Penn Metabolic & Bariatric Surgery Program

Penn Metabolic & Bariatric Surgery Update

Wednesday, January 21, 2015

Weight-loss Surgery: Chris D'Elia Gets a Second Wind

For many people, having bariatric surgery has allowed them to do things they never could before, like run a 5K race, play with their grandchildren without getting winded or ride the roller coaster at a theme park.

For Chris D’Elia, bariatric surgery has allowed him to do something perhaps even more important – breathe.

Struggling with heart failure, D’Elia has been on oxygen for the past 10 years. “At my highest weight, I was 399 pounds,” he remembers. “ I couldn’t walk three blocks without being out of breath. I was depressed, I was sick much of the time and I felt defeated.”

D’Elia needed a wake-up call. A visit from his pastor while in the hospital proved to be just that.

“I was in the hospital with pneumonia, and he told me, ‘Chris, if you want to stay alive, go to any hospital. If you want to get better and live, go to Penn Medicine.’”

Coming to Penn

D’Elia took his pastor's advice, though he was not a stranger to Penn Medicine. He called his dermatologist, a Penn doctor, to get a recommendation for a cardiologist and pulmonologist for his care.

“Going to Penn was the best decision I’ve made,” says D’Elia. “Not only did my health improve dramatically, but Drs. Jessup and Patterson encouraged me to lose weight and were able to recommend me to Dr. Williams."

This time, D’Elia was determined to lose the weight and get better for good.

“I’d tried other weight-loss programs – even weight loss drugs – but nothing was ever long-lasting for me,” he says.

D’Elia completed all the pre-surgical requirements including tests and nutritional support.

“Knowing everyone was at Penn and on my team felt great,” says D’Elia. “I knew that my pulmonologist, cardiologist and bariatric surgeon were all on the same page and knew how to coordinate my care.”

D’Elia had a sleeve gastrectomy in January 2014.

After Bariatric Surgery

“I began eating totally differently, concentrating on lean proteins like fish, chicken and eggs,” says D’Elia. “I began walking more and more. That’s the exercise I love to do the most. I live in South Philly and walk everywhere. I walk about seven to eight miles a day!"

D’Elia began attending post-bariatric surgery support groups through Penn's program.

“I go to almost all of the support groups,” he says “We try to emphasize to the new people that you should come to as many as you can. I am still learning stuff that I didn’t know before. The support is wonderful."

Today, D’Elia is down more than 166 pounds since he started his weight-loss journey with Penn Bariatrics. And, amazingly, he’s off most of his oxygen.

“I only need two liters per minute now – almost 70 percent less than when I started my weight loss journey with Penn,” says D’Elia. “And, my doctors think I will probably be able to get off the oxygen tank completely.”

D’Elia continues to walk, eat well and attend support groups.

“I get so much support from the team at Penn, people in our support group, and my friends and family. It’s been an amazing experience for me, and I feel like a real success.”

Find out more about weight-loss surgery and sign up for an information session at Penn.

Tuesday, December 30, 2014

Real Resolutions that Stick

You know the drill. You make a resolution for the new year and swear that this year is going to be different.

You’re strong the first week – maybe even the first month. But by February or March, your visits to the gym are declining, and you aren’t tracking every bit of food that goes into your mouth.

“Many people make resolutions that involve losing weight, eating healthier or being more active,” says Dr. David Sarwer, Professor of Psychology and member of the Bariatric Surgery Program at the Hospital of the University of Pennsylvania. “This includes people who have undergone bariatric surgery. However, most people set those goals too high, and when they get back to their daily routines during the winter, it can be hard to find the time and effort to reach them. Smaller, reachable goals are the better way to go.”

We have a solution to your resolution. This year, instead of focusing on those giant goals, we want to help you take small steps toward your target with these tips.

Go to a support group

Weight-loss surgery isn’t a magic pill or a quick fix to lose a lot of weight. Ask anyone who has had bariatric surgery will tell you it's a lot of work.

