Penn Metabolic & Bariatric Surgery Program

Penn Metabolic & Bariatric Surgery Update

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!

Tuesday, June 30, 2015

Meet Renee Bearman, MSN, CRNP with Penn Bariatrics

Renee Bearman
Renee Bearman, MSN, CRNP is not new to Penn Medicine. She's been at Penn Presbyterian Medical Center for about 10 years and has worked in many facets of patient care. She started her career working with Dr. Korus in the OR and is now back to working with him in bariatric surgery. You can find Renee all over Penn Medicine: at Penn Presbyterian Medical Center, the Perelman Center for Advanced Medicine, Penn Medicine University City and Penn Medicine Bucks County.

What sets the Penn Bariatric Surgery program apart?

The education we provide our patients sets the program apart. One of our roles as providers is to educate, and I think we do a very good job in making sure our patients are prepared. The information sessions that we hold offer a very good explanation of the three procedures and the expectations of those procedures. By preparing our patients before we actually see them in the office, they have a chance to process the information. They come in with the understanding that weight loss is a lifelong commitment, that bariatric surgery is not a quick fix and that different variables come into play depending on which procedure they do.

You’ve been seeing bariatric patients for 10 years. Have you noticed a difference in how much patients know about bariatric surgery or the Penn program?

I think that there is much more awareness now simply because so many people have had the surgery. Almost everybody who comes in can reference a friend, a neighbor, a coworker or even a celebrity who has been through this. A lot of people use those individuals as their support group, which is great.

Once a patient has gone through the information session, what's your first meeting like?

Most people are anxious and excited and scared. A lot of people say that attending the information session is the hardest step. Then some people feel that the first appointment can be overwhelming. It lasts anywhere from two to three hours. They meet everyone on the team. They're asked a lot of questions, some of them personal. We go back to the very beginning, asking things like, "When do you first remember being overweight?" For many people, it was being picked on during their childhood.

What’s your advice for patients?

Just showing up is a big deal! Literally half the battle is showing up and taking ownership of the situation. It shows us a lot: That you're committed and that you're willing to take the "downs" and can turn them around.

Also, if you gain a pound or two pounds, that does not mean don't come back. If you need to quit smoking and you haven't, that doesn't mean don't show up again. We have the resources as a program and as a health system to get you any type of help and support that you want or need. We're here for you.

What do you like best about your job?

Patients go through this process, anywhere from three to six to 12 months, and I'm actually with them the entire time. The best part of this job is on Mondays when a patient who is one year out comes in, and the sticker says "at goal weight." I walk in and the patient is smiling and happy. They tell me that they do Zumba and take their kids to the park. That's the best part of this job: When somebody gets their life back.

Personal Favorites

Favorite healthy food?

My favorite food is cheese.

How do you exercise?

I actually am a huge fan of kettle bells; my basement is full of them.

Favorite music?

I love jazzy blues. New Orleans music is actually my favorite.

Meet Renee 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, June 22, 2015

Summer Salads for Bariatric Surgery Patients

Nicole Giguere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers her favorite summer-inspired salads for before and after weight-loss surgery.

Salads are a great way to add fresh fruits and veggies into your mealtimes. Eating fiber is important for maintaining healthy bowel function and also helps to keep you fuller for longer. Plus, the antioxdiants in fruits and vegetables help to fight cancer-causing free radicals. Choosing high protein ingredients to top your salad creates a well-balanced summertime meal.

Try one of these summer-inspired salad recipes when you are looking for a fresh, healthy summertime meal.

Salmon Strawberry and Feta

Makes 1-2 servings


2 strawberries
1 Tbsp feta cheese
8 walnuts
3oz salmon
1 cup baby spinach


1 Tbsp balsamic vinegar


  1. Bake or grill salmon until cooked through. 
  2. Slice strawberries. 
  3. Mix sliced strawberries, feta cheese, walnuts, and baby spinach together with balsamic vinegar. Top with cooked salmon and enjoy!

