All posts by Dee Anne Agonis

The Benefits of Cauliflower in Your Weight Loss Journey


When it comes to weight loss – cauliflower is a hot food trend lately in the low-carb spectrum. But do you know the weight loss benefits of eating this cruciferous plant?

Cauliflower is a rich source of Vitamin C, which aids in iron absorption and acts as an antioxidant to fight off infections such as the common cold. It is also high in Vitamin K, Vitamin B6, folate, and fiber. Fiber helps to promote good digestive health to keep symptoms like constipation at bay. Cauliflower is also a great source of antioxidants, which protect our cells from free radicals and inflammation. Cauliflower is high in Choline, an essential nutrient that supports metabolism and a healthy nervous system, and also helps prevent cholesterol from accumulating in the liver. (Source:

Have you thought about adding cauliflower to your meals? It’s a great low-carb option to enjoy foods that you love, such as pizza and even tacos! Here are some great recipes to get you started.


weight-loss-Cauliflower-Pizza-Crust-KC-BariatricCauliflower Pizza Crust  



  • 1 cup cooked, riced cauliflower
  • 2 egg whites
  • 1 cup mozzarella cheese
  • 1 tsp oregano
  • 1 tsp minced garlic
  • ¼-1/2 cup pizza sauce
  • Parmesan cheese (optional)
  • Pizza toppings


  1. Riced cauliflower: 1 head cauliflower, washed and patted dry. Chop into small bite size pieces and then process in food processor until the size of rice.
  2. Place riced cauliflower in microwave safe dish and microwave for 7-8 minutes.
  3. Preheat oven 450 degrees F.
  4. Spray pizza pan with non-stick spray.
  5. In a medium bowl, combine cauliflower, egg whites, mozzarella, oregano, and garlic.
  6. Press mixture evenly into pizza pan.
  7. Sprinkle with Parmesan cheese.
  8. Bake 12-15 minutes.
  9. Remove from oven and pan. Add sauce, toppings, cheese.
  10. Place under broiler 30-60 seconds, until cheese is melted.



Cauliflower “Potato” Salad  



  • 1 large head cauliflower, cut into small bite-sized pieces
  • 3 hard-boiled eggs, chopped
  • 3 T low-fat mayonnaise
  • 3 T sour cream (substitute non-fat plain Greek yogurt for increased protein)
  • ¼ cup sweet pickle relish
  • 1 T finely chopped Vidalia onion
  • 1 T mustard
  • 1 tsp salt
  • ¼ tsp black pepper


  1. Bring pot of salted water to a boil over high heat. Add chopped cauliflower; cover and cook for 5 minutes. Drain and rinse under cold water to cool and stop the cooking process.
  2. Combine cauliflower and all remaining ingredients. Chill for at least 30 minutes to allow flavors to blend.
  3. Salt and pepper to taste as garnish when serving.


weight-loss-Cauliflower-Tortillas-Crust-KC-BariatricCauliflower Tortillas 



  • 4 cups cauliflower florets (½ large head)
  • 1 egg or 2 egg whites
  • ½ tsp garlic powder
  • ¼ tsp salt
  • 2.25 cups shredded Mexican cheese


  1. Preheat oven to 400 degrees F.
  2. Lay parchment paper on two baking sheets. Set aside.
  3. Place florets into food processor and pulse until grated, and no large pieces remain.
  4. Add remaining ingredients into food processor and pulse until combined.
  5. Scoop 3 tablespoons of mixture onto the baking sheet and pat down into an even, flat, round circle about ¼ inch or 1/8 inch thick. Continue until all tortillas are made (makes ~16).
  6. Bake 15-20 minutes until golden.
  7. Allow to cool then layer between paper towels to absorb grease from the cheese. Keep refrigerated when not using.

And remember, you can always get creative and find other easy ways to prepare! Weight loss can be a wonderful journey and we hope you find these recipes helpful. 

Roasted Cauliflower Florets
Riced Broccoli and Cauliflower

August 1, 2017 – Key Steps for Getting Weight Loss Back on Track


Facilitator:  Stephanie Wagner, MS, RDN

Stephanie started with the two most important issues in getting back on track whenever you find you’ve regained some weight and stopped following your guidelines:  Motivation and Accountability; the “mental side” of getting back on track.

Key 1:  Motivation – what motivated you a year ago is different than what motivates you today.  A year ago, or whenever you first had surgery, you were motivated by the new surgery.  Now you have to find a new motivation.

