Finding Time To Work Out

Whether we work full time or manage a house full family, everyone is busy. Finding time to work out and fit in fitness isn’t always easy to do, but it is important for your health, and to set a good example for your family, children and friends.

Kathryn Schmitz, PhD, MPH, FACSM, is an associate professor at the Perelman School of Medicine at the University of Pennsylvania. She is also the mom of two teens who works 60 to 70 hours a week, and still manages to find time to work out. In this blog, she discusses her own fitness goals, and how she finds time to exercise.



I work 60 to 70 hours a week, I’m the mother of two teens, and I work out three to five times a week.

In the past, I kept up with my workout schedule by setting a goal to train for a particular running event. I’ve done many 10-mile and half-marathon races in the Philadelphia area. I’m not fast, but by setting a goal for myself, I was able to focus and train for a specific event, even if I wasn’t the fastest person there.

The last race I trained for was the Broad Street Run in 2011. I trained to do this 10 mile event with a breast cancer survivor who was participating in one of my studies and who wanted to do the race but didn’t know whether she could.

We crossed the finish line together with our arms raised high.

I decided it was a terrific note on which to end my long races. You see, I have never enjoyed running long races. I just set the goal of completing a particularly long running event so that I would be motivated to stay on my training schedule.

But since I haven’t been training for an event, I needed a new way to set goals. Late last year I found a terrific one on the blog of a cancer survivor fitness professional by the name of Alwyn Cosgrove. Mr. Cosgrove set a goal of completing 200 workouts a year. I liked this idea so much that I’ve adopted it for 2012. I’m three months in and have 48 workouts to show for it!

Finding time to work out

I fit in my workouts in the evening. I have a rule that I cannot sit and watch television in the evening, I have to be lifting weights, stretching or on the treadmill if the television is on. This limits my television viewing and motivates me to exercise if there is a particular show I like to watch.

I also use exercise time to spend time with my family. My partner and my children and I work out together sometimes. Those are my favorite workouts because we get to spend time together, and I know I am setting a good example for my children.

We also make it fun. My 14-year-old son and I make faces when we are lifting weights and that makes us both laugh. Then we find ourselves remembering those faces later and we laugh again!
The bottom line is that for me, setting fitness goals helps me stay on track and focus on personal fitness achievements. You don’t have to run a race, or climb a mountain to focus on getting exercise. Do what works for you, find time when you can, and remember to have fun.

Do you struggle to find time to work out? How do you do it?

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Snacking Tips During Football Season

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for healthy eating during the football season.

Football season is here, and for so many of us, that means snacking during the game. Avoid taking a time-out from healthy eating during football season by following these easy tips:

• If you are hosting the game, provide healthy foods for you and your guests to enjoy. If you are going to watch the game at someone's house, offer to bring a healthy snack like one of those listed below.
• Use a small bowl or plate. Eating from a small plate helps limit portion sizes and reduces overall intake.
• Designate half-time as the only time to eat. Grazing during the game can lead to mindless eating.
• Avoid high calorie beverages. Drink calories can add up quickly, especially if they contain alcohol. Instead, opt for low-calorie beverages such as coffee, tea, water with lemon or sugar-free soft drinks with fresh fruit slices. For low-calorie alcoholic beverages, choose light beer or a mixed drink with a sugar-free mixer.
• If you do overindulge, stay positive and get back on track the next day.

These healthy and tasty snack ideas can help you stay on track.

• Cottage cheese and lemon pepper dip with fresh vegetables
• Whole-grain crackers and hummus
• Oven-fried chicken tenders with light ranch dip
• Baked tortilla chips with bean dip and salsa
• Thin-crust, whole-wheat pizza loaded with vegetables

Many more healthy snacks and recipes can also be found online.
- Cara Stewart, RD, LDN

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Healthy Snacks While Losing Weight

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


Now that school is back, and everyone is getting back to daily routines, it's easy to forget to eat healthy an dhave healthy snacks throughout the day.

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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Believe it or not: Carbs are an Essential Part of Your Healthy Diet after Weight-Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the importance of carbohydrates for a healthy diet after weight-loss surgery.

