Remember These Healthy Tips at the Thanksgiving Table

Lisa Harris of Clementon, NJ, was a self-proclaimed “yo-yo” dieter her whole life. Moved by her father’s dying request to get healthy, Harris had gastric bypass surgery at Penn Medicine with Alan Shuricht, MD, FACS. In this blog post, she discusses her strategies for tackling holiday meals after bariatric surgery.

Autumn has arrived. There’s a crispness in the air, trees are displaying their colors, and sweaters are coming out of hibernation. Autumn also means something else: The holidays are right around the corner, looming like a double-barreled shotgun of food.

As a bariatric patient, holidays have taken on a different meaning. My family has always been food-centric, and having a lot of Italian-based traditions, sometimes it can turn into a veritable carb-fest. Having survived my first year of holidays in a post-op world, I have several pointers to help others get through the next few months.

Eat Before You Eat

If you’re going to a party, try to eat beforehand. Make sure what you eat before a party is quality protein, and get as much water in as you can before the party. Slip a protein bar in your purse or jacket pocket just in case.

Here’s the main rule for going to any party or gathering: Indulge a little. Yep, you heard me. You want something? Go ahead and have a taste. As long as you’re not immediately post-op and still healing, one bacon-wrapped scallop, half a mini egg roll, or a mozzarella stick isn’t going to hurt. If you eat it slowly, take small bites and chew it completely, you can stretch one of those little treats out while socializing.

Stick With Spoonfulls

Thanksgiving can be easy. Turkey is a well-tolerated protein. Stuffing? Sure, have a TINY spoon. Green bean casserole? A tiny spoon.

Cranberry sauce? You bet! (Check out the mini-recipe below since the canned stuff is full of sugar.)

Corn Bread? Sure, have a teeny piece, but save it for last. If it doesn’t fit, skip it.

The only thing that I absolutely skip on Thanksgiving is the candied sweet potatoes. But just because I can’t eat them, I can still smell them! A good whiff of anything can go a long way!

Pick Protein First

The December holidays are pretty much handled the same. Whether it’s Hanukkah or Christmas, Kwanzaa or New Year’s Eve, there’s bound to be a gathering for a special meal.

Choose wisely. Follow the “protein first” rule. Watch out for sugar-laden sauces (candied anything is a big no-no), and stay away from most pasta, potatoes, rice or corn dishes that are high in carbs. Desserts are usually off-limits due to their sugar content. Lucky for me, my sister will make a small sugar-free version so I get to try whatever the rest of the family is having.

Enjoy What Holidays Are Really About

For me, the holidays are much less centered on food and much more a celebration of family and enjoying life again. The main ideas here are to know that it’s okay to indulge a little, make wise choices, and enjoy the holidays.

There is no mistake or misstep that can’t be corrected tomorrow.

Make Cranberry Sauce Without Regrets

Put about a half-cup of fresh cranberries and a quarter cup of water in a small saucepan. Heat to boiling, then lower heat to a simmer, and stir while the cranberries cook down. Simmer until reduced and thickened. Stir in 2 to 3 packets of Splenda for sweetness.

Cool and store in the refrigerator until turkey time.

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How to Understand Grocery Store Lingo

The grocery store can be a tricky place to navigate. It can be especially frustrating if you are trying to strike a balance between health and affordability. If you frequently find yourself questioning whether you should choose the organic croutons or the croutons on sale, you are not alone.

Below, are definitions of this new grocery store vocabulary.

Certified Organic

Organic agriculture is grown without the use of genetically engineered seeds or crops, sewage sludge, long-lasting pesticides, herbicides or fungicides.

Certified organic goes beyond crops to include certified organic livestock as well. These animals are fed organically grown feed and have access to fresh air and the outdoors while receiving no antibiotics or added growth hormones.

The United States Department of Agriculture (USDA) requires that everyone who produces, processes or handles organic agricultural products must be certified by a USDA-accredited certifier in order to sell, label or represent their products as "organic."

To become certified they must develop, implement and maintain an organic system plan.

Certified Naturally Grown

Certified naturally grown is an alternative to the USDA's National Organic Program meant primarily for small farmers distributing through local channels such as farmers markets, roadside stands, local restaurants, community supported agriculture (CSA) programs and small local grocery stores.

The standards and growing requirements are no less strict than the USDA National Organic Program rules. The primary difference between Certified Naturally Grown and the USDA Organic program is cost to farmers and paperwork requirements.

