What is The hCG Diet?

Cara Stewart, RD, LDN, is a member of the PennMetabolic and Bariatric Surgery team. In this blog post, she discusses hCG, what is hCG and the dangers of the hCG diet.

Over-the-counter products containing human chorionic gonadotropin (hCG) may promise quick weight loss, but are ineffective for weight loss and illegal to sell.

The Food and Drug Administration advises consumers to avoid weight-loss products that contain hCG.

What is hCG?

hCG is a hormone produced during pregnancy. hCG is approved for prescription use to treat female infertility and other medical conditions, but there is no scientific evidence that it is an effective tool for weight loss. In fact, the prescription drug label notes there “is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or ‘normal’ distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets.”

The hCG Diet

The hCG Diet may include weight-loss products claiming to contain hCG. These are often marketed along with a severely restricted diet of as little as 500 calories per day. The weight loss that may occur in conjunction with hCG products results from caloric restriction, not from the supplement itself.

Without medical supervision, following such a low-calorie diet like the hCG diet can be hazardous to your health, causing protein malnutrition, vitamin and mineral deficiencies, and increasing the risk for gallstone formation, imbalance of electrolytes, irregular heartbeat.

If your goal is to lose weight, eating a balanced diet and exercising regularly is the best approach. If you have followed diet and exercise plans without success, consider talking to your health care provider about weight-loss surgery.

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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FDA Approves New Weight-Loss Drug Qsymia

The U.S. Food and Drug Administration recently approved the diet drug Qsymia(TM).

This weight-loss drug, a combination of the stimulant phentermine and the anti-seizure drug topiramate, claims to help people lose weight by suppressing the appetite and creating a feeling of fullness after eating. Researchers say the drug works by targeting multiple brain pathways that trigger overeating.

Clinical trials of Qsymia have shown that people who took the drug combined with a healthy eating plan and fitness regime did lose weight. However, Qsymia does come with several side effects that include:

• Increased heart rate
• Birth defects
• Hyperventilation
• Fatigue
• Anorexia

Should I take a diet pill?

Only you and your doctor can decide if it is safe for you to take a diet pill. People who take any diet drug should be monitored closely by a physician who can detect heart disease or other cardiovascular risks.

The safest and best recommendation for long-term weight loss is a healthy diet combined with a fitness regime. For some people who have struggled to control their weight throughout their whole lives, weight-loss surgery may also be an option to lose weight.

Get more information about weight-loss surgery at Penn

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

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

Register for this free weight-loss information session.

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Are You a Yo-Yo Dieter?

If you have battled obesity and weight loss throughout your life, you know all about “yo-yo” dieting. What is yo-yo dieting? And why do so many people succumb to a cycle of losing weight only to gain it back again.

Why do we Yo-Yo Diet?

Yo-Yo dieting, also known as weight cycling, refers to the cycle by which a person loses weight, but later gains it all back. In some cases, people gain back more than they lose.

The reasons for yo-yo dieting are varied, but yo-yo dieting is usually attributed to a diet that is too extreme or restricting. You might initially be happy with the results from a very extreme diet. The diet, however, is usually too restrictive and often leads to overeating – usually more than you would have eaten before embarking on such a diet. This results in rapid weight gain.

How to Avoid Yo-Yo Dieting

The best way to avoid weight cycling is to maintain balance. Basic guidelines for weight loss advise you to eat less, and exercise more. However, eating too little can set you up for disaster.

It sounds oversimplified, but to lose weight, it’s important to eat a balanced diet full of healthy, filling foods while incorporating daily exercise into your life. It’s best to eat small and frequent meals to constantly fuel your metabolism

It’s a good goal to aim for 1/2  to 1 pound of weight loss per week.

Get more information about weight-loss surgery at Penn

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

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

Register for this free weight-loss information session.

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Lose Weight and Eat Ice Cream? The Real Scoop on the Summertime Staple

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains how to incorporate ice cream into a healthy diet. 


Whether you prefer chocolate, vanilla or a specialty flavor like mint chocolate chip, nothing screams summer like a delicious ice cream cone.

Well, get out your scooper, folks, because ice cream is no longer on the "do not eat" list for people trying to lose weight.

While ice cream can be loaded with calories, saturated fat and sugar, a variety of reduced-fat and light options are now available, which means you can enjoy this summertime treat without sabotaging your diet.

It's easy to go overboard once you start eating ice cream. To prevent overeating, use a small spoon to savor every bite and scoop your ice cream into a bowl instead of eating directly from the container. Another option is to purchase individually packaged treats like ice cream sandwiches or ice cream bars.