  • Internal Motivators – that is the excitement that comes from within
  • External motivators – these are easier – things like coming to support group, family and friends who support you, looking at pictures of where you were a year ago, etc. The more you surround yourself with external motivators, the more you will be able to ignite that internal motivator

Key 2:  Accountability – you need an accountability partner (preferably not a family member or best friend) who will be honest with you and check in with you on a regular basis.  This is someone who is able to hold your feet to the fire when you don’t do what you said you would

 Key 3:  The 4 Pillars of Health – these are the basics – the things the body needs all the time

  • Water – a lot of people confuse hunger with dehydration – you have to keep up with your water, or you won’t feel good. Water is also essential for metabolizing the fat.  A good way to remind yourself to get your water (sugar free fluids) is to set your phone alarm for every 15 minutes and make yourself drink
  • Meal Structure – your body craves consistency, and you need to have consistent times you eat your 3 meals a day so you stop snacking
  • Food Choices – you need to eat quality food, not junk food, and not simple carbs
  • Exercise – you have to move – find something you enjoy doing and “just do it”

Key 4Setting a Realistic Plan – focus on your ACTIONS and not the results (don’t weigh daily)

  • Set a start date
  • Develop a meal plan
  • Make a grocery list

 One of the biggest reasons for weight regain is people let simple carbs back into their diet.  These can slide on through and you begin eating bigger portions.  Many people thing they’ve stretched out their stomach, but usually the anatomy hasn’t changed, but the quality of what you are eating has.

 A “pouch reset”  is not about changing the size of your stomach, but about clearing the carbs out of your system.  This takes about 4 – 5 days.  Treat it more as a mental reset, and ignore the scales.  Look at is as a way to clean the slate, and start back on your initial post op diet.  Have a day of sugar free clear liquids, then a day of full liquids with a protein shake, then a day of pureed food, then a day of soft, low fiber food that is all protein, then begin adding in a few veggies, and finally some fruit.

Key 5:  Trash the Triggers – we spend most of our time at home in the kitchen, and a lot of time at work.  We can clean out the items that are triggers for us.  While you can’t completely control your environment, control what you can. 

  • It’s hard for others to support you when they don’t have to
  • Have separate shelves in the pantry or fridge that are for specific family members
  • Have a contraband list – something that cannot be brought into the house – and let everyone contribute to it (like Oreo cookies, or other snack foods that have no nutritional value)
  • Soda pop – if other family members drink it and won’t give it up, see if you can get a mini-fridge and keep it out of sight

You can go to Stephanie’s website: and join for 2 weeks free.  After that it is $10 a month, but you can get recipes, do meal planning which will then generate a grocery list, and watch her educational videos.  She has a whole section of “Back on Track” videos to watch.  She showed how to navigate through the website to use it to make getting back on track much easier, and there are over 500 recipes on there.  If you don’t want to do meal planning, she has some pre-planned meals for you.   It’s a fun way to do your weekly planning and then it will generate your grocery list and you are done!

July 20, 2017 – Loss of Control Eating

Facilitator: Kathi Williams, LMFT-T

Kathi started with an exercise that helped show us how much we associate food with relationships. Some of those associations are good, and some are bad, but they frequently involve family and a lot are about comforting ourselves with food. Then she did another exercise where we did some “self-soothing” and talked about how good that felt. She pointed out that frequently, our self-talk is negative – especially when we eat something we shouldn’t, or get off track for a meal. We often give up for the rest of the day because we made a mistake and there’s no point in following the guidelines now. We need to learn to be more compassionate with ourselves – not so hard on ourselves – and replace that negative self-talk with something you would be more inclined to say to a friend who had made a mistake. You would be more supportive and forgiving and help them to get back on track. We need to do the same with ourselves.

Many patients who are overweight eat for emotional reasons or because of unresolved psychological issues. Having the surgery helps with the eating portion, but doesn’t resolve the psychological issues that remain. To be successful, addressing those psychological issues can help with weight loss and maintaining that loss by eliminating the reasons we overeat.

Binge eating disorder (BED) is the most common eating disorder in the U.S. today, and after bariatric surgery it is known as “loss of control eating.” It is consistently eating more than we should because we are unable to resist something, or once we start eating something we are unable to stop. This frequently has a psychological component that needs to be addressed. Kathi passed out a screening tool so folks could see if they might be at risk for Binge Eating Disorder. The screening tool can be found below.

If you check any of the shaded boxes, you may be at risk for loss of control eating, and making an appointment with a psychologist or therapist could help to prevent or address any loss-of-control eating.  Dr. Ravi Sabapathy and Dr. Michelle Coker, staff Psychologists with The Bariatric Center of Kansas City, are available to help with loss-of-control eating issues.  Feel free to call 913.677.6319  to schedule an appointment for their assistance.

(click on the document to enlarge)

Weight Loss: The Bariatric Center of Kansas City Opens New Comprehensive Care for Obesity Wing


We are happy to report that, with the increasing demand for weight loss services in the Kansas City Metro Area, The Bariatric Center of Kansas City has expanded its services to more fully support the needs of bariatric patients. An additional office in Building A of the Shawnee Mission Health Prairie Star complex is now open for business at 23351 Prairie Star Pkwy, Suite A-305. (Our new office is just steps away from our primary office, still located in Suite B-300 of Building B in the Prairie Star Complex)  


KC Bariatric Reception weight loss new office wing


Providing Comprehensive Care for Obesity and weight loss, we are pleased to offer specialty services by obesity medicine physician, Hassan M. Saradih, MD, MMM, a Board-Certified Internist specializing in Bariatric Medicine who is assisted by nurse, Whitney Venegoni, APRN. Having been trained to understand the unique needs of the bariatric patient, Dr. Saradih and his team are highly skilled in helping to address the day-to-day medical needs of post-surgery bariatric patients and able to provide assistance with weight loss and re-gain if needed. 


