Penn Metabolic & Bariatric Surgery Program

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Wednesday, February 24, 2016

Grains 101

Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, gives a guide to grains, so you can understand the benefits and best ways to eat them.

Consuming whole grains can be a surprising way to boost your daily protein intake. With the common mindset of “carbs are bad,” many people try to avoid them at all costs. Yes, whole grains do contain carbohydrates, but many whole grains contain more protein than one would think. The chart below gives an example of how much protein is provided in various grains.

Whole grains are not just a good source of protein. They contain other healthy nutrients such as B vitamins, vitamin E, minerals, healthy fats, and antioxidants. Experiment with a grain you haven’t used before with one of the recipes below.

Peanut Butter Banana Quinoa Breakfast Bowl


  • ¼ cup dry quinoa
  • ¼ cup milk (or non-dairy milk)
  • ½ very ripe banana – mashed 
  • 1 Tbsp peanut butter
  • ½ tsp vanilla extract
  • ¼ tsp cinnamon
  • Optional toppings: sliced banana, walnuts, unsweetened coconut shreds


1. Cook quinoa according to package directions. Once quinoa is finished cooking, keep the burner on low heat and mix in milk, mashed banana, peanut butter, vanilla extract and cinnamon.

2. Pour into a bowl to serve. Top with desired toppings.

Warm Farro Salad


  • 1 cup dry farro
  • 1 medium butternut squash, pealed, seeds removed, and cubed
  • 2-3 large kale leaves
  • 1 small apple, diced
  • 3-4 radishes, sliced thin
  • ¼ cup extra virgin olive oil
  • 2 Tbsp apple cider vinegar
  • 1 Tbsp Dijon mustard
  • ½ Tbsp Honey
  • Salt and pepper


1. Preheat oven to 400 degrees. Toss butternut squash cubes lightly with olive oil, salt, and pepper. Arrange on a baking sheet and bake for 25 to 35 minutes until tender.

2. While squash is baking, prepare farro according to package directions.

3. In a large bowl, whisk together olive oil, apple cider vinegar, Dijon mustard, honey, salt, and pepper in a small bowl. Tear up bite sized pieces of kale and place in the bowl. Using your hands, gently massage dressing into kale leaves.

4. Once butternut squash and farro are finished cooking, toss them in the bowl with the dressed kale.
To finish, toss in diced apple and radish slices. Serve warm.

Easy Wheat Berry Chili


  • 1 lb. ground turkey
  • 1 medium yellow onion
  • 1 pepper (any color)
  • 1 Tbsp. olive oil
  • 1 cup cooked wheatberries
  • 1 (14.5 ounce) can of beans, liquid drained
  • 1 (28 ounce) can crushed tomatoes
  • 1 (14.5 ounce) can diced tomatoes
  • 1 Tbsp chili powder
  • 2 tsp garlic powder
  • 2 tsp cumin
  • Salt and pepper
  • Optional toppings: fat free sour cream, low fat shredded cheese


1. Heat a large pot over medium heat and add olive oil. Dice onion and pepper, then sauté with olive oil until onion is translucent. Next, add ground turkey and heat until cooked through.

2. Add wheatberries, beans, crushed and diced tomatoes, and spices. Mix thoroughly and heat until warmed through. Add salt and pepper to taste and adjust seasonings accordingly.

3. Serve with a dollop of fat free sour cream or low fat cheese.

Remember to always look for real whole grains. This means that in the ingredient list you should see the word “whole” written before the grain. Some examples are “whole grain brown rice” or “whole rolled oats.” If the word “pearled” is used, this means that the outer layer of the whole grain is brushed off, which takes away some of the nutritional value. Words such as “enriched” or “fortified” do not mean the product is a whole grain. Look for the word “whole” to ensure you are getting the healthiest grains out there!

Learn more about weight-loss options at a free information session.

Thursday, December 10, 2015

Recipe Hacks Using Cauliflower

Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers some simple switches you can make with cauliflower to change your favorite food into a healthy meal or snack.

Cauliflower is one of the more popular ingredients in cooking these days. It is packed with fiber, vitamin C and K, and only weighs in at 29 calories per cup. This cancer-fighting veggie can be used to transform some favorite dishes into bariatric-friendly recipes.

Alfredo Sauce


  • Medium head of cauliflower (about 4 cups)
  • 4 Garlic cloves
  • 1 yellow onion
  • 1 tbsp. olive oil or butter
  • ½ cup Parmesan cheese
  • ½ cup vegetable or chicken broth
  • ½ cup skim or 1 percent milk
  • Salt and pepper
  • Optional: Parsley


  1. Chop cauliflower into medium sized pieces.  Place cauliflower pieces in a microwave safe bowl and cover with either plastic wrap or a plate.  Microwave on high for 8-10 minutes until cauliflower is tender enough to be easily poked with a fork. 
  2. Place a sauté pan over medium-low heat and add oil or butter.  Dice the onion, mince the garlic and add both to the preheated sauté pan.  Cook the onion and garlic, stirring frequently, until onion is translucent. 
  3. Place microwaved cauliflower and sautéed onion and garlic mixture into a food processor or blender.  Add vegetable or chicken broth, milk, and parmesan cheese, and then blend until smooth. 
  4. Add salt and pepper to your liking, and then stir in parsley if desired. 