Always remember to check out the nutrition label before you dig into your ice cream treat. Even some ice cream varieties with the label "light" can be deceiving, which underscores the importance of reading the nutrition facts. Stick to nutrition labels that follow these guidelines:

• 120 calories or less
• 4 grams of total fat or less
• 3 grams of saturated fat or less
• 15 grams of sugar or less (equal to approximately 3 teaspoons of table sugar)

These are examples of healthy ice cream choices:

• Breyers^® Double Churned light ice cream
• Edy's^® fat free frozen yogurt or Slow Churned light ice cream
• Turkey Hill^® fat free frozen yogurt
• Whole Fruit^® no sugar added sorbet
• Skinny Cow^® low fat fudge bars or ice cream sandwiches
• Healthy Choice^® fudge bars
• Rice Dream^® frozen yogurt

- Cara Stewart, RD, LDN

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3 Proven Weight-loss Plans

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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Are You A Perfect Dieter or Realist?

If you’ve failed at dieting and weight-loss programs, the cause may be your personality and not the kind of diet you’ve tried. Which one of these diet personalities fits you?

The All-or-Nothing Dieter

The All-or-Nothing dieter doesn’t believe in moderation – he can either have something or not, not even a small portion or a taste. This extreme thinking can be dangerous, and often sets the person up for a binge on the “forbidden foods.” One slip is all it takes for this dieter to deem himself a failure.

Ideas for Change

Even dieters can treat themselves every once in awhile.  Portion control is the key as is selecting the low fat version of your favorite treat.

The Instant Gratification Dieter

This dieter is gung ho…for about a week. She spends hours at the gym, eats only salad, and wants one thing: To fit into a dress or look good for an event. This dieter is setting herself up for failure too, as it is difficult to maintain this kind of momentum for the long term.

Ideas for Change

Make changes you can stick with. Be realistic as weight loss takes time.

The “Perfect” Dieter

This dieter has a clear image of everything he has eaten all day – and all of it is good. He  “forgets” the chocolate nibbled on after dinner, “doesn’t count” the dressing used on the very, healthy salad, and “loses” his food journal. But he steps on the scale, and can’t figure out why he is not losing weight.

Ideas for Change

Research shows keeping a food diary, either paper or electronic is a must to help you achieve your weight loss goals.

The Realist

The realist dieter knows what she’s doing. She tracks her food – even if she makes less-than-nutritious food choices. She is prepared; her pantry is filled with whole grain snacks, and her refrigerator is filled with fruits and vegetables. She is honest, and accepts the fact that weight loss is a slow process, and a lifelong learning experience.

Ideas for Change

You’ve got it!  Continue to practice mindful eating.  Make exercise a part of your routine.

What kind of dieter are you?

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What Kind of Dieter Are You?

If you’ve failed at dieting and weight-loss programs, the cause may be your personality and not the kind of diet you’ve tried. Which one of these diet personalities fits you?

The All-or-Nothing Dieter

The All-or-Nothing dieter doesn’t believe in moderation – he can either have something or not, not even a small portion or a taste. This extreme thinking can be dangerous, and often sets the person up for a binge on the “forbidden foods.” One slip is all it takes for this dieter to deem himself a failure.

Ideas for Change

Even dieters can treat themselves every once in awhile.  Portion control is the key as is selecting the low fat version of your favorite treat.

The Instant Gratification Dieter

This dieter is gung ho…for about a week. She spends hours at the gym, eats only salad, and wants one thing: To fit into a dress or look good for an event. This dieter is setting herself up for failure too, as it is difficult to maintain this kind of momentum for the long term.

Ideas for Change

Make changes you can stick with. Be realistic as weight loss takes time.

The “Perfect” Dieter

This dieter has a clear image of everything he has eaten all day – and all of it is good. He  “forgets” the chocolate nibbled on after dinner, “doesn’t count” the dressing used on the very, healthy salad, and “loses” his food journal. But he steps on the scale, and can’t figure out why he is not losing weight.

Ideas for Change

Research shows keeping a food diary, either paper or electronic is a must to help you achieve your weight loss goals.

The Realist

The realist dieter knows what she’s doing. She tracks her food – even if she makes less-than-nutritious food choices. She is prepared; her pantry is filled with whole grain snacks, and her refrigerator is filled with fruits and vegetables. She is honest, and accepts the fact that weight loss is a slow process, and a lifelong learning experience.

Ideas for Change

You’ve got it!  Continue to practice mindful eating.  Make exercise a part of your routine.