Basic Conventional Farming

Basic conventional farming has been recognized since the 1950s. These farmers use synthetic pesticides, fertilizers, genetically engineered organisms and growth enhancers to stimulate the soil and crops.

Synthetic fertilizers add various nutrients to the soil and pesticides or fungicides help control insects. The focus is on short-term yield increases rather than long-term soil health.

When it comes to choosing conventional versus organic, check out the Environmental Working Group’s list of the Dirty Dozen or Clean 15.

Grass-fed or Pasture-raised

Livestock that is fed a natural diet, which could include grass, bugs, and other organisms in a field are considered to be grass-fed or pasture-raised.

Typically, farmers who raise pastured livestock do not feed their livestock antibiotics or inject them with hormones.

Research shows that meat, eggs, and dairy products from grass-fed animals have higher omega-3 fatty acids, more favorable omega-3 to omega-6 ratios, and lower cholesterol than non-pastured animals.

Grass Finished

Animals considered “grass finished” are fed grass only during the period preceding processing. This is distinguished from the industry standard of feeding grain, usually corn, during the same period.
Chemical Free
Part of sustainable agriculture prohibits the use of harmful chemical pesticides.
As a practice, chemical-free farming tries to restore soil stability and fertility in target locations. Chemical-free agriculture is difficult to practice, especially where land has already been degraded.

Heirloom

Similar to your great-grandmother’s tea pot, heirloom is a variety of horticulture that is maintained by small groups of private individuals to preserve genetic diversity and/or certain characteristics, over thousands of years.

Genetically Modified Organisms (GM or GMOs)

The term GM foods or GMOs (genetically modified organisms) is most commonly used to refer to crops created for human or animal consumption using the latest molecular biology techniques.

Gluten-free

The term gluten free means a product does not contain gluten, a combination of protein fragments found in wheat, rye, barley and sometimes oats. A gluten-free diet is currently the only known treatment for Celiacs’ disease, a chronic digestive disorder. Individuals with Celiac’s disease experience a toxic immune response when they ingest gluten.

Wheat-free

Some people are allergic to the wheat protein itself, including wheat albumin and wheat globulins. People allergic to wheat need to avoid wheat and its by-products.

Learning how to read and understand grocery store lingo is important for eating healthy. Knowing what you’re eating, and where it came from can make food and cooking more enjoyable.

Get More Information About Weight-loss Surgery at Penn

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

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 event here.

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Sugar, Spice and Everything Nice: Flavorful Thai Beef Cabbage Cups

Thai cuisine is known for expertly balancing sour, sweet, salty and bitter flavors. This recipe for Thai beef cabbage cups is no exception. The ground beef mixture, or "larb" in Thai, adds spice and aroma with sour from the lime and sweet from ginger. It all comes together to form a delicious, flavorful and healthy meal. Just make sure to use ground sirloin or a 95 percent lean ground beef to keep saturated fat at a minimum.

Nutritional Information:
Amount per serving

• Calories: 292
• Fat: 16.7 g
• Saturated fat: 5.4 g
• Monounsaturated fat: 7.3 g
• Polyunsaturated fat: 2.4 g
• Protein: 25.4 g
• Carbohydrate: 10.9 g
• Fiber: 2.4 g
• Cholesterol: 74 mg
• Iron: 3.1 mg
• Sodium: 516 mg
• Calcium: 51 mg

Ingredients:

• 2 1/2 teaspoons dark sesame oil, divided
• 2 teaspoons fresh ginger, minced and peeled
• 3 garlic cloves, minced
• 1 pound ground sirloin
• 1 tablespoon sugar
• 2 tablespoons fresh lime juice
• 1 1/2 tablespoons fish sauce
• 1 tablespoon water
• 1/4 teaspoon red pepper, crushed
• 1/2 cup red onion, vertically sliced
• 1/2 cup fresh cilantro, chopped
• 8 large green cabbage leaves
• 2 tablespoons unsaled, dry-roasted peanuts, finely chopped
• 1 lime, cut in wedges

Preparation:

1. Heat a large nonstick skillet over medium-high heat.
2. Add 2 teaspoons oil to pan; swirl to coat. 
3. Add ginger and garlic; cook 1 minute, stirring constantly. 
4. Add beef; cook 5 minutes or until browned, stirring to crumble.
5. Combine remaining 1/2 teaspoon oil, sugar and next 4 ingredients (through pepper) in a large bowl. Add beef mixture, onion, and cilantro; toss well. 
6. Place 2 cabbage leaves on each of 4 plates; divide beef mixture evenly among leaves. 
7. Top each serving with 1 1/2 teaspoons peanuts.  Serve with lime wedges.