Matt Kirkland, MD, FACS, bariatric surgeon at Penn, says that after bariatric surgery, ongoing support is important. Penn Bariatrics offers several support groups each month at different locations for those who have had bariatric surgery.

“I try to emphasize to people that if they don’t continue to do what they’re supposed to
do and incorporate what they learned pre-operatively, they can potentially regain their weight,” says Dr. Kirkland. “You can cheat on any of these operations. You may not enjoy that as much as it sounds like you might, but you can cheat on any of them. With all the resources available before and after surgery, you can be successful - but you need to work at it.

Eat heart-healthy foods to lower cholesterol

Did you know that most of the time there are no symptoms associated with elevated cholesterol? Serum cholesterol tends to increase with age, especially among women, who have reduced estrogen levels as they reach menopause. High cholesterol increases your risk for heart disease and heart attacks; however, because it's asymptomatic, it's difficult to monitor it.

Why don't you make a goal to be more conscious of the foods you're consuming and lower your cholesterol? Try eliminating trans fats and cholesterol and adding more vegetables and fiber. Focus on one thing at a time. Have your blood levels checked regularly by your health care provider to see what is working for you. Sometimes just concentrating on one number like cholesterol can lead to other healthier habits.

Start a walking program

Chiara finishing a race
Want to run a 5K this year? That’s a great goal, but it can be pretty daunting if you are just starting to work out. Instead, focus on starting a program that will get you to your goal.

Chiara Gravell, a three-year bariatric alumna who has maintained a 100+ weight loss, says to sign up for a race if that’s your goal, but be realistic.

“A program like ‘Couch to 5K’ is a good guide to help you get started,” she says. “If it takes you three weeks to complete Week One of the program, that's okay! Do as much as you can, and remember that whether you walk or run a 5K race, you’ve still completed the race.”

Schedule a health screening

One of the most important things you can do for your health is get regular screenings. No one ever feels like doing it, but it is a step on the way to a healthier lifestyle. The mammogram, for instance, remains the most important screening device in the detection of breast cancer, and it likely saves thousands of lives every year.

Beginning at the age of 40, all women should have an annual mammogram to check for breast cancer. Depending on a woman’s personal risk, a physician may recommend annual mammograms before the age of 40.

Develop a plan to stop smoking 

Quitting tobacco is a big resolution to keep, but it is the most important one if you currently smoke or use tobacco.

You know the risks of tobacco. You also know that you must quit smoking and be smoke-free for two months before you can undergo bariatric surgery. What you may not know is that there are more tools and techniques to help you quit smoking than ever before.

Instead of resolving to quit entirely, resolve to give Penn Medicine’s Comprehensive Smoking Cessation Program a call. Clinicians and staff in the program will help you by working with you to develop a quit plan, identify strategies that will work with your lifestyle and teach you about available medications to help you quit for good.

Go to a weight-loss information session at Penn

Losing weight is one of the biggest resolutions people make this time of year. It’s a great goal, but many people set themselves up for failure by going on crash diets or working out too much, too soon.

This year, resolve to make a plan to lose weight. Join us at a free information session about weight-loss surgery at Penn Medicine.

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

It’s a first step, to a healthier you this year.



Monday, December 22, 2014

Bariatric-Friendly Winter Recipes


It’s cold outside. And with cold weather, comes cravings for warmed-up dishes to share with family and friends. But those go-to recipes could use healthier makeovers.

“Many of our favorite winter comfort foods can be very high in fat and carbohydrates,” says Vincent Benchino, bariatric program coordinator at Pennsylvania Hospital. “It’s important to read nutrition labels and modify recipes if it is something we are making ourselves."

To help, we’ve compiled a list of our favorite recipes that will fill your home with cozy comfort and won’t break your calorie budget.

Chicken Escarole

There is nothing better than eating a bowl of hot soup on a chilly day. Soup can be incredibly healthy and nutritious when prepared the right way. This is a fool-proof recipe that uses colorful tomatoes, fat-free and low-sodium chicken broth, lean skinless chicken breast, and fiber-dense escarole.

