How to Avoid Regaining Weight After Bariatric 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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Regaining Weight After Bariatric Surgery

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 why some people gain weight after weight-loss surgery, and how support groups at Penn can help avoid post surgery weight gain.

It’s hard for a lot of people to understand, but the fact is some people who have bariatric surgery – whatever the type of surgery – regain the weight they lost. People regain weight after bariatric surgery for a number of reasons, one of which is emotional eating.

We all eat and drink for different reasons. Some people turn to food in times of stress – or happiness – and use food as a coping mechanism. Their emotions surrounding food and eating have not been addressed and new eating patterns revert back to old habits.

This is why every patient considering weight-loss surgery at Penn is required to undergo a psychological evaluation before bariatric surgery. The evaluation is an opportunity to identify motivations, address psychological challenges that may contribute to their obesity or impact preparedness for surgery and arrange for appropriate follow-up support. It is not designed to be a barrier to surgery.

If you have gained weight after bariatric surgery, you are not alone. Returning to one of the program’s support groups may help you get back on track. Others may work with the program’s dietitians to improve their diet. Still others may benefit from revisional surgery for weight loss.

Penn Can Help You Lose Weight

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

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Is Weight-Loss Surgery Expensive?

Weight-loss surgery at Penn Medicine can be an affordable decision.

Bariatric surgery procedure costs depend upon the patient, the surgery, and any post-operative difficulties that may occur.

In many cases, insurance companies cover the cost of the surgery since morbid obesity can be a life-threatening condition. You should speak with your insurance company to confirm that the surgery and any related expenses are covered.

Another thing to consider is the health benefits of weight-loss surgery. Research has shown that weight-loss surgery can control chronic diseases like type 2 diabetes, as well as other obesity-related conditions such as sleep apnea and hypertension.

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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Are You a Candidate for Weight-Loss Surgery?

Although it may seem like a quick fix to a lifelong struggle with weight, bariatric surgery, or weight-loss surgery, is a major step toward leading a healthy life.

Bariatric surgery is an operation that reduces the size of the stomach using one of a variety of procedures such as adjustable gastric band, gastric bypass, sleeve gastrectomy or robotic-assisted bariatric surgery.

Research has shown that bariatric surgery can cure, or help patients prevent, obesity-related conditions such as hypertension, type 2 diabetes, heart disease and sleep apnea.

Is Weight-loss Surgery Right For You?

If dieting hasn’t worked for you in the past, you may be considering weight loss surgery. Because the decision to have bariatric surgery can be a difficult one, the Penn Metabolic and Bariatric Surgery Program provides prospective and current patients with all the information they need to make informed choices.

All patients considering bariatric surgery at Penn must meet specific criteria before being scheduled for a screening evaluation.

These criteria are based on universal standards established by the National Institutes of Health and include:

• Exceeding your ideal body weight by more than 100 pounds or 45 kg
• Body mass index (BMI) greater than 40 or BMI greater than 35 with medical complications related to obesity, including high blood pressure, type 2 diabetes, sleep apnea and high cholesterol
• A documented history of weight management and weight loss attempts with supervised diets and exercise programs
• No indication of active alcoholism, active drug addiction or major psychiatric disorder

Patients must undergo a complete pre-operative evaluation that includes physical and psychological assessments.

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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What is Bariatric Surgery?

Bariatric surgery is a type of weight-loss approach that uses surgical procedures to help patients lose weight, avoid or reverse some diseases such as type 2 diabetes and high blood pressure, and improve overall health.

Because every patient considering bariatric surgery is unique, the Penn Metabolic & Bariatric Surgery Program offers a full range of bariatric surgical options. This ensures that patients receive the bariatric surgery that will provide them with the best possible results.

Here are four types of bariatric surgery at Penn.

Sleeve Gastrectomy

Sleeve gastrectomy is typically considered for patients with a body mass index (BMI) of 50 or higher. During the surgery, a sleeve–shaped tube is created from a small portion of the stomach and the majority of the stomach is removed. The small intestine is not surgically altered. Sleeve gastrectomy may require a second operation like conversion to Roux-en-Y gastric bypass (see below) if even more weight loss is required to improve a patient's health.