Carbohydrates often get vilified in weight-loss circles, with claims of preventing weight loss and even contributing to weight gain. But the truth is that carbohydrates, or carbs for short, are actually your body’s main source of energy and an essential component of a balanced diet.

In fact, your body relies on carbs to power everything from breathing to walking to thinking! So, while it is important to focus on eating adequate protein after weight-loss surgery, it is also essential to incorporate good carbs into your diet. 

The first few months after weight-loss surgery, your diet should primarily consist of protein since your stomach is too small to consume much else. Once your stomach is ready for a more diverse selection of food, aim to get half of your daily calories from carbs. That should amount to approximately 130 grams of carbs per day. Remember, it might take several months or up to a year after surgery to get to this point, so it is important to be patient and set short-term goals along the way.

Consuming adequate carbs from good food sources allows your body to use protein for healing and maintaining muscle mass, instead of being diverted for energy. The best sources of carbs contain fiber, which slows digestion, keeps you full longer and helps regulate your bowel. Examples of healthy carbs include:

• 1 piece of fruit (i.e. an apple the size of a baseball) = 15 grams of carbohydrate
• 1 cup of milk = 12 grams of carbohydrate
• ½ cup of oatmeal = 15 grams of carbohydrate
• 1 slice of whole-grain bread = 15 grams of carbohydrate
• ½ cup cooked beans = 15 grams of carbohydrate 

Try to avoid simple carbs like white bread, white rice, white pasta and sweets. They contain minimal nutrients, promote hunger and can cause blood sugar spikes.
Keep in mind that your carbohydrate needs may vary depending on medical issues such as diabetes, so check with your dietitian or health care team to determine your personal dietary goals.   

- Cara Stewart, RD, LDN

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What to Eat After Weight-loss Surgery

There is a misconception that after weight loss surgery, people can only eat tiny morsels of food, are malnourished and no longer enjoy food.

While patients do, in fact, need to restrict the amount of food they eat – especially in the first few weeks after surgery – most people can resume healthy, moderate eating.

Patients cannot eat large quantities of food they ate before surgery, because their digestive tract is physically different and can no longer accommodate large amounts of food.

Following surgery, meals will likely consist of two to four tablespoons of food. As you advance your diet, you should be eating "regular" food within six to eight weeks of surgery.

Smoothies, shakes and purees

Following weight-loss surgery at Penn, you meet regularly with a dietitian who offers nutritional support. And, since protein plays an important role in both the healing and weight loss process following surgery, it is recommended you incorporate high protein drinks that are low in fat and sugar into their diets.

As you are able to eat more and increase the variety in your diet, you should rely on high protein foods to help meet your protein goal as outlined by the nutrition team.

Try this recipe for a Banana Berry Smoothie.

Get more information about weight-loss surgery at Penn

Learn if bariatric surgery is right for you by attending a free information session about the Penn Metabolic and Bariatric Surgery Program.

At this free session, you will learn more about weight-loss surgery at Penn, and meet physicians and team members from the Penn Metabolic and Bariatric Surgery Program.

Register for this free event here.

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5 Weight-loss Apps for Your Smartphone or Notebook

Research shows that people lose more weight when they track their food and exercise and receive a lot of motivation and support throughout their entire weight-loss journey.

Here are 5 weight-loss apps for your smartphone or notebook.

My Fitness Pal (iTunes®, free)

This app was designed to support the features of the website, My Fitness Pal. With its large database of foods, and simple design and functionality, you can track food and exercise, take photos of bar codes to identify foods and servings, and share your success with friends.

Weight Watchers® Mobile (iTunes, free)

You don’t have to be a Weight Watchers member to enjoy the perks of this weight-loss app. If you are a Weight Watchers member, you have access to the full benefits of this application. It helps you track your points, find recipes, locate a meeting, and track your weight. Not a Weight Watchers member? No worries. You can still use some of the features this app offers like recipes and Weight Watchers articles.