What kind of dieter are you?

Learn more about how Penn can help you meet your weight-loss goals. Join us for a free information session about weight-loss surgery at Penn. 

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Three 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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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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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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Healthy Bites for People on the Go: Meal and Snack Bars

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the nutritional value of meal and snack bars and provides a guide for making healthy selections. 

It can be hard to fit healthy eating into a busy lifestyle. Between work, family, social obligations and more, sometimes it feels like there’s not enough time to prepare or sit down for a healthy, balanced or home-cooked meal.

But a shortage of time does not mean you have to sacrifice your commitment to healthy eating!

In fact, snack and meal replacement bars are perfect items to stock up on for those moments when you’re strapped for time and need a healthy bite to eat. They are easy, convenient, portable and if you make smart choices, they can be healthy, too.

From breakfast bars to granola bars to energy bars and protein bars, it’s hard to know which variety is the best, most healthful choice. The wide variety of bars on the market can make selection overwhelming and it doesn’t help that many bars masquerade as healthy despite being packed with sugar and fat.

Use this guide to find a healthy snack or meal replacement bar for the next time your stomach is grumbling but you’re on the way out the door.

Meal Replacement Bars
These bars are ideal when you’re in a rush and otherwise would skip a meal. Look for the following nutritional requirements per serving when making a selection:

• 200 to 300 calories
• At least 15 grams of protein
• At least 5 grams of fiber
• Less than 20 grams of sugar (Less than 10 grams of sugar for people who had gastric bypass surgery)
• Less than 10 grams of total fat
• Less than 2.5 grams of saturated fat

Snack Bars
Snack bars are great for quenching hunger between meals or as fuel before a workout. Make sure that your snack bar contains the following nutritional requirements per serving:

• 150 to 200 calories
• At least 5 grams of protein
• At least 3 grams of fiber
• Less than 15 grams of sugar
• Less than 7 grams of total fat
• Less than 2 grams of saturated fat

These general considerations are helpful to keep in mind when deciding which meal or snack bars to purchase:

• Bars that are low in carbohydrates are generally low in fiber or high in fat, especially saturated fat. Be careful that you’re not trading one unhealthy nutrient for another.
• Some bars, especially those that are low in sugar and carbohydrates, contain sugar alcohols, which can cause bloating, gas and diarrhea.  
• Bars that contain fruit naturally have more sugar. With fruit bars, you can be more flexible with the sugar content per serving.
• Pay attention to flavor and consistency. Make sure that you actually enjoy the taste of the bar!

Snack and meal bars made specifically for people who have had bariatric surgery are available on the following websites:

• BariatricAdvantage.com
• BariatricChoice.com
• BariatricEating.com
• DoctorsBestWeightLoss.com

- Cara Stewart, RD, LDN

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Buon Appetito: Eggplant Parmesan – the healthy way

An Italian favorite, Eggplant Parmesan is typically made with fried eggplant and loads of high-fat cheese – a dieter’s nightmare! But there are ways to modify the recipe so it fits into your healthy diet. To reduce the calories, fat and sodium while retaining the flavor, try this healthy recipe for Eggplant Parmesan.

Ingredients:
Eggplant

• 2 large eggs, lightly beaten
• 1 tablespoon water
• 2 cups whole-wheat panko (Japanese breadcrumbs)
• 1/4 cup (1 ounce) grated fresh Parmigiano-Reggiano cheese
• 2 (1 pound) eggplants, peeled and cut crosswise into ½-inch slices
• Cooking spray

Filling

• 1/2 cup torn fresh basil
• 1/4 cup (1 ounce) grated fresh Parmigiano-Reggiano cheese
• 1/2 teaspoon crushed red pepper
• 1 1/2 teaspoons minced garlic
• 1/4 teaspoon salt
• 1 (16 ounce) container part-skim ricotta cheese
• 1 large egg, lightly beaten
• 1 (24 ounce) jar premium pasta sauce
• 1/4 teaspoon salt
• 8 ounces thinly sliced mozzarella cheese
• 3/4 cup (3 ounces) finely grated fontina cheese

Preparation:

