Providing Support, Education and Advocacy for People with Obesity

Rebecca Dilks, RD, LDN, research coordinator at the Center for Weight and Eating Disorders and member of the Penn Metabolic and Bariatric Surgery team, explains the mission of and Penn's involvement with the Obesity Action Coalition.

Obesity is a disease and its patients require support, education and access to treatment. Several members of the Penn Metabolic and Bariatric Surgery team had the privilege of learning about expanding access to obesity treatment, ending weight bias and preventing obesity through education, awareness and advocacy at the 28th annual meeting of the American Society for Metabolic and Bariatric Surgery, the largest bariatric society in the world.

At the annual meeting, we learned about the Obesity Action Coalition's (OAC) website, magazine, newsletter, support groups and other methods being used to increase education about obesity, including a "Walk from Obesity." It was clear to us that the OAC offers a unique opportunity for bariatric health care providers and patients to team up and improve the lives of people affected by obesity. In fact, we were so impressed by the OAC that several members of the Penn Metabolic and Bariatric Surgery Program joined the coalition.

A major focus of the OAC is advocating for widespread recognition of obesity as a disease. Patients can be denied access to important medical treatments, including medically managed weight loss or bariatric surgery, because insurance companies do not recognize obesity as a disease. The OAC wants to change this by encouraging patients and providers to contact elected officials, legislators and employers and emphasize the importance of treating obesity as a disease. They also provide guidance for those seeking insurance coverage for bariatric surgery.

With tools provided by the OAC, people affected by obesity can help eliminate the negative stigma and encourage key decision makers to recognize obesity as the medical disease that it is.

We encourage you to consider joining the OAC as part of your bariatric surgery experience with the Penn Metabolic and Bariatric Surgery Program.

For more information about the Obesity Action Coalition, visit the website.

- Rebecca Dilks, RD, LDN

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Hearty and Healthy: Huevos Rancheros with Zucchini and Green Pepper

Take advantage of the delicious, abundant summer vegetables to create a meal hearty enough for a hardworking rancher and healthy and tasty enough for you. With lots of vegetables, protein-packed eggs and melted cheese, this recipe makes an energizing breakfast, brunch or even dinner. To top it off, it has only 250 calories! So, head to the garden, farmers market or grocery store to pick up summer vegetables while they last and add this southwestern staple to your upcoming menu plan.



Ingredients:

• 1 teaspoon olive oil
• Cooking spray
• 1 1/2 cups diced zucchini
• 1/2 cup diced green bell pepper
• 1/4 cup water
• 1/4 teaspoon salt
• 1/4 teaspoon ground cumin
• 1/8 teaspoon freshly ground black pepper
• 1 (10-ounce) can diced tomatoes with green chiles, undrained
• 4 (6-inch) corn tortillas
• 4 large eggs
• 1/3 cup (1 1/4 ounces) pre-shredded, reduced-fat cheddar cheese
• 2 teaspoons chopped fresh cilantro

Preparation:

1. Heat oil in a large nonstick skillet coated with cooking spray over medium-high heat. Add zucchini and bell pepper. Sauté for six minutes or until lightly browned. Add water and next four ingredients (water through tomatoes). Stir to combine. Cover and simmer for three minutes.
   
   
2. Warm tortillas according to package directions.
3. Break one egg into a small custard cup. Slip egg onto tomato mixture. Repeat procedure with remaining eggs. Cover and simmer for three minutes or until eggs are done. Sprinkle with cheese. Cover and cook for 30 seconds or until cheese melts.
4. Place one tortilla on each of four plates. Spoon one egg and 3/4 cup tomato mixture onto each tortilla. Sprinkle with 1/2 teaspoon cilantro.
   
   

Nutritional Information:

Amount per serving

• Calories: 248
• Calories from fat: 31%
• Fat: 8.5g
• Saturated fat: 2.1g
• Monounsaturated fat: 2.9g
• Polyunsaturated fat: 0.9g
• Protein: 13.2g
• Carbohydrate: 31.5g
• Fiber: 4.1g
• Cholesterol: 214mg
• Iron: 2.6mg
• Sodium: 679mg
• Calcium: 155mg

The recipe is courtesy of Jean Kressy, Cooking Light (May 2003).

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Tips for bringing your diet on vacation

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, offers tips for maintaining your post-surgical diet during your vacation.



Following the recommended post-operative diet after bariatric surgery is always a challenge, but it is especially difficult when traveling. By planning ahead, you can maintain good eating habits and continue to meet your nutritional goals – even on vacation.



If you are traveling by car, here are tips for healthy eating on the road:

• Pack plenty of water. If you are traveling by car, pack an insulated cooler filled with water, sugar-free beverages and protein drinks.
• Bring high-protein foods. Light yogurt, cheese, cottage cheese singles, hard-cooked eggs and individual packets of tuna or lean deli meats can be kept in the insulated cooler with ice packs or frozen water bottles to keep them cool.
• Always keep healthy snacks on-hand. Protein bars, nuts and soy crisps are easy, nutritional snack choices that also are high in protein. Fresh fruit, light fruit cups, vegetable medleys and cherry tomatoes make excellent are also great choices.
• Read the nutrition facts. Before making any purchases on the road, use the nutrition label to guide your selection and portion size to make sure you stay on track with your diet. Highway rest stops carry a variety of calorie-free beverages, but their healthy snack options are often much more limited.
• Stick to plain or simply prepared foods. When purchasing meals on the road, simple is usually best. If you have any questions about sugar content, ingredients or method of preparation, ask the restaurant for clarification. Many restaurants have brochures with nutrition information available upon request.
  
