All posts by Dee Anne Agonis

Healthy Eating Tips During the Holiday Season

Healthy Eating for a Healthy Bariatric Lifestyle

Fall has arrived, and quickly approaching us is the holiday season. Invitations to dinner parties we don’t want to miss will soon trickle into your inboxes, work socials with holiday pot lucks will begin, and we might find ourselves wondering, “How can I avoid weight gain with all of this food around me?” It is important not to stress over what you can and cannot enjoy. In fact, you should still be able to enjoy everything, but with one tip to remember – moderation is key for your bariatric health! So how can you enjoy healthy eating during the holidays? Here are seven healthy eating tips to keep you on track this season:

  1. Focus on your protein. Remember, your goal is 3oz of protein 3 times per day. Look for the turkey or ham, or take your own high protein stuffing dish or sausage and cheese meatballs. Ask yourself, “Did I get 3oz of protein in?”
  2. Control your portion sizes. Moderation, moderation, moderation….our eyes will be much bigger than our stomachs. Grab a smaller plate, and don’t work to fill the plate. You should still be able to see the plate between each food item.
  3. Eat before you go. If you arrive to a dinner party hungry, you are more likely to overeat. Make sure you eat balanced, nutritious meals for breakfast and lunch before heading out to that dinner party.
  4. Be mindful and pace yourself. Remember you need to be looking for the feeling of satiety (fullness) so that you know when to stop and not overeat. You should take at least 20 minutes to finish your plate.
  5. Decrease your food availability. It’s easy to eat unconsciously at a party, especially if you are talking to friends or co-workers right next to the party trays and buffet line. Grab your plate and migrate away from the food. If it’s not directly in front you, you won’t be as tempted to keep grabbing bites.
  6. Remember to stay hydrated! Drink plenty of water throughout the day and continue to take in fluids after the party. Especially if you plan on drinking alcohol at the party, which can dehydrate you.
  7. Don’t forget to be physically active throughout the season. Physical activity in addition to healthy eating will help prevent weight gain. Aim for 30 minutes of cardio activity at least 5 days per week. Taking a 10-minute walk on a few times a day adds up to 30 minutes, making it easy to complete this goal.

In addition to these tips, consider making your own healthy holiday dishes to enjoy at home or take to that work potluck. Here are some healthy holiday cooking tips from The Bariatric Team at UCLA:

  • Grilled asparagus with bacon, basil and sesame
    Grilled asparagus with bacon, basil and sesame
    Asparagus and Bacon appetizer: wrap 3-4 stalks of asparagus together with 1 slice of bacon. Roast in the oven on 350 degrees F for 15-20 minutes.
  • Try mashed or whipped cauliflower instead of mashed potatoes for a low carb dish. Recipe: steam cauliflower until tender, about 10 minutes. Then place the cauliflower in a blender or food processor and blend until smooth. Once creamy, add garlic, parmesan cheese, and black pepper.
  • Gravies: refrigerate first to harden the fat, then remove all the visible fat before heating up to serve.
  • Green bean casserole: cook fresh green beans with cubed potato pieces instead of cream based soups. Top with sliced or roasted almonds instead of fried onions.
  • Holiday egg nog: Blend together 4 bananas, 1 ½ cups of skim milk, ½ cups of plain nonfat yogurt, and ¼ teaspoon of rum extract, until smooth. Top with ¼ teaspoon of nutmeg. Serves: 8.
  • Desserts: Substitute 2 egg whites for each whole egg in your recipes. Try a low carb dessert such as crustless pumpkin pie. Use fresh fruits to top cakes instead of frosting.


Healthy Eating During the Holiday Season By: Michelle Adams MS, RD, LD

Reference: UCLA Center for Obesity and METabolic Health (COMET),

October 6, 2016 – Macro-nutrients & Regular Exercise Help Maximize Post-Surgery Weight Loss

Bariatric Support Group

Date: October 6, 2016

Facilitator:  Whitney Venegoni, NP 

 Nurse Practitioner, Whitney Venegoni, began with a short presentation on the 3 main macronutrients the body needs to remain healthy – Proteins, Carbohydrates and Lipids (Fats). 

