All posts by Dee Anne Agonis

Alcohol Consumption after Bariatric Surgery


What Happens When You Drink?

We have all experienced the effects that come with drinking an alcoholic beverage or two.  Drinking alcohol can come with considerable costs also. Moderate amounts of alcohol can feel socially beneficial, but an excessive amount can cause a variety of negative consequences. Impaired judgement from excessive alcohol can cause people to over-consume empty calories and perhaps drive when they shouldn’t. It is important to remember that weight loss surgery cannot protect you against gaining weight from liquid calories and alcohol relaxes the esophagus and stomach, allowing you to eat even more. The combination of impaired judgement and a relaxed stomach can be a dangerous combination!

Risks of overconsumption of alcohol can stem beyond calorie surplus and have even more serious consequences. After bariatric surgery, even 1 drink could place someone at risk of getting a DUI. Obviously, this is never worth it!

Why do you get drunk faster after bariatric surgery?   

Weight loss surgery makes all of the consequences of drinking alcohol come a lot faster. When the stomach is smaller, there is less of the enzyme alcohol dehydrogenase present in the body. This enzyme is responsible for breaking down alcohol, therefore alcohol lingers in the system longer and peaks higher. Because of reduced stomach size, alcohol also moves more rapidly into the small intestine, causing it to be absorbed more quickly.  



Tips to plan ahead for social gatherings

  • Eat your meal before you drink
  • Rule of thumb- 1 drink before surgery = 3-4 drinks after surgery – know your limit!
  • If you do drink, consider options that are low in sugar and avoid mixed cocktails that contain juice or soda
  • If you are to drink, have your 1 drink after other people have had a few too so that you feel the effects at a similar pace and you are less pressured to overconsume as the night goes on
  • You may carry around some water in a cocktail glass with some lime and sip on it at the beginning of the night so that you do not need to repeatedly explain yourself why you do not have a drink in your hand
  • Be aware of the possibility of addiction transfer. If you have been addicted to food in the past you want to be aware of the risks of becoming addicted to alcohol and keep yourself out of situations that put you at risk.



Non-Alcoholic Mint Mojito




2 cups water

1/2 cup natural sweetener ex: Stevia or Swerve

1/2 cup fresh mint leaves

 1 oz lime juice (approx half a lime)



Instructions Simple Syrup

Boil water and natural sweetener over the stop for about 5 minutes or until thickens into a syrup.

Instructions for Mojito

  1. Add mint leaves to a glass container with a lid (such as a mason jar). Pour syrup over mint leaves and let steep at least 20 minutes. Use immediately or can save for later.
  2. Add ice to drinking glass. Pour 1 tbsp of mint syrup and 1/2 cup cold water. Add 1 oz lime juice. Stir and serve.
  3. Add more mint syrup or lime juice per preference. Recipe Notes This recipe makes one mojito with additional simple syrup to make 4 glasses.

 This recipe provides an estimated 32 calories, 0 grams protein, 3 grams carbohydrate and 0 grams fat.

With the holiday season upon us, we encourage you to have fun and enjoy social functions with friends, family and co-workers.  Just be careful and remember, “everything in moderation”! 




Dr. Duc Vuong on “Alcohol after weight loss surgery”

Alcohol and the Gastric Bypass Patient



November 7, 2017 – Setting & Meeting Activity Goals

Facilitated by:  Kari McKeown, RPT  and Barb Cashman, RPT

Our two new physical therapists in the office were introduced and they spoke briefly about how they would be meeting with all patients pre-operatively to do a physical evaluation of mobility and making recommendations for activity that can be started prior to surgery. 

Kari shared the information from an article that states “Sitting is the New Smoking,” and how we spend a lot of time sitting behind the wheel of a car, then at a desk, then in front of the television, and how all the sitting has shown to increase the risk of heart disease, diabetes, cancer and even depression.  Even if you exercise an hour a day, if you are sitting the rest of the time, you are still at risk.  “Your body is designed to move. Sitting for an extended period of time causes your body to shut down at the metabolic level.”  We all need to take breaks, get up and move, even for as short a period of time as a few minutes can improve your health.  It is important to get regular activity throughout the day in addition to regular exercising.

