgery process. Helping people make changes to something as personal as what you eat is challenging & rewarding.

What first drew you to the Penn Bariatric Surgery program?

One of the things I really love about Bariatrics is its kind of niche; At Penn, we offer individualized coaching & support, customized to each patient’s needs. We offer compassionate support every step of the way — before, during and after bariatric surgery

It’s gratifying to see people change their lives for the better and become healthy – I love when our patients visit and tell us all the wonderful things they’re able to do since losing weight. They are thrilled to be able to play with their grandkids or take them to the zoo. A patient will call me and say, "I don't believe this, I was able to tie my shoes today, or I walked around home depot without having to sit down, or, "I could get on a plane without using the extender seat belt." There's a lot of what I call "non-scale victories" that mean so much to people. It's not always just about the scale. I’m so fortunate to be a part of the team that helps change lives for the better.

What are the most common questions patients ask you?

“Will I be able to eat my favorite foods after surgery?”

It’s easy to get overwhelmed by what you think you can and can’t eat after surgery. I help patients choose foods they like and make them fit into their new lifestyle, while being mindful of bariatric guidelines and overall health.

What key piece of advice would you give to patients?

Take tiny bites, chew thoroughly, and eat slowly. It’s the best advice because if you do that, you can eat just about anything without problems.

Additionally, you have to exercise. Incorporating some type of physical activity, every day, for at least 60 minutes is the key to success.

What do you think sets the Penn Bariatrics program apart?

We have a team of highly experienced and dedicated healthcare professionals providing the safest, most successful bariatric surgery experience possible.

Personal Favorites

Favorite food?

I love avocado, watermelon and chocolate… It's all about moderation.

How do you exercise?

I enjoy Pilates. I also walk my dogs every day.

Any special hobbies?

My husband and I enjoy boating and making wine. I’m also a huge NASCAR fan.

Meet Ginger and the Penn Bariatric Surgery Team

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

Monday, September 21, 2015

Fasting After Bariatric Surgery

After bariatric surgery your digestive tract is physically different and can no longer accommodate large amounts of food. However, it’s just as bad for you to consume no food.

You know that after bariatric surgery, it’s critical to have an adequate intake of fluids and nutrients. Because of the quick weight loss, you need to make sure you get all of the nutrients, vitamins and minerals you need to recover.

People who observe a fast, whether for religious or lifestyle reasons, face several challenges.

Your new eating and drinking habits are being established. Since you can’t consume large amounts in one sitting, you should be sipping fluids throughout the day. A complete fast can put you at risk for dehydration and poor calorie and nutrient intake. Additionally, an inadequate intake of protein can reduce lean body mass and metabolic rate.

Fasting for long periods of time could result in vomiting, compounding dehydration and poor nutritional intake. Foods that are usually eaten at the end of a religious fast are sweets, carbohydrates and fats that can also put you at risk for dumping syndrome and steatorrhoea (excess fat in feces caused by fat malabsorption). Sounds pleasant, right?

Moreover, the small amount of volume in the stomach may make it difficult to fit the proper amount of food, nutritional supplements and medications at meal times after a fast.

We recommend that you avoid the fast and stick to foods that are high in protein and low in fats and sugars. Protein is great because it builds tissue and regulates various bodily processes necessary for good health. You also don’t need to eat as large an amount to feel full.

If you have any questions about fasting or your diet, contact your doctor, nurse practitioner or bariatric dietitian.

If you want to learn more about weight-loss surgery and its results, sign up for a free informational session.

Monday, September 14, 2015

Back to School, Back to Basics

Nicole Giguere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers bariatric-friendly lunch recipes to keep both you and your kids on track.

Now that school has started, many of my bariatric patients have expressed that they are ready to “get back on track” after enjoying the summer. An easy way to start heading in the right direction is to start packing your lunch along with your kids’.

Preparing meals and snacks is a great way to stay focused so that you are not tempted to purchase unhealthy foods. Here are some recipe suggestions for quick and easy make-ahead lunches.

Low-Carb Tuna Melts

  • 2 thick slices of tomato
  • 1 can tuna packed in water, water drained
  • Low-fat mayo (optional- Dijon mustard)
  • 2 thin slices of low-fat cheddar cheese (or any other cheese you like!)

Prepare tuna salad by mixing one can of tuna with either mayo, Dijon mustard, or a combination of the two. Use only enough mayo/Dijon to form the tuna into a salad.

Lay the tomato slices on an aluminum foil covered baking sheet.

Place one to two ounces of prepared tuna salad on each tomato slice, then top each with a slice of low-fat cheddar cheese.

Place under the broiler in the oven, or toast in a toaster oven until cheese melts.

Serve warm, or pack and reheat in the microwave at a later time.

Egg Salad with Cucumber Chips

  • 2 hard-boiled eggs, shells removed
  • Low-fat mayo
  • Dijon mustard
  • Salt and pepper
  • Optional - fresh chives or parsley
  • Cucumbers, sliced in ¼ slices

To prepare egg salad, chop hard boiled eggs and mix together with equal parts low-fat mayo and mustard. Only use enough mayo/mustard to create a salad. If desired, mix in chopped chives or parsley. Add salt and pepper to taste.

Serve egg salad on cucumber slices.

Making roll-ups are a quick and easy way to get in both protein and veggies. Roll-ups are a bariatric-friendly way to capture the flavors of your favorite sandwiches without the excessive carbohydrates! Here are a few of my favorites.

Turkey Hoagie Roll-ups

  • Lettuce leaves, such as Romaine Bibb, Boston, or other leaf lettuce, washed and dried
  • Low-sodium, low-fat deli turkey
  • Low-fat deli American cheese
  • Dried Oregano
  • Red wine vinegar
  • Optional - thin slices of tomato and/or red onion

Lay 1 lettuce leaf on a clean counter or cutting board. Top with one to two slices of turkey and one slice of American cheese. If desired, lay one to two thin tomato slices and thinly sliced red onion on top.

Sprinkle oregano over the top and add a few drops of red wine vinegar.

Roll lettuce leaf tightly, making sure to roll in all of the toppings.

Roast Beef Roll-ups with Low-fat Horseradish Sauce

Ingredients for roll-ups
  • Roast beef deli slices
  • Low-fat cheddar cheese
  • Baby spinach
  • Roasted red pepper
Ingredients for low-fat horseradish sauce
  • Grated horseradish
  • Plain Greek yogurt
  • Salt and pepper

Lay one slice of roast beef on a clean counter or cutting board, then top with one slice of low-fat cheddar cheese. Place roughly five baby spinach leaves in the center and top with one to two thin slices of roasted red pepper. Roll roast beef up tightly making sure to pack in the spinach leaves and roasted red pepper.

To make the low-fat horseradish sauce, mix one-fourth cup Greek yogurt with enough grated horseradish to meet your liking. Add salt and pepper to taste.

Cuban Roll-ups

  • Low-fat deli ham
  • Low-fat Swiss cheese
  • Pickle spear
  • Yellow mustard

Lay one slice of ham on a clean counter or cutting board, then top with one slice of low-fat Swiss cheese. Spread a thin layer of yellow mustard over the cheese. Roll meat and cheese slices around one pickle spear to create the roll-up.

I hope these recipes help to get you back on track! Remember, deli meats and cheese can be very high in sodium so purchase low-sodium options when they are available. You can also use thin slices of home-cooked meats to lower the sodium intake.

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