Lose Weight and Achieve a Better Quality of Life, Too!

David Sarwer, PhD, director of clinical services at the Center for Weight and Eating Disorders and member of the Penn Metabolic and Bariatric Surgery team, explains the psychosocial benefits of weight loss surgery.

The physical benefits of bariatric surgery include weight loss, improvements in obesity-related diseases such as type 2 diabetes and hypertension, but that’s only half the story. A growing body of evidence now shows the significant impact of bariatric surgery on psychosocial health and well being, particularly quality of life.

Many people with morbid obesity experience impairments in their quality of life, including persistent pain, low self-esteem and issues with social relationships, body image and sexuality. For individuals suffering from obesity-related diseases, the negative effect on their quality of life is only enhanced by their illness.

The good news is that research suggests that bariatric surgery can benefit mental and social well being in addition to facilitating weight loss and reducing typical metrics of obesity-related diseases like blood sugar and blood pressure.

In fact, a recent study conducted by the Penn Metabolic and Bariatric Surgery Program shows the psychosocial benefits of bariatric surgery begin earlier than previously thought. Patients reported significant improvements to quality of life as early as just 20 weeks after surgery.

These findings suggest the need for a broader view of the benefits of bariatric surgery. The transformation people experience after bariatric surgery often involves significant physical, psychological and interpersonal changes. It is important to consider – and prepare for – all the benefits, including better qualify of life, when deciding whether bariatric surgery is the right treatment option for you.

The Penn Metabolic and Bariatric Surgery Program provides ongoing support groups to help you prepare for and successfully cope with post-surgical changes in your life. 

- David B. Sarwer, PhD

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Does milk give you problems? A guide for choosing milk alternatives

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides a list of healthy milk alternatives.  

Milk is not the beverage of choice for everyone. Despite its nutritional benefits and popularity as a complement for everyday foods like coffee and cereal, cow’s milk is actually problematic for many people, especially those suffering from lactose intolerance or milk allergies and those who are vegans.

In fact, some patients become lactose intolerant after gastric bypass or sleeve gastrectomy surgery.

But the good news is that there are more lactose-free milk options available today than ever before. Follow this guide to choose the best milk alternative for you.

Lactose-free Milk - Lactase enzyme is added to regular cow’s milk to break the lactose down into a simpler sugar.

• Protein per cup: 8 grams
• Flavor: Slightly sweeter than regular milk.
• Where to purchase: Grocery store refrigerated section; available in low-fat, conventional and organic varieties; refrigerated cartons.

Goat and Sheep Milks - Milk from other animals contains lactose with a high degree of cross-reactivity, meaning that people with an allergy to cow’s milk have a high chance of reacting to these milk varieties as well.

• Protein per cup: Goat milk - 9 grams; Sheep milk - 14 grams
• Flavor: Sweeter than cow’s milk; grassy undertones.
• Where to purchase: Whole Foods or local farm market; refrigerated cartons.

Soy Milk - Made from cooking and pressing soybeans.

• Protein per cup: 7 grams
• Flavor: Nutty, beany flavor with thick consistency.
• Where to purchase: Grocery store; shelf stable and refrigerated cartons in variety of flavors.

Nut Milk - Made by soaking and grinding nuts into pulp, then straining the creamy liquid. Almond milk is the most readily available, but there are other nut milks including hazelnut and cashew as well.

• Protein per cup: 1 gram
• Flavor: Nutty with thin consistency.
• Where to purchase: Grocery store; shelf stable and refrigerated cartons in a variety of flavors.

Hemp Milk - Made from the seeds of cannabis plants, hemp milk does not contain psychoactive substances. It is a good source of omega-3 and -6 fatty acids.

• Protein per cup: 2 grams
• Flavor: Nutty, earthy flavor with thick texture.
• Where to purchase: Natural foods store, Whole Foods; shelf stable cartons.

Grain Milks - Made from cooked grains such as oats or barley.

• Protein per cup: 4 grams
• Flavor: Mild, grainy and nutty.
• Where to purchase: Whole Foods or natural foods store; shelf stable cartons.

Rice Milk - Made from cooked rice.

• Protein per cup: 1 gram
• Flavor: Sweet with watery consistency.
• Where to purchase: Grocery store; shelf stable cartons.

Coconut Milk - Made from coconut meat and the water inside the coconut.

• Protein per cup: 4 grams
• Flavor: Slight coconut flavor; creamy texture.
• Where to purchase: Grocery store; refrigerated cartons.

- Cara Stewart, RD, LDN

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Weight Loss Surgery Reduces Cardiovascular Risk

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses recent study findings, which reveal the cardiovascular benefits of weight loss surgery and identify diabetes, not BMI, as the best indicator of cardiovascular risk.

Obesity is a well-known risk factor for a host of cardiovascular problems, including heart attack, stroke and heart disease, but a recently published study in the Journal of the American Medical Association suggests that weight loss surgery can significantly reduce that risk.