LIVESTRONG® MyPlate Calorie Tracker (iTunes, $2.99)

If you’re a fan of LIVESTRONG brands, you might enjoy this app for counting calories, too. LIVESTRONG MyPlate Calorie Tracker helps you determine your calorie needs based on your weight and weight goal. It has an extensive database of foods to help you track, and an easy-to-read design that inspires you to be well and eat nutritiously.

Lose It!® (iTunes, free)

Lose It! is another app for tracking food and exercise. While the database is not as large as some other apps might be, its barebones and simplistic approach to logging food and exercise keeps people motivated to lose on the go.

The Eatery® (iTunes, free)

The Eatery lets you take advantage of your phone’s camera to decide if you are eating balanced meals. What we like about this app is that it forces you to look closely, and think about what you are eating. While other people’s reviews of your plate may not be inspiring, we think it’s a great way to be mindful of how and what you eat.

Have you used an app to help you lose weight? What would you recommend?

Note: Penn Medicine does not specifically endorse any of these recommended apps. 

Penn Medicine can help you lose weight with weight-loss surgery. Learn more about weight-loss surgery at Penn in a free information session about weight-loss surgery. 

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How Much Weight Will I Lose with Weight-loss Surgery?

Here’s an exercise:

Imagine losing 1/3 of your weight.

Take your weight and multiply it by .30. Now subtract that number from your current weight. Imagine what your life would be like if you weighed that number.

Could you move easier? Would your knees still hurt? Could you keep up with your kids or grandchildren?

Would you be able to stop taking some of the medications you take every day? What would it be like to regain your health?

On average, someone who undergoes weight-loss gastric bypass surgery can expect to lose approximately 30 percent of his or her starting weight. Most of this loss is experienced during the first few months following surgery with the weight loss continuing for 12 to 18 months after surgery.

Weight loss associated with the adjustable gastric band and sleeve gastrectomy may not be as rapid and the weight loss may not be quite as great.

Each person’s weight-loss progress is different, but one thing is clear: healthy eating habits, exercise and ongoing support are critical for continued success.

Get more information about weight-loss surgery at Penn
Learn if bariatric surgery is right for you by attending a free information session from the Penn Metabolic and Bariatric Surgery Program.

At this free session, you can learn more about weight-loss surgery at Penn and meet physicians and team members from the Penn Metabolic and Bariatric Surgery Program.

Register for this free event here.

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Is Bottled Water Better Than Tap Water?

Water is the best beverage for staying hydrated and avoiding extra calories, but it’s not necessary to buy it in a plastic bottle. The bottled water industry promotes bottled water as being healthier, yet the reality is that bottled water is less regulated for quality than tap water. Plus it is more expensive and can be environmentally unfriendly, too.
Before buying bottled water, consider these facts:

• Bottled water can cost nearly 2,000 times as much as tap water.
• Environmental Protection Agency (EPA) guidelines for regulating municipal tap water are far more rigorous in terms of control, disinfection and monitoring than those used by the U.S. Food and Drug Administration (FDA) to oversee bottled water. In fact, a National Resource Defense Council (NRDC) study of the bottled water industry, tested over 1,000 bottles of water, and concluded that bottled water is not guaranteed to be any cleaner or safer than tap water. The study found that approximately 25 percent of bottled water was tap water packaged in a bottle and 22 percent of the samples contained chemical contaminants above the strict state limits on municipal tap water.  
• Bottled water companies are not required to disclose information about their products. A recent report released by the Environmental Working Group (EWG) indicates that more than half of the bottled water products surveyed failed EWG's transparency test. According to the report, 18 percent of the companies failed to reveal the source of the water and another 32 percent did not disclose any information about the treatment or purity of the water.
• Studies have also shown that chemicals called phthalates, which disrupt testosterone and other hormones, can leach into bottled water over time.  Although there are regulatory standards limiting phthalates in tap water, there are no legal limits for phthalates in bottled water.  
• Although plastic bottles are recyclable, nearly 90 percent of them end up as litter or garbage contributing more than 2 million tons of plastic to landfills each year. 

A comprehensive list of the tap-water contaminants in your area is available on the EPA website. If you are concerned about the quality or flavor of your tap water, purchase a water filter to put on your tap. It is both easier on your wallet and on the environment. To keep filtered water accessible to drink when you’re on the go, put it in your own reusable bottle to carry with you throughout the day.  