Robotic-assisted Bariatric Surgery

All procedures performed by Penn bariatric surgeons are available using a minimally invasive approach called laparoscopic surgery. Laparoscopic surgery offers many benefits for patients including shorter recovery times and less post-operative pain. In addition, Penn performs robotic-assisted bariatric surgery for the adjustable gastric band and sleeve gastrectomy procedures. Penn's bariatric specialists are highly experienced in robotic-assisted surgery and have performed more than 500 robotic LAP-BAND® and sleeve gastrectomy procedures.

Roux-en-Y Gastric Bypass (RGB)

The most common type of bariatric surgery performed in the United States, during the Roux-en-Y procedure a Penn surgeon divides a small gastric pouch from the upper portion of the stomach and attaches it directly to the small intestine, completely bypassing the larger part of the stomach.

Adjustable Gastric Band

The adjustable gastric band does not divide or reattach any part of the gastrointestinal tract. During the procedure, a Penn surgeon places a band around the upper portion of the stomach creating a small pouch with a narrow opening to the lower stomach. The food eaten stays in the small pouch for more time, so the patient feels full longer. The band is adjustable, which means it can be tightened or loosened after surgery as needed.

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 & Bariatric Surgery Program.

Register for this free event here. 

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Adjustable Gastric Band: A Tool for Weight Loss

Samantha Warner-Grimsley, RN, CBN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for achieving weight loss success with an adjustable gastric band.

If you have or are considering an adjustable gastric band as a way to lose weight, it is important to remember that the band is just a tool for weight loss. Like most tools, it requires proper management to function optimally.

Making the most of your adjustable gastric band requires a combination of lifestyle and dietary changes along with gastric band adjustments.

Follow these tips to to achieve the best results from your adjustable gastric band surgery:

Set reasonable, incremental goals for weight loss.
Aim to lose one to two pounds per week.

Follow the postoperative dietary guidelines.
For four to six weeks after surgery, follow the postoperative dietary guidelines provided by the dietitian. Slowly advancing from a liquid to solid diet gives your stomach the chance to heal while keeping the lap band in the right position.  It may take up to one month for your stomach to fully heal from surgery.

Re-introduce solid food gradually.  After the initial postoperative period, slowly re-introduce soft and then solid foods to your diet.

Take small bites and eat slowly. Always remember to take small bites, eat slowly and chew well. Developing these habits teaches you to recognize when you are satisfied and prevent stomach upset.

Adjust the gastric band to manage symptoms.The band can be tightened or loosened to manage symptoms or help you achieve better portion control to expedite weight loss. Symptoms that should be reported to your health care team include:

• Painful or difficult swallowing
• Severe abdominal pain
• Heartburn
• Food sticking in the esophagus
• Frequent regurgitation or inability to tolerate solid foods
• Vomiting

Remember that success is a team effort.
Schedule regular follow-up visits with your surgeon or nurse practitioner and dietitian. The Penn Metabolic and Bariatric Surgery Program recommends visits every six to eight weeks.

Exercise regularly. Make sure to exercise regularly but within your limitations. For the best results, add 30 minutes of moderate exercise into your daily schedule. Keep in mind that every minute of exercise counts, so even 10 or 20 minutes of exercise is better than nothing.

Get support. Attend support group meetings to connect with other people who have adjustable gastric bands, share your experiences and exchange ideas. For a list of support group meetings at Penn Medicine, click here.

- Samantha Warner-Grimsley, RN, CBN

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Start Walking for a Healthier You

Rebecca Dilks, RD, LDN, research coordinator at the Center for Weight and Eating Disorders and member of the Penn Metabolic and Bariatric Surgery team, provides tips for starting and maintaining a walking program.

Gym memberships are expensive. Running or biking outside can put stress on the body, especially when starting an exercise program after surgery. But walking? It’s free, convenient and easy on your body. That is why walking is the recommended form of exercise after weight loss surgery.

The following tips can help you get motivated to start and maintain an active walking program:

Lace up your shoes rain or shine
Make a commitment to walk in all kinds of weather. If it is cold, bundle up. If it is raining, carry an umbrella. Don’t let the weather be an excuse for not walking.

Plan ahead
Look at your schedule at the beginning of each week and decide which days to walk. By planning ahead, you help ensure that your busy life does not get in the way of your walking program.

Make walking fun
Just because walking is a form of exercise does not mean it has to be miserable. Make walking fun by starting a walking group and asking friends and family to join you. A lively conversation makes exercise more enjoyable. You might even forget you’re walking for exercise.

Bring a dog
Pets make wonderful companions – even for exercise. Use your exercise time as an opportunity to walk the dog or even borrow a friend’s dog. Dogs are great motivators to keep moving and stay active.