She started with protein, which is always stressed.  She talked about how important protein is for your muscles and your body organs, and that they have a lot of jobs to do:

  • Some provide enzymes that are necessary for your body reactions
  • Some are hormones, such as insulin, that regulate metabolism
  • Some make antibodies to keep us from getting certain diseases
  • Some transport vitamins and minerals into your cells
  • And some are structural, making up collagen, bone, skin, teeth, tendons, cartilage, blood vessels, hair and muscle

In order to prevent your body from using muscle as energy, you need to eat protein to keep building strong muscles. 

Carbohydrates are important to provide the body energy, and the body will use carbs as energy first.  They are easiest macronutrient for the body to digest and absorb, but the refined carbohydrates, such as refined and processed food, cause the blood sugar to go up rapidly.  This causes the body to increase the insulin that is released, and insulin causes the body to store fat, so you want to eat complex carbohydrates that digest more slowly, and keep your intake of carbs low.  That leads to decreased insulin release, which then leads to fat breakdown.

Lipids (fats) is how we store energy that we don’t use up.  Fat is made up of cells called adipocytes, which are storage sites for triglycerides.  We need some fat in our diets to absorb fat soluble vitamins.  It also slows emptying of the stomach and helps with digestion.  Fat stores are the body’s second choice for energy.  So if you keep your carb intake low, your body will break down the fat in the body to use as energy, which helps you lose weight. 

Discussion then occurred on the topic of the “weight loss curve”.  It was stressed that it is easiest to lose weight in the first 1 to 1 ½ years.  After that, your body begins to resist losing weight.  When we look at the trend in weight loss of our patients, we see that 70% of the weight loss comes in the first 6 months, and then the last 30% comes in the next 6 – 9 months.    Initially the average weight loss in the first 2 months, walking 30 minutes a day, is 1 pound every 2 days.  Then if you increase your activity to 60 minutes a day that can be increased to 2 lbs every 3 days.  If we don’t see that you are losing weight in that first 2 – 4 months at that rate, it is beneficial to  intervene early on to increase that weight loss so you are able to take advantage of the “honeymoon” period to get 70% of your weight off in that first 6 months.  There are medications that we can use after surgery to increase your metabolism, or you can increase it by increasing the intensity of the activity you are doing.  Weight training and building muscle is a great way to do that.  Activity needs to become a part of your new lifestyle so you can continue to lose weight and then maintain your weight. If you do it every day for 18 months, it will become a new habit and you will be able to continue to do it daily.

Greg Justice, the exercise physiologist that does support groups with us occasionally, does High Intensity Interval Training, which helps with that.  Katherine Caddell from Element Fitness on 79th and Quivira also was present and spoke about the training they do at their gym to help with that.  We have a number of patients who use that gym and really like it.  Katherine brought One Week Free handouts to folks can try it out for free for a week and see how they like it.  They have water aerobics for those with painful joints, and personal trainers that can work with you to design a program for your goals. 


Benefits of Bariatric Surgery Before Knee or Hip Surgery

A new study from the Journal of Bone and Joint Surgery (JBJS) this year has confirmed that obese patients who undergo weight loss surgery in Kansas City (or elsewhere) before having knee replacement surgery fare better than those who do not.

Why is Bariatric Surgery Beneficial Before Knee or Hip Replacement Surgery?

The American Society of Metabolic & Bariatric Surgery’s (ASMBS) February newsletter, “Connect”, referenced the JBJS study in an article titled, “New Study Shows Bariatric Surgery Before Total Knee Replacement May Reduce Complications and Costs for Patients with Severe Obesity”. They state, “…patients with severe obesity who have bariatric surgery two years before knee replacement tend to have fewer complications and an improved quality of life…”

The ASMBS shared details from the American Academy of Orthopedic Surgeons (AAOS) who state, “Obesity is a known risk factor for osteoarthritis and places total knee replacement patients at increased risk for complications, including delayed wound healing, infection, the need for revision surgery and lower functional outcomes.”

Knee Replacement SurgeryLead study author, Alexander McLawhorn, MD, MBA, from the Hospital for Special Surgery in New York, relayed, “We know that bariatric surgery can be an effective treatment for morbid obesity, reducing a patient’s excess weight. In addition, the surgery also reduces the burden of co-morbidities, like diabetes and high blood pressure, and may extend a patient’s life span.”

