Penn Metabolic & Bariatric Surgery Program

Penn Metabolic & Bariatric Surgery Update

Monday, March 9, 2015

What a Registered Dietitian Can Do for You

Nutrition is an important part of the before and after weight-loss surgery process. But making changes to something as personal as what you eat can be a real challenge. That’s why at Penn Medicine, our registered dietitians work with and support you, so you can achieve and maintain your weight-loss goals.

The most qualified healthy eating advice

Colleen Tewksbury, RD
Registered dietitians (RDs) or registered dietitian nutritionists (RDNs) are the food and nutrition experts. All registered dietitians are nutritionists, but not all nutritionists are registered dietitians. RDs are the only nutrition professionals who are regulated by law and governed by an ethical code to ensure they provide the best care. Nutritionists, on the other hand, can work without providing any formal certification.

When RDs help you set diet goals, rest assured they actually know what they’re talking about.

“The RD at the end of our names lets you know the information you are getting has been proven, not our opinion,” says Bariatric Surgery program manager, Colleen Tewksbury, MPH, RD, LDN.

They have to earn a bachelor’s degree with course work approved through the Accreditation Council for Education in Nutrition and Dietetics (ACEND) accredited Didactic Program in Dietetics or Coordinated Program in Dietetics. They also must complete 1200 hours of a supervised practice program, or internship, that is accredited by ACEND and pass a national examination overseen by the Commission on Dietetic Registration.

Guidance for the long haul

When you first see your RD, the last thing you’ll get is a one-size-fits-all-diet. He or she gets to know your eating habits and behaviors to make a more tailored plan that will most effectively help you. Each visit builds on the last to keep the patient moving forward and strengthen the earlier learning’s.

“The weight loss surgery journey is a marathon, not a sprint. Life happens. We’re here to help you reach your diet and weight goals when it does,” says Colleen.

The weight loss surgery program fosters this ongoing support by making sure that we always have dietitians available during our clinic hours, as well accessible via phone, email and MyPennMedicine.

Personally tailored plan for your needs and condition

At Penn, our RDs specialize in different conditions and treatments, like obesity and bariatric surgery, so they can customize nutrition advice specifically to patients’ needs.

It’s easy to get overwhelmed by what you think you can’t eat and end up with a boring diet. RDs can help you take the foods you like and fit them into your new lifestyle.

The idea is that you can still eat foods you enjoy while being mindful of your overall health and accomplishing your goals. It has to be sustainable for patients to have long-term success. This goes for exercise as well as diet. You don’t want to get burnt out in the first few months and lose interest.

“Every person is different,” says Colleen. “Every person’s diet should be, too.”

Safe and creative strategies

RDs are actually required to stay up to date on the most current developments in food and nutrition science. Following successful completion of the registration exam, they must earn continuing education credits on a regular basis to complete a re-certification process. This process makes sure they increase their knowledge of the rapidly changing nutrition trends and stay on top of the latest nutritional research.

By working with someone you know is an expert, you get a weight-loss program that is safe and effective. Your RD can use creative ways to help with meal planning, grocery shopping and food journaling. They can help you make changes, so you can reach your weight loss goals.

Check out our Facebook page, where you can get more weight-loss tips. On Wednesday, March 11 from 12 to 1 p.m, Colleen Tewksbury will answer all your nutrition questions live in a Facebook chat on our page.

Monday, February 16, 2015

Lou's Story: Learning to Live Actively

Lou Schopfer is a married father of two who had bariatric surgery at Penn in July 2014. Since then, he has lost 110 pounds and has discovered new activities to keep fit, including a fitness program at Penn Medicine called Fitness Now. In this post, he shares his story and what has made his weight loss a success.

I grew up as the youngest of six kids, in a Christian home filled with the fundamental values of faith, family, fellowship, friends and fun.

Like other families, we had our share of ups and downs, and fitness was never a priority for us. We didn’t have a lot of funds to spend on activities or time discussing a healthy diet.

By the time I was born, my parents were older – they were actually grandparents. My dad didn’t play sports with me outside like he did with my older siblings and, partly as a result, I was much less active. As I grew older, I found myself settling into a sedentary lifestyle that added to weight gain. Rather than playing sports with my kids, I was more of a spectator. I never had enough energy to join them.

Due to my inactivity and unhealthy eating habits, I was heavy. I suffered from high blood pressure, high cholesterol, Type 2 diabetes and sleep apnea. I tried every diet and was in a constant cycle of losing and gaining weight. The quality of my life just started to decline.

One of the turning points for me was when I went to “back to school” night at my daughter’s high school. I couldn’t fit in a school desk and finally felt: I needed to do something.

Coming to Penn

My brother became very ill with cancer. During that time, we’d talk about my weight often. He told me to “live life like you’re dying.” I had thought about bariatric surgery, but it wasn’t until I went to an informational session in Cherry Hill that I seriously considered the procedure. At the time I was 363 pounds, and I knew I needed to something drastic to change my life.

That was August 28, 2013, and I decided to go through the medical weight management, not knowing if I would have the courage to go through the surgery. By going through the process and being fully prepared on what to expect, I found I did.

In July 2014, at 344 pounds, Dr. Schuricht performed my gastric sleeve procedure . And now, just six months later, I really believe I have a second chance at life. I am more than 100 pounds lighter. I am off all of my diabetes medications. I have ditched my cholesterol medications and significantly lowered the dosage for my blood pressure medications.

What Led to My Success

There are a lot of people and activities that really helped me get to where I am today. Having a surgeon like Dr. Schuricht has been a blessing. He is the best at what he does, and I highly recommend him.

In addition to my surgeon, I had the privilege of training with a personal trainer, Beth Marks, at a local facility in South Jersey. I also trained with Penn physician Dr. Sara Slattery, who ran a study on obese patients under Penn’s Fitness Now Program. Having these women train me in a safe place without mirrors and teach me everything from nutrition to monitoring the number of steps I take, has been pivotal to my success.

I attend monthly support meetings at Penn Medicine, swim four days a week at the local YMCA, take four exercise classes a week and power walk at least five days a week. I keep to a 1,000 calorie diet a day and continue to have the support of my beautiful wife, Jan, of 28 years and my great kids, Elizabeth and Matt.

I want people struggling with their weight to know that you don’t have to live like this. I hope my simple story helps and encourages you.

Tips from Me to You

Find a tool you like and use it. I use apps like “My Fitness Pal” and “Lose it.” All my meals are entered the day before, so I have a plan.

Get enough protein. I don’t eat many carbs, so I like to fill up on protein, which keeps me fuller, longer.

Know portion control. When we go out to eat, I might have half of the meal and take the rest home.

Get organized. At home, I have my own shelf in the pantry for “my” food. I know what I can eat, and it’s easier to make decisions.

Get support. I go to as many support meetings as I can at Penn Medicine. There, you can help others, and they can help you.

Color your plate. At mealtime, I load my plate up with greens first, then protein and whole grains.

Set goals. As a father, I want to be able to walk my daughter down the aisle at her wedding. My biggest goal is just to live a long, healthy life.

Try something new. I always wanted to take a ballet class. I was embarrassed at the thought because I knew I would be the only guy, but now I take a Pure Barre class and guess what? It’s difficult!

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.

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