Set a destination
Having a destination in mind makes the walk pass quicker. Before you begin your walk, set a destination such as a flower shop or bookstore. You can even reward yourself by buying a bouquet of flowers or magazine when you get there.

Clear your mind
Walking is a great form of self therapy or catharsis. Use your time walking to clear your mind and channel positive energy.

Keep things new and fun
As soon as a walking path starts feeling routine, change it up. Find a new trail or go to a park you’ve never been to before. Avoiding routine helps keep things new and fun.

Jazz up your walk with tunes
Update your music player with upbeat songs. Music is energizing and sometimes even gives you an extra pep in your step. You can also upload audio books if you prefer listening to books instead of music.

The key to maintaining a long-term exercise program is making it enjoyable instead of a chore. Also, remember that physical activity is a key component of a healthy lifestyle, so make walking a priority and invest in a healthier future.

Make sure to consult with your health care team before starting any exercise program, including walking.

- Rebecca Dilks, RD, LDN

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Bariatric Surgery Better Than Medication for Diabetes

A new study says people with type-2 diabetes may have more success in managing their diabetes with bariatric surgery rather than traditional medical therapies.

The study, published this week in the New England Journal of Medicine compared the standard treatment of medication, diet and exercise to weight-loss surgery, also known as bariatric surgery, for the treatment of type-2 diabetes.

“Research has already shown that gastric bypass surgery improves or resolves type-2 diabetes in days or weeks following surgery,” says Noel Williams, MD, director of the Penn Metabolic and Bariatric Surgery Program. “This new study shows that in addition to gastric bypass, sleeve gastrectomy has the same positive impact on type-2 diabetes and is more effective than medical management alone.”

During a sleeve gastrectomy, a sleeve-shaped tube is created from a small portion of the stomach and the majority of the stomach is removed. Food passes through the new stomach tube directly into the intestines. Nutrients and calories are absorbed from food normally, but patients feel full sooner and longer.

“It is important that patients choose an experienced physician to perform their weight-loss surgery,” says Dr. Williams. “The Penn Metabolic and Bariatric Surgery program performs more than 500 procedures every year and more sleeve gastrectomies than any program in the Philadelphia region.”

Type-2 diabetes is a chronic disease in which the body cannot or does not produce enough insulin to manage blood sugar levels. Type-2 diabetes is often associated with obesity, though people of average weight may also develop the disease.

“Research is proving that weight-loss surgery reduces the co-morbidities associated with obesity,” says Dr. Williams. “Following surgery some patients quickly see their blood sugar level return to normal and they are able to stop taking insulin and other medications.”

The study also found bariatric surgery helped people lower their blood pressure and cholesterol.

Read more about the study here.

Learn more about weight-loss surgery at Penn, and how it may help you control your diabetes by attending a free informational session about weight-loss surgery. 

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Drinking Alcohol after Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains how to incorporate alcohol in a healthy diet 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

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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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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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Having a Baby After Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, and Monica A. Mainigi, MD, fertility specialist at Penn Fertility Care, provide important information for women trying to become pregnant and maintain a healthy pregnancy after weight loss surgery.

Many women struggle with fertility as a result of their weight. In fact, obesity puts women at greater risk for ovulation dysfunction and menstrual irregularity, both of which can interfere with fertility. In addition, obesity can lead to an increased risk of miscarriage and decreased success with fertility treatments. For overweight women who are having a hard time conceiving, weight loss surgery may be an option to consider.

For women considering pregnancy after they have had bariatric surgery, it is important to keep the following information in mind.


Fertility boost
Obesity can interfere with hormone production, making it more difficult to get pregnant.  Weight loss after bariatric surgery can lead to regular cycles and ovulation, and improved fertility. In fact, a 2005 study published in the Journal of Clinical Endocrinology and Metabolism found that surgical weight loss for women with PCOS often resolved their reproductive and metabolic abnormalities. 

Healthier pregnancy, healthier baby
After weight loss surgery, medical conditions such as high blood pressure and diabetes are significantly improved or resolved leading to a lowered risk of developing serious complications during pregnancy or delivering a baby born with complications.  Many women are still obese after weight loss surgery which places them at a higher risk for gestational diabetes and preeclampsia, but the risk is far less than before surgery.  Pregnant women who have had bariatric surgery should see a high-risk obstetrician to best manage prenatal care.