1. Preheat oven to 375 degrees.
2. Eggplant: Combine 2 eggs and 1 tablespoon of water in a shallow dish. Combine panko and 1/4 cup Parmigiano-Reggiano in a second shallow dish. Dip eggplant in egg mixture; dredge in panko mixture, pressing gently to adhere and shaking off excess. Place eggplant slices 1 inch apart on baking sheets coated with cooking spray. Bake at 375 degrees for 30 minutes or until golden, turning once and rotating baking sheets after 15 minutes.
3. Filling: Combine basil, Parmigiano-Reggiano cheese, red pepper, garlic, salt, ricotta cheese and egg.
4. To assemble, spoon 1/2 cup pasta sauce in bottom of a 13 x 9 inch glass baking dish coated with cooking spray. Layer half of eggplant slices over pasta sauce. Sprinkle eggplant with 1/8 teaspoon salt. Top with about 3/4 cup pasta sauce. Spread half of ricotta mixture over sauce and top with a third of mozzarella and 1/4 cup fontina cheese. Repeat layers once, ending with about 1 cup pasta sauce. Cover tightly with aluminum foil coated with cooking spray. Bake at 375 degrees for 35 minutes. Remove foil; top with remaining third of mozzarella and 1/4 cup fontina cheese. Bake at 375 degrees for 10 minutes or until sauce is bubbly and cheese melts; cool 10 minutes.

Nutritional Information:
Amount per serving

• Calories: 318
• Fat: 15.1 g
• Saturated fat: 8.2 g
• Monounsaturated fat: 2.7 g
• Polyunsaturated fat: 0.6 g
• Protein: 19.3 g
• Carbohydrate: 26.8 g
• Fiber: 4.8 g
• Cholesterol: 99 mg
• Iron: 1.6 mg
• Sodium: 655 mg
• Calcium: 365 mg

The recipe yields 10 servings. Serving size is one slice. Preparation time is one hour and 45 minutes.

This recipe is courtesy of Kathy Kitchens Downie, RD, Cooking Light (September 2010).

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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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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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Convenient and Healthy, Too! Finding Diet-Friendly Frozen Food

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for finding healthy frozen food.

Although it gets a bad rap, the supermarket’s freezer section is actually brimming with time-saving, nutritious food choices: as long as you know what to look for on the label.  By learning about healthy frozen foods, you can stock up on diet-friendly options to have on hand when you do not have time to cook.

Produce – Frozen fruits and vegetables are often more nutritious than fresh produce because they are frozen shortly after harvesting, preserving nutrients.

• Vegetables: Look for plain frozen vegetables without added butter, cheese or sauce.  Heat them in the microwave for a quick side dish or tasty addition to your favorite soup or casserole.
• Fruits: Look for products without added syrup or sugar.  Add frozen fruit to yogurt, smoothies and cereal or eat them straight from the freezer as a snack.

Frozen meals – Although they typically do not taste like a fresh, homemade dish, frozen meals can be helpful for those times when you do not have the time or energy to cook.  Choose products with no more than 3.5 grams of fat per 100 calories and 600 mg of sodium or less.  Make sure the frozen entrée has at least 4 grams of fiber and 15 grams of protein to keep you satisfied.  Reliable brand options include Kashi, Lean Cuisine, Healthy Choice and Smart Ones. 

Waffles – Choose 100 percent whole grain varieties.  The first ingredient listed on the label should be whole wheat flour.

Pizza – Choose a pizza product with a thin, whole wheat crust if possible.  Avoid high-fat toppings like pepperoni and sausage. Opt for vegetable toppings or get a plain pizza and top it with your own favorite vegetables at home. 

Desserts –Choose pre-portioned novelty ice creams with 150 calories or less, like Skinny Cow or Weight Watchers varieties. Sugar-free or 100 percent fruit popsicles are also good options.

Vegetarian – There are several options for vegetarian burgers, patties and sausages.  Choose varieties with 300 mg of sodium or less per serving.

- Cara Stewart, 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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Tips for bringing your diet on vacation

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



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



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

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

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

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

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



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



Safe travels!



- Karen Buzby, RD, LDN

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Low-calorie but not a Freebie: Get the Scoop on Sugar Alcohol

Sugar alcohols, or polyols, are carbohydrates that get their name from their chemical structure. Adding sweetness and texture to foods like sugar-free candy, gum and desserts, sugar alcohols contain fewer calories than regular sugar -- 2.6 calories versus 4 calories per gram – and do not contribute to tooth decay.

The body absorbs sugar alcohols slowly and incompletely, reducing their effect on blood sugar. This can be helpful for people with diabetes or those who are limiting caloric intake. Sugar alcohols do not cause dumping syndrome for people with gastric bypass, although their abnormal absorption can cause cramping, bloating and diarrhea when consumed in large quantities. Studies indicate that people can tolerate 10 to 15 grams of sugar alcohols per day without gastrointestinal distress, although some individuals can experience side effects from less.