KC Bariatric Dr.  Hassan Sarahdih Whitney Venegoni, weight loss new office wing
Whitney Venegoni, APRN & Dr.  Hassan Saradih  – Prairie Star Medicine


Additionally, we have expanded psychology services with the addition of Dr. Michelle Coker, PhD who now works with Dr. Ravi Sabapathy, PsyD in the provision of expanded mental health assessment and counseling services. Additional therapies offered include couples and family counseling to address common concerns of patients and/or their families when facing pre-surgery and post-surgery issues that impact relationships with partners and/or other family members.  Therapeutic services for post-surgery patient concerns continue to be provided as well.


KC Bariatric LLC Psychology team
Psychology Team – Dr. Ravi Sabapathy & Dr. Michelle Coker


We have also expanded provision of nutritional health counseling and medically supervised weight loss services with the addition of Dietitian, Michelle Adams, RD. Michelle works with our Lead Dietitian, Laura Hernandez, MBA, RD, to further round out the provision of comprehensive bariatric care for our patients. 


KC Bariatric LC Dietitian Team Laura Hernandez & Michelle Adams
Dietitian Team – Laura Hernandez & Michelle Adams


Our Sleep Studies Unit managed by Sleep Medicine Coordinator, Brandon Miller, has relocated to the Comprehensive Care for Obesity wing as well. Brandon provides sleep study assessments and treatment for sleep apnea within our patient population, providing for better quality of life through improved sleep and increased safety for bariatric surgical procedures. 


KC Bariatric LLC Sleep Study Coordinator
Sleep Medicine Coordinator, Brandon Miller


Lastly, The Bariatric Center of Kansas City’s Program Coordinator, Chris Bovos, BSN, RN, CBN, and her assistant, Katherine Hiller, BSN, RN, have joined the team at this location to further enhance support services provided to our bariatric weight loss surgery patients through the provision of pre-op education classes and post-op support group meetings held bi-monthly in the first-floor conference room of Building A (Suite A-105). 


KC Bariatric LLC Bariatric Program Coordinators
Bariatric Program Coordinators – Katie Hiller & Chris Bovos

Existing patients should note that services you may require from our Bariatric Internist, Psychologists, Dietitians, Sleep Medicine Coordinator and/or Bariatric Program Coordinator will now be provided to you at The Bariatric Center of Kansas City’s Comprehensive Care for Obesity wing at 23351 Prairie Star Pkwy, Suite A-305, Lenexa, KS 66227.

Phone access to our providers can still be obtained by calling our main number at 913.677.6319.  Erica, Masie or Carla  will be most happy to assist you when you arrive!


KC Bariatric LLC Front Desk Coordinators
Front Desk Coordinators – Carla, Masie and Erica

    We hope you will find these expanded services beneficial for you and your family!

June 22, 2017 – Nutrition for Joint Health

Facilitator:  Laura Hernandez, MBA RD LD

What Foods to Eat and Avoid for Joint Health

If you suffer from joint discomfort in your knees, wrists or other parts of your body, you are by no means alone. Many people have dealt with discomfort in their joints, and it is so prevalent in part because it can be caused by such a wide range of factors. From repetitive use of a joint to hereditary dysfunctions, there are a lot of ways people find themselves in discomfort.

The good news about joint discomfort is that many people have found natural alleviation of discomfort simply by eating the right foods – and avoiding others. The best foods for joint discomfort are those that have natural anti-inflammatory properties and that are high in Omega-3 fatty acids.

Foods That Help Fight Joint Discomfort

One common source of joint discomfort is inflammation, which can be caused by a variety of factors. As such, one can help reduce inflammation, stiffness and swelling associated with some sources of inflammation and joint discomfort by eating foods that are high in Omega-3 and Vitamin D. Popular sources of these nutrients include fatty fish like salmon, sardines, cod and herring, as well as walnuts, pumpkin seeds, flax seeds and canola oil.

Of course, there are other foods you can incorporate into your diet. The following foods can also help keep those joints and tendons discomfort-free and flexible:

  • Sweet peppers
  • Citrus fruits, kiwi, papaya
  • Broccoli
  • Cauliflower
  • Brazil nuts
  • Onions
  • Leeks
  • Cherries
  • Green tea
  • Ginger
  • Butternut squash
  • Mushrooms
  • Pineapple

Foods to Avoid When You Have Joint Discomfort

In some cases, a person’s diet may be an instigating factor in their joint discomfort. This is due to certain foods having inflammatory properties, which can acerbate joint discomfort symptoms. So, if you are experiencing joint discomfort or are at risk of it, consider avoiding these types of foods:

  • Fried foods
  • Sugar
  • Grain-fed meats
  • Alcohol
  • Fast food
  • Flour-based products
  • Foods with trans-saturated fats
  • Soda

Supplements for Relieving or Preventing Joint Discomfort

In addition to eating foods known to promote joint health and avoiding those that can cause inflammation, many people decide to take supplements for joint pain for added support.

