Penn Metabolic & Bariatric Surgery Program

Penn Metabolic & Bariatric Surgery Update

Monday, August 24, 2015

Alcohol Intake After Bariatric Surgery

Samantha Stavola, RD, LDN
Samantha Stavola is a registered dietitian with the Penn Metabolic and Bariatric Surgery program. In this article, Sam gives information and recommendations for drinking alcohol after bariatric surgery.

Alcohol consumption after surgery is one of our most frequently discussed topics with patients.

Generally, it’s recommended to avoid alcohol for six months after bariatric surgery, whether you have undergone the sleeve gastrectomy or roux-en-y procedure.

When you undergo bariatric surgery, the large fundus, or reservoir, portion of the stomach has either been totally bypassed or removed from the rest of the GI tract.  Because of this, alcohol enters the body more rapidly for processing, which can increase your risk of developing alcohol poisoning.

How one drink affected your body before surgery now is equal to three to four drinks after surgery.

Alcohol consumption can also increase your risk of developing a stomach ulcer by eroding the lining of your stomach wall, which left untreated, can lead to an internal bleed.

After the initial six months, you may choose to drink alcohol. We recommend only doing so on special occasions and in small amounts. Remember that the intoxicating effects of alcohol occur a lot sooner than before surgery, and alcohol can slow down weight loss.

If you do drink, consider drink options that are lower in sugar content and avoid mixed cocktails with juices or soda and added sugars. Those contain minimal nutrients, promote hunger and can cause blood sugar spikes.

If you have any questions about alcohol intake 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.

Thursday, August 13, 2015

Healthy Picnic Ideas

Nicole Giguere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers her favorite healthy foods to bring on a picnic.

Nothing says summer like a picnic in the park or at the beach! There are easy ways to make your favorite packed lunches a little more bariatric friendly. Try some of the suggestions below the next time you have lunch on the go.

Bean Dips

Everyone loves an easy appetizer! Bring hummus or a low fat bean dip with a mix of raw veggies for dipping.

Low-Calorie Breads

Make a high protein sandwich on low calorie bread. When in the bread aisle look for 100 calorie bread thins. These usually look like a round, flat roll for only 100 calories! Make sure to add a lean source of protein, such a chicken or turkey, and a few veggies to make an easy and healthy sandwich.

Low-Carb “Pasta” Salad

Pasta salad is usually a crowd favorite at picnics. Try replacing the pasta with zucchini noodles in your favorite pasta salad recipe. Zucchini noodles can be made with a commercial vegetable noodle maker or by using a veggie peeler or mandolin to make thin strips of zucchini to act as noodles.

Antipasto Platter

Bringing an antipasto platter makes any picnic seem a little more exotic! Pack small take-along containers with lower sodium / lower fat meats and cheeses along with grilled vegetables of choice, such as roasted red peppers, grilled zucchini, or grilled eggplant. Top with balsamic vinegar or pile your favorites in a lettuce wrap for a low-carb Italian sandwich.

Rotisserie Chicken

Packing a rotisserie chicken is an easy way to make sure you have a lean protein at your picnic. Add rotisserie chicken to a mixed veggie salad or on your low calorie bread or in a lettuce wrap for an easy sandwich.

The best part of a picnic is that you can either pack food from home or purchase foods out. Whichever you choose, make sure to incorporate lean proteins and plenty of vegetables to ensure a healthy meal wherever you are.

Want to lose weight?
Register for a free information session.

Thursday, August 6, 2015

Kidney Stones After Bariatric Surgery

Samantha Warner-Grimsley
Samantha Warner-Grimsley, RN, BSN, CBN, works as a clinical nurse for Penn bariatric surgery patients. Since many patients worry about developing kidney stones after surgery, she explains what makes kidney stones form, symptoms and ways to prevent them.

After bariatric surgery, patients have an increased risk for kidney stones.

Research shows that gastric bypass patients have changes in urine and higher levels of particles, called oxalates, which form kidney stones. You see, the gastrointestinal (GI) tract naturally absorbs oxalate. However, once the GI tract is altered during surgery, higher levels of oxalate can occur in the urinary tract. The oxalate can form crystals, which may lead to the formation of kidney stones.

Symptoms of kidney stones include:
  • Back pain 
  • Blood in the urine
  • Nausea or vomiting
  • Fever and chills
  • Urine with a bad smell
  • Cloudy urine
If you have symptoms of a kidney stone, contact your doctor or nurse practitioner. You may be asked to drink extra fluid to flush out the stone in the urine, and then strain your urine so that a stone can be sent to a lab for testing.

There are ways to prevent kidney stones from forming.

1. Drink lots of water. 

You’ve probably heard again and again from your dietician that you need to consume water throughout the day to help your body function, keep up with physical activity and keep the hunger at bay. In addition, proper hydration helps the body get rid of waste and keeps digestion on track.

2. Limit oxalate-containing food. 

Foods that contain oxalates include beets, spinach, rhubarb, strawberries, nuts, chocolate, tea, wheat bran and dry beans.