Spinach Cheese Bake

Spinach and cheese is a great combination for recipes because it contains a lot of healthy vitamins and nutrients in one, comfort-rich recipe. This dish would be great on Christmas morning or New Year’s Day.

Beef Daube Provencal

A flavorful and hearty beef and vegetable stew is the perfect cold weather meal for a family or company dinner. Beef daube provencal is easy to prepare and can be cooked at a low temperature, in the oven or in a slow cooker.

Chicken Souvlaki with Tzatziki Sauce

Want to try cooking with Greek yogurt? Try this delicious, healthy and protein-packed dish. With 30 grams of protein per serving, you will be sure to fill up quickly—and stay that way.

Spicy Roasted Butternut and Apple Soup

Butternut squash has a sweet, nutty taste similar to that of a pumpkin. It is amazing roasted and blended into a soup. Squash contains approximately 60 calories per cup and is packed with fiber, potassium, vitamin A and vitamin C. Add cannellini beans to the soup to boost the protein content and enhance the flavor and texture even more.

This recipe is also great because it is incredibly simple to make and incorporates a beautiful balance of flavors between the cinnamon, cumin and cayenne pepper.

Chunky Vegetarian Chili

This quick, meatless chili is full of fiber and protein, low in fat, and delicious enough to please meat-lovers. Make this meal ahead of time and pack it in a thermos or microwave-safe dish for easy lunches during the week.



Friday, December 19, 2014

The Bariatric Patient's Holiday Survival Guide

For someone who is trying to lose weight, is preparing for bariatric surgery or has had bariatric surgery, the winter holidays can be one of the most challenging times of the year. Unlike other food-centric holidays like Halloween, Thanksgiving and Valentine’s Day, this one lasts for weeks. There are parties, potlucks, cookies and treats. With all of the gift buying, decorating, party-throwing and party-hopping, the stress and lack of time makes it a lot easier to give in to temptation and a lot harder to take the time to cook healthy meals for yourself and keep active.

For this reason, we wanted to offer some advice for how to stay healthy and still enjoy yourself during the season.

1. Stick to people who will keep you on track

There is strength in numbers. Enlist a buddy to be your personal cheerleader – or nagger, if necessary.

“A strong, supportive group of family members and friends can play an important role in long-term success after bariatric surgery,” says David Sarwer, PhD., professor of Psychology in the Psychiatry and Surgery departments at Penn and member of the Bariatric Surgery Program. “Ideally, you should surround yourself with people who will support your healthy eating and activity habits.”

You’re not the only one heading into the holidays with weight on your mind. Don’t be afraid to ask for help. You are always welcome to come to one of Penn Bariatric Surgery’s support groups or to reach out to your bariatrics care team.

2. Make a holiday wish list

Your friends and family may struggle with the right gift for you. They know you're going through a weight-loss journey; they will want to support your healthy goals and lifestyle, but they also need to be mindful of the challenges and emotions that you're naturally experiencing. If you're asked what you want for the holidays, request gifts that will be enjoyable as well as practical.

Are there any healthy restaurants you want to try? Or perhaps, you need a new cookbook? You know, there are actually specific cookbooks for bariatric surgery patients.

There are a ton of fun kitchen supplies in the market right now. Shaker bottles for protein shakes, juicers or blenders with a to-go cup, ice-pop makers, crock pots and vegetable steamers are all awesome.

There’s a good chance that your clothing size is changing or will change. Ask for a gift card to your favorite store. It’s easy for your friends to get, and you’ll be able to pick out exactly what you want – it’s a win-win.

3. Ask potential gift givers to avoid certain gifts

Foods with sugar are often a big part of the holidays, but sugar can negatively impact health and weight status. If you've had bariatric surgery, you know that your body can no longer accommodate large amounts of food, and you need to eat ones that are rich in protein and low in fat and sugar. It is completely okay to give your family and friends gift suggestions. You should tell them to skip candy, desserts, alcohol or holiday-specific food treats.