Emerald Joint Health

Ancient Nutrition Bone Broth Protein



Medications, Pain Relievers & Antibiotics After Bariatric Surgery

weight loss surgery medications kc bariatric kansas city

Weight loss and medications after bariatric surgery article written for by Dr. Guillermo Alvarez

June 16, 2017

Should you continue your medications after weight loss surgery? Will reducing the medications effect how you feel? What medications do you advise against? What can you expect long term? These are just a few of the many questions I answer on an almost daily basis. I understand you have concerns, you’re worried and maybe even anxious. You’ve been dependent on those medications for years and now you’re told you might be able to reduce them or eliminate them altogether. Sounds too good to be true, right?

Those suffering from diabetes, high blood pressure, gastroparesis, depression, and even joint pain (just to name a few) take a regimen of daily medications in order to maintain the quality of life they need to survive. Yet, these patients are usually the first to proclaim their freedom from medications after weight loss surgery. It’s not a miracle…it’s just the science of weight loss surgery. Why?

The more weight you lose…the less medication is needed.

Let’s Talk About Medications After Weight Loss Surgery

Did you know the average morbidly obese patient takes on average 6 medications per day to be able to live their life?MEDICATIONS - weight loss surgery kansas city kc bariatric

Those medications help regulate the body and compensate for what is missing. So, the moment you start losing weight you may experience a reduction in the need for the very medications you’ve been so dependent on. It can be frightening but also overwhelming.

Oh, but you say you’ve tried dieting, and using weight loss pills and low impact exercising and you didn’t see a difference. And that would be true. Those things alone just don’t have the power to change how your body deals or adjusts so your medications stay the same.

Sometimes when you diet; you skip meals, consume the wrong foods and get advice from people who really don’t understand your body chemistry and instead of losing weight, you gain weight. Instead of reducing the need for certain medications you actually increase your need.

Oh, and don’t get me started on weight loss pills. Sure, you might have seen an advertisement that touts how much weight you will lose, but in most cases, those pills could interact with your daily medication and cause all sorts of side effects.

Weight Loss Surgery Resets Your Body

reset-body weight-loss-surgery-KC-Bariatric-This is the benefit to weight loss surgery…it helps reset your body. As you start losing the pounds, you may notice you feel healthier, you’re more energetic and the need to continue with some of your needed medications is reduced. That’s a good thing. Embrace it.

Weight loss surgery is a life-changing event that does more than make you thinner. It saves your life. Imagine being 50, 75, 100, 150 pounds lighter, how much happier do you think you’ll be?

Well, once you start losing weight, you’ll also notice that your body doesn’t need the medication it was so dependent on for so long.

Now, this doesn’t mean the day you receive your weight loss surgery you immediately stop your medication. No! What this means is that the process takes time. It’s not immediate. Be patient. And consult with your primary care physician.

Consult Your Doctor Before You Stop Your Medication

Just don’t stop your medication because you think it’s time. Wait until your PCP tells you it’s okay. Under no circumstances should you reduce your own medications without first consulting with your doctor or primary care physician. In most cases, they (your doctors) will adjust your medication four to five weeks after surgery and then will evaluate you on a monthly basis.consult-physician-medications-weight-loss-surgery

This so important! And I can’t emphasize this enough. Just because you’re losing weight and feeling awesome, and can feel that you might not need the medication, you must never adjust your own medications, please check with your doctor first.

As you heal after weight loss surgery, I would I recommend you stay away from any medications that might harm your stomach.

What are they, you might be asking?

These are ones that cause the most irritation to your stomach, have way too many side effects and sadly the easiest to buy over the counter.

They’re classified as NSAID’s or nonsteroidal anti-inflammatory drugs. They have names like Aleve, Celebrex, Motrin, Advil, Daypro, and Aspirin. The side effects of these NSAIDs include nausea, vomiting, diarrhea, constipation, rash, dizziness, headaches, drowsiness, ulcers, and prolonged bleeding after surgery. Raise your hand if any of those things sound appealing. So, honestly, why bother? If you’re going to strive to be healthier then why take an over the counter drug that could cause you harm? Just say no to NSAIDs!

So, Are You Ready To Be Thinner And Healthier?

Are you ready to embrace the feeling of reducing or eliminating your daily medications?

weight loss surgery benefits kansas city KC bariatricThen I would suggest learning as much as you can about bariatric weight loss surgery. Discover for yourself information about the VSG (Vertical Sleeve Gastrectomy) or commonly referred to as the Gastric Sleeve, learn about the Band, Gastric Bypass (RNY) or the Duodenal Switch (DS) and uncover the pros and cons about each one so you are comfortable with how they will work for you.