But study researchers were also wanting to know if it would be cost effective to recommend bariatric surgery to achieve weight loss and improve preoperative health prior to joint replacement. They found the study’s computer model did predict that patients with severe obesity who have bariatric surgery two years before knee replacement are more likely to have an improved quality of life at a lower cost than obese patients who have joint replacement without bariatric surgery and significant weight loss before that surgery.

According to the ASMBS, Dr. McLawhorn has suggested results of the new study might help surgeons in counseling patients with severe obesity and knee osteoarthritis in devising individualized treatment plans that include “optimization of overall health, nutrition, and weight prior to knee replacement.”

Bariatric Surgery Before Joint Replacement Makes Sense!

In summary, ASMBS President, Raul Rosenthal, MD, concluded “This study shows it makes both health and economic sense for patients with severe obesity and osteoarthritis to strongly consider bariatric surgery before knee replacement. Not only will the knee surgery go better, but the improvements in overall health can be dramatic.”

If you are struggling with obesity and have joint problems, or perhaps are moving in the direction of joint replacement surgery for weight bearing joints, The Bariatric Center of Kansas City urges you to consider the benefits of bariatric surgery prior to joint replacement and recommends a discussion about it with your Orthopedic Surgeon.

September 17, 2016 – Small Groups & Pumpkin Pudding

Bariatric Support Group

Date: September 17, 2016

Facilitator:  Laura Hernandez, MBA, RD, LD

As we move into fall, Laura wanted to share a pureed pumpkin pudding that patients can make when they start the pureed foods in their post-operative diet progression.  It does not contain sugar so is something any of our patients can make. 

Bariatric Friendly Pumpkin Pudding Recipe

(Original recipe from “Baked by Rachel” and modified to be “bariatric friendly” by KC Bariatric Registered Dietitian, Laura Hernandez.)


2 cups unsweetened vanilla almond milk (Laura used Skim Fairlife Milk)

¼ cup cornstarch

1/4 tsp salt

1 tsp vanilla extract

3/4 cup pumpkin puree

1/2 tsp pumpkin spice

1/2 tsp cinnamon

1 egg

5-7 drops Stevia to taste (Laura used 8 packets of Splenda)


In a medium saucepan combine milk, cornstarch, salt, Stevia, and vanilla extract. Whisk until combined. Cook over medium heat. In a separate bowl, whisk egg and add to the saucepan. Stir constantly and reduce heat to low and cook for 1-3 minutes. Add pumpkin puree, pumpkin spice, and cinnamon. Whisk all ingredients. Pour through a mesh strainer into a medium bowl. Enjoy warm or chilled.

You can either use it as a warm thick liquid to drink (which we did) or put it in cups and refrigerate to pudding consistency.  Fairlife Milk, which Laura used, is an ultra-filtered cow’s milk that has no lactose in it.  Due to the ultra-filtration, it has twice the protein and 1/3 more calcium than regular milk and it lasts much longer than regular milk (2 – 3 months).  Everyone loved the pudding!  You can make it thicker or thinner depending on how much cornstarch you use.   

We had some great small group discussions and our first support group in October is on Thursday evening, the 6th, and Dr. Sabapathy will answer any questions you have.  We do have to cancel the support group November 3rd as we will all be at the annual conference in New Orleans, but will return November 19th.  We hope to have some more chair yoga soon!   

September 1, 2016 – Music Therapy for Stress Control

Bariatric Support Group

Date: September 1, 2016

Facilitator:  Janalea Hoffman, Music Therapist


Janalea Hoffman has been providing music therapy at Shawnee Mission Medical Center for 12 years, and works with oncology patients, surgical patients, and patients experiencing pain or stress. 

She spoke about how music can be used therapeutically and for recreation, and there was discussion about how when used therapeutically it is frequently to decrease stress and to calm, and when used for recreation,  it is usually louder and used for increasing energy.  Janalea cited a number of scientific studies which have shown the power of music to heal.  One of the first was done in a critical care unit and ½ hour of listening to classical music had the same effect as 10 mg of Valium for the patients. 