Cauliflower Shrimp Fried Rice


  • 1 head of cauliflower
  • 1 pound shrimp (small to medium in size, thawed and deshelled)
  • 1 tbsp. Sesame oil (or olive or canola oil)
  • 3 garlic cloves
  • 1 onion, diced
  • ½ cup thinly sliced carrots
  • ½ cup frozen peas
  • 2 eggs, beaten 
  • 3 tbsp. low sodium soy sauce


  1. Chop cauliflower in medium sized chunks and place into food processer. Process cauliflower until it resembles rice, making sure to not over process. 
  2. Heat a wok or skillet over medium-high heat and add sesame oil. Add garlic, onion, carrots, and peas and sauté until tender.  
  3. Pour beaten eggs into pan and scramble until cooked, mixing with the vegetables. 
  4. Next, add shrimp and cook until pink.
  5. Add cauliflower “rice” to pan, and then drizzle soy sauce over mixture. Cook for another three to five minutes until cauliflower is tender. Serve immediately. 

Cauliflower Tots


  • 1 head cauliflower
  • 1 egg
  • ½ low fat shredded mozzarella cheese
  • ¼ cup yellow onion, small diced
  • ¼ cup whole wheat Italian breadcrumbs


  1. Preheat oven to 375 degrees.
  2. Chop cauliflower into small chunks. Place cauliflower in a microwave safe bowl and microwave on high for 8 to 10 minutes until tender. 
  3. Place cauliflower in a food processor and pulse until it resembles grains of rice. Make sure to not over process. 
  4. Dump cauliflower into bowl and mix in egg, cheese, diced onion, and breadcrumbs. Mix with clean hands until combined. 
  5. Place parchment paper on a baking sheet. Form mixture into tater-tot shaped pieces with hands and place on baking sheet.  
  6. Bake at 375 degrees for 15 minutes; then flip over and bake for another 15 minutes. 
  7. Serve warm with low sugar ketchup or marinara sauce.

Universal Cauliflower Crust

Use this to make pizza, breadsticks or Stromboli.


  • 1 head of cauliflower
  • 1 large egg
  • ¾ cup shredded low fat mozzarella cheese
  • 1 tbsp. Italian seasoning
  • 1 tsp. pepper
  • Cooking spray


  1. Chop cauliflower into medium sized chunks. Add to food processor and pulse until cauliflower resembles grains of rice.  
  2. Place cauliflower into a baking dish and bake at 375 degrees for 20 minutes. 
  3. Allow cauliflower to cool, and then dump cauliflower onto a dish towel. Wrap the towel around the cauliflower to form a ball and then squeeze the liquid out.  Repeat this until the cauliflower does not release any more liquid. 
  4. Increase oven to 450 degrees. 
  5. Place dry cauliflower into a bowl and mix with egg, cheese, Italian seasoning, and pepper until combined. 
  6. Line a baking sheet with parchment paper.  Fold cauliflower mixture onto baking sheet and form into a large rectangle shape with your hands, making sure to pat down the mixture as you go.  Spray a thin layer of cooking spray over the top of the crust.
  7. Bake crust at 450 degrees for about 20 minutes. 
  8. Take crust out of the oven and top with the required ingredients to make your dish:
    • Pizza: Top with pizza sauce, low fat cheese, and toppings of your choice, then bake for another 5 to 10 minutes until cheese is melted. 
    • Breadsticks: Top with low fat cheese and bake another 5 to 10 minutes until cheese is melted. Slice into breadstick shapes and serve with marinara dipping sauce. 
    • Stromboli: Top with desired Stromboli ingredients- marinara sauce, vegetables, meats, and cheeses. Starting at either of the longer sides of the crust, use the parchment paper to help you gently roll the crust up forming a long Stromboli. Spray the top of the Stromboli with cooking spray, the bake for another 10 to 25 minutes to heat through. Slice Stromboli log into half-inch-thick pieces. Serve with your favorite marinara sauce for dipping. 

I hope you can incorporate these warm dishes into your diet during the upcoming winter months. Please let me know how you like them!

If you'd like us to help you lose weight, sign up for an information session.

Friday, December 4, 2015

Festive Fare for the Holiday Season

Becky Pollack Golen, dietetic intern at Penn Bariatrics, offers some creative recipes to add to your holiday table.

The holidays are quickly approaching. Spend this time enjoying the company of your loved ones and celebrating the season. Take some time for self-care, and while you’re at it, discover a few delicious (and healthy!) holiday food recipes.