Whichever method you chose for yourself, make it a point to create a medication/weight board. Write down all your medications you currently take. Then after weight loss surgery, at least once a week, place on the chart your weight and what dosages you are taking of each medication. As the weeks progress, and you are cleared by your PCP to reduce the dosage, make note of it on the board. And as time goes by, those medications may not be needed at all. But remember to stay away from NSAIDs and your stomach will thank you.

Now you might be wondering what the long-term effects are when it comes to not needing those medications any longer, right?

Well, what I can tell you, based on helping over 11,000 patients, the long-term effects of weight loss surgery are simply amazing. You’ll be thinner, healthier, more active and not as dependent on those medications.

June 6, 2017 – The Appetite Regulation System – Simplified

Facilitator:  Dr. Hassan Saradih, Bariatrician

Dr. Saradih began by showing that the body’s organs “talk” to each other through a signaling system. The organs, like the stomach, liver, intestines, pancreas, etc. send signals by secreting hormones that then send signals to the brain.  These signals either tell a person they are hungry or they are full, which is called satiety.  These two signaling pathways – the hunger pathway and the satiety pathway – counter balance each other, and they cannot both be active at the same time.  When the two pathways are pulling against each other, the strongest one wins.

When you gain weight, and have an increase in the amount of fatty tissue, you develop leptin and insulin resistance.  This means they are no longer pulling for the satiety side, but move to the hunger side   which makes Ghrelin even stronger. 

When we do bariatric surgery, this signaling system is reset back to normal.  Now the hormones can work normally. You begin to feel satisfied more easily, and the hunger is knocked out.  (If you feel hungry right after surgery, it is not physical hunger.  It is more likely emotional hunger, and that can be managed with treatment.)

The one piece missing in the above is the “organ” that affects metabolism –  muscles.  Following weight loss after surgery, your goal is to maintain that weight.  The surgery helps you to lose weight and your muscles help you to keep it off.  While still in the early stages of research, we have discovered that your muscles send out myokines, which is their signal to the brain to adapt your metabolism to assist the body in reaching “equilibrium,” or that state where the energy you take in equals the energy you put out.  If you take care of your muscles, your muscles will take care of your weight.   By feeding your muscles protein and exercising them every day, you keep your muscles strong. And when they are strong, they will keep burning fat.  The type of exercise that helps muscles burn the most fat is called High Intensity Interval Training, where you are constantly changing up the muscles used. This allows them to continue to burn fat for many hours after you stop exercising.  



Bariatric Health: Shop Fresh at Your Local Farmer’s Market!

Bariatric Heatlh KC Bariatric Farmers Market

June is National Fruit and Vegetable Month, which fits nicely with our discussions about bariatric health. What better way to celebrate than to shop at your local farmer’s markets for fresh produce? Other than the benefit to your bariatric health, there are many benefits to buying fresh produce from our local farmers. Here are our top reasons for shopping local:

  • Buying local produce contributes to your community and its economy. Every dollar spent on local foods generates twice as much income to provide for the local economy.
  • When you’re buying local produce, you’re getting in touch with the current season. Seasonal fruits and vegetables are most abundant, and are typically the least expensive.
  • Local produce is guaranteed to be fresh and ripe. Produce is allowed a longer time to ripen on their vines because they don’t have to travel long distances, and they are typically sold within 24 hours of harvesting. You get a tastier, vine-ripened product.
  • Because the produce isn’t traveling far, your carbon footprint is reduced, which is promoting better air quality and reducing pollution. The foods are also less likely to be contaminated and tampered with.
  • Supporting your local farmers is supporting responsible land development. The farmers are able to keep their land to continue growing produce to supply to their communities, giving their land good reason to stay undeveloped. The sustainability of their land then allows for production of a wider variety of fruits and vegetables.Bariatric-Health-Farm-Fresh-Produce-KC-Bariatric
  • Shopping at farmer’s markets allows you to build relationships with the farmers who grow your produce. Knowing where and how your food is grown can be empowering and reassuring that your food is healthier and cultivated in an environmentally friendly atmosphere.
  • Buying local is inspiring. With a variety of fruits and vegetables to choose from, you are more likely to incorporate this same variety into your own meals. The farmers typically have ideas for cooking, and sometimes even have recipe cards to hand out.

Bariatric health is a constant consideration for those post surgery. Here are a few special tips for smaller stomachs: 


  • Buy small amounts. Markets usually carry produce in a variety of sizes so you can pick the amount you’ll be able to eat. You can choose as little as 10 cherries, 1 pear, and 2 tomatoes. Local markets will help you manage your portions and budget!
  • Buy produce with a longer shelf life. Carrots, onions, sweet potatoes, winter squash, and beets are among many of the vegetables that stay fresh for a week or more, so they don’t go bad faster than you can eat them.
  • Aim for a rainbow of colors. Brighter vegetables are often packed with the most nutrients. For fun, look for unique colors like orange cauliflower, purple beans, or rainbow carrots. Bonus tip: eat the peels if they’re edible – that’s where most of the vitamins are!
  • Hydrate while shopping. Markets are usually outdoors. Prepare for weather conditions and hydrate as often as you need to prevent dehydration.Bariatric-Health-Farm-Fresh-Produce-KC-Bariatric-basket-of-produce