• Complete guide to purchasing a water filter 
• More details on the NRDC study results

- Cara Stewart, RD, LDN

Get more information about weight-loss surgery at Penn

Learn if bariatric surgery is right for you and attend a free information session about the Penn Metabolic and Bariatric Surgery Program.

At this free session, you will learn more about weight-loss surgery at Penn, and meet physicians and team members from the Penn Metabolic and Bariatric Surgery Program

Register for this free event here.

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Grocery Shopping and Cooking for One

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for grocery shopping and cooking for one.

Shopping and cooking for one person can be a challenge. Reduced prices for bulk quantities cater to large families and can make it easy to prepare – and eat – more than you really want.

The difficulty of cooking for one can make options like take-out or fast food seem more appealing, but there are economical ways to shop and cook without resorting to unhealthy food. With planning and creativity, you can successfully stock up on healthy foods while keeping your portion size and budget in mind.

Follow these tips when grocery shopping for one:

Make a weekly meal plan  
Taking time to create a meal plan can help you shop strategically. To start, consider how many nights of the week you want to cook. Rotate between preparing single portions and multiple portions, which you can then use for leftovers.

Check the weekly supermarket circulars to see what items are on sale and for meal inspiration. Try to think of ways to reuse key ingredients so they do not go to waste. For example, a grilled chicken dinner can easily become a protein-packed salad topper the next night.

Be careful with coupons
While coupons are an excellent way to save money, they are often for processed foods that contain excess sugar, fat, refined grains and with little nutritional value. Try to avoid using coupons for food you would not otherwise purchase because of its nutritional contents.

Buy smaller portions of perishable foods
Sometimes it is worthwhile to pay slightly higher prices for less food. When buying smaller portions, you might spend more per ounce of food, but you avoid wasting food or overeating.  For example, next time you are at the grocery store, buy six eggs instead of a dozen, three bananas instead of the whole bunch or a quarter of a watermelon instead of a whole one.

Stock up on non-perishable foods
Dry goods like whole grain pasta, brown rice, dried beans, oats, nuts and spices are pantry staples. It is helpful to keep larger quantities in stock so you always have them on hand when you need them.

Shop the meat counter
Pre-packaged meats are often sold in relatively large quantities. At the meat counter, you can specify exactly what you want. For example, at the meat counter, you can request a single sirloin steak instead of purchasing the pre-packaged, larger quantity.

Freeze the extras
Storing leftovers in the freezer is a helpful way to keep ready-made meals on hand. It’s also a great way to keep larger packaged items fresh for longer. Next time you buy a loaf of bread, store it in your freezer to keep it fresh and avoid the temptation to eat too much too quickly. Cooked vegetables, beans and grains also freeze well, so plan to prepare extra and freeze them for a future quick meal starter.

- Cara Stewart, RD, LDN

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How to Find Your Target Heart Rate

Most experts agree that low- to moderate-intensity workouts are best for weight loss.

“For overweight or obese adults trying to lose weight, we recommend at least 200 to 300 minutes a week of moderate-intensity aerobic activity,” says Gary B. Korus, MD, FACS, member of the Penn Metabolic and Bariatric Surgery team. “It’s also good to get two days of strength training exercise per week.”

The intensity of a workout depends on how hard your heart is working. To learn how intense your workouts should be, you need to know your target heart rate.

Your target heart rate can be found with this equation:
220 – Your Age = Maximum Heart Rate

For example, if you are 50, your target heart rate is:
220 – 50 = 170

Be aware this serves only as a guide and applies to healthy people.  Consult your health care professional to determine the appropriate heart rate for you.

How to Take Your Heart Rate

It’s easy to take your heart rate while working out.

One way to do this is to wear a heart rate monitor. A heart rate monitor uses a strap on your chest, and tracks your heart beats while sending them to a receiver you wear on your wrist like a watch. Some heart rate monitors allow you to input your height, weight and age to get the most accurate exercise and heart rate recommendations.