Total preparation time is 27 minutes.

This recipe is courtesy of Karen Levin, Cooking Light (October 2011). 

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

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

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

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

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

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

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

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

- Cara Stewart, RD, LDN

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Unhealthy “Health” Food

Rebecca Dilks, RD, LDN, research coordinator at the Center for Weight and Eating Disorders and member of the Penn Metabolic and Bariatric Surgery team, and Casey Siegel provide tips for avoiding misleading health claims and being your own healthy food judge.
 

Just because the package or ad claims that a food is “healthy” does not necessarily mean that it is. More and more, food marketers are using healthy as a marketing technique to promote foods that by most people’s definitions do not actually qualify as healthy.

Don’t fall into the food marketing health trap: Next time you are the grocery store, check the nutrition label and ask yourself the following three questions to make sure the food qualifies as healthy health food.  

1. Does it contain too much sugar?
When food manufacturers reduce the fat content in foods, they often sacrifice flavor too. To compensate, many food manufacturers add sugar.
 
Further complicating matters, the sugar listing on nutrition labels groups all sugar together, which can be deceiving. In general, try to stay away from added sugar as much as possible. The American Heart Association recommends women consume no more than 100 calories (6 teaspoons or 24 grams) of added sugar per day and men consume no more than 150 calories (9 teaspoons or 36 grams).

Fruit juices, fruit cups, granola bars and energy drinks all contain added sugar, significantly increasing the calorie content. Try fresh fruit or flavored seltzer to avoid extra sugar without skimping on flavor.

2. Does it contain too much sodium?
Food can be loaded with sodium even if it does not have that traditional salty taste. That is why you must check the sodium content on the nutrition label. Don’t assume a food’s salt content meets the healthy food requirement. Stick to foods that contain less than 140 milligrams of sodium per serving.

For example, fat-free cottage cheese, which does contain healthy nutrients like calcium, also contains 400 milligrams of sodium per four ounce serving.

3. Does it contain healthy nutrients?
Food manufacturers are onto the growing healthy diet trend and have started making snacks in healthier portion sizes than ever before. But while many of these foods have reduced calories and fat, they also fall short on healthy nutrients like fiber or protein.

Instead of reaching for a pre-packaged, manufactured snack, try opting for all natural low-calorie and low-fat snacks that also offer important nutritional benefits, like fruits and veggies.

Check out this “buyers beware” list of foods that are commonly marketed as healthy despite questionable nutritional contents:

• Bran muffins: Some may be high in fiber, but many are loaded with calories due to excessively large portion sizes.
• Trail mix and granola: These products tend to come in small portion sizes that are loaded with calories and fat. Get more bang for your buck by snacking on low-calorie, nutrient-rich foods like fresh fruits and vegetables.  
• Tuna salad: Don’t be fooled by the word “salad.” Tuna fish alone is a great choice for lean protein and omega-3 fatty acids, but by adding mayonnaise to make tuna salad you also add lots of calories and fat.  
• Dried fruit: Dried fruit contains healthy nutrients such as fiber, but it also contains large amounts of sugar. Stick with fresh fruit for all the same nutrients but with less sugar. 
• Veggie chips: These chips may have some “veggie” ingredients, but most brands do not contain whole vegetables.  

There are many food claims out there masquerading as healthy despite a lack of nutritional facts to back them up, so you be the judge. Use the nutrition label to determine which foods actually qualify as healthy by your standards, not the food marketers.

Rebecca Dilks RD, LDN
Center for Weight and Eating Disorders
University of Pennsylvania Perelman School of Medicine

Casey Siegel, University Of Pennsylvania, Class of 2012
Biological Basis of Behavior/Nutrition minor

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A Guide for Making Healthy Fast-Food Choices

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides a guide for how to make a fast-food meal as healthy as possible.

There’s no denying that preparing food in your own kitchen is the easiest way to lose weight. When you cook at home, you control exactly what goes into your meals and you can stick to pre-planned portion sizes.