Eating protein first is always important, but even a bite or two of fruits and vegetables can add nutrients and flavor! Here are some tips for adding that local produce to your high protein meals:


  • Add fresh berries to Greek yogurt
  • Use butter lettuce to make tacos or tuna salad wraps
  • Toss chopped spinach or arugula and goat cheese into your scrambled eggs
  • Serve cheddar cheese with a few apple slices – try Honeycrisp, Braeburn or Ambrosia!
  • Blend a handful of raw kale and blueberries into a protein smoothie
  • Make a salad with sliced tomatoes, fresh mozzarella, basil, and balsamic vinegar
  • Serve a side of roasted asparagus with grilled salmon
  • Munch on cherry tomatoes and cucumbers dipped in hummus or tzatziki (yogurt dip)
  • Make a lentil soup with pureed winter squash



  1. Green Living.
  2. Ozark Natural Foods.


May 18, 2017 – Frequently Asked Questions

Facilitator:  Dustin Huff, PA-C


Dustin is Dr. Hamilton’s Physician Assistant, and assists Dr. Hamilton in all surgeries.  He has worked with Dr. Hamilton for 4 years, and sees Dr. Hamilton’s patients post operatively.  He graciously agreed to come to support group and answer any questions our support group members had.  Below are the questions and answers. 


  • Is it normal to not have a normal menstrual cycle after surgery? Yes, there are a lot of changes that can occur after surgery due to the disruption in hormones after surgery.  Some people have another cycle, some have a much heavier cycle due to the Lovenox, and some will have a delay.  Your fatty tissue holds estrogen, so as you begin to lose weight, that estrogen is released and can cause a lot of changes over the next few months.  That is normal, and we only worry if someone is having very heavy bleeding while still on Lovenox.  They need to know about that, and may stop the Lovenox if someone is bleeding too heavily.


  • How long do you need to be off estrogen/birth control before/after surgery? Generally, they like people off birth control pills 2 weeks before surgery and 30 days after surgery due to an increased risk of blood clots.  For women who are taking estrogen (estradiol) for menopause, we would like to have patients off for the same time, but also do not want patients feeling too anxious if they become too symptomatic.  In that case, you may restart your medication and just make sure you remain very hydrated and increase your mobility to prevent clots.


  • Does pregnancy cause problems right after surgery? The first thing you need to do is have a meeting with the dietitian to ensure you are getting enough calories a day to feed both yourself and the baby.  Then follow your weight with your OBGYN physician.


  • When should I call the physician if I’m having trouble eating? If something is causing you to not be able to eat, you need to call the physician and be seen. It is always difficult to eat right after surgery, but once you get through the first month, if you find you cannot eat, do not just stay on liquids – call and be seen.


  • Why do I have hiccups or pain after sleeve surgery? Both of those can be caused by eating too fast and eating a few bites too much.  Food does not move down the esophagus into the stomach by gravity.  It moves down through muscle contractions that push food on into the stomach.  If you are eating too quickly, it gets backed up and can cause pain or painful hiccups.  If you slow down your eating or stop eating a bit or two earlier, that should resolve.    


  • If you have had a bypass, it could also be an ulcer – when we do a bypass, the 2nd part of the small intestine, the jejunum, is brought up to the pouch. This part of the small intestine is not used to having any stomach/digestive acids on it.  If you eat too fast or too much, the acid in the stomach can get on that jejunum and cause burning and eventually an ulcer where it meets the stomach.  You need to eat slowly and stop before you are too full. 


  • How much food should I be able to eat at once after healing? Your stomach should be completely healed at 8 weeks after surgery.  You should be able to eat about ½ cup of food, or 4 oz., of protein at a time. 


  • Why do I have reflux after stopping my omeprazole after 8 weeks? It could be too much intra-abdominal pressure, which should resolve as you lose more weight.  It is best to wean off the omeprazole rather than stopped it suddenly. 


  • Why do alcohol cause effects so quickly after surgery? Alcohol is the only thing we take in that is absorbed in the stomach.  Food gets absorbed in the intestines.  Since you are not drinking with eating, you are drinking on an empty stomach, and get immediate absorption.


  • How can you tell the difference between and ulcer and stricture? Both will have about the same symptoms – they will hurt and you will feel a “stuck” feeling every time you eat.  We treat an ulcer with medication.  We treat a stricture with dilation during an EGD.  Because we always want to do the least invasive procedure, we will treat the symptoms medically for 2 weeks.  If that doesn’t resolve it, then we will do an EGD to see if it is a stricture and dilate it.  Frequently we have to do at least 2 dilations to completely resolve a stricture.


  • When can I take ibuprofen (Advil) after surgery? We don’t want you to take ANY for at least 8 weeks after surgery.  Then you can take an occasional one with food.  If, however, you need to take them routinely, you will need to take omeprazole twice a day. You take omeprazole for 8 weeks after surgery to keep acid off the staple lines.  Once they are healed, you still need to protect the stomach by not taking large amounts of non-steroidal anti-inflammatory medications, such as ibuprofen.