For a lower-tech alternative, you can take your pulse at your wrist. Rest your middle and index fingertips lightly on the opposite wrist, directly below the base of your thumb. Count the beats for one minute, or, for 30 seconds and multiply that number by two.

Working out at your target heart rate

Now that you know your target heart rate, and how to take it,  you can calculate where your heart rate should be while working out at different intensity.

Low-Intensity Workouts

Low-intensity workouts stay within 60 to 65 percent of your target heart rate.

So, if you want a low-intensity workout and you are 50 years old, use this calculation:

170 x .60 = 102
170 x .65 = 110

This means that while working out, your heart rate should be between 102 and 110 beats per minute.

If you are working out at a low intensity  you should be able to breathe easily, or sing while exercising.

Some examples of low-intensity workouts include:

• Walking for 30 minutes
• Biking for 30 minutes
• Taking a low-impact aerobics class for 45 minutes

Moderate-Intensity Workouts

Moderate-intensity workouts stay within 65 to 75 percent of your target heart rate.

So, if you want a moderate-intensity workout and you are 50 years old, use this calculation:

170 x .65 = 110
170 x .75 = 127

This means that while working out, your heart rate should be between 110 and 127 beats per minute.

If you are working out at a moderate intensity you should be able to speak in sentences while exercising.

Some examples of moderate-intensity exercises include:

• Walking two miles in 30 minutes
• Biking four miles in 15 minutes
• Going up and down stairs for 15 minutes
• Doing water aerobics for 30 minutes
• Shooting baskets for 30 minutes
• Jumping rope for 15 minutes

High-Intensity Workouts

High-intensity workouts are workouts that stay within 75 to  80 percent of your target heart rate.

So, if you want a high-intensity workout and you are 50 years old, use this calculation:

170 x .75 = 127
170 x .80 = 136

This means that while working out, your heart rate should be between 127 and 135 beats per minute.

If you are working out at a high intensity  you should be able to speak only in short phrases. Most high intensity workouts can only be maintained for short periods of time.

Some examples of high intensity workouts include:

• Running for 15 minutes
• Biking uphill for 10 minutes
• Swimming for 45 minutes
• Interval training for 30 minutes
• Jumping rope for 10 minutes

Ready to kick off your exercise routine? What will you do to get started?

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Exercises for People With Knee Pain

It’s a dilemma many overweight people face: They want to exercise, but their knees or other joints hurt too much to do anything strenuous.

Rather than get caught in cycle of not exercising because your knees hurt  and your knees hurt because you are not exercising, here are some exercise ideas for your aching knees.

Spinning® / bike riding

Any activity that takes pressure off of your knees and back is a great exercise. When you are fitted properly for a bike and ride in a safe, correct way, your knees are protected. That’s because most of the weight falls on your seat – not on your knees like in walking or running. And, if you’re wearing special shoes fit for your body, they can help center the pressure on the ball of your foot and take the pressure off of your knees.
Pros: Spinning classes are easy to join in and follow.
Cons: Bike equipment can be expensive, need to join a gym for classes.

Swimming / water aerobics

If you think swimming and water aerobics is for sissies, think again! Water exercises are extremely beneficial because the water acts as natural resistence to your body. When you work out in the water, your body is tasked to push against that resistance and build muscle. At the same time, the water makes you buoyant and takes pressure off of your joints.  This is why so many fitness experts refer to swimming as the perfect aerobic exercise.
Pros: An all-around great excercise for cardiovascular and muscular strength, easy on joints,
Cons: Must have access to a pool.

Walking

Most experts agree that walking is one of the best forms of exercise. You can do it anywhere, it costs nothing but a good pair of shoes and you can do it in any climate. When beginning a walking program, start slow – walk only 20 to 30 minutes at a time, three to five times a week. Gradually build up endurance by walking longer and more frequently.

And if your knees are aching, visit a shoe store that offers shoe-fitting consultation. Finding the right support and cushion can help minimize your knee pain.
Pros: Can walk anywhere – no gym needed!
Cons: Must invest in a good pair of walking shoes.

Do you suffer from knee pain? What exercises have you found to be "nice to your knees?"