But the reality is that eating at home isn’t always possible. Whether you’re tight on time, out of groceries or just not in the mood to cook, it is possible to maintain a healthy diet while occasionally eating fast food.

This guide helps you make the healthiest possible fast-food choices.

Choose:

• Salads
• Grilled chicken sandwiches
• Open-faced sandwiches
• Chili, bean and broth soups
• Water or other unsweetened beverages 

Avoid:

• Fries
• Chips
• Cream soups
• Sugar-sweetened soft drinks
• Fried, crispy or crunchy sandwiches
• Upsized meals
• Double meat
• Bacon

You should also feel comfortable making special requests. You can modify many fast-food meals to reduce the calories or fat as well as increase the healthy nutrients.

Here are some examples of healthy special requests.

Ask for:

• Light salad dressing
• Hold the mayo or other special sauces
• Whole wheat bun
• Hold the cheese
• Grilled not fried
• Extra vegetables on sandwich
• Fruit on the side

While it is possible to incorporate fast food into a healthy diet, it is important to remember that fast-food meals must be an occasional occurrence and not a staple of your diet.

Also, keep your eyes peeled for new, healthy options on fast-food menus. More people are becoming interested in weight loss and healthy eating, and restaurants are paying attention. Healthy items like yogurt, veggie burgers and fruit are appearing on menus around the country, giving you more options for healthy food choices than ever before.

- Cara Stewart, RD, LDN

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Best Snacks for Weight Loss

When it comes to eating healthy, “snack” is not a bad word. In fact, many nutrition experts suggest shifting away from the traditional three-meals-a-day diet, recommending you eat small, nutritious meals every three hours or eating five to six times a day.

The key to healthy snacking is choosing healthy portions that have a good balance of protein, healthy fats and good carbohydrates to avoid spikes in blood sugar and keep your energy levels up longer. Also, when you have a healthy snack, you avoid getting too hungry. When you are too hungry, it is easy to make poor food choices.

So what is a healthy snack? Here are some healthy snacking suggestions that include a mix of complex carbohydrates and protein.

• One serving Greek yogurt with fresh fruit
• One cup homemade vegetable soup
• ½ whole wheat English Muffin with pesto, 3 oz. canned salmon and diced tomatoes
• Three handfuls of air-popped popcorn seasoned with spray butter and herbs
• ½ whole wheat English Muffin topped with a sliced hard-boiled egg, 1 tsp. light mayo and fresh herbs

What gets you through the day in between meals? Share your healthy snack suggestions in the comments below. 

Penn Medicine can help you lose weight. Find out how Penn can help you lose weight at one of these free information sessions about weight-loss surgery at Penn. 

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Asian-Inspired Sesame-Miso Cucumber Salad

It’s the perfect way to kick off the summer – refreshing, tangy and good for your waistline, too. Made with miso, a thick soybean paste that has a salty, slightly sweet flavor, and sesame seeds, which are high in protein and omega 6 fatty acids, sesame-miso cucumber salad makes the perfect summer side dish. You can find miso in the refrigerated section of your supermarket.

And the best part? This Asian-inspired dish only takes 20 minutes to prepare from start to finish.

Nutritional Information:
Amount per serving

• Calories: 60
• Fat: 2.7 g
• Saturated fat: 0.2 g
• Monounsaturated fat: 0.6 g
• Polyunsaturated fat: 0.7 g
• Protein: 1.9 g
• Carbohydrate: 7.2 g
• Fiber: 1.6 g
• Cholesterol: 0.0 mg
• Iron: 3.8 mg
• Sodium: 182 mg
• Calcium: 12 mg

Ingredients:

• 1 1/2 tablespoons sesame seeds, toasted
• 2 tablespoons white miso (soybean paste) or low-sodium soy sauce
• 1 tablespoon rice vinegar
• 1 tablespoon honey
• 1 tablespoon hot water
• 1 teaspoon crushed red pepper
• 2 teaspoons dark sesame oil
• 4 cups thinly sliced seeded cucumber

Preparation:

1. Combine first 7 ingredients in a large bowl, stirring with a whisk.
2. Add cucumber; toss to coat.

Total preparation time is 20 minutes.

This recipe is courtesy of Maureen Callahan, Cooking Light (May 2011).

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Nutrient-Rich Wheat Berry Salad with Raisins and Pistachios

Wheat berries are a health buff’s dream come true. The whole wheat kernels are filled with fiber, protein, iron, vitamin E and magnesium and remain virtually unprocessed, packing a nutrient-rich punch to your diet.