  • Why is there so much swelling after surgery? You will feel a pressure in the center of your chest, which is normal reaction to the surgery.  When we do the sleeve surgery, we place a long, snake-like rubber tube down through your mouth into the stomach, and we use that to know how big to make your sleeve.  We always use a size 34Fr. Because the research shows that a 32 is too small for patients to eat enough, and a 36 is too big to get the best weight loss.  We use a small balloon that is the size of a large egg to show us how big to make the pouch for bypass surgery.  Because we are placing these into the stomach, there can be swelling which will get better every week.


  • When they can fix an abdominal wall hernia? Abdominal wall hernias are where there is weakness in the abdominal muscle that allows some of the intestine to poke through, which is why you see a lump.  The larger the hernia is, the less likely it is to kink off and cause a bowel obstruction.  We want to wait until you have lost some weight in order to make the surgery easier.  A hiatal hernia is where there is small hole in the diaphragm which allows a portion of the stomach to poke up into the chest.  We always repair those type of hernias during surgery, as the surgery will not work well if you have a hiatal hernia.


  • How will I take all the medications I’m on after surgery? You won’t be going home on nearly as many medications, and you won’t take them all at once.


  • What should I do if my PCP doesn’t support my surgery? Call Dr. Saradih – he is also a PCP and takes care of a lot of our patients.


  • When I can I go back to work after surgery? You should be off at least 1 week. You will be tired for a few weeks. 


  • Who should I have remove excess skin? Our surgeons will do an abdominoplasty (tummy tuck) for our patients once you have gotten down to your lowest weight.  For other body parts, you need to go to a plastic surgeon.


  • How long does it take to heal after tummy tuck? You will have 2 drains in place after a tummy tuck.  We will remove 1 drain and half the staples after 1 week.  We will remove the 2nd drain and the rest of the staples after 2 weeks.  Then you can go back to work.  The surgery takes about 1 ½ hours, and there are always 2 surgeons in the room, plus the PA.


  • I have constipation – how often should I have a bowel movement? You probably won’t have a BM for the first week after surgery.  Once you begin eating more, then if you feel constipated you can take Miralax every day until you have one.  Once you begin eating more high fiber foods, which you don’t for 8 weeks, then you should eat more fiber.  You must also get your water in every day.  But Miralax is fine.  If you are having very hard stool, use a suppository to get things started. 


  • I am moving to Texas – how do I find a doctor who understands the surgery down there? Call or email Chris, our coordinator, and she will find you one.  ( or call 913-676-8491, 


KC Bariatric CURE FOR TYPE 2 DIABETES Phyllis Cronbaugh blog

Is There a Cure for Type 2 Diabetes?

I was amazed when I heard the word cure used in the same sentence with Type 2 Diabetes (T2D) by a friend of mine. She’d been in the hospital three times in the last few months with out-of-control blood sugar issues. Always a model patient, insulin and the explicitly followed strict diabetes protocol was no longer working for her. The same surgery I’d had a year ago for the wildly fluctuating weight challenges I’d endured over the past twenty years couldn’t possibly be her cure too.

My friend was searching on the web when she found a June 2016 article, Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes 1. The article stated that countries like Japan and Brazil had been routinely using surgery in the treatment of T2D for some time. It went on to say that with minimally invasive metabolic surgery it might be possible to eliminate all medications and injections, instead of suffering through life with a Band-Aid on her disease.  

The first bariatric surgery was done in 1954 and became more widely used for obesity when laparoscopy or minimally invasive surgery became routine in the 1980s. Metabolic surgery became a more appropriate name for bariatric surgery about ten years ago when medical studies showed the myriad of conditions, diseases, and comorbidities that were helped, reversed, or cured with the simple procedure. The most common include:

  • T2D (even Type 1 Diabetes to a degree),
  • high cholesterol,
  • high blood pressure,
  • depression,
  • cardiovascular disease,
  • migraines,
  • venous stasis (blood clots),
  • stroke,
  • gastric reflux disease,
  • polycystic ovarian syndrome,
  • pregnancy and fertility problems,
  • asthma,
  • sleep apnea, and
  • stress urinary incontinence.
Dr Rober Aragon The Bariatric Center of Kansas City - Cure for Type 2 Diabetes - Phyllis Cronbaugh
Robert Aragon M.D, The Bariatric Center of Kansas City

Dr. Robert Aragon, one of four highly trained surgeons with The Bariatric Center of Kansas City in Lenexa, Kansas2 says that most patients with T2D can see a marked reduction in the need for insulin within a few days after surgery and may be able to quit their doses completely within a few weeks or months. If the individual suffers from T2D and obesity, this occurs even before the patient has lost significant weight. Of course, one solution is not optimal for every patient.