Barb shared information about High Intensity Interval Training (HIIT), which allows you to get a higher impact training in a much shorter period of time, and talked about using Tabata Workouts on You-Tube that can help you time those workouts with high intensity for 20 seconds, 10 seconds of rest and do 2 circuits before resting for a few minutes.  Unfortunately, the video would not work, so we weren’t able to show it, but you can access it now by playing the video below. It is important to modify the exercises as you gradually work up to it, so you want to start with beginner routines.  Many of the routines are only 10 minutes long.  We hope to be able to save some of the workouts and share them at a future support group meeting. 




Physical Therapy Benefits Your Bariatric Weight Loss Journey!

The Bariatric Center of Kansas City Physical Therapy Weight Loss

Physical therapy plays an important role in your bariatric weight loss experience.  Physical therapists work with you during various points of your journey, both prior to and often after surgery.  They offer a pre-operative evaluation to start you on an exercise program appropriate to your level of function, activity level and/or mobility constraints.  They also provide post-operative care to address weight loss changes to your body, orthopedic problems and to advance your exercise program.  Physical therapists can also help you manage the many aspects of recovery after bariatric weight loss surgery and help ensure the most successful outcomes by:

weight loss with physical therapy– Creating an individualized treatment program;

– Educating you on the benefits of exercise and how to incorporate it into your new lifestyle;

– Teaching you safe exercise techniques and progressions before and after your procedure;

– Helping you find ways to stay motivated and continue on the path of better health.

Your Weight Loss Journey Is Unique!

Each person’s weight loss journey is unique, and may require different skills from the physical therapist. Physical therapy may address the following:

  • Improving endurance and aerobic capacity;physical therapy weight loss stretching ball

  • Decreasing pain in the spine and extremities;

  • Regaining range of motion and/or strength;

  • Improving balance and/or coordination;

  • Improving postural awareness.

Ensure A Successful Outcome In Your Bariatric Journey!

As you know, the decision to have bariatric surgery is also a decision for making healthy lifestyle changes.  Working with a physical therapist provides you with an additional tool to help ensure a successful outcome in your bariatric journey.  Here are some tips to keep in mind as you recover and progress:

 – Surround yourself with supportive friends and/or family;

 – Keep track of your progress;

 – Attend support groups, which are held twice monthly on-site;

 – Get involved in something you have always wanted to do or try;

 – Be sure to treat yourself with healthy rewards;

 – Remember, everyone makes mistakes; learn from them.

It is also important to consider what went wrong and correct it in the future.

The Bariatric Center of Kansas City is pleased to announce that physical therapy services are now available in our Comprehensive Care Wing in Suite A-305 of Building A in the Shawnee Mission Health Prairie Star Complex at 23351 Prairie Star Pkwy, Lenexa, KS.  PT services are covered by most insurance plans and are a valuable resource to take advantage of. To schedule an appointment, just call our main office line at 913.677.6319 and we’ll be happy to get you scheduled!

October 19, 2017 – Making Seasonal Protein Bars

Facilitators: Laura Hernandez, RD & Anne Epp, RD

                Bariatric Apple Pie Protein Bars

Laura and Anne, our new dietitian, made some no-bake bariatric Apple Pie Protein Bars.  The recipe is below.  Everyone got to try them, and discussed ways that the recipe can be modified for individual tastes.  One 1” square of the bars contained 38 calories, 1.9 gm of fat, 2.4 gms of protein, and 3.3 gm of carbohydrates. These are not intended as a “meal substitute” but rather as a way to share something patients can make during the upcoming holidays that is high quality food and nutritious, rather than a highly processed food.

Laura shared a number of new sweeteners out on the market you may want to try for baking in the upcoming holidays:  Swerve Sugar Replacement (tastes, bakes and measures like sugar); Monkfruit sweetener (also a 1 to 1 sugar replacement); and Allulose – a naturally occurring low-calorie sugar with 90% fewer calories and shows no impact to glucose or insulin levels.


