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Susanne is a 20-something nurse who had lap-band surgery at Penn in 2012. In this blog post, Susanne discusses her lifelong struggle with weight, and the decision she made to have weight-loss surgery at Penn.

You can read more about Susanne on her blog, Read Purl Before Swine


Few people feel good about themselves in winter - especially in January when you are acutely aware of the softness that has developed around your middle. Those aren't merely "love handles," they're the red flags calling "FOUL" on all those naughty plays you've been executing at the dinner table.

They're the extra pounds that have been accumulating since the first pass of your hand through the bowl of candy intended for trick-or-treaters, right on through Thanksgiving pie, Christmas cookies, and New Year's Eve champagne cocktails.

In January of 2011 I found myself at my doctor's office for a check-up only to receive a fright that might have been better reserved for Halloween. The scale was clearly not correctly calibrated. Surely, I was not 307 pounds. That was a number usually reserved for contestants on The Biggest Loser!
307 is not a "whoops I ate too much this holiday" number. 307 was the culmination of 20 years of bad eating habits, of consoling myself with sugar and fat, of eating in secret, of 2 attempts at Weight Watchers and countless other fad diets, and plus-sized clothing.

It was also the result of taking high doses of steroids for 6 months after being diagnosed with an auto-immune kidney disorder that had come out of left field earlier that fall. My physician was minimally empathetic, telling me that individuals were capable of managing their weight while on steroids and that I could hardly use my medication regimen as an excuse. Devastated seems too soft a word for the feelings I had at the time. Rock bottom feels appropriate though cliche.

A Struggle

I didn't consider it an option to remain at that weight. As a nurse, I knew all too well that I was already at risk for any number of lifestyle-related illnesses: hypertension, diabetes, cardiac disease, sleep apnea and on. I also knew that I felt out of step with all of my friends who enjoyed active lives that included running marathons and hiking. I felt that I might as well be standing at the bottom of Mt. Everest without any climbing gear.

I was 25 years old and had gotten myself into a royal mess.

I had considered bariatric surgery almost 2 years prior to this incident in my doctor's office but my insurance coverage at the time was not covering any of the available procedures. In my disappointment, I talked myself out of the option and told myself that I would lose weight the "natural" way. The "natural" way has always been considerably difficult for me. I would put in a great deal of effort in changing my eating habits, reducing my calories, and sweating at the gym for very little reward. One pound here, another there, but there was never any dramatic decrease in pounds. Eventually, I would become discouraged eating so little food, counting every calorie, and agonizing over whether or not I could get away with 30 minutes at the gym or if I should push myself for a full hour.

Maintaining a very strict diet was hard at 25 when socialization is focused mainly on food and alcohol. No one wants to go out with friends and sip water. In February, I started my first nursing job and more or less put my weight struggles aside. I was able to stop taking the steroids later that spring and a minimal amount of the weight came off without any intervention, but I was still hovering between 290 and 300. In August, I had a frank discussion with both my primary care doctor and my kidney specialist. We discussed bariatric surgery and I felt ready to pursue the option, especially now that I had an insurance carrier that was willing to approve the procedure.

Preparing to Change for Good

I decided that the laparascopic gastric band was the most appropriate surgical option for me. I found the staff of the bariatric surgery clinic at Penn Medicine to be extremely encouraging and supportive of my choice. I spent 9 months with them before the procedure. I might have much preferred to get the results I craved right away but I now appreciate the months I spent going to the support group meetings, improving my knowledge of nutrition and exercise, and the thorough medical assessments needed to ensure my health and safety.

My surgery was completed in May 2012 and I am learning to use this new tool that I have to manage my weight. It felt like such a relief to know that I now had help in achieving my goals. It is still difficult to change my habits and behaviors but my changing shape and increased endurance motivate me to continue to live a healthy and active lifestyle. It has been exciting to fit into clothes that I hadn't worn in over a year and to buy smaller sizes from my favorite stores.

On a recent trip, I no longer needed a seatbelt extender on the airplane and I didn't feel that I was smothering my neighbors. I started a running program and marvel at my new capabilities in the gym. Even though the scale doesn't always show me dramatic results, I know that I have lost inches in places where I lost fat and gained muscle. For the first time, I am excited about continuing this weight-loss journey. I finally know that I am capable of success.

This winter, I look forward to feeling better about myself even after the holidays are over, to being in more pictures, and to bundling up because I am cold not because I am trying to hide my body.

Learn More About Weight-loss Surgery at Penn

Penn can help you lose weight, and get back to a healthier lifestyle.