Wheat berries can be ground into whole wheat flour and develop a chewy consistency with a nutty, mild taste when cooked whole. You can add wheat berries to hot cereal, as a healthier alternative to rice or to make a creative salad.

In addition to its delicious taste, you can prepare all of the ingredients for this salad while the wheat berries cook.

Nutritional Information:
Amount per serving

• Calories: 240
• Fat: 8.9 g
• Saturated fat: 2.3 g
• Monounsaturated fat: 4.8 g
• Polyunsaturated fat: 1.3 g
• Protein: 7.2 g
• Carbohydrate: 36.8 g
• Fiber: 5 g
• Cholesterol: 4 mg
• Iron: 0.7 mg
• Sodium: 284 mg
• Calcium: 28 mg

Ingredients:

• 1 cup uncooked wheat berries (hard winter wheat)
• 3/4 teaspoon salt, divided
• 3 tablespoons pistachios, shelled
• 2 tablespoons olive oil
• 2 tablespoons fresh lemon juice
• 2 teaspoons honey
• 1/2 teaspoon ground coriander
• 1/2 teaspoon fresh ginger, grated and peeled
• 1/2 cup golden raisins
• 1/4 cup thinly sliced green onions
• 2 tablespoons fresh cilantro, chopped
• 1/2 cup (2 ounces) crumbled goat cheese

Preparation:

1. Preheat oven to 350 degrees.
2. Place wheat berries and 1/2 teaspoon salt into a medium saucepan. Cover with water to 2 inches above wheat berries and bring to a boil. Cover, reduce heat to medium-low and simmer for 1 hour or until tender. Drain.
3. Place pistachios on a baking sheet. Bake at 350 degrees Fahrenheit for 8 minutes, stirring once. Cool slightly and chop.
4. Combine oil, juice, honey, coriander, ginger and remaining 1/4 teaspoon salt in a large bowl, stirring with a whisk. Add hot wheat berries and raisins; stir well to combine. Let stand for 20 minutes or until cooled to room temperature.
5. Add nuts, 1/4 cup green onions and cilantro to wheat berry mixture. Transfer to a serving bowl and sprinkle with goat cheese.

This recipe is courtesy of Jackie Mills, MS, RD, Cooking Light (April 2010).

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Crispy, Crave-worthy and Low-Calorie: Kale Chips Recipe

You know those days when carrots or low-fat yogurt just won’t cut it and you need a snack with a satisfying crunch? Fear not, there’s no need to resort to potato chips. Instead, try this recipe for kale chips. They’re low-calorie, filled with powerful antioxidants, a good source of calcium, fiber and vitamins A and C and they’re oven-baked, not fried. Sound too good to be true? Give them a try and you’ll be raving, too.

Ingredients:

• One bunch of kale, any type, rinsed and dried
• 2 to 3 tsp olive oil
• Salt or soy sauce, to taste
• Seasonings of choice - try chili flakes, paprika, garlic powder or Parmesan cheese*

Directions:

1. Preheat oven to 375 degrees.
2. Remove the kale leaves from the tough end and inner stems. Cut longer leaves in half or bite-size pieces. 
3. Place kale pieces in large bowl and toss in about 1 teaspoon of olive oil. The kale leaves only need to be lightly coated with oil. Too much oil makes the chips limp and greasy. If more oil is needed, add about 1 teaspoon at a time. Sprinkle in salt or soy sauce and seasonings of choice.
4. Put the kale pieces in a single layer in a baking sheet lined with parchment paper for easier cleaning. 
5. Bake for 12-15 minutes or until crisp.  Toss halfway through for more even baking. Watch carefully as they can burn easily.

Nutrition Information: Amount per serving

• Calories: 47
• Total Fat: 1.5 g
• Total Carbohydrate: 6 g
• Protein: 2 g
• Fiber: 2 g

This recipe yields 10 servings (5 large chips).

*Adding Parmesan cheese increases calorie and fat content.

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Shape Up Your Plate in Honor of National Nutrition Month

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses a new government-sponsored program to encourage better food choices and provide tips for eating healthy.
March is National Nutrition Month and the Academy of Nutrition and Dietetics is providing you the information you need to achieve a healthier lifestyle. But even after you make the commitment to eating healthy, figuring out how to achieve that on a meal-to-meal basis can be tough and confusing. The U.S. Department of Agriculture has developed a program to help.