Zucchini Squash Stuffing Adapted from Hungry Girl

Serves 5


  • 6 slices light bread 
  • 1 cup chopped onion
  • 1 cup chopped celery
  • 1/2 cup chopped yellow zucchini squash
  • 1/2 cup chopped mushrooms
  • 1 cup fat-free chicken or vegetable broth, room temperature
  • 1/4 cup fat-free liquid egg substitute (can be Egg Beaters)
  • 1 tbsp light whipped butter or light buttery spread 
  • 2 cloves garlic, finely chopped
  • Salt, pepper, rosemary and thyme to taste


  1. Leave bread uncovered at room temperature for one to two nights until it begins to stale. You may also lightly toast the bread instead.
  2. Preheat oven to 350 degrees.
  3. Cut bread into half-inch cubes. Spray a medium baking dish with nonstick spray, and place bread cubes evenly along the bottom of the dish.
  4. In a medium pot, combine broth, celery, zucchini squash and onion. Cook for eight minutes over medium heat.
  5. Remove pot from heat, add mushrooms and garlic. Season mixture with salt, pepper, rosemary and thyme. Let cool for several minutes.
  6. Add egg substitute and butter to veggie/broth mixture and stir. Pour mixture into the baking pan, evenly covering bread cubes. Mix gently with a fork. Bread cubes should be moist, not saturated (if necessary, add one to two tablespoons of water; then mix again).
  7. Cover with foil, and cook dish in oven for 20 minutes.
  8. Remove foil, and fluff and rearrange stuffing. Return dish to oven (uncovered), and cook for 15 more minutes.

Per Serving:

89 calories, 1.5 g fat, 17 carbs, 4 g fiber, 4g sugar, 5 g protein

Note: This may cause discomfort for some patients following weight loss surgery due to expansion.

Buttery Brussels Sprouts Adapted from Fitness Magazine

Serves 6


  • 1 1/2 pounds Brussels sprouts, trimmed and halved lengthwise
  • Salt
  • 1 1/2 tablespoon unsalted butter
  • 3/4 teaspoon fresh lemon juice
  • Salt to taste


  1. Bring a large pot of salted water to a boil. Add the Brussels sprouts and boil about five minutes. Drain well and transfer to a serving bowl.
  2. In a small saucepan, melt the butter over medium heat.
  3. Pour butter over Brussels sprouts, add pinch of salt and serve.

Per Serving: 

73 calories, 6 g total fat, 2 g sat. fat, 10 g carb., 4 g fiber, 4 g protein

Warm Fruit Crumble - Adapted from Hungry Girl 

Serves 6


  • Fruit Fusion
  • 3 apples, peeled, cored and thinly sliced
  • 3 peaches, peeled, and thinly sliced
  • 1 tbsp. lemon juice
  • 1 cup cranberries
  • 1/3 cup granulated white sugar
  • 1 tbsp cornstarch
  • 1/2 tsp. cinnamon
  • Dash of salt


  • 1/2 cup lightly crushed fiber cereal (Fiber One Original bran cereal recommended)
  • 1/4 cup old-fashioned oats
  • 2 tbsp. brown sugar (not packed)
  • 2 tbsp. light whipped butter or buttery spread (Brummel & Brown recommended), room temperature
  • 1 tsp cinnamon
  • 1/8 tsp salt


  1. Preheat oven to 350 degrees. Spray 8” x 8” baking pan with non-stick spray and set aside.
  2. Put apple and peach slices in large bowl and toss to coat with lemon juice. Add remaining ingredients for fruit mixture. Toss until mixed thoroughly. Transfer to baking pan, and cover pan with aluminum foil.
  3. Bake in oven for 30 minutes, or until fruit mixture has softened. (Leave oven on after removing the pan.)
  4. Meanwhile, in another bowl, combine all topping ingredients and stir until well mixed and crumbly. Set aside.
  5. Once fruit mixture has softened, remove foil from pan carefully and mix well. Smooth surface with the back of a spoon or spatula. Sprinkle topping over the fruit mixture.
  6. Return pan to oven and bake uncovered about 15 minutes, or until top is slightly crisp.
  7. Let cool and enjoy!

Per Serving: 

123 calories, 1.5 g fat, 1 g protein, 30 g carbs, 4.5 g fiber, 19.5 g sugar

We hope you'll put these recipes to use, and enjoy some good food this holiday season. Happy holidays from all of us at Penn Bariatrics!

Monday, November 23, 2015

Meet Dr. Ian Soriano, Surgeon at Penn Bariatrics

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

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

Why did you choose to be a bariatric surgeon?

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

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

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

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

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

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

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

What makes bariatric surgery different from other areas of medicine?

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

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

What else is important to know post-surgery?

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

What makes the Bariatric Surgery program at Penn Medicine different?

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

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

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

Meet Dr. Soriano and the Penn Bariatric Surgery Team

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

Thursday, October 29, 2015

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

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

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

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

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

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

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

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

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

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

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

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

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

Monday, October 26, 2015

Halloween Treats that Won't Scare Your Stomach

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

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

Spooky Spider Deviled Eggs

Serves 12


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


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

Monster Mouths 

Serves: 2


2 green apples
4 Tbsp peanut butter
Handful of almond slivers


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

Pumpkin Mousse

Serves 4


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


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

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

Tuesday, October 20, 2015

Tricks for Avoiding the Treats this Halloween

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

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

10 Tips for a Healthy Halloween

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

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

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

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

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

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

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

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

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

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

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