Join us for a free information session abut weight-loss surgery at Penn. Meet Penn weight-loss surgeons, and learn what weight-loss options are available to you.

Register for a free information session today.
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Heart Healthy Recipe: Thyme Scented White Bean Cassoulet


Cara Stewart, RD, LDN, is a member of the Penn Metabolic and Bariatric Surgery team. Here, she shares a heart-healthy recipe that's lower in fat and high in fiber.

Celebrate American Heart Month with a vegetarian meal! A study done at the University of Oxford in England reveals that the risk of hospitalization and death from heart disease is 32% lower in vegetarians than in people who eat meat and fish. Researchers say that the health benefit is likely related to having lower blood pressure and cholesterol.

While following a vegetarian diet likely not enough to prevent heart disease, choosing more meatless meals can decrease your intake of saturated fat and cholesterol, as well as increase your intake of heart healthy unsaturated fats and fiber.

Try this cassoulet where meatless Italian sausage stands in for the traditional pork sausage. With this recipe, you can also saute the sausage slices in a nonstick skillet over medium-high heat until browned, then stir into the dish.

Thyme Scented White Bean Cassoulet

Yield: 6 servings (serving size: 1 1/3 cups)

Ingredients

1 tablespoon olive oil
1 1/2 cups chopped onion
1 1/2 cups (1/2-inch-thick) slices diagonally cut carrot
1 cup (1/2-inch-thick) slices diagonally cut parsnip
2 garlic cloves, minced
3 cups cooked Great Northern beans
3/4 cup vegetable broth
1/2 teaspoon dried thyme
1/4 teaspoon salt
1/4 teaspoon freshly ground black pepper
1 (28-ounce) can diced tomatoes, undrained
1 bay leaf
1/4 cup dry breadcrumbs
1 ounce grated fresh Parmesan cheese (about 1/4 cup)
2 tablespoons butter, melted
2 links frozen meatless Italian sausage, thawed and chopped
2 tablespoons chopped fresh parsley

Directions

  1. Heat oil in a large nonstick skillet over medium heat. Add onion, carrot, parsnip, and garlic; cover and cook 5 minutes or until tender.
  2. Place in a 5-quart electric slow cooker. Add beans and next 6 ingredients (through bay leaf). Cover and cook on low 8 hours or until vegetables are tender.
  3. Combine breadcrumbs, cheese, and butter in a small bowl; toss with a fork until moist. Stir breadcrumb mixture and sausage into bean mixture; sprinkle with parsley.

Nutritional Information

  • Amount per serving
  • Calories: 298
  • Fat: 9.9g
  • Saturated fat: 3.9g
  • Monounsaturated fat: 3.6g
  • Polyunsaturated fat: 1.6g
  • Protein: 13.8g
  • Carbohydrate: 40.5g
  • Fiber: 10.4g
  • Cholesterol: 14mg
  • Iron: 3.5mg
  • Sodium: 709mg
  • Calcium: 187mg
Source: Robin Robertson, Cooking Light
OCTOBER 2004
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7 Ways to Lower Your Cholesterol

Author, Danielle Rosenfeld, MS, RD, LDN, is a member of the Penn Metabolic and Bariatric Surgery team.

Having high cholesterol levels can nearly double your risk for developing heart disease. The good news is that high cholesterol is a modifiable risk factor and every 1% reduction in your total cholesterol can lower your risk of heart disease 2% to 5%. February is Heart Month and there is no better time than now to get your numbers in check.

Know Your Cholesterol Numbers

Most of the time there are no symptoms associated with elevated cholesterol. Serum cholesterol tends to increase with age, especially among women, who have reduced estrogen levels as they reach menopause. This is why it is important to have your blood levels checked regularly by your health care provider.

Here are the cholesterol numbers you should know.

Total Cholesterol

Less than 200 mg/dl is a desirable level that puts you at lower risk for coronary heart disease. A cholesterol level of 200 mg/dl or higher raises your risk

HDL (Good) Cholesterol

60 mg/dl and above is considered protective against heart disease. Less than 40mg/dl (for men) and less than 50mg/dl (for women) are considered to be a major risk factor for heart disease

LDL (Bad) Cholesterol

Less than 100mg/dl is optimal, 200 to 99 mg/dL and 160 to 189 mg/dl is considered to be high

Triglycerides

Less than 100 mg/dl is optimal. High triglyceride levels combined with low HDL or high LDL can increase risk for heart disease

*Information is adapted from the American Heart Association


How You Can Lower your Cholesterol

Limit your saturated fat and trans fat intake

  • Dietary saturated fats are actually much more dangerous than dietary cholesterol in terms of raising LDL. Saturated fats are found in: red meats, whole-milk dairy products such as butter, cream and cheese, coconut oil, palm oil, hydrogenated vegetable oils, and pastries.
  • Trans fats are chemically engineered fats that help to increase the shelf life of foods. These fats increase your LDL and decrease HDL. Always make sure to read the food label and if possible, avoid all Trans fats.