MyPlate is an online resource that provides dietary advice based on the 2010 Dietary Guidelines for Americans. Unlike other diet guides, MyPlate uses an actual place setting to visually illustrate a healthy meal made up of all the major food groups. That means no more confusion about how to translate dietary advice to an actual meal and no more guessing about portion size.

Follow these tips to get your plate in shape*:

Balance calories
If you’re unsure how many calories you need to manage your weight, there’s no need to guess! Go to www.ChooseMyPlate.gov to find out your daily caloric needs. MyPlate provides the recommended number of daily servings from each food group to help you make smart and healthy dietary choices.

Enjoy your food, but eat less
Take your time to eat and pay attention to feelings of fullness.

Avoid oversized portions
Use smaller plates to encourage smaller portions. When eating out, opt to share a meal or take home part of the serving.

Fill up on nutrient-rich foods
Make vegetables, fruit, whole grains and low-fat dairy products staples in your diet. They’re high in nutrients and vitamins and low in fat, making them ideal food choices for good health. In fact, experts recommend covering half your plate with fruits and vegetables and ensuring that half your grains are whole grains.

Always choose low- or non-fat milk
By choosing fat-free or 1 percent low-fat milk, you cut calories and fat without losing the flavor or important nutrients like calcium and vitamin D.

Curtail your sweet tooth
There’s no doubt that sweet foods and beverages are both tasty and addicting, but they’re also high in fat, sugar and salt. Eat them only occasionally and in small quantities to satisfy your sweet tooth without compromising your healthy diet. One easy way to do this is by replacing sugar beverages with water and unsweetened drinks. 

Pay attention to sodium
You might be surprised by the sodium content in everyday foods. Before making a food selection, read the nutrition facts label and stick to foods that are low in sodium to help promote cardiovascular health.

For more information, visit the MyPlate website. 

- Karen Buzby, RD, LDN

*USDA, Center for Nutrition Policy and Promotion, DG Tip Sheet No. 1, June 2011.

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

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

Ingredients:

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

Preparation:

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

Nutritional Information:
Amount per serving

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

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

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

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Get the Facts about Healthy Fats: Omega-3 and Omega-6 Fatty Acids

Rachel Griehs, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the nutritional importance of essential fatty acids.


For years experts have been saying that all fats are bad, but it turns out that is not the case. Among the healthy fats are omega-3 and omega-6, which are considered essential fatty acids. Although the body needs them, it cannot produce them itself, which is why they must be incorporated into your diet.

There are three types of omega-3 fatty acids:
1.    Alpha-linoleic (ALA)
2.    Docosahexaenoic (DHA)
3.    Eicosapentaenoic (EPA)

ALA is found in plant foods and flaxseed is the richest source. EPA and DHA are found in similar foods, including seafood, algae and higher fat cold water fish, such as mackerel, albacore tuna, salmon, sardines, Atlantic herring, swordfish and lake trout. Enriched eggs are also a good source of omega-3 fatty acids because the egg-producing hens are fed a diet that includes flaxseed and algae. As a result, these eggs contain all three types of omega-3 fatty acids. 

Omega-6 fatty acids are made up of linoleic acid. They are found in nuts, seeds and vegetable oils, specifically soybean, safflower and corn oil. Experts recommend that 5 to 10 percent of your total caloric intake should come from omega-6 fatty acids.

How do these fatty acids benefit health?

Omega-3 fatty acids thin the blood, reducing the risk for blocked blood vessels, heart attacks and strokes. They also prevent hardening of the arteries, lower triglycerides and help reduce blood pressure.

Omega-6 fatty acids lower cardiovascular disease risk by decreasing total cholesterol, including “bad” cholesterol (LDL—low density lipoprotein). However, by reducing the total cholesterol, omega-6’s also lower “good” cholesterol (HDL—high density lipoprotein), which functions like a sponge and carries “bad” cholesterol and other lipids to the liver for excretion.

The American Heart Association recommends that people who do not have coronary heart disease (CHD) eat a variety of fish, specifically oily fish, at least twice a week. For those with CHD, they recommend one gram of EPA and DHA from oily fish a day. It can be hard to obtain sufficient omega-3 from your diet alone. If so, talk to your physician about adding a fish-oil supplement.