Give it time
It is important to wait at least 18 months after surgery to start trying to get pregnant. In the period immediately following gastric bypass or sleeve gastrectomy, rapid weight loss causes stress on the body, including diminished nutrition intake, which can cause complications for an expecting mother and growing baby. Effective contraception is absolutely critical for women pursuing weight loss surgery.  For women with an adjustable gastric band, fluid may be removed from the band during pregnancy to accommodate the need to eat more calories.

Keep supplementing
Good nutrition is especially important for women trying to conceive.  After weight loss surgery, patients are at a higher risk for deficiencies of certain nutrients, including vitamin B12, folic acid, calcium, iron, and vitamin D. It essential to continue taking vitamin and mineral supplements as recommended by the bariatric team.

Be ready for weight gain
After having weight loss surgery, it can be difficult to accept that pregnancy is a time when it is normal, healthy and necessary to gain weight.  Healthy weight gain during pregnancy is important to nourish a growing baby, but work with the program dietitians to avoid unhealthy weight gain during pregnancy.

The Penn Metabolic and Bariatric Surgery Program offers lifelong follow-up care and nutritional support for patients who have had weight loss surgery. Women considering pregnancy after weight loss surgery should discuss their plans with the bariatric surgery team.

For more information on fertility services at Penn Medicine, visit the Penn Fertility Care website.

- Cara Stewart, RD, LDN and Monica Mainigi, MD

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Tips for Healthy Holiday Eating After Weight Loss Surgery

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for managing your post-surgical diet during the holidays.

There is no getting around it. Food is a central part of the holiday season. Whether you’re enjoying holiday food with friends and family or inundated with unhealthy treats at the office, it is hard to maintain your healthy eating goals over the holiday season, but it is possible.

These tips can help you stay on track with your post-surgical diet and lifestyle changes while still allowing you to enjoy the holiday festivities.

Don’t skip meals
Always make time for breakfast, lunch and dinner. Going long stretches without eating can lead to eating too much or too quickly and cause nausea or vomiting in people who have had weight loss surgery. It can also result in unhealthy food choices due to overwhelming hunger.

Be selective about food choice
Resist the temptation to try foods that are high in sugar and fat. After gastric bypass surgery, fatty and sugary foods can cause “dumping syndrome,” resulting in severe abdominal pain and cramping, diarrhea, nausea and vomiting. Instead, choose low-calorie party foods such as raw vegetables, fruit with yogurt dip or boiled shrimp with lemon or cocktail sauce.

Stay well hydrated
Stay hydrated by drinking water and low-calorie beverages. Avoid alcoholic beverages and try to separate eating and drinking by 30 minutes.

Keep a food diary
Research* shows that recording what you eat helps you stay on track during the holidays. It also helps you meet your protein and fluid goals. Take a minute each night to record your food and fluid intake for the day.

Click here for more healthy eating tips for you and your family.

- Karen Buzby, RD, LDN


*Cornett R, Akers J, Salva J, Zoellner J, Davy B. Daily self-monitoring during the winter holiday period: a feasible strategy for holiday weight maintenance. SCAN’s PULSE. Fall 2011, Vol 5, No 4: 1 – 6.

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Eat Right When Eating Out

Karen Buzby, RD, LDN, and Cara Stewart, RD, LDN, members of the Penn Metabolic and Bariatric Surgery team, offer these tips for eating healthy when dining out.

Dining out can be a challenge for anyone trying to follow a healthy eating plan, but it is especially difficult if you have had weight loss surgery. Restaurant portions are notoriously large and the meals are often packed with sodium and hidden calories from fats, sugars and sauces. Before weight loss surgery, larger portions may have tempted you to eat more than you wanted or needed. After weight loss surgery, the food may go to waste or cause discomfort. 

The following tips can help you enjoy your meal out while sticking to your diet plan.