3. Reduce sodium intake. 

Reduce the amount of salt you eat, as well as red meat. Too much sodium can trigger kidney stones because it causes you to get dehydrated, and the minerals will crystalize when there is not enough fluid in the body to dilute them. It also may raise the level of calcium in your urine.

Because the GI tract will absorb less calcium (in addition to oxalate), a lot of people believe that a build-up could lead to kidney stones. In actuality, kidney stones have no relationship to calcium; the oxalate is really the problem. You need calcium in your diet, so make sure you keep taking your calcium supplements as directed.

If you have any questions about kidney stones 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.

Thursday, July 30, 2015

High Protein Recipe Remakes

Nicole Guiere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers some creative ways to swap the fat and carbs for protein in your favorite foods.

Many of the foods we love tend to be higher in fat and carbohydrates. Making some simple switches can change any food into a bariatric-friendly, high-protein meal or snack. Try some of the suggestions below to increase your protein intake while still enjoying your favorite foods.

High-Protein, Low-Fat Ranch Dressing

There are two ways to whip up an easy, lower fat version of ranch dressing.
  1. Look in the dressing aisle of your grocery store for a powdered ranch seasoning pack. Slowly add seasoning to a plain Greek yogurt until your desired flavor. Use as a dip for veggies, or thin out with low fat milk to create a creamy ranch dressing for salads.
  2. Dried ranch packages contain a lot of salt. If you are watching your sodium intake, try making your own dried ranch mix with equal parts dried parsley, dried dill weed, dried chives, dried onion flakes or powder, garlic powder, and a little salt and pepper to taste. Add your dry mix to Greek yogurt for dip, or thin out with low fat milk if desired. 

High-Protein Cheese Taco Shells

Ditch your high carbohydrate tortillas and try these delicious cheese taco shells instead!

Preheat the oven to 375 degrees. Line a baking sheet with parchment paper and place three slices of provolone cheese on baking sheet, making sure they don't touch. Bake for 10 minutes until golden brown. Take out of the oven and immediately form into taco shells. Here are a couple ways to do this: 
  1. Pull parchment paper off baking sheet. Fold parchment paper around cheese to form taco shells, and then peel the shell from the parchment paper and let it cool. 
  2. Using a flat spatula, lift cheese and place over something to form shells, such as wooden spoon handles or the tall sides of a baking pan covered with foil. 
Once cooled, stuff your taco shells with lean proteins and lots of veggies. Your taco shells do contain fat, so make sure not to add extra fats inside the shell.

High-Protein Cheesecake Bites

It’s hard to be at a summer barbecue and not be tempted by cool, refreshing treats at the dessert table. Offer to bring this high protein dessert to your next summer gathering so that you can enjoy something sweet without the guilt.
  • 2 cups low fat cottage cheese
  • ¼ cup fat free cream cheese
  • 1 scoop vanilla protein powder
  • 3oz box of sugar-free lemon gelatin dissolved in ½ cup boiling water 
Blend all ingredients in a food processor or blender until very smooth. Pour into a mini muffin tin lined with cupcake liners and place in refrigerator until set. Top with fruit, low sugar fruit jam or preserves, or with fat-free whipped cream.

Increasing the protein content in foods can be as easy as adding a scoop of unflavored protein powder to your recipe.  How do you add protein to your meals?  Try experimenting with your favorite dishes, and let me know how it goes!

Want to lose weight?

Monday, July 20, 2015

Healthy Food Options While Traveling

Nicole Giguere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers her favorite healthy snacks to bring or buy during your travels.

During summer vacation, there can be many temptations that make it harder to stick to the bariatric diet. One way to stay on track is to prepare for your trip with healthy snacks. Below are some bariatric-friendly snacks that can be pre-packed or purchased at the airport or gas station during your travels.

100-Calorie Nut Packs

Nuts are loaded with healthy fats, protein and fiber to keep you fuller for longer. Though nuts are good for us, they are a high calorie food. Purchase pre-portioned packs or portion out nuts in small baggies to prevent overeating.

Homemade Trail Mix

Making your own trail mix helps to control the sugar content, which may be higher in pre-packaged trail mixes. Try mixing your favorite nuts and seeds with a few dark chocolate morsels or dried fruit for a sweet mix. You can also try adding spices such as cinnamon, nutmeg, or even cayenne pepper to mix up the flavor of your trail mix.

Beef or Turkey Jerky

Though beef jerky and turkey jerky are loaded with protein, it also contains a lot of salt (also called sodium) to help preserve the meat. Be sure to stick to small portions of jerky and to drink plenty of water and eat fresh fruits and vegetable to balance out the salt content.

High Protein Chips

If you really need something crunchy to munch on during your trip there are a few brands of bariatric friendly chips to try. The best places to purchase these high protein low carbohydrate chips are either online or at your local vitamin and supplement shop. Try searching “bariatric chips” on the internet to find the brand and flavor that suits you best!

Individual Peanut Butter Packets with Whole Wheat Crackers

Individual peanut butter or other nut butter packets are an easy way to stick to proper portion sizes. Pair with whole wheat crackers for a quick easy snack.