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Prevent Weight Gain After Weight-loss Surgery

Many people who have weight-loss surgery are excited at the new opportunities for them post surgery. They imagine a life without medical conditions associated with obesity and are ready to begin living without the extra weight.

They are also concerned about the possibility of gaining weight back post surgery.

Unfortunately, over time some people do regain the weight after weight-loss surgery. Therefore, to achieve optimal weight-loss results, it is important to follow the nutritional guidelines provided post-surgery as a part of your new lifestyle.

To prevent weight regain after weight-loss surgery patients must follow a healthy diet plan with the focus on whole foods and continue to follow the guidelines for eating after surgery. Suggestions to stay on track include:

• Eat lean proteins, whole grains, low-fat dairy, fruits and vegetables.
• Avoid foods containing more than 15 grams of sugar per serving.
• Select foods low in fat.
• Track protein intake and get at least 60 to 80 grams/day. Protein containing foods will help keep you full and satisfied.
• Making time to eat, at least 3 times a day. Eating slowly (20 to 30 minutes/meal) is also very important.  
• Make sure your fluid needs are met with 48 to 64 ounces of low or non-calorie beverages.
• Separate eating and drinking by 30 minutes. This is a primary diet principle that must be continued. 
• Continue to take suggested multivitamins and mineral supplements on a daily basis.
• Exercise 250 to 300 minutes per week. This level of activity plays an import role in the maintenance of weight loss.

Poor food choices

In some cases, people who resume eating foods high in fat or sugar regain weight or experience minimal weight loss following weight-loss surgery. Therefore, to achieve optimal weight-loss results, it is important to follow the nutritional guidelines provided post-surgery as a part of your new lifestyle.

Foods to avoid include:

• Milk shakes, malt drinks and all high-calorie liquids
• Cakes and pastries
• Fried foods
• Pudding
• Chips and other high fat snack foods
• Soft drinks
• Ice cream
• Candy

You can also find many healthy recipes after weight-loss surgery on this blog.

Learn more about weight-loss surgery at Penn by attending a free information session about weight-loss surgery.

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Alcohol After Weight-loss Surgery

People considering weight-loss surgery often ask if it is possible to safely incorporate alcohol into a healthy diet and lifestyle after surgery. The short answer is “yes,” but gradually and with modifications.

Here’s why:
       
Altered metabolism
Research shows that blood alcohol levels peak higher and faster and take longer to return to normal due to altered metabolism after gastric bypass surgery. In addition, many post-surgical patients consume less food when they’re drinking alcohol, which contributes to expedited absorption of alcohol in the blood stream. For many post-surgical patients, all it takes is a single drink to elevate blood alcohol level to the point of legal intoxication. This is important to remember for maintaining a healthy diet and before getting behind the wheel.

Low blood sugar
Rapid weight loss and low carbohydrate intake can lead to reduced sugar or glycogen in your body. Alcohol consumption further depletes glycogen, which causes your blood sugar levels to drop, putting those who have had bariatric surgery at higher risk for developing low blood sugar.

Hypoglycemia, or low blood sugar, is a dangerous condition that can lead to loss of consciousness, brain and nerve damage or even death if left untreated. As a result, it’s important to be on the lookout for symptoms, which include loss of coordination and balance, slurred speech, poor vision and confusion.

If you experience symptoms of hypoglycemia, drink diluted juice or take a glucose tablet immediately to raise your blood sugar level, and then have a snack with complex carbohydrates and protein to sustain it. If hypoglycemic episodes occur frequently even without alcohol consumption, make sure you seek proper medical treatment.

Excess calories
Alcohol is high in calories and low in nutrients, which is why excess calories from alcohol can slow weight loss or even contribute to weight gain. 

Addiction transfer
Patients with a history of addiction are at higher risk for developing a new addiction. With the dramatic reduction of food consumption after bariatric surgery, some patients may trade their food addiction for other addictive behaviors, including drugs, shopping, gambling, sex and alcohol.