Limit calories:

• Be conservative with food selection, especially during the first few months after surgery. Stick with simple prepared foods.
• Before ordering, ask yourself: “Is this food pouch worthy?” Make sure you order foods that are a good source of protein and fiber.
• Look for heart-healthy, low-fat or light options. U.S. Food and Drug Administration (FDA) regulations require restaurants to back up their health claims. Feel free to ask for nutrition information if it is not already provided.
• Stay away from the bread and chip baskets as well as dessert and alcohol menus. Ask the server not bring out the dessert cart. If you choose to eat bread, opt for a small, plain yeast roll and avoid items with added fat like garlic bread, cornbread, croissants and muffins.  
• Salad dressings are often high in calories and fat. Always order dressing on the side and ask for low-fat dressing, a lemon wedge or flavored vinegar instead of the full fat and calorie version. 
• Don’t drink your calories. Quench your thirst with calorie-free drinks like water or unsweetened iced tea. Limit or avoid alcoholic beverages.
• If your job requires socializing or doing business over meals, call ahead or go online to learn about your options in advance. Inform the restaurant manager of your dietary restrictions and make special requests ahead of time if necessary.
• Savor each bite of food, enjoy the company and take your time. Allow at least 20 to 30 minutes for each meal. Remember, conversation is calorie-free!

Control portion sizes:

• Watch your portion size. People who have had bariatric surgery receive a “restaurant card” to request smaller portions when dining out. Use it to make sure your meals are an appropriate size.
• Share a meal or order a smaller portion. This reduces portion size and the expense as well.  
• Order from the lunch menu if it is available. Often the lunch menu offers smaller and less expensive entrees.
• Order from the children’s menu if there are healthy selections available.
• Order an appetizer as a main entrée. The portions of appetizers are usually two to four ounces, which is the ideal meal size after weight loss surgery. 
• Ask the waiter to split the main dish and box half before serving it. You can also request a “doggie bag” as soon as you feel satisfied to avoid the temptation of overeating. 
• Try a tapas restaurant, which serves snack-sized appetizers and entrées.  

Manage leftovers:

• When you take home leftovers, remember to refrigerate the food promptly to avoid food-borne illness. Food left out for more than two hours may not be safe to eat.
• Write the date of purchase or preparation on leftovers and remember to discard the food after three to five days. Always follow the mantra: “When in doubt, throw it out.” Plus, you don’t want your refrigerator to turn into a jungle of leftover containers. 
• Reheat food thoroughly.

- Karen Buzby, RD, LDN and Cara Stewart, RD, LDN

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Penn Advancing Bariatric Surgery with Clinical Research

Jacque Spitzer, MSEd, research project manager at the Center for Weight and Eating Disorders and member of the Penn Metabolic and Bariatric Surgery team, explains the various ways patients can stay connected with the program after surgery.

There are many ways to stay connected with the Penn Metabolic and Bariatric Surgery Program after your surgery. In addition to regular follow-up appointments and an annual visit, many people choose to join Penn’s post-operative support groups or participate in clinical research programs.

As one of the leading research programs in the country, Penn Metabolic and Bariatric Surgery is deeply committed to advancing medicine by finding new, improved ways help people with morbid obesity. At any given time, the Penn Metabolic and Bariatric Surgery Program conducts multiple research studies aimed at better understanding the underlying cause of severe obesity, developing new surgical techniques and finding optimal strategies for improving post-operative outcomes and success.

The first step in participating in clinical research involves learning about the study, asking any question you may have and providing informed consent if you choose to participate. Informed consent means getting all the information about the study and then making an educated decision about whether you want to participate. The decision is all yours and it does not affect the quality of care you receive from the program.

The next step in the process is a screening interview or visit to make sure you fit all of the requirements to participate in the study. Research studies vary greatly in the number of visits and types of activities that they involve. Some involve filling out a one-time survey while others involve repeated visits over months or even years. You learn about all of these parameters before deciding whether to participate.

Participating in clinical research provides the unique opportunity to contribute to the growing understanding of obesity and obesity-related diseases as well as obtaining access to the latest treatments. Click here for a list of all obesity and weight loss surgery research studies currently under way at Penn Medicine.

In addition, support groups provide an opportunity to meet other people who are on a similar weight loss journey, share experiences and offer support to one another. Staying in close contact with the team also allows them to quickly address any problems you may be having so you can stay on track with your post-operative lifestyle changes and achieve your weight loss goals.

- Jacque Spitzer, MSEd

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Bariatric Surgery's Halo Effect: Weight Loss for the Whole Family

Bariatric surgery improves the health and well-being of those who undergo surgery, but a recent study at Stanford University School of Medicine shows the positive impact actually extends to the entire immediate family. 

Researchers found that one year after a family member's gastric bypass surgery, other obese adults in the family lost an average of eight pounds and obese children had a lower body mass index than expected for their growth curve. The family members and children that participated in the study accompanied the bariatric patient to all pre- and post-operative clinic visits, including diet and lifestyle counseling. 