Other Great Snacks

Packing a cooler for your trip? Here are some high protein snacks that are best refrigerated.
  • Protein shakes
  • Fresh fruit
  • Cheese sticks
  • Low fat cheese and crackers
  • Low fat yogurt
Remember, going on vacation does not mean giving up on your diet! Packing ahead of time ensures that you are prepared for whatever eating challenges arise. Continue to choose healthy options wherever you go and enjoy your vacation this summer.

Tuesday, July 14, 2015

Meet Dr. Joshua Fosnot, Plastic Surgeon for Weight-Loss Patients

Dr. Joshua Fosnot
For many patients, plastic surgery and body contouring are topics of conversations, following bariatric surgery. To learn more about the process, we caught up with Joshua Fosnot, MD, board-certified plastic surgeon at Penn.

Can you tell us a bit about body contouring surgery?

Body contouring is a category of procedures (including abdominoplasty, breast lift, arm lift, thigh lift) that can be performed on patients not just from an aesthetic prospective, but also massive weight loss patients who have a lot of excess skin, and sometimes there's fat that’s still there.

I tell patients it's all a trade-off. With body contouring, you improve upon the contour and excess that they have in certain areas, in exchange for long scars. All of the procedures involve pretty long incisions.

Who is a candidate?

Body contouring is an option for many people. {The case} doesn’t necessarily have to just be a massive weight loss patient. Massive weight loss patients, in general, are good candidates for it because of the nature of how we lose weight. When you have a significant weight loss, you lose the fat, but the skin doesn’t recoil the way an 18 year old's would if they were to have gained and loss weight.

How long after weight loss should patients start thinking about body contouring?

Since bariatric patients generally continue to lose weight for a full year after the procedure, I like to see patients when their weight has been stable for about six months. So, if they’re still losing weight after a year, then maybe a year and a half after their surgery is an appropriate time to start thinking about these things. We also have to make sure they're healthy, from a medical and nutritional stand point. Since this is an elective procedure, we want to try to optimize their results by having them in the best shape that they can be in.

What should patients expect after body contouring surgery?

First, the thing about the body contouring consult that can be challenging is sorting out who is a good candidate for surgery. Not everyone that comes in the door is a great candidate for different reasons.

Second, is financial coverage. Most patients don’t realize that insurance is not going to cover body contouring; it’s actually probably a minority of procedures that we’re able to get covered by insurance.

Third, all procedures involve pretty long incisions, so the recovery period can be long.

What's the best part of this job?

These patients can be some of the happiest patients I’ve had in plastic surgery. They’re very grateful. And that’s one of the reasons why I do this work. Because the patients are very happy with the results.

Meet Dr. Fosnot 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, July 2, 2015

Summer Grilling with Weight Loss in Mind

Nicole Giguere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers her favorite grilled dishes for bariatric patients.

The summer is known for backyard barbecues and cook-outs with friends and family. There are ways to enjoy the grill this summer without jeopardizing your waistline. Try some of the grilling suggestions below to keep you on track during the grilling months.

Preparing Summer Vegetables

Grilling vegetables is easy!

Prepare veggies by cutting them in large enough slices, so they won't fall through the cracks on your grill. Season with salt and pepper, and lightly brush with olive oil or spritz with oil spray. Then place the veggies on a hot grill and cook until vegetables are tender, flipping once. Try using kabob skewers to keep smaller vegetables or onions in place.

Foil Fish Packet

Here's how to prepare a healthy fish and veggie dish with easy clean up: Place a piece of fish and your favorite vegetables in the center of a piece of foil about 20 inches long. Top with fresh herbs, lemon juice, a little salt and pepper, and a drizzle of olive oil. Fold up the edges of the foil to form a pouch, making sure it is completely sealed. Place the foil packet on a hot grill, away from the direct flame. Close the grill and cook for 10 to 15 minutes until fish is opaque and flakes easily with a fork. The cook time may be longer depending on the thickness of the fish.

Summer Kabobs

Kabobs are a quick way to ensure a high protein/low calorie meal. Mix and match your favorite proteins with vegetables or fruit to create a healthy grilled meal. Try some of these combinations during your next cook-out.

Pineapple Shrimp Skewers

Alternate shrimp, cherry tomatoes and pineapple chunks on a skewer. Grill until the shrimp it cooked through. Then mix lime juice, chopped cilantro and a little bit of honey together in a small bowl. Brush the cooked skewers with lime sauce before serving.

Chicken Cheesesteak Kabob

Skew thinly sliced chicken breast or chicken breast chunks along with your favorite cheesesteak toppings, such as peppers, onion or mushrooms. Grill the skewers until the chicken is cooked through and the veggies are tender. Top with a light sprinkling of low fat shredded cheese before serving. 

Grilled Fruit Dessert Skewers

Grilling fruit brings out their natural sweetness. Try making skewers of strawberries, peaches, watermelon, grapes or bananas. Grill the skewers until the fruit has softened and grill marks form. Pair with your favorite low sugar Greek yogurt for a high protein/high fiber dessert.


I hope these ideas help you add tons of flavor, without the fat, to your barbecues. Have a happy and healthy Fourth of July!

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