- Rachel Griehs, RD, LDN

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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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Warm Up This Fall with Peasant Stew

As the temperature drops and winter draws near, there is nothing cozier than a bowl of warm, delicious stew. Dust off the crock pot and serve up a satisfying meal that takes little effort but offers plenty of healthy nutrients.

Ingredients:

• 1 teaspoon ground cumin
• 1/4 teaspoon salt
• 1/4 teaspoon black pepper
• 6 chicken thighs (about 1-1/2 pounds), skinned
• 1 cup chopped onion
• 1 (14.5-ounce) can Mexican-style stewed tomatoes with jalapeño peppers and spices, undrained
• 1 (4.5-ounce) can chopped green chile peppers, undrained
• 1 (15-ounce) can pinto beans, rinsed and drained 1 (15-ounce) can kidney beans, rinsed and drained
• 1/4 cup fresh cilantro, minced
• 1/4 cup reduced-fat sour cream 

Preparation:

1. Combine cumin, salt and pepper; sprinkle over chicken.
2. Place chicken in an electric slow cooker; stir in onion, tomatoes and chiles. Cover and cook on high-heat setting for three hours. Stir in beans, cover. Cook on high-heat setting one hour. 
3. Place one chicken thigh in each of six soup bowls. Ladle 1-1/4 cups stew into each bowl. Top each serving with two teaspoons cilantro and two teaspoons sour cream.

Nutritional Information:Amount per serving

• Calories: 214
• Calories from fat: 16 percent
• Fat: 3.9 g
• Saturated fat: 1.4 g
• Monounsaturated fat: 0.9 g
• Polyunsaturated fat: 0.9 g
• Protein: 21.5 g
• Carbohydrate: 23.7 g
• Fiber: 6 g
• Cholesterol: 61 mg
• Iron: 3 mg
• Sodium: 773 mg
• Calcium: 85 mg

The recipe yields six servings.

This recipe is adapted from Cooking Light (August 2002).

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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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Savor the Tastes of Fall: Roasted Pumpkin and Sweet Potato Pilaf

Roasted pumpkin and sweet potato pilaf presents the perfect opportunity to mix warm, cozy and delicious fall flavors with healthy ingredients. Pilaf is a form of grain that gets its flavorful taste from cooking in broth. With fiber-rich brown rice and vitamin-packed vegetables like pumpkin and sweet potato, this tasty side dish adds important nutrients to your meal.

Ingredients:

• 2 cups (1/2-inch) cubed, peeled fresh pumpkin (about 12 ounces)
• 1 1/2 cups (1/2-inch) cubed, peeled sweet potato (about 1 medium)
• Cooking spray
• 2 teaspoons olive oil
• 1 cup diced onion (1 small)
• 1/3 cup diced celery (about 1 rib)
• 2 teaspoons minced garlic
• 4 cups fat-free, less-sodium chicken broth
• 1 cup brown rice (not instant)
• 2 teaspoons chopped fresh sage
• 1/2 teaspoon freshly ground black pepper
• 1/4 teaspoon salt
• 1 bay leaf

Preparation:

1. Preheat oven to 400 degrees.
2. Arrange pumpkin and sweet potato in an even layer on a jelly-roll pan coated with cooking spray. Bake at 400 degrees for 18 minutes, stir and return to oven for another 17 minutes or until the vegetables are tender and begin to brown.
3. Heat oil in a large saucepan over medium-high heat. Add onion, celery and garlic to pan; sauté 3 minutes or until onion is tender. Add broth and remaining ingredients to onion mixture, stirring to combine; bring to a boil. Cover, reduce heat and simmer for 50 minutes or until rice is done and liquid is mostly absorbed. Remove from heat; discard bay leaf. Add pumpkin mixture; stir gently to combine.

Nutritional Information:
Amount per serving

• Calories: 200
• Calories from fat: 11 percent
• Fat: 2.5g
• Saturated fat: 0.4g
• Monounsaturated fat: 1.4g
• Polyunsaturated fat: 0.5g
• Protein: 5.9g
• Carbohydrate: 38.8g
• Fiber: 3g
• Cholesterol: 0.0mg
• Iron: 1.3mg
• Sodium: 428mg
• Calcium: 45mg

The recipe makes 6 servings. Serving size is about ¾ cup.

This recipe is courtesy of Jaime Harder, MA, RD, Cooking Light (October 2007).

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