Guidelines for drinking:
Follow these guidelines to re-introduce alcohol without compromising your commitment to a healthy lifestyle after weight-loss surgery:

• Avoid alcohol for the first six months after bariatric surgery.
• When you get permission to start drinking alcohol again, avoid carbonated beverages and sugary drink mixers. 
• Remember that after surgery, even small amounts of alcohol can cause intoxication and low blood sugar. 
• Never drink and drive, even after consuming only minimal alcohol. 
• Only drink with meals or while eating to help slow absorption of alcohol. 
• Be aware of the calorie content of alcohol.
• If you find yourself drinking regularly to cope with emotions or stress, seek help by consulting with your doctor.

- Cara Stewart

Cara Stewart, RD, LDN, is a member of the Penn Metabolic and Bariatric Surgery team.

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Healthy Take on a Coastal Classic: Crab Cakes and Spicy Mustard Sauce

Celebrate the last couple weeks of summer with crab cakes that won’t break the bank — or your diet. Rather than ordering expensive, high-fat crab cakes at a restaurant, you can save money and make this healthier version at home.

The recipe uses panko breadcrumbs to provide a crispy but airy outer texture. You can also use light mayonnaise to reduce the fat content.
So, enjoy this healthy, flavorful and economical coastal classic before summer officially sets sail.

Nutritional Information 
Amount per serving

• Calories: 404
• Fat: 23.7 g
• Saturated fat: 3.1 g
• Monounsaturated fat: 13.5 g
• Polyunsaturated fat: 5.4 g
• Protein: 2 g
• Carbohydrate: 16.3 g
• Fiber: 1.2 g
• Cholesterol: 219 mg
• Iron: 1.6 mg
• Sodium: 670 mg
• Calcium: 149 mg

Ingredients
Crab cakes

• 1/3 cup red bell pepper, chopped
• 2 tablespoons mayonnaise
• 1/4 teaspoon kosher salt
• 1/4 teaspoon black pepper, freshly ground
• 2 green onions, chopped
• 1 large egg, lightly beaten
• 1 large egg yolk, lightly beaten
• 1 1/3 cups panko (Japanese breadcrumbs), divided
• 1 pound lump crabmeat, drained and shell pieces removed
• 2 tablespoons olive oil, divided

Sauce

• 2 tablespoons mayonnaise
• 2 tablespoons reduced-fat sour cream
• 2 teaspoons fresh parsley, chopped
• 2 teaspoons Dijon mustard
• 1 teaspoon white wine vinegar
• 1/8 teaspoon red pepper, ground

Preparation

1. Combine the first seven ingredients. 
2. Add 1/3 cup panko and crab; toss gently.
3. Divide crab mixture into eight equal portions; shape each into a 3/4-inch-thick patty. Place remaining panko in a shallow dish. Gently dredge patties in panko.
4. Heat a large skillet over medium-high heat. Add one tablespoon of oil to pan. Add four crab cakes to pan; cook for four minutes on each side. Remove from pan; keep warm. Repeat procedure with remaining oil and crab cakes.
5. Combine remaining ingredients; serve with crab cakes.

This recipe is courtesy of Vanessa Pruett, Cooking Light (September 2011).

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3 Weight-loss Plans That Work

Juicing, fasting, low-carb, high-fat… Have you tried everything to lose weight?

“It seems like every few months, another book comes out that spurs a diet trend,” says Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team. “Weight loss comes down to one thing: creating a calorie deficit by eating less and being more active."

A plan may help some people stay on track. Are you one of them? Then read below for three weight-loss plans that might work for you.

Weight Watchers®

Weight Watchers uses a points system to track food, calories and exercise. Founded in 1963, Weight Watchers has outlasted every fad diet by allowing you to eat anything you want, as long as you stay within your daily point allotment.


“The new Weight Watchers Point Plus program encourages the selection of nutrient-rich foods that are low in calories,” says Buzby.  “Fresh fruit and non-starchy vegetables are unlimited on the new plan. It is these fiber containing foods along with lean proteins that promote a sense of fullness and a healthy slow weight loss.”

One thing Weight Watchers offers that some other plans do not is weekly meetings.

“The weekly Weight Watchers meeting is a great way to hold yourself accountable for what you’ve eaten the previous week,” says Buzby. “It’s also a great time to get peer support from other people trying to lose weight.”