Choose THIS
  • White-meat chicken, lean turkey meat without the skin
  • 92-99% lean ground beef
  • Egg whites or substitutes
  • Baked, grilled, steamed or roasted cooking methods
  • Fat-free or low-fat dairy products
  • Fresh fruit and vegetables

Instead of THIS
  • Red meat, dark meat chicken
  • Regular ground beef
  • Whole eggs with yolks
  • Fried foods
  • Whole milk dairy products
  • Pastries, potato chips and other snack foods

Opt for healthy MUFAs (monounsaturated fats)

MUFAs can actually lower total cholesterol and increase good, HDL cholesterol. Try to include a few servings of these foods into your diet: Nuts, peanuts, walnuts, pistachios, cashew nuts, hazelnuts (remember, keep nut servings to ¼ cup), avocado oil, canola oil, olive oil.

Remember, just 1 tablespoon of oil contains approximately 120 calories and 14 grams of fat- although it is a healthier fat you still need to use it in small amounts.

Include Omega-3 fatty acids

Omega-3s are polyunsaturated fats that aid in lowering total and LDL cholesterol. Food sources include: Fatty fish (salmon, tuna, mackerel, sardines, and herring), flax seed oil, canola and soybean oil, flax seeds, walnuts.

Aim for 25-30 grams of fiber/day

Increasing dietary fiber intake can result in lower cholesterol levels,
Eat beans (kidney, lentils, black beans, chickpeas), whole-grain cereals, oatmeal, quinoa, fruits (pears, raspberries, blackberries, apple) and vegetables.
Aim for 5 servings of fruits and vegetables/day.

Exercise regularly

Regular exercise can help reduce cholesterol. Aim for at 200 to 300 minutes each week.

Weight Management

  • If you are overweight, simply shedding 5 to 10% of your weight can significantly reduce your blood cholesterol.
  • Cutting 500 calories/day can promote a 1 lb weight loss/week.

Make healthier lifestyle choices

  • Avoid smoking and drinking excess alcohol.
  • Always compare food labels when shopping—pick foods low in saturated and trans fats.
Don’t wait until it’s too late. Follow these healthy lifestyle guidelines to help keep your numbers under control, regardless of what your family history is.

Lose Weight at Penn Medicine

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.
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I'm Running a 5K in 2013

Susanne is a 20-something nurse who had lap-band surgery at Penn in 2012. In this blog post, Susanne discusses her one goal for 2013, and how she is planning on achieving it.

You can read more about Susanne on her blog, Purl Before Swine.

My goal for 2013? Run a 5k.

I know, ambitious, right? I’ve been working with a personal trainer at my local gym since August and I feel pretty strong these days. Not necessarily skinny, but strong and capable. I felt that I had accomplished quite a lot just by sticking to my weekly meeting with my trainer for 6 months and I was getting bored with my cardio routine. In December, I felt that I needed a goal to keep in mind while on the treadmill.

My goal is to participate in the Color Run in Philadelphia this summer. I chose this particular run because it is advertised as an event for all ages and abilities. It is supposed to be a fun, happy event intended to make you feel good about yourself. The best part? All participants wear white t-shirts and colored powder is blasted at you at certain checkpoints along the race-course, ensuring that you finish the race in candy-colored, rainbow glory.

The smartest thing I did in choosing this goal was to tell other people about it. In telling those nearest and dearest to me, I raised my level of commitment to my goal. I also enlisted a few others to participate with me as my teammates for the Color Run, thus enhancing my chances of achieving my goal.

To prepare for the run, I am using an iPhone app called “Couch 2 5K” – it is an 8-week program that gently eases you into running by engaging you in interval training. Each week consists of 3 workouts where you alternate walking with jogging for various amounts of time. Gradually, you begin running more and walking less until, voila!, you are a runner! I am on week 2 – stay tuned for my progress over the next 6 weeks.