If someone ends up presenting you with an insensitive gift, such as a gym membership or item that hints strongly at more exercise, try not to take offense. Yes, it will probably feel annoying and belittling, especially from someone who hasn’t been there. Obviously you know that you need to be healthier and you’re working on it. Just try to keep in mind that this person cares about you and is trying to help. If it’s someone close to you, like a sister or best friend, you may want to address it directly and explain your feelings.

4. Pack your own treats

People who have a plan and keep their goals in mind are the ones who eventually attain them. When you know you have a dinner or party to attend, have a game plan. Volunteer to bring the vegetable platter or another healthy dish that you’ll enjoy eating. That way, you’ll have your own food options, you won’t feel out of place by not eating and you won’t give into temptations. Moreover, you’ll look thoughtful to your hosts.

If you work in an office where your coworkers are constantly bringing in their extra cookies or venders are sending in sweets, avoid the break room areas. Stock up on nutritious snacks and protein powders that you can whip out whenever you get a craving.

5. Keep a positive outlook

The holidays aren't just about food and presents. Try to enjoy the little moments – spending time with family and friends, fun activities, the beauty of all the lights.

We hope our suggestions will help lessen some of the stress. If you need any more information or support, please do not hesitate to reach out to your dietitian or program coordinator. From the entire Penn Metabolic and Bariatric Surgery program, we wish you the happiest of holidays.



Thursday, December 18, 2014

Fred Lost 235 Pounds with Penn Bariatrics

Last year, we interviewed Fred Jiminez, a weight-loss surgery patient at Penn who'd lost 70 pounds just one month after his sleeve gastrectomy. We caught up with Fred again to see how he is doing now.

For Fred Jiminez, a competitive weight lifter for three decades, eating right and exercising came naturally. He knew what to put into his body in order to achieve maximum strength and performance.

“I was extremely competitive,” he remembers. “I ate very healthy with a lot of protein and was dedicated to working out. I weighed 275 pounds, but I was all muscle.”

However, as time went on, Fred stopped eating well and working out. As a result, it became harder for him to do what he liked best: coaching.

“I was getting heavier and heavier,” he says. “It was hard to keep up with the girls I was coaching through my softball pitching clinic, and I began having health problems creep up like high blood pressure and sleep apnea.”

Fred tried every diet – Weight Watchers, The Cabbage Soup Diet, Atkins. He even mixed and matched diets to try to make them work for him, but nothing was effective long-term.

Then, Fred fell and couldn’t get back up.

“I lay on the ground, not able to get my 472-pound body up off the floor, and I thought long and hard about where my weight had led me and how I needed to reverse this cycle I was in.”

Fred knew he needed to make a change, but it wasn’t until he met Bruce Sachais, a Penn physician who had weight-loss surgery, that he decided to learn if weight-loss surgery was right for him.

“I met Bruce through the softball clinic, and I hadn’t seen him in a while. When I did see him, he’d lost so much weight I hardly recognized him. It was Bruce that really helped me take the first step,” says Fred.

Taking the First Step

Fred went to an information session at Penn Medicine, and after speaking with his surgeon, Noel Williams, MD, director of the Penn Metabolic & Bariatric Surgery Program, Fred was scheduled for a vertical sleeve gastrectomy.

“I felt like this was the right thing for me, but at the same time, I knew this was a tool and not a quick-fix strategy. For me, I needed to give myself a no-option way of life. I knew this surgery would change the way I would live forever.”

Fred began his weight-loss surgery journey by meeting with a team of physicians including cardiologists, pulmonologists and, of course, his bariatric surgeon, nurses, dietitians and psychologists.

“Everyone was amazing and made me feel like part of the team,” says Fred. “There were no surprises, and everyone was always on the same page. It was a great feeling knowing I was in their care.”

After Surgery

Fred had surgery in July 2013, and soon thereafter, began to see the weight come off – and his health come back.