Pros: Points system makes it easy to know how much you are allowed to eat, meetings provide support, online tools.
Cons: Cost – monthly fees can vary depending on how you want to pay.

The Biggest Loser® Diet

Made famous by NBC’s reality show “The Biggest Loser,” this plan is modeled after the same diet and lifestyle changes the show participants follow. The diet and exercise guidelines are straight forward: the calorie controlled meal plan focuses on eating small frequent meals of whole foods and the exercise plan emphasizes starting a cardio and a strength training program.

“If you follow the Biggest Loser guidelines, yes, you will lose weight,” says Buzby. “The problem for many of us is that without a personal trainer it may be hard to stay motivated to exercise 60 minutes a day.”

The Biggest Loser books tell inspirational stories from people who have been on the show as well as give guidelines for implementing the diet and exercise plans.

“Online support is available to help you stay motivated and reach your goals,” says Buzby.

Pros: Inspirational, balanced diet and exercise plan that includes healthy foods.
Cons: Weight loss will most likely be slower than the results achieved by TV contestants.

The DASH Diet for Weight Loss

The Dietary Approaches to Stop Hypertension (DASH) Diet was originally developed to help people make dietary changes to lower their blood pressure.  However, following the DASH  diet’s calorie guidelines can also help promote slow and steady weight loss.  The diet is based on an eating plan that focuses on fruits and vegetables, balanced with protein and low fat foods.  The book, The DASH Diet Action Plan, provides calorie adjusted menus and shows you how to implement the plan.

“Research studies show this diet has heart-healthy benefits, lowers the risk of certain diseases and improves health. “I like this plan because it is a healthy, nutritious diet that the whole family can enjoy,” says Buzby.

Pros: Diet based on tasty foods that promote fullness and improves health.
Cons: The primary focus is on heart health and reducing hypertension lower, calorie levels may be needed for weight loss in some individuals.

What diets have you tried? Which ones have worked for you?

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Preparing and Recovering from Weight-Loss Surgery

Samantha Warner-Grimsley, RN, CBN, member of the Penn Metabolic and Bariatric Surgery team, explains how the team at Penn Medicine helps patients prepare and recover from weight loss surgery. 

Preparing people for weight-loss surgery and the lifestyle adjustments that are necessary after surgery are crucial components for long-term weight loss. That is why the Penn Metabolic and Bariatric Surgery team helps prepare you for your weight-loss surgery and then assists in your recovery so you can quickly get on track for achieving your weight-loss goals.

All patients scheduled for bariatric surgery at Penn Medicine attend a nutrition class approximately two weeks before surgery. The purpose of the class is to prepare you for the post-surgical dietary changes that are necessary for successful weight loss. 

During the class, a nurse reviews important information about your surgery and post-operative care. Knowing what to expect during and after surgery can help reduce anxiety and promote well-being during the recovery phase. The nurse also addresses any concerns or problems that you may have.

To bridge the transition from hospital to home, the Penn Metabolic and Bariatric Surgery team offers homecare or visiting nursing services for people who have had gastric bypass and gastric sleeve surgery. These services provide you with the expertise of a professional health care provider within the comfort of your own home, acting as a liaison between you and the bariatric surgery team.

Even with homecare services after bariatric surgery, health care professionals only come to your home for prescheduled visits. Therefore, it is important that you are aware of symptoms that can signal post-surgical complications and know when you need to contact your surgeon.

If you experience any of the following symptoms, call your bariatric surgeon’s office immediately:

• Fever greater than 101 degrees
• Severe pain
• Persistent nausea
• Vomiting
• Wound redness or drainage
• No bowel movement within three to four days after surgery
• Inability to consume adequate liquids
• Inability to tolerate your medications

When you make the decision to have bariatric surgery, you’re making a life-long commitment to a healthier you. A vital part of that commitment includes follow-up care. Regular visits with your bariatric surgery team, including the surgeon, nurse practitioner and dietician, can help you achieve and maintain long-term weight-loss success.

- Samantha Warner-Grimsley, RN, CBN

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