Nutrition Facts*

317 calories
20g fat
8.3g carbohydrates
26.6g protein

Taco Salad

Makes 1-2 servings


2 ounces shredded chicken (made from chicken breast)
2 Tbsp black beans
2 Tbsp sweet corn kernels
1 Tbsp low fat shredded cheddar or Monterey Jack cheese
1 cup shredded Romaine lettuce
¼ avocado, mashed with garlic powder, salt and pepper
2 Tbsp salsa
2 Tbsp fat-free sour cream
1 lime wedge (optional)


  1. Boil chicken breast in water until cook through. Cool, then shred chicken either with two forks (insert fork prongs with backs facing each other, then gently pull forks away from each other creating long, shredded pieces) or by using your fingers. 
  2. Place avocado in a bowl and mash together with garlic powder, salt, and pepper to create a quick guacamole. 
  3. Top shredded romaine lettuce with shredded chicken, black beans, corn, low fat cheese, mashed avocado, salsa, and fat free sour cream. If desired, squeeze lime wedge over salad before eating. Enjoy!

Nutrition Facts*

295 calories
15g fat
17.7g carbohydrates
20.5g protein

Mango Shrimp Salad

Makes 1-2 servings


¼ mango, diced
¼ avocado, sliced
1 cup spring mix
6 large Shrimp
2 Tbsp edamame
3 cherry tomatoes, halved
1 tsp red onion, chopped


1 Tbsp lemon juice
1 tsp extra virgin olive oil
½ Tbsp cilantro, chopped
Salt and pepper


  1. Sautee, bake, boil, or grill shrimp until no longer pink. 
  2. If using frozen edemame, defrost or cook using package instructions. 
  3. Top spring mix with cooked shrimp, mango, avocado, edamame, cherry tomatoes, and red onion.
  4. To make dressing whisk lemon juice, extra virgin olive oil and cilantro together, adding salt and pepper to taste. Pour dressing on top of salad and enjoy. 

Nutrition Facts*

256 calories
14.4 g fat
21.2g carbohydrates
14.8g protein

*Nutrition facts are for one prepared salad using all ingredients listed. All nutrition facts are approximate.

Let Penn Medicine help you lose weight.
Register for a free information session.

Thursday, June 18, 2015

Meet Nicole Giguere, MA, RD, LDN, Clinical Dietitian with Penn Bariatrics

Nicole Giguere
Nicole Giguere, MA, RD, LDN is a clinical and bariatric dietitian at Pennsylvania Hospital. As a bariatric dietitian, she sees patients through every step of the process: pre-surgery, post-surgery and follow ups. She does nutrition counseling (medical weight management) for patients, which helps them get ready for surgery and for all their life changes after surgery.

We sat down with Nicole to learn more about her role in the program and with patients. Here are the highlights of our conversation.

What’s the process when a patient first meets you?

At our first meeting, patients get a binder that has information on nutrition for the whole bariatric surgery journey. I go over that and teach them about what to expect after surgery. Then we start to make small changes because they see me for three to six months before surgery. We try to tweak their diet and get them on the right path before they actually go in to surgery.

What's your favorite part about your job?

I like that I get to see people throughout the whole process. I love the counseling aspect and being there, helping people. And of course seeing their success. That's the best part. You're working with them so closely and then to see all of this weight comes off. They're usually happier, more upbeat and just so excited that they did this. It’s such a good feeling that you get to be part of that with them.

What tips do you have for keeping off the weight and weight loss?

Exercise is key for a lot of people – it’s important to keep moving. Before surgery it's hard for a lot of people to exercise because of their weight, but after surgery, as people start to lose more, it seems like it's easier for them to move around. We’re not asking them to run a marathon or anything – just to get up and start moving. If your knees hurt, then you can move your upper body – whatever you can do to get your heart beating a little faster is great. It's a good way of making sure you're burning extra calories.

What do you think sets Penn apart?

I love our program! Not to sound cheesy, but I really do. Some patients have started at other hospitals and then they've switched over because other programs aren’t as involved or comprehensive. At Penn, we have a huge Bariatrics binder with bunch of different resources. I think we have a lot to offer everybody, and we're super involved. Our program truly has the whole Penn Medicine system supporting the patients, clinicians and staff.

Personal Favorites

Favorite healthy food?

I have too many! I love avocados on whole grain toast. I love eggs too. I can eat them any way; they're delicious. And they're a perfect source of protein – really good for Bariatric patients.

How do you exercise?

I do P90X 3, and I really love it. That's what works for me. Whatever exercise people do is great.

Where is your happy place?

I like to be out and about! I'm from the beach and am a beach girl. Whenever I can dunk in the ocean, that's my favorite thing to do.

Hidden talent?

I used to make jewelry. Haven't done it that much in a while, but yeah, one of my hidden talents.

Meet Nicole 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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