It is important to remember that sugar alcohols are typically used in foods that have little nutritional benefit but still contain calories, such as desserts and snacks. Therefore, portion control remains very important for long-term, sustained weight loss.

Products containing sugar alcohols list the grams per serving on the nutrition fact label. The sugar alcohol content can also be found by looking for ingredients ending in “-tol,” such as sorbitol, mannitol and xylitol.

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Take Control of Your Blood Pressure

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, offers advice for managing hypertension with diet and exercise.

Healthy lifestyles play a major role in the prevention and treatment of hypertension or high blood pressure. For those who have high blood pressure or those at risk for hypertension, small diet and exercise changes can help you control your blood pressure without medication.

These simple lifestyle tips can help prevent or manage hypertension:

Eat plenty of fresh or frozen vegetables and fruits. When using canned vegetables, choose products with “no salt added.”

Skip the salt when cooking. Use herbs, spices, herbed vinegars and fruit juices to add flavor instead.

Choose foods that are low in sodium. If you have hypertension, you should consume no more than 1,500 mg of sodium per day. That is the equivalent of just under two-thirds of a teaspoon of salt.

Read the nutrition facts on the label to determine sodium content in packaged food. The sodium content is usually listed in milligrams per single serving. Look for the products that say:

• Unsalted
• No salt added
• Reduced sodium
• Sodium-free
• Low in sodium

Spend at least 30 minutes a day doing physical activity. Take a brisk walk around the neighborhood or join a fitness class with a friend. If you have physical limitations, try seated exercise programs.

Be mindful of calorie intake and gradually increase exercise to facilitate weight loss. Your blood pressure rises as your body weight increases, so weight reduction often helps lower blood pressure.

When eating out:

• Request that your food be prepared without added salt.
• Ask for sauces and salad dressings on the side since they are often high in sodium. When eating a salad, use a twist of lemon, a splash of vinegar or a light drizzle of dressing, or dip your fork in the dressing before getting a bite of salad.

These tips can help you manage high blood pressure, but please consult your health care team before making any adjustments to your hypertension medications.

For more information on managing hypertension, visit the National Heart, Lung and Blood Institute or the American Heart Association.

- Cara Stewart, RD, LDN

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Super Foods for Supercharging Your Diet

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the nutritional value of “super foods.”

Take your pre- or post-surgical diet to the next level by incorporating these nutritious and delicious super foods in your meals. For those who have had weight loss surgery, it may be necessary to reduce portion sizes. Consult your dietician to determine the appropriate portion sizes for you.

Oatmeal – Start your day off right with oatmeal as a healthy breakfast cereal. Oatmeal is a whole grain containing soluble fiber, which has been shown to lower blood cholesterol and low density lipoprotein (LDL) in the arteries. A serving size of 1.5 cups has three grams of soluble
fiber, 225 calories and nine grams of protein.

Blueberries – Blueberries make the perfect snack or topping for salads or cereal. They are packed with phytochemicals, the disease-fighting antioxidants that are linked to heart health. Available all year long, blueberries can last up to 10 days when refrigerated. Purchase organic blueberries when possible to reduce pesticide exposure. A serving size of one cup contains 80 calories.

Beans – Add beans for extra color, flavor and protein to soups, salads, side dishes and entrees. Linked to decreased risk of certain cancers, beans contain soluble fiber, which controls cholesterol, and antioxidants. The Dietary Guidelines recommend having three cups of beans weekly. Start with a quarter of a cup daily and work your way up to the three cups recommended, allowing your system to gradually adjust to the fiber. A serving size of half a cup is approximately 110 calories and has seven grams of protein.

Almonds – Almonds are a great snack or garnish on salads, cereal, yogurt and grain dishes. They have heart-healthy mono- and polyunsaturated fatty acids, phytoserols and are rich in protein and fiber. Studies also suggest that eating almonds may help reduce LDL cholesterol. A standard serving is one ounce or 23 almonds, containing 160 calories and six grams of protein.

Salmon – Enjoy salmon for a healthy and tasty lunch or dinner. As a good source of omega-3 fatty acids, salmon reduces the risk of heart disease by lowering cholesterol levels. The American Heart Association recommends eating a four ounce portion of a fatty fish, such as salmon, twice a week. When possible, look for wild Alaskan salmon, which contains an even greater amount of omega-3 fatty acid than farmed salmon. Fresh filets should be bright orange or red with a firm texture and mild aroma. Prepare salmon by grilling, baking or poaching. A four ounce portion of salmon contains approximately 200 calories and 28 grams of protein.

- Karen Buzby, RD, LDN

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