Easy Ways to Stay on Track for Your New Year’s Goals

  1. Pick something that excites you. Please do not try to conquer your fear of brussels sprouts or force yourself to love kale.
  2. “Go big or go home” is a stupid saying. Make sure your goal is realistic and can be achieved within a relatively short-time frame (think: 3-6 months) or you will lose interest.
  3. Tell people you trust and who care about you what goal you are working towards. This is key – you want to enlist support and encouragement, but you want to avoid snide remarks from your pesky coworkers or other people who don’t have your best interests at heart.
  4. Enlist people to participate in your goal, if applicable. Fitness is always more fun with friends (think: walking club, dance class, yoga instruction) or a cooking class could help you gain confidence in changing your eating habits.
  5. Celebrate your achievements along the way and at the end! Every time I go to the gym, I put a sticker on my calendar (don’t underestimate the power of stickers, even as an adult).
  6. When I finish the Color Run, I plan on celebrating with a healthy brunch at a favorite restaurant.

What are your goals for 2013?
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Love Your Heart

This February is Heart Month, and Penn Medicine encourages you to make changes in your lifestyle that will help your heart get or stay healthy.

It's no secret that obesity, and being overweight directly affects your health. When it comes to your heart health, however, obesity is only second to tobacco as a risk factor for heart disease.

The American Heart Association describes obesity as being 20 percent or more above your ideal body weight and between 60 and 70 percent of Americans are either overweight or obese. Letting your weight gain get out of control can increase your risk for health problems such as heart disease, stroke, high blood pressure, diabetes and more.

Did you know that by losing just 5 to 10 percent of your total body weight, you can bring about significant health gains?

  • Lowered blood pressure
  • Reduced cholesterol levels
  • Reduced risk of type 2 (adult onset) diabetes
  • Less chance of stroke
  • Decreased complications from heart disease
  • Reduced overall mortality

“Weight-loss procedures and the weight loss that comes with them have amazing and almost instant dramatic and rapid results,” says Gary Korus, MD, bariatric surgeon at Penn. “We see a change in some medications within days of surgery. Some of our patients report they were given the ‘okay’ to stop taking certain medications very early in their weight-loss journey.”

heart-month-infographic

Lose Weight at Penn Medicine

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.


Register for a free information session today.
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No More Resolutions

Susanne is a 20-something nurse who had lap-band surgery at Penn in 2012. In this blog post, Susanne discusses why New Year’s resolutions aren’t for her, and how her continued journey after weight-loss surgery at Penn is helping her get healthy in 2013, with or without resolutions.

You can read more about Susanne on her blog, Purl Before Swine.


I hate the idea of “New Years’ Resolutions.”

My first problem with the idea is the fact that waiting until January 1 to make the changes that I want to see in myself makes little sense. Of course, if it is August, waiting until January does buy a person a few months to come to terms with that crazy diet they want to try. Life is short, though, and there really is no time like the present. Start tomorrow or even today!

My second problem with the “New Year’s Resolution” is that resolving to do something makes life sound like it needs a complete overhaul year after year. The term is so loaded that I don’t even know anyone who has ever achieved his or her “resolution.” In my opinion, resolutions are for governments, GOALS are for people.

Third, we often fail to provide ourselves with even the most basic of road maps for achieving said resolutions. You might as well stand at the bottom of a sheer rock face without a rope and decide to climb. Just because we are flipping a page on our calendars doesn’t suddenly mean that the treadmill will no longer be the clothes rack that many of us use it as.

To get from point A to point B, it is really helpful to have some idea of where you are going, some knowledge of what obstacles might greet you along the way, and a few helpful tools in your back pocket in case you hit a really big pothole.

Have you made New Year’s goals? Are you sticking to them?
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Flaxseed Oil: A Rich Source of Healthy Fats

Flax seed oil is a rich source of alpha-linolenic acid (ALA), and omega-3 essential fatty acid. Flax seed oil comes from flax plants.

Flaxseed-oil
Flax seeds come in two basic varieties, brown and yellow (gold.) They both have similar nutritional characteristics and equal numbers of short-chain omega-3 fatty acids.

Benefits of Flax seed Oil

  • Flax seed oil contains omega-3 fatty acids, or “good” fats that have been shown to have cardiovascular benefits.
  • Studies have shown that flax seeds may lower cholesterol levels, lower risk for cancer, and lessen the severity of diabetes.

How to Get Flax seed Oil Into Your Diet

It’s important to consult with your physician before incorporating flax seed oil into your diet, because there may be interactions with other drugs you are currently on, or with your own health conditions.

If your doctor tells you it is okay to use flax seed oil, here are some easy ways to incorporate it into things you already eat.
  • Add some to the blender when making a smoothie or protein shake. 
  • Drizzle it onto quinoa or brown rice.
  • Use it in salad dressing.
Be mindful to account for the fat and calorie content of flax seed oil. One tablespoon contains 130 calories and 14 grams of fat.

Lose Weight at Penn Medicine

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia. 

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.
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