Janalea spoke about your “sound environment” and how that can affect all living things. Sunflowers, which as we know follow the sun, turn away from loud rock music, but return to following the sun when listening to soft, calming music.  Cattle are known to provide healthier and better quality meat when they are in a peaceful environment, as opposed to those subjected to loud noise all day.  One couple working with a therapist because the husband was abusive found that when he came home, if he played more peaceful music instead of loud aggressive music, the battery stopped.    The sound environment also affects children – particularly in school.  Schools next to airports, subways, and other loud environments were found to be much further behind in school that those where the school was in a more peaceful environment. 

Janalea spoke about how we adapt to the beats per minute of what we are listening to, and we did a couple of experiments to see if our breathing and heart rates adapted to music that was set at 50 beats per minute.  A lot of Janalea’s music is performed at 50 beats per minute in order to physiologically slow the heart rate, breathing and blood pressure of patients, because we tend to synchronize with the beat.  The body responds to music physiologically, emotionally, spiritually and even analytically, and as we slow to the 50 bpm, it also increases our immunity.  Ocean waves lap the shore at 60 beats per minute, which is why so many are drawn to the shore and find it such a peaceful place to relax.

Janalea also showed us some of the instruments she uses to teach people how to play in order to relieve stress and prevent themselves from returning to addictive behaviors, such as alcohol, drug or food addictions.  She uses a number of Native American flutes, and also demonstrated a beautifully full sounding Cathedral Drum, which has a full, echoing tone, and is wonderful for children to experience.

Janalea has a studio out near the Overland Park Arboretum and Botanical Gardens on 179th just west of Metcalf Ave., and provides 2 hour classes there for $25.  She also has a number of CD’s for use in relaxation.  For more information about her and her classes, instruments and CD’s you can go to her website:   Chris has 100 of her CD’s that were designed for surgery patients, and normally sell for $15. You can buy one for $10 (cash please) anytime from Chris Bovos either at support group or in her office by the conference room. 

August 18, 2016 – Changing Habits

Dr. Sabapathy discussed changing habits with the group. He used the acronym CARE to explain the change process.

C – Concern: first we have a concern about something that makes us want to make a change. For our patients it is usually a concern about their health. This starts the process.
A – Awareness: Becoming aware of why we have developed the habit, where we want to be after the change, and what it will take to make the change is next.
R – Responsibility: Now we have to own the changes we are going to make and take full responsibility for how our behavior needs to change in order to be successful.
E – Energy and enthusiasm: Then we need to gear up and get ready to make the change, get excited about the positive things the change will bring to us, and get ourselves into the right mindset to make the change.

For our patients, that mindset can be divided into two different time frames:

Pre-operative mindset, where you prepare for the implementation of change, and begin change, such as the pre-op diet, doing your pre-operative appointments, etc.
Post-operative mindset, where you have to maintain that mindset and constantly reassess where you are and keep that mindset to help you stay on track.

The reason this is so hard, is this is affected by biological/neurological factors, and then there is the psycho-social factors that are part of the process. When we are children, we are forced to change all the time, because our parents and teachers require change – such as changing grades every year, moving and meeting new people as their jobs change, etc.
As adults, we don’t like to change unless it is forced on us, such as in losing a job, getting divorced, death of someone close. Many of our memories are tied to food – favorite meals with our families, perhaps special food we had on a trip or at an occasion. Some foods are addicting – for example sugar has been shown to be more addicting than heroin. When you do the pre-op diet, it cleanses a lot of those addictions. But as we begin to eat again after say 6 months, if we have a little sugar, we’ll be okay the 1st or 2nd time, but then the 3rd or 4th time, the biology kicks back in and we become addicted again.
People with weight issues tend to eat 50 – 60% of their daily calories after 5 pm, which is dangerous. Your metabolism slows in the evening, and we are less likely to be active then. After surgery, you are eating 3 meals a day. But when our routines get thrown off, by a trip or vacation, we tend to fall back to old habits if we don’t plan for them. By planning the eating and drinking into the trip, you can help yourself maintain the good habits you need.

