All posts by Dee Anne Agonis

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

 

Facilitator:  Dr. Hassan Saradih

Dr. Saradih began by discussing the different compartments that the body is composed of:

  • 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 Dr. Saradih’s office.  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 and Dr. Saradih 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!

 

 

References:

  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
  2. http://bariatrictimes.com/when-in-doubt-just-say-no-to-all-sugars/

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. 

Iron Deficiency Anemia and Pica

 

Iron deficiency anemia is the most common nutrient deficiency worldwide. Globally, this deficiency affects 9-16% of adult women (1). Iron deficiency occurs when the levels of hemoglobin carried by the red blood cells are decreased. Hemoglobin is an iron-rich protein that helps to carry oxygen from the lungs to the rest of the body. When hemoglobin levels are low, this causes the heart to work harder in order to move the oxygen-rich blood throughout the body.

 

This can cause symptoms such as fatigue, shortness of breath, dizziness, headaches, cold hands and feet, pale skin, chest pain, and weakness, and in more severe cases, irregular heartbeats, heart murmur, enlarged heart, or even heart failure. Iron deficiency can also present with brittle nails, swelling/soreness of the tongue, cracks in the sides of the mouth, an enlarged spleen, and frequent infections (2).

 

 

 

 

While iron deficiency is most often seen in women of child bearing age due to menses, or also during pregnancy, increased risk is also seen in bariatric patients. Studies have reported that 20-49% of patients who have had gastric bypass develop iron deficiency anemia. This may be due to several reasons. Typically, iron-rich foods, such as meats and fortified grains, are limited following surgery. The stomach produces less hydrochloric acid to help with the break-down and foods and subsequently iron absorption. Foods and supplements bypass the duodenum and proximal jejunum, where iron absorption takes place, and there are fewer receptors available to transport and reduce iron to its more absorbable form, heme iron. Additionally, nonadherence to vitamin and mineral supplementation is common, leading to the develop of iron deficiency (1).

 

coffee grounds

With an increased risk of iron deficiency anemia, bariatric patients have subsequently been shown to develop Pica. Pica is defined by the DSM-IV as “the persistent eating of non-nutritive substances for a period of at least one month, without an association with an aversion to food.” Strong cravings and intakes of laundry starch, ice, cigarette ash, diet, clay, coffee grounds, etc., have been reported in patients diagnosed with Pica. These practices may interfere with iron absorption in the body, and continuation can prevent improvements in iron levels within the body. Additionally, cases have been reported describing irreversible consequences of Pica following gastric bypass as developing periodontal disease, including dental fractures and the absence of pieces of teeth (1).

 

Treatment for Pica involves treating the underlying deficiency of iron. Iron supplementation has been shown to   relieve any cravings for non-food items as found with Pica. Consuming iron-rich foods will also help to improve iron levels. These foods are in meats, beans, eggs, nuts and seeds, peanut butter, and dark leafy green vegetables such as spinach, kale, mustard greens, and collard greens. To further improve the absorption of iron from foods, consumption of Vitamin C rich foods in conjunction with iron-rich foods is beneficial. These foods include citrus fruits, bell peppers and chili peppers, and dark leafy green vegetables. Conversely, foods that impair iron absorption include bran products, cocoa, tea, coffee, and calcium containing foods and supplements* (1).


Iron deficiency anemia is treatable, and your physician and dietitian will work closely with you to improve this deficiency. If you experience any of the symptoms listed above, don’t hesitate to tell your physician or dietitian at your next appointment, or call to come in for examination. You may need to have bloodwork done to diagnosis a deficiency, and supplementation, or sometimes an infusion, may be recommended or prescribed.

*Calcium and iron fight for absorption, which is why it is recommended to take a multivitamin high in iron or iron supplement 2 hours apart from a calcium supplement.

 

Sources:

  1. http://bariatrictimes.com/new-column-nutritional-considerations-in-the-bariatric-patient-this-month-Pica-an-ancient-disorder-with-modern-casualties/

https://www.nhlbi.nih.gov/health/health-topics/topics/ida/signs

The Benefits of Cauliflower in Your Weight Loss Journey

weight-loss-Cauliflower-Recipes-KC-Bariatric

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: https://authoritynutrition.com/benefits-of-cauliflower/)

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  

(from: www.dailydishrecipes.com)

Ingredients:

  • 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

Directions:

  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.

 

weight-loss-Cauliflower-Salad-KC-Bariatric

Cauliflower “Potato” Salad  

(from: www.thekitchenismyplayground.com)

Ingredients:

  • 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

Directions:

  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 

(from: www.sugarfreemom.com)

Ingredients:

  • 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

Directions:

  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. 

weight-loss-Roasted-Cauliflower-Florets-KC-Bariatric
Roasted Cauliflower Florets
weight-loss-Riced-Broccoli-and-Cauliflower-KC-Bariatric
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:  www.foodcoach.me 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.

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