“In the first month, I lost almost 70 pounds,” says Fred. “I completely changed the way I eat and look at food.”

Fred also was able to stop taking his blood pressure medication and start exercising again.

“I followed my team’s instructions to the tee, and the weight just was melting off,” says Fred. “Weight-loss surgery has changed my perspective on everything I eat. I used to have six eggs for breakfast every morning, and now I am totally satisfied with some yogurt or one egg. I never want to go back to the way I used to be.”

To date, Fred has lost 235 pounds.

He is no longer on medications and no longer needs his CPAP machine to sleep. Fred has started high intensity interval training (HIIT) and continues to lift weights at the gym. He even runs and has completed a 5k race.

For Fred, the weight loss journey has given him regained personal confidence in every part of his life.

“Weight loss has saved me from the embarrassment of asking for a table at a restaurant because a booth was not an option,” says Fred. “Weight loss has stopped me from only wearing sweatpants. I no longer wait in my car while my wife shops; I can do the shopping now. I can walk and run, and look in the mirror and truly love the man I'm looking at.”

Weight loss has also pushed Fred to look forward to the future and being a great grandfather.

“I have five grandchildren, and I want to see them have children,” says Fred. “I feel like I’ve already added 20 years to my life.”

Lose Weight at Penn Medicine

Penn can help you lose weight. Learn about Penn Bariatrics at a free information session.

Hear about weight-loss surgery options, and how Penn can help you lose weight and be healthier than you’ve ever been.




Friday, December 12, 2014

Before Bariatric Surgery: Laying Your Fears to Rest

While there are a lot of options out there for those struggling with obesity, bariatric surgery gives people the best opportunity to lose weight and keep it off. Nevertheless, having surgery is often a very tough, scary decision.

“I think most patients fear the uncertainty and what it will mean for them long-term,” says bariatric surgery Gary Korus, MD, FACS.

Some of you are probably afraid of undergoing something as serious as surgery. Some of you may wonder if you’re a candidate. Others come in with a lot of pressure from family and friends not to do it, which can present another challenge. You are finally reaching a decision to improve your own health – which is something you should be supported and congratulated for – but the people that you would hope for the greatest support from throw obstacles in your way.

Here are a few steps that you should take to make the best decision for you and gain the support you need.

1. Attend an information session

Being able to get good information about what to expect, what’s realistic, and what’s not realistic with regards to bariatric surgery is very important. Information sessions at Penn are free, and if you attend, you are by no means committing to having surgery. Plenty of people come and then decide it isn’t for them or schedule a consultation months down the road.

Information sessions are just a way for you to get a sense of all of your options, meet some of the Penn Medicine surgeons and staff, and see what bariatric surgery entails. Then if you decide to pursue surgery and come back, it’s easy.

“It’s easy to talk to those patients because they’ve taken the toughest step. Which is the first one to recognize that what they have tried hasn’t worked and that there is a better way,” says Dr. Korus.

2. Bring supporters and those who are doubtful to an information session

Family, children, friends – the more the merrier.

“The more people who know the process,” says Dr. Korus, “the more support that patients have individually and the greater chance there is for them to succeed.”

In fact, Dr. Korus says he often sees patients come to an information session with someone – a mother, spouse, brother, sister – and then that person ends up having surgery too.

“I’ve actually operated on five people who work together in one office. Every year this group goes on a vacation together. They sent me a picture of all five of them on a cruise together after surgery. So it’s like one person, then another, then another,” he says.

Even if your other family members don’t end up getting surgery too, it still affects the entire family. There’s strong evidence that the families of patients who have weight-loss surgery get healthier. There is a theme in the house about better eating, paying attention to nutrition, exercising and being more active.

“A couple of Saturdays ago, I went to Dr. Slattery’s Fitness Now,” recalls Dr. Korus. “It’s an activity for all patients – not just bariatric surgery ones. There was a couple there with all of their children, exercising, doing planks, walking. Dr. Slattery charges $1 a visit, and if you show up at each visit, you get your money back. Getting exercise to be part of the family’s culture can make a huge difference.”