2 cups gluten free oat flour                                                     

½ cup coconut flour

½ cup vanilla protein powder                                                  

6 packets of Splenda

1 T cinnamon

1 tsp all-spice

1 tsp nutmeg

¼ cup almond or peanut butter

½ cup unsweetened apple sauce

3 T half and half

1 tsp vanilla extract

¼ tsp low calorie agave nectar


  1. Line large baking dish with greased paper and set aside
  2. In large mixing bowl, combine flour, protein powder, Splenda, and spices and mix well
  3. In microwave safe bowl, combine the nut butter and liquid sweetener and and heat until melted. Pour the wet mixture into the dry and mix well. Add applesauce and mix until combined- the batter should be crumbly
  4. Add the half and half until a thick batter is formed
  5. Transfer to lined baking dish and press firmly. Refrigerate for at least 30 min.


Bariatric Center of Kansas City Surgeons Participate in J & J Institute Program

Bariatric Center of Kansas City

From Left to Right: Dr. Brice Hamilton, Dr. Aaron Lloyd, Dr. Billy Helmuth, Dr. Stanley Hoehn & Dr. Kelvin Higa


Bariatric Center of Kansas City surgeons Stanley Hoehn and Brice Hamilton recently participated as faculty members for the course Enhancing the Bariatric Patient Experience, presented by the Johnson & Johnson Institute September 15 and 16, 2017. The J & J Institute presents specialized programs to healthcare providers as part of their “…commitment to advance education to improve patient care.” The program was held at the Shawnee Mission Health – Prairie Star campus in Lenexa, Kansas for a select group of bariatric surgeons from across the country along with their practice or hospital administrators and representatives from Ethicon, one of the J & J subsidiaries that provides surgical equipment used in bariatric surgery.


Program Participants Touring the Facility
Dr. Hassan Saradih

Other faculty members were Dr. Helmuth Billy, from Ventura, CA, Dr. Kelvin Higa, from Fresno, CA, Aaron Lloyd, Director of the Bariatric Program at Fresno Heart & Surgical Hospital, and Dr. Hassan Saradih, Bariatrician at Shawnee Mission Health. Dr. Higa, current president of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) and past president of the American Society for Metabolic and Bariatric Surgery (ASMBS), served as moderator for the day and a half course, which covered topics such as Best Practices in Seminar Education, Gaining Efficiencies in Surgery, Maximizing Patient Health Improvement Outcomes, Reimbursement Dynamics, and Coordinated Care for Patient Success. 

Program Participants from Around the Country

Ethicon and Johnson & Johnson regularly provide educational courses for surgeons around the country, and this is the first time they have presented in Kansas City.The Prairie Star facility is unique in that it houses the entire Bariatric Center of Kansas City bariatric surgery program, allowing patients to have their pre-op workup, surgery, and post-op follow up all in one facility, a unique concept for bariatric care in the country. 

Dr. Stanley Hoehn Sharing Practice Experience with Program Participants

Johnson & Johnson chose to have this educational workshop here to demonstrate how the partnership between The Bariatric Center of Kansas City & Shawnee Mission Health has allowed us to become a leader in Metabolic & Bariatric Surgery.

The Bariatric Center of Kansas City at The Shawnee Mission Health Prairie Star Complex






October 3, 2017 – Body Composition

The different components that the body is composed of are:

  • Bones
  • Organs
  • Muscles
  • Fat

Along with water, these are what our bodies are made up of.  When we talk about your “fat free mass” we are talking about water, bones, organs and muscles.  Once you have finished growing, your bones and organs don’t grow anymore – they continue to weigh about the same throughout adulthood.  The two areas that you can change are muscle and fat. 

There are two types of fat in your body composition:

  • Essential fat:    necessary for normal body function. This includes fatty tissue making up nerves, brain, heart, lungs, liver and mammary glands.
  • Non-essential fat:  this is simply fat or energy storage. This is also known as adipose tissue, and exists mainly just below the skin, and then around the organs. The fat around the organs is known as “visceral fat.”  This varies from person to person. 

The typical body composition of men and women is distributed as below:

Today, our lifestyles have led to a decrease in muscle mass and an increase in non-essential fat.  The body has an unlimited capacity to store energy, leading to increasing amounts of excess fat.  Men often carry their excess fat in the abdominal region, while women tend to carry it in the hips, thighs and buttocks.  