Why surgery works so fast on T2D symptoms

“Most people considering bariatric/metabolic surgery, for whatever reason, initially have a very simplistic view of the process,” says Dr. Aragon. “They believe the surgery, which will either reduce the size of their stomach or bypass it completely depending on the procedure3, will ultimately cause them to eat less and the result will be to lose weight. The reality is that the smaller stomach is the least of the factors that cause the weight loss. The surgery causes a massive metabolic and hormonal change. It’s no different from when a woman has her ovaries removed. Without ovaries, she is likely to have hot flashes, night sweats, mood swings, sleeplessness, fatigue, anxiety, and even loss of sex drive. Our stomachs and intestines are not just reservoirs for food. Like ovaries, they secrete substances that influence our appetite, sense of fullness, the way our bodies manage sugar, store fat, and more. The surgery removes or bypasses the source of these hormones. That is why we see almost immediate results for diabetics, whether weight has been part of the equation or not; their blood sugar comes under control without insulin. … An overweight patient does lose weight, but what’s interesting is that patients who are not obese do not seem to lose weight. They maintain their current weight and just enjoy the metabolic results of the surgery.”

Dr. Aragon also indicated that individuals with Type 1 Diabetes that opt for surgery have much better control of blood sugars. They can reduce the amount of injected insulin, but not eliminate it.

From someone who has had bariatric surgery for weight loss, having the simple procedure done so that I did not have to stick myself with a needle several times a day and have to live with a very restrictive diet seems elementary.

Insurance companies are willing to pay

In 2015, the 2nd Diabetes Surgery Summit (DSS-II)1 stated as part of their conclusions, “Health care regulators should introduce appropriate reimbursement policies [for individuals suffering from metabolic imbalances].”

Currently, most insurance carriers are more than willing to pay for surgeries for obese patients that meet certain criteria3. “From a financial point of view, bariatric surgery makes overwhelming sense,” says Dr. Aragon. “The money that is saved years down the line by an insurance company is astronomical. We tell patients that on a yearly basis they can save $10,000-$12,000 in prescription drug costs, doctor’s visits, diet programs, and food costs. So for an insurance company to not have to pay for twenty years of diabetic care or other commodities of obesity, it just makes sense. The government is well aware of this, so for individuals that qualify, Medicare doesn’t set up a lot of roadblocks either.”

Dr. Aragon says that if an insurance policy does not cover the surgery, it isn’t the insurance company that is the problem, but the employer that did not negotiate the surgery into their program because rates would be higher. “We’ve had patients band together and change corporate policy,” he says.

So, why hadn’t my friend heard about the surgery before?

 Insulin syringe with 29G. needle on white background.In the 60s, 70s and even 80s before minimally invasive surgery was common there were stories of patients who had bariatric surgery and required weeks in the hospital, had postsurgical problems, did not reach desired outcomes, or developed nutritional deficiencies. This caused most of the stigma and bias that we still see today,” said Dr. Aragon. “Now, with laparoscopic, the surgery takes less than two hours (KC Bariatric does most in less than 45 minutes), there’s minimal downtime, patients lose weight, get off medications, off insulin, become more mobile, and complications are rare.

“In 2005 there were around 140,000 bariatric surgeries in the US. That [number] has grown but at a marginal rate. An impressive or actually unimpressive statistic from the American Society for Bariatric Surgery who sets the standard is that of the patients that would qualify for the surgery based on weight and medical problems, only 2%-3% actually have the surgery. There’s a huge discrepancy between those who need it and those who get it. Even with that today I would say there are over 200,000 surgeries every year in the US. Here at The Bariatric Center of Kansas City, we’ve done about 8000 since we opened in 2002, and around 1600 in 2016 alone.”

Why do I care?

Twenty-one years ago my husband was diagnosed with a rare form of leukemia. A seemingly perfectly healthy man was given three months to live if he did not undergo chemotherapy; with the chemo, he was told he should go into remission and live at least another four or five years. Doctors wouldn’t predict after that. Like my friend with T2D, he was a model patient and followed their the protocol, but somehow was overdosed on the chemo and lived three months eight days. It wasn’t until his death that I researched alternatives to his treatment. I believe that one of those alternatives would have given us a totally different outcome.

If you have a medical condition and aren’t completely satisfied with the treatment suggested, or the treatment you are undergoing isn’t working, do your research. We are led to believe that we have the finest health care in the world, but numerous countries treat medical conditions successfully in different ways than what is common here in the US. Take charge of your health. My friend is determined to have the metabolic surgery and is working to convince her physician and insurance company that in her case, it is the best solution.



  1. Diabetes Care Volume 39, June 2016 Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.
  2. The Bariatric Center of Kansas City (
  3. Surgical Procedures – Wikipedia – The two most common procedures today are the gastric sleeve, in which the stomach is reduced to about 15% of its original size by surgically removing a large portion and leaving a tube, sleeve, or banana shape. Gastric bypass surgery is where the stomach is divided into a small upper pouch and a much larger lower “remnant” pouch, and then the small intestine is rearranged to connect to both.

This article was originally posted by  on Mar 7, 2017 on Executive Life Magazine. It is with the author’s permission that we post this article in its entirety.