Researchers found that bariatric surgery lowered the risk of heart attack and stroke by 33 percent and the risk of death from heart-related causes by nearly 53 percent. The results are based on a Swedish study of over 4,000 obese adults that compared the outcomes of people who had bariatric surgery with those that did not.

The study showed that diabetes and risk factors for diabetes, including high blood sugar, were significant indicators of post-surgical cardiovascular benefit. Body mass index (BMI) before surgery and weight loss after surgery were not associated with reduced incidence of cardiovascular events, based on the study results.

Currently, candidates for bariatric surgery must have either a BMI over 40 or a BMI over 35 with one or more obesity-related condition, such as diabetes, high blood pressure or sleep apnea.  The findings of this study highlight the importance of considering diabetes, in addition to BMI, when deciding whether bariatric surgery is the best treatment option.

- Cara Stewart, RD, LDN

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Tasty Ways to Keep Your New Year’s Resolution: Sweet and Sour Shrimp

A New Year’s resolution to lose weight does not have to mean sacrificing your favorite cuisines, such as Chinese food. Many Chinese menu items are loaded with fat, calories and sodium, but there are ways to prepare healthier versions that preserve the flavorful taste you love. This sweet and sour shrimp is nutritious, low in fat and calories and takes less than 30 minutes to prepare.

Ingredients:

• 1 (3 1/2-ounce) bag boil-in-bag brown rice
• 8 ounces firm, light tofu
• 2 tablespoons cornstarch, divided
• 1/2 pound peeled, large shrimp (approximately 15 to 17 medium-sized shrimp)
• 1/4 cup fat-free, low-sodium chicken or vegetable broth
• 1/4 cup low-sodium soy sauce
• 2 tablespoons sugar
• 3 tablespoons rice vinegar
• 1 tablespoon chili paste with garlic
• 2 teaspoons dark sesame oil
• 2 teaspoons canola oil
• 1 cup chopped onion
• 1/2 cup chopped green bell pepper
• 1 tablespoon ground fresh ginger
• 1 (8-ounce) can pineapple chunks in juice, drained

Preparation:

1. Cook rice according to package directions, omitting salt and fat; set aside.
2. Place tofu between paper towels until barely moist; cut into 1/2-inch cubes. Combine tofu, one tablespoon cornstarch and shrimp. Combine remaining cornstarch, broth, soy sauce, sugar, vinegar and chili paste; set aside. 
3. Heat sesame oil in a large nonstick skillet over medium-high heat. Add shrimp mixture to pan; sauté for three minutes. Place shrimp mixture in a bowl. Heat canola oil in pan over medium-high heat. Add onion, bell pepper, ginger and pineapple to pan; sauté for two minutes. Add shrimp mixture; cook for one minute. Add broth mixture to pan; cook for one minute. Serve over rice.

Nutritional Information:
Amount per serving

• Calories: 318
• Calories from fat: 19 percent
• Fat: 6.8 g
• Saturated fat: 1 g
• Monounsaturated fat: 2.7 g
• Polyunsaturated fat: 1.3 g
• Protein: 19.8 g
• Carbohydrate: 45.4 g
• Fiber: 4 g
• Cholesterol: 86 mg
• Iron: 2.7 mg
• Sodium: 681 mg
• Calcium: 89 mg

The recipe yields four servings. Serving size is one cup of shrimp and half a cup of rice.

This recipe is courtesy of Cooking Light (May 2008).

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What exactly is “moderate-intensity” aerobic exercise?

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains what “moderate-intensity” aerobic exercise is and the activities you can do to achieve it.

Exercise improves overall health and physical fitness, reduces the risk of many chronic diseases and is an essential component of any weight loss plan.  For healthy adults, the Physical Activity Guidelines for Americans recommends at least 150 minutes every week of moderate-intensity aerobic activity and at least two days per week of muscle-strengthening activities. 

For overweight or obese adults trying to lose weight, the Penn Metabolic and Bariatric Surgery Program recommends at least 200 to 300 minutes a week of moderate-intensity aerobic activity as well as the standard two days of muscle-strengthening work.

These forms of exercise are considered moderate-intensity physical activity:

• Walking two miles in 30 minutes
• Biking four miles in 15 minutes
• Going up and down stairs for 15 minutes
• Fast dancing for 30 minutes
• Doing water aerobics for 30 minutes
• Swimming laps for 20 minutes
• Gardening for 30 minutes
• Wheeling yourself in a wheelchair for 30 minutes
• Shooting baskets for 30 minutes
• Jumping rope for 15 minutes

If you are starting a new exercise program, remember to ease into activity gradually and consult your physician first. In fact, there are certain programs customized for beginning exercisers, including this walking program from the National Heart, Lung and Blood Institute.  There’s no day better than today to begin exercising in pursuit of a healthier lifestyle.

- Cara Stewart, RD, LDN

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