Since two people can weigh the same, but be composed of completely different percentages of fat and muscle, a better way to determine the amount of excess fat a person has is by using a body composition analyzer.  We now have a medical body composition analyzer in our Comprehensive Care Center.  It works by measuring sound waves as they move through different types of body tissue.  It can determine what percentage of fat and muscle is in your body.   Sometimes a regular scale doesn’t show a change in overall weight, but the change may be in body composition.  Muscle weighs more than fat, so if you are increasing muscle and losing fat, you may not see a change on a regular scale. But a body composition analyzer will show if you are losing excess fatty tissue.  Also, we always want to preserve your lean muscle mass. If you begin to lose lean muscle mass, we can see that on the analyzer and focus your diet on building muscle. 

This tool will be a big benefit to the work the dietitians  do by individualizing a program for each patient based on how their body composition is changing.  We hope to be using it routinely by October 15th.  We will need to get a baseline measure, and then can do a body composition analysis every 3 – 4 months to see how the program is working for each patient, and make changes as indicated.   Normally people pay about $100 for a body composition analysis.  We will offer it to our patients for $25.  (We don’t want to make money on it – just pay for the cost of the machine, which is very expensive.) This additional resource will help us to optimize your weight loss and design a plan specifically for each patient.  

September 21, 2017 – Cross Addiction or Addiction Transfer


Facilitator:  Michelle Coker, PhD

Dr. Coker is a clinical psychologist at the Bariatric Center if Kansas City, and sees patients both before and after surgery.  She defined cross addiction, or transfer addiction as it is sometimes called, as “…the state of being enslaved to a habit or practice that is psychologically or physically detrimental to your health and well-being.  The body and brain crave and adapt to the substance in a way that gradually requires increased amounts of that substance to achieve the same results.”

Food addiction has been scientifically shown to operate on the reward or pleasure center of the brain by causing the same dopamine response that other drugs, as cocaine and heroin, causing the ongoing addiction.  In order to stop the addiction, the person needs to do the emotional work necessary to understand why they use food as comfort.  When they have surgery and can no longer use food for comfort, they may transfer that addiction to some other substance or behavior.

When the initial addiction is never dealt with, which may be food, there is still an addiction component in the brain that needs to be addressed, so the person may choose to find some other way to trigger the reward center of the brain.  The new addiction could be anything from gambling, alcohol, sex, drugs, work, prescription medication, or shopping.  It can become the new “go to” and then a new addiction grows. 

Once you have had one addiction, you are at risk for developing another, because addiction cannot be cured, but it can be managed.  One of the main components of addiction is that the addict is very uncomfortable with being uncomfortable. It is that inability to be uncomfortable that leads the person to seek comfort in the food or substance.  There is a void that they are trying to fill rather than dealing with the personal issues and feelings that are being suppressed with food or other self-destructive habits.  The person needs to be full from within, rather than trying to use external things to feel full.  In order to reach that inner fullness, a person must first clear out the old toxicity, wounds, and hurtful behaviors that cause the addiction.  There is no way of getting over a hurt – you must go through it.  You must feel it to heal it. 

Unfortunately,  we have been taught not to feel – that there is a shortcut. But there are no quick fixes.  While we want instant relief from the suffering or grief, it is part of the human condition and “It is through experiencing our deepest sorrows, we are able to appreciate our greatest joys.”   You don’t have to go through it alone – the first step is to get help.

Figure out your triggers – addictive impulses are simply the body seeking the release of endorphins, which give you the pleasure sensation. By developing new strategies to deliver those endorphins, you can switch to a healthy way to give you the same pleasure but without the regret.  Exercise, running or biking is a great way to release endorphins that is good for you.

Reframe – think about the compulsive urges as an indication for something to be taken care of or some need to be met.  When you see it as something besides just an urge, you can take steps to find a new way of meeting that need.  Addictions tend to isolate people, where they sit and listen to the addiction calling and block everyone and everything else out.  Turn the urges into something that serves you instead of you serving it, you can be free to experience real joy.

Other helpful ways to deal with addiction are:

  • Change the playlist in your head
  • Cognitive Behavioral Therapy
  • Support and Spirituality
  • Practice and Patience

We are here to help you!

Fructose & The Metabolic Impact of Sugar on Weight Loss and Body Function

The Bariatric Center of Kansas City - weight loss sugar


Christopher Still, DO, FACN, FACP, recently published an article in Bariatric Times that provided helpful insights into the world of sugar (“When in Doubt, Just say ‘NO’ to All Sugars”) -.  Specifically, he cited a certain type of sugar, fructose (or fruit sugar), as being detrimental for all people, not just those actively seeking weight loss.  But for folks on a weight loss journey, it can be especially harmful in working against their weight loss efforts! This is because studies are beginning to show that fructose can trigger brain changes that may lead to overeating.