Sometimes our expectations are not realistic, so as you set goals for making change, instead of the goal being to lose a certain number of pounds, let the goal be a “process of health improvement.” No matter how much weight you lose, you are proceeding to a healthier state. Don’t let a negative mindset throw you off. Keep going back to the process, get back to basics and keep in mind that the process is constantly circular. Our behavior affects our thoughts, our thoughts affect our feelings, our feelings affect our behavior and so on. Break it down into management parts, and reassess how you are doing every 3 hours. Celebrate the positives and put aside the negatives and keep moving forward. And the best way to do that is have support, which is what support groups are all about. Surround yourself with positive folks who will support you in your change process, and remember you are improving your health!


August 4, 2016 – Food & Family / Eating Disorders after Surgery

How Family and Friends Affect Bariatric Surgery Success

A great support system is critical to the long-term success of a post-operative bariatric surgery patient. Part of a patient’s responsibility, starting even before surgery, is to plan for and create the support structure that will help them reach their weight loss goals.

Support and motivation from family members is a critical component of your support program. Family members are often the closest to us and, as a result, the people we see most often. Ideally, family members will join you in your weight loss efforts – dieting and exercising alongside you. They may be able to change their lives and health using the same methods you do – and be very successful at it. You can lean on each other to succeed where previous weight loss efforts may have failed. Further, you can use your time together to strengthen already solid bonds or repair fragile ones. Even if they don’t participate however, they should understand, with your guidance, the lifestyle change you’ve committed to.

Friends can also play a significant role in your ultimate success after bariatric surgery. After all, social occasions (holidays, birthdays, travel, going out to eat) are the hardest times to stick to your diet and exercise program. Having someone to lean on during a night out, a party or while on vacation can save you from the frustration and discomfort of overindulging.

Beyond your core group of friends, you may also make some very good friends at support group. After all, they are experiencing the same victories and struggles that you are and can be very helpful in offering advice and guidance.

The bottom line is that the support of your friends, family and acquaintances are a very important part of the bariatric surgery process. There are not many times we can successfully navigate a life changing event all by yourselves – bariatric surgery is no different. We encourage you to be open to bringing others into your weight loss journey and get your routine into high gear (source: Peachtree Bariatrics).

Emotional vs. Physical Hunger Infographic– Can you tell when you are physically vs. emotionally hungry? It’s not easy!! Here is an infographic to help walk you through the signs and more importantly what to do about it (source: Albers, Susan).

Click here to download the infographic

Practice Exercise: Self-Comfort

PURPOSE:     To learn to physically self-soothe

RATIONALE:   Self-soothing is a necessary skill in regulating emotions, a combination of positive self-talk and receiving physical comfort (even from yourself!).

WHAT YOU NEED: Something comfy to sit on

DIRECTIONS: Sit in a comfortable chair or on a stack of big, soft pillows and burrow in until your body feels just right in your cozy nest. Now wrap your arms around yourself and give yourself a gentle hug. Notice how it feels. If it’s okay, rub your arms gently, give yourself a pat on the back, or stroke your hair. Say comforting things to yourself. Try to connect your gestures and words with being soothed, and relax into them. It’s fine if the exercise feels silly, strange, or makes you uncomfortable. Keep at it until the discomfort dissolves and you relax.

REFLECTION (to be done after completion of exercise): What was it like trying to physically soothe yourself? Did you connect with any comforting experiences from childhood or did your attempts feel foreign or have negative associations? If your reaction was negative, try to understand why you might feel this way (source: Koenig, Karen R.).

BED, Bulimia in Bariatric Surgery Patients

By Kathryn Hillstrom, EdD, CDE, RD, and Nicole M. Avila, BS

Today’s Dietician

Vol. 16 No. 1 P. 12

“Eating disorders are considered psychological problems, fueled by guilt, shame, and low self-esteem, and they’re prevalent among obese patients.  In a sample of nearly 300 obese individuals qualifying for gastric bypass surgery, 66% had a lifetime history of an eating disorder, and 48% met the diagnostic criteria for BED at the time of their preoperative evaluation for bariatric surgery. Of the 48% diagnosed with BED pre-surgery, 28.8% developed bulimia nervosa post-surgery.”