3. Talk to a bariatric surgeon

Schedule a new patient appointment to get the opportunity to really talk to a bariatric surgeon. Try to be honest and genuine during the appointment. You want to get to know each other since he or she will be your partner in your weight-loss journey. You should tell your surgeon about your fears and your background, so you can get more personalized information to help in your decision. From there, you’ll be able to really compare the benefits with the risks.

And remember...

Weight-loss surgery is a lifelong commitment. It requires hard work from you, a lot of support from those around you and a strong, open relationship with your entire care team. But just thinking about and researching it is healthy: It means you're taking the opportunity to examine your life and wellbeing.

Thursday, November 20, 2014

Meet Gary Korus, MD, FACS, Surgeon at Penn Bariatrics

Gary Korus, MD, FACS, is a bariatric surgeon at Penn Medicine. Although he focuses in weight loss surgery, Dr. Korus also performs surgery on the upper gastrointestinal track (esophagus and stomach) for the treatment of reflux, heartburn, hernias, stomach tumors and ulcers. You can find him at Penn Presbyterian Medical Center, the Perelman Center for Advanced Medicine, Penn Medicine University City and Penn Medicine Bucks County.

We recently sat down with Dr. Korus to get the inside scoop on his role as a Penn bariatric surgeon and what it’s like for patients under his care. Here are the highlights of our conversation:

Why did you choose to be a bariatric surgeon?

I had been a general surgeon in practice for almost 10 years doing general surgery and trauma. The situation that I was in was changing, and weight loss surgery was an area that was growing and attracted me for several reasons. One reason in particular is that taking care of bariatric patients is a little different from taking care of general surgery patients. It really allows us to build a relationship with patients to see how they do, to follow them long-term. It’s different than what we do in a lot of areas of general surgery. If you come into the hospital with appendicitis, we take your appendix out, make sure you’re doing well, see you once or twice, and that’s it. But with bariatric surgery, it’s a progression. We help people through the process, understand everything that’s needed and then follow up with them. And we expect the follow up to be life-long.

What would you say to people who are nervous or might be on the fence about weight loss surgery?

The toughest step is the first one, which is to recognize that what you have tried hasn’t worked and that there is a better way. While there are a lot of options out there, at least right now, bariatric surgery gives people the best opportunity to lose weight and to keep it off.

Weight loss surgery isn’t the folklore that people have heard in the past or read about online. It’s important to come to an information session to get the real information about what to expect, what’s realistic and what’s not realistic. I tell patients, “You deserve to know.” You’re making a decision that’s going to be life changing; it’s important that you have all of the information, so you’re making an educated choice. Then, coming to a support group can mean even more to you because there you have an opportunity to talk to patients who have been through the process. One of the most common things I hear from patients after surgery is: “I wish I did it sooner.”

What’s it like for patients after weight loss surgery?

Before surgery, my patients may not have been able to walk five feet. Now, I’ll meet them on Kelly Drive when they’re out for a run in the morning with their new group. I have one patient who had the goal of doing the Broad Street Run. He told me that one year after surgery he walked it, and then the next year he ran it. Other patients have told me that the family went to Disney World, and they were able to go on the rides when last time they couldn’t. They didn’t have to ask for the seatbelt extender. On the airplane, they only had to pay for one seat.

Personal Favorites

Favorite healthy food?
Right now I’m on a Brussels sprouts kick. Just roasted. You know, little salt, little pepper, cut in half in, olive oil.

How do you exercise?
I run and bike, primarily. I’ve done five marathons, and my wife and I bike a lot. It’s become our vacation of choice to go on bike trips.

Best vacation?
They all are – as long as I’m with my wife and kids, it doesn’t matter where we are.

Favorite movie?
Maybe it’s the cycling theme – Breaking Away.

Meet Dr. Korus 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.

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