Adult family members reported improved eating habits with less uncontrollable eating, emotional eating and alcohol consumption. Both adults and children reported a significant increase in their activity levels. 

The results of this study come as no surprise to members of the Penn Metabolic and Bariatric Surgery team who have witnessed this pattern many times. After bariatric surgery, patients often report that their pursuit of a healthier lifestyle spurred changes for their whole family, including kitchen cabinet makeovers, healthier home-cooked meals and family fun nights that involve physical activity.

Family members and friends are always welcome to attend Penn Metabolic and Bariatric Surgery Program information sessions and support groups to help their family members and to help themselves as well. 

Note: The study was published on Oct. 17, 2011 in the Archives of Surgery. 

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The Essential Kitchen Tools, Utensils and Appliances for Successful Weight Loss

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses kitchen tools that can help you eat healthier and lose weight.
Whether you’re trying to lose weight or recovering from weight loss surgery, healthy meal preparation is critical for weight loss.  Follow these recommendations to make sure your kitchen is set up with the right appliances and utensils to help you successfully shed the pounds.

Use the right utensils

• Measuring spoons: The tablespoon is useful for portion control and the ¼-, ½- and 1-teaspoon measurements are commonly used in recipes.
• Measuring cups: The ¼-, ⅓-, ½-, and 1-cup measurements are frequently used for solids, and an 8-ounce glass or clear plastic measuring cup works best for liquids.
• Food scale: A scale is helpful to weight meat, poultry and fish for portion control

Slow the pace of eating

• Mini or baby spoon and fork: The small surface area of small utensils reduces consumption by making bites smaller.
• Tea cup saucer: The bigger the plate, the bigger the serving. A smaller plate size often means eating less. 
• Cup warmer: Place a cup warmer under a ceramic plate to keep food hot so you don’t feel rushed when you eat.
• Egg or kitchen timer: Use the timer to slow down the pace your meals and to remind you to drink plenty of water.  

Use storage items to keep healthy meals on hand and promote small portions

• Insulated, reusable water bottle and brush: A portable beverage container allows you to keep your protein drink or beverage with you at all times. The brush is useful for cleaning your container.
• Small non-stick frying pan and ceramic baking container: The small size helps you regulate portion size.
• Extra small, reusable, plastic storage containers: Use the environment-friendly containers to store lunches and on-the-go snacks in the refrigerator and freezer.

Handy kitchen gadgets and countertop appliances make healthy meal preparation easier

• Meat thermometer: The thermometer allows you to ensure that entrées are cooked appropriately to help avoid food-borne illness.
• Vegetable peeler: A peeler removes tough skin from produce such as potatoes.
• Blender: Helpful for making protein drinks and low-calorie smoothies, you can choose a counter-top blender, hand-held stick blender, wire whisk or shaker.
• Food processor: A food processor is a kitchen essential during the pureed food phase of the post-surgical diet.

- Karen Buzby, RD, LDN

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Avoiding Food-borne Illness after Weight Loss Surgery: What You Need to Know

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses the importance of prevention and fast recovery from food-borne illness, especially after bariatric surgery. 


Contracting a food-borne illness, or food poisoning, is distressing for anyone, but it is particularly dangerous after bariatric surgery. When recovering from bariatric surgery, the pace of drinking and eating is often limited and makes rehydration difficult. For people who had the adjustable gastric band procedure, there is also an increased risk for the gastric band to slip out of position if vomiting is severe or prolonged.

Food-borne illnesses are caused by bacteria, viruses or parasites in food. They are the result of mishandling during processing or preparation, failure to cook items to the recommended temperature or improper storage. Foods from animals and unpasteurized milk are particularly at risk for food poising. This includes raw or undercooked meat, poultry, fish, shellfish and eggs. Although less common, fresh fruits and vegetables can also contain harmful bacteria from contaminated water or soil.

Food poisoning causes flu-like symptoms, including nausea, vomiting, diarrhea and fever. Symptoms usually appear four to 48 hours after eating and pass after one or two days. However, some cases of food-borne illness can be severe and even life-threatening. It is important to seek immediate medical attention if you experience any of the following symptoms:

• Light-headedness when standing
• Persistent vomiting
• Fever higher than 101 degrees Fahrenheit
• Blood in bowel movements
• Diarrhea for more than three days

Keep in mind that after bariatric surgery, food intolerance and dumping syndrome cause similar symptoms to food poisoning, such as nausea and vomiting. The difference is that symptoms from food intolerance and dumping syndrome typically occur immediately or soon after eating and resolve within several hours. Symptoms from food poisoning tend to have delayed onset and longer duration.