Still’s article summarized findings from a study published by Yale University scientists in the Journal of the American Medical Association (JAMA).  Their findings state that when fructose beverages are consumed, the brain does not register the same feeling of being full as it does when simple glucose is consumed.  The body uses glucose for energy.  The brain imaging scans they conducted showed that consumption of sweetened beverages, actually suppressed brain activity associated with the sensation of hunger.  The study has led researchers to consider that fructose and high-fructose corn syrup (HFCS) may be part of the root cause of the nation’s obesity epidemic.

Does Fructose Cause Fatty Liver?

Bariatric Center of Kansas City Program Coordinator, Chris Bovos, RN, CBN, shared additional key points about fructose from The Journal of the American Osteopathic Association [1], (JAOA) in support of the fact that cutting fructose will quickly improve metabolic function:

Fructose has been identified as a particularly damaging type of simple sugar.  Compared to glucose, which metabolizes 20 percent in the liver and 80 percent throughout the rest of the body, fructose is 90 percent metabolized in the liver and converts to fat up to 18.9 times faster than glucose; 

HFCS is found in 75% of packaged foods and drinks, mainly because it is cheaper and 20% sweeter than raw sugar.  Fructose turns on the metabolic pathways that convert it to fat and store it in the body, adding weight.  At the same time, the brain thinks the body is starving and becomes lethargic and less inclined to exercise;

“Fructose provides no nutritional value and isn’t metabolized in the brain.  Your body converts it to fat, but doesn’t recognize that you’ve eaten, so the hunger doesn’t go away . . . many young patients tell me they’re always hungry, which makes sense because what they’re eating isn’t helping their bodies function.”;

“If we cut out the HFCS and make way for food that the body can properly metabolize the hunger and sugar cravings fade. At the same time, patients are getting healthier without dieting or counting calories,” Dr. Winters says. “This one change has the potential to prevent serious diseases and help restore health.” (Dr. Tyree Winters, DO is head of the Pediatric Health and Weight Management Program at Children’s Hospital of New Jersey at Newark Beth Israel Medical Center).

Still’s conclusion and suggestion is that people try to cut down on ALL sugar because of the double benefit of helping to suppress one’s appetite AND reduce caloric intake.  Whether you’re trying to lose weight or just want to establish healthier eating habits while maintaining your current weight, sugar reduction overall will help contribute positively to achieving your goal! While consumption of diet and/or low-calorie beverages, or use of artificial sweeteners, may be considered an improvement, it is still not the best answer overall.

A better way to help curb intake of either type of sugar (fructose or glucose) is to quench our thirst with water. Still’s clinic compared patients who primarily drink water with patients that drink artificially sweetened/low-calorie beverages and found that those who drink water lose more weight.  He recommends that people drink the recommended eight, 8-ounce glasses of water each day before consuming any type of diet or low-calorie drinks.  He suggests, “When it comes to sugar (of any type) and artificial sweeteners in your diet, just keep it simple and say “no” to as many as you can – regardless of the type of sugar”.

In the end, getting into a habit of regularly checking nutrition/ingredient labels when food shopping to assess sugar and specifically, fructose content, in the products you buy will open your eyes to how much it is used and guide you in steering clear of it as much as possible! For better health and weight loss, just say NO to sugar!




  1. Jean-Marc Schwarz, PhD; Michael Clearfield, DO; Kathleen Mulligan, PhD (2017). Conversion of Sugar to Fat: Is Hepatic de Novo Lipogenesis Leading to Metabolic Syndrome and Associated Chronic Diseases? The Journal of the American Osteopathic Association, August 2017, Vol. 117, 520-527. doi:10.7556/jaoa.2017.102

September 5, 2017 – The Science Behind Willpower

Facilitator:  Chris Bovos, RN, CBN :

Chris spoke about Willpower, which most of us wish we had more of, to stop us from making choices that turn out to be bad for us.  Since temptations never stop, it is important to understand that we can improve or strengthen our willpower.