  
• Find a nearby grocery store. Once you reach your final destination find a local grocery where you can replenish your beverages and diet essentials.
• Request an in-room refrigerator. It it easier to eat healthy if you have a place to keep your healthy beverages and snacks. Also, take advantage of the complimentary ice machine to fill your beverage container or cooler when you pack up to leave.
  
  

If you are traveling by plane, here are tips for healthy eating in the air:

• Buy a calorie-free beverage after you are through the security checkpoint. The Transportation Security Administration (TSA) requires that all carry-on liquids fit inside a 3.4-ounce or smaller container that is stored in a quart-sized, clear, plastic, zip-top bag. Each passenger is limited to one zip-top bag of liquids. Purchase calorie-free beverages to bring on the flight after you have been cleared by security.
• Pack protein powder in your carry-on bag. Dense foods items like peanut butter and sugar-free preserves should be packed in your checked luggage, but carry a quick protein fix in your carry-on. Just remember to leave time for any additional screening.
• Order special in-flight meals in advance. Many airlines offer meal accommodations for passengers with specific dietary needs on long or international flights, including low-fat and sugar-free meals. Special meals need to be ordered at least 24 hours before your flight.
  
  

Regardless of your means of traveling, keeping a food diary is a foolproof way of ensuring that you meet your nutritional needs no matter how far you are from home.



It may take extra planning on your part, but it is possible to stay on-track with your diet on vacation.



Safe travels!



- Karen Buzby, RD, LDN

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Considering bariatric surgery? Quit Smoking. Today.

Anyone who smokes knows they should kick the habit. But quitting smoking is especially important for people considering bariatric surgery. The guidelines for bariatric surgery require patients to quit smoking 60 days prior to surgery.

The health consequences of smoking are well known and well documented, but these dangers are amplified for people with obesity. Along with the associated higher risk for cancer, heart disease and stroke, smoking increases the risks associated with surgery, including anesthesia-related complications, infections, heart attack, stroke, pneumonia and death. It also slows down healing time by narrowing blood vessels, restricting blood flow to the surgical site.

Smoking after bariatric surgery puts patients at significantly higher risk for a host of complications, such as ulceration of the gastric pouch, gastritis, infection and increased shortness of breath.

It is never too late to quit and Penn has several options to help people break their smoking habit. The health benefits of smoking cessation occur almost immediately and have a long-lasting impact.

Effects of quitting smoking* after:

• 20 minutes: Heart rate and blood pressure drop.
• 12 hours: Carbon monoxide level in the blood drops to normal.
• 2 weeks to 3 months: Circulation improves and lung function increases.
• 1 to 9 months: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) start to regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs and reduce the risk of infection.
• 1 year: Excess risk of coronary heart disease is half that of a smoker.
• 5 years: Risk for cancer of the mouth, throat, esophagus and bladder are cut in half; cervical cancer risk falls to that of a non-smoker; stroke risk can fall to that of a non-smoker after two to five years.
• 10 years: Risk of dying from lung cancer is about half that of a smoker; risk for cancer of the larynx and pancreas decreases.
• 15 years: Risk for coronary heart disease is that of a non-smoker's.
  

For smokers who are interested in bariatric surgery, enroll in a smoking cessation program to begin the quest to a healthy lifestyle.

Local resources:

• Penn’s Comprehensive Smoking Treatment Program: A multidisciplinary team of specialists offers state-of-the-art, individualized treatment to help smokers quit safely and comfortable.
• Quit Smoking Program at Pennsylvania Hospital: The respiratory care team offers a five week program with counseling and support to help smokers overcome their addiction.
  
• Pennsylvania’s Free Quitline: The Philadelphia Department of Public Health offers a variety of resources to help residents quit smoking, including a free one-month supply of nicotine patches through the PA Free Quitline telephone counseling program at 877-724-1090.
  

Additional resources:

• American Cancer Society, 800-ACS-2345
• American Lung Association, 800-586-4872
  

Get help to begin the journey to health - today!

*American Cancer Society, Guide to Quitting Smoking.

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Eat More to Lose More: Healthy Snacks for Weight Loss

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the benefits of healthy snacking.

Don't overlook the benefits of snacking when trying to lose weight. Snacking helps you fuel up between meals and can prevent you from overeating and making unhealthy food choices. The healthiest snacks include a mix of complex carbohydrates and protein to keep you feeling full throughout the day.

In fact, many nutrition experts suggest shifting away from the traditional three-meals-a-day diet. Instead, they recommend eating small, nutritious meals every three hours or eating five to six times a day. Although it may seem counter-intuitive to weight loss, eating smaller, more frequent meals helps you maintain consistent blood sugar levels throughout the day, and prevents ravenous hunger that often leads to overeating and poor food choices.

If you are tired of your usual snacks or looking for healthier alternatives, here are a few ideas to liven up your healthy snack options:

• Celery sticks spread with one to two tablespoons of almond or peanut butter
• Fresh vegetables (i.e. carrot sticks, cherry tomatoes or fresh green beans) with two tablespoons of hummus
• One serving of whole grain crackers topped with one ounce of reduced-fat cheese and sliced green grapes
• One small apple, sliced with one tablespoon of peanut butter for dipping
• Half a cinnamon raisin, whole-grain English muffin topped with low-fat cottage cheese, no-calorie sweetener (i.e. Splenda^®, Truvia or Pure Via™) and cinnamon
• One serving Greek yogurt with fresh fruit
• One cup homemade vegetable soup
• One brown rice cake with pesto, canned salmon and diced tomatoes
• Three handfuls of air-popped popcorn seasoned with spray butter and herbs
• One brown rice cake topped with a sliced hard-boiled egg, light mayo and fresh herbs
  

- Cara Stewart, RD, LDN

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