To prevent contracting food-borne illness, take the following precautions:

• Wash your hands. Make sure to wash your hands with soap and water before preparing or eating food. If you are unable to wash your hands, use an alcohol-based hand gel that is at least 60 percent alcohol.
• Cook meat, poultry, fish and eggs thoroughly and serve hot. If a restaurant serves an undercooked item, send it back and request a new plate.
• Meat and poultry: Cook to an internal temperature of 160 degrees Fahrenheit. Make sure the meat is no longer pink inside and the juices are clear.
• A whole chicken or turkey should be cooked to an internal temperature of 180 degrees Fahrenheit. Make sure the poultry joints move easily.
• Poultry breasts and roasts can be cooked to 170 degrees Fahrenheit.
• Egg: Yolks and white should be firm, not runny. Avoid food with raw egg, including salad dressing, sauces, homemade ice cream, uncooked cake batter or cookie dough.
• Fish: Cook fish until the internal temperature is 145 degrees Fahrenheit. Make sure the fish is opaque and easily flakes with a fork.
• Only drink pasteurized dairy products. Avoid foods made from unpasteurized milk.
• Refrigerate perishable food promptly. Food that is left out for more than two hours may not be safe to eat. Store perishable foods in a refrigerator that is below 40 degrees Fahrenheit. In the summer, when the temperature can be over 90 degrees, do not leave food out for more than an hour.
• Wash fruits and vegetables before eating.

If you do fall victim to a food-borne illness, follow these tips for a quick recovery:

• Hydrate with water or low-calorie fluids. Clear broths, diluted juice, weak tea, diet gelatin or sugar-free ice pops are good sources of hydration. Start with small sips and gradually increase the pace of drinking.
• Reintroduce food slowly. Start with bland foods that are easy to chew and digest.
• Separate drinking and eating by 30 minutes. Take several days to progress to your regular bariatric diet.
• Talk to your doctor. Tell your provider about your symptoms to avoid a long-term impact on your health.

- Karen Buzby, RD, LDN

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Taking Vitamin and Mineral Supplements: Make time even if you feel fine!

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, outlines the important vitamin and mineral supplements to take after weight loss surgery.

After weight loss surgery, you need to commit to taking a regimen of vitamin and mineral supplements for the rest of your life. Eating smaller amounts of food means your body receives fewer nutrients. In addition, after gastric bypass or sleeve gastrectomy surgery, your system does not absorb some vitamins and minerals as well.

This table highlights the functions of several key nutrients and the symptoms of their deficiency. The damage to your body from many of the deficiencies is permanent, so be sure to follow your dietician’s instructions for taking supplements and have your lab values checked routinely with your primary care physician.

NUTRIENT	WHAT IT DOES	DEFICIENCY
Vitamin B1 (thiamine)	Helps all cells of the body produce energy from carbohydrates	Fatigue, weak muscles, nerve damage
Vitamin B12	Works with folate to make red blood cells Vital part of every cell Helps body use fatty acids and some amino acids	Anemia, fatigue Permanent nerve damage including tingling or numbness in hands and feet
Folate (folic acid)	Plays essential role in making new body cells Works with B12 to form hemoglobin in red blood cells Helps reduce risk of neural tube defects (spina bifida) in developing fetus	Anemia caused by malformed blood cells that won’t carry as much oxygen Increased risk of neural tube defects in developing fetus
Vitamin A	Promotes normal vision, helps eyes see normally in the dark Promotes growth and health of all cells Keeps tissues healthy to prevent infection Works as an antioxidant	Night blindness Dry, scaly skin Reproductive problems
Vitamin D	Promotes absorption of calcium and phosphorus Regulates amount of calcium in blood	Osteoporosis (loss of bone mass) Osteomalacia: softening of bones
Calcium (**NOTE: Supplements are still needed even if blood levels are normal)	Helps bones remain strong by slowing rate of bone loss with age Helps muscles contract and heart beat Promotes normal nerve function	Osteoporosis
Iron	Essential part of hemoglobin that carries oxygen in blood Supports healthy immune system	Iron deficiency anemia Fatigue Infections

- Cara Stewart, RD, LDN

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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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