There has been a great deal of research regarding will power done by social workers and psychologists over the last 50 years.  It has been found that people will high self-control are more successful in many ways than those who do not.  Studies of college studies found the only predictor of grades in college was self-control.  Those with high degree of self-control did better in school and after school, and grew into adults with better health, better hygiene, lower rates of obesity, fewer criminal convictions, and had higher paying jobs. 

In one landmark study done in the 60’s, children were taken into a room by an adult and there was one marshmallow on the table.  They were told if they could wait 15 minutes until the adult got back, they could have 2 marshmallows.  Some of the children immediately ate the marshmallow, some tried to hold out the whole 15 minutes, but gave in and ate it before the 15 minutes were up, and another group were able to wait the whole 15 minutes and got 2.  The group that was able to wait were able to find ways to distract themselves in the room without focusing on the marshmallow.  That seems to be the biggest key. 

They also found that you only have a certain amount of willpower per day, and once you use it up, then your willpower is gone.  You use the same reservoir of willpower for all manner of tasks. The more stress you are under, the more decisions you have to make, the more you are having to resist urges, whether emotional or physical, the more you use up, which is why we often have less self-control later in the day.

Will power requires a source of energy, and in the brain that source is glucose.  The body uses 20% of the body’s glucose, which it converts to neurotransmitters to send signals.   If you have low blood sugar, you will have less self-control, so maintaining a steady level of glucose through eating protein is very important.  If you eat a candy bar, you may get a momentary boost of glucose, but then your blood sugar spikes, your body produces a lot of insulin to get it back down, and then you end up with a low sugar and a complete loss of self-control.  You will feel things more intensely, get mad more easily, cry more easily, be tempted more easily.  Eating 3 protein centered meals a day will help prevent that. 

The best way to preserve willpower to meet those unforeseen challenges in life is to arrange your life to reduce stress as much as possible.  If you are in a bad living situation, a job that makes you unhappy, etc., you need to make changes that can remove some of that stress which will preserve your will power and help you to manage time better and focus on the task at hand. 

If you find yourself feeling emotions more intensely, try have some protein to eat. Avoid anything full of sugar or fat, as they are addictive.  If you crave something, tell yourself you can have it later (the power of positive procrastination).  Find ways to distract yourself when you feel tempted.  Go for a walk, call a friend, read a book, etc. – something you like to do.  It will pass in less than 10 minutes.  Every time you make it through one of those, you add strength to your willpower, so look at those times as opportunities to strengthen that “muscle.” 

Reward yourself – not with food – when you reach a goal, such as resisting temptation for 3 days.  That’s part of self-teaching.  And don’t forget the basics:  healthy food, sleep, and don’t skip meals!


August 17, 2017 – How to Dress Your Body Type

Facilitator:  Gina Daugherty, CM

Gina has been involved in fashion since she was in high school, when she worked at Jones Store to coordinate outfits for fashion shows.  She pulled a number of clothing items from the clothing exchange closets to show how to put together different outfits using just a few items of clothing. 

She started with a few “rules” that she always abides by:

  • Leggings are NOT pants. Leggings are fine as long as you cover your bottom – always!
  • Buy basic colors in shorts, pants, skirts: black, white, navy, gray, and khaki
  • If you wear capris, they need to either come right above the knee or right above the ankle. Otherwise they cut you off and make you look shorter.
  • Horizontal stripes should have a print, or the stripes should just be on the sleeves
  • Buy a size that FITS – don’t continue to buy too big. Stop buying the size you were – you are not that size anymore.
  • For abdominal weight, wear A-line or empire waist tops, and keep them long and “flowy” – don’t wear tight fitting clothing that shows off the “rolls”
  • To make you look longer, wear V-necks or scoop necks with a long necklace
  • If you don’t love it, don’t buy it!
  • Shop at Goodwill (135th & 69 highway is good) or Savers. Other good stores are:

Platos closet (caters more to younger set)

Elephant Tree

Beyond Exchange

Target, Kohls, Walmart, TJ Maxx and Marshalls

Kohls is great for undergarments by Warners          


For men,  she had just a few rules:

  • Wear only dark color slacks – no white!
  • Don’t mix textures
  • Buy clothes that fit


You have to take the time to shop; browse frequently and look at mannequins for ideas; reward yourself (not with food!) everytime you lose another 10 lbs, or reach your next goal.