Information About Binge Eating Disorder (B.E.D.):

  • B.E.D. is a real medical condition
  • B.E.D. is the most common eating disorder in US adults

Although the cause of B.E.D. is unknown, these may play a role:

  • Certain chemicals in the brain
  • Family history and certain life experiences

Talk to your health care provider and learn more about B.E.D. through an interactive slideshow


What B.E.D. Looks Like in Adults

  1. Regularly eating far more food than most adults would in a similar time period and in similar circumstances, and feeling that one’s eating is out of control during a binge
  2. Binge eating episodes that include three of the following:
    • Eating extremely fast
    • Eating beyond feeling full
    • Eating a lot when not hungry
    • Eating in secret to hide how much is being eaten
    • Feeling terrible after a binge
  1. Feeling very upset by eating binges
  2. On average, binge eating at least once a week for three months
  3. Unlike people with other eating disorders, adults with B.E.D. don’t routinely try to “undo” their excessive eating with extreme actions like throwing up or over-exercising

This is not a complete list of Binge Eating Disorder symptoms. It is always best to talk to your health care provider for an individual diagnosis.

More Details About the Symptoms of Binge Eating Disorder

Your health care provider will consider whether you have all the following symptoms before making a diagnosis of B.E.D.

  1. Regular binge eating instances during which both of the following are taking place:
    • Regularly eating far more food than most people would in a similar time period under similar circumstances
      • To qualify as “regular binge eating” the instances must take place at least once per week for three months
      • The time period during which binge eating instances take place can vary by individual, but is generally considered to be less than two hours and does not have to be in one setting
    • Feeling that one’s eating is out of control during a binge
      • The feeling of not being in control can be either the inability to keep from starting to eat or the inability to stop eating once a binge eating episode has begun
  1. Binge eating instances that include three or more of the following:
    • Eating extremely fast
    • Eating beyond feeling full
    • Eating large amounts of food when not hungry
    • Eating alone to hide how much one is eating
    • Feeling terrible after a binge
  1.  Being very upset by one’s eating binges
  2. On average, binge eating takes place on at least a weekly basis for three months
  3. Unlike people with other eating disorders, adults with B.E.D. don’t routinely try to “undo” their excessive eating with extreme actions like throwing up or over-exercising

Other factors could be involved based on your own personal experiences. For that reason, it is always best to talk to your health care provider for an individual diagnosis.


Tip: Print, e-mail, or take a screen shot of this page, and bring it to discuss with your health care provider.

What Makes It a Binge Eating Episode?

A binge eating episode can be characterized by the following:

  • When one eats an amount of food that is far more than what most people would normally eat in a similar time frame, under similar circumstances, usually less than two hours
  • Feeling one’s eating is out of control
  • The type of food consumed during a binge eating episode may vary from person to person, the setting may change, and episodes are typically defined by the unusual amount of food being consumed rather than the kind of food involved
  • Those with Binge Eating Disorder may feel bad about themselves after an episode and may try to hide their actions from those around them

Occasionally overeating, such as someone might do at a party or a family holiday meal, is not considered Binge Eating Disorder. Neither is continually snacking on small amounts of food throughout the day. To find out if your eating habits may be the result of B.E.D., talk to your health care provider.

Possible Causes and Risk Factors

About JW Player 6.9.4867 (Premium edition)

There are a number of possible causes and risk factors for B.E.D. While the exact causes of B.E.D. are unknown, certain theories suggest that adults with B.E.D. may have differences in brain chemistry that may:

  • Interfere with the ability to regulate food intake
  • Create or increase the “wanting” of a particular food
  • Increase the “liking” of a particular food

There is evidence that suggests one potential risk factor for B.E.D. is that the condition may run in families. Research suggests that genetic influences for an individual with B.E.D. could possibly stem from a family history of B.E.D.

Particularly stressful events that happen in your daily life at home and/or at work could be associated with B.E.D. Some types of events that may increase the risk of B.E.D. include life-threatening accidents or natural disasters.

Talk to your health care provider if you have any question

Potential Impact of B.E.D. in Adults

Individuals with B.E.D. may experience some effect on their ability to function day to day. These effects may include, but are not limited to:

  • Difficulty adapting to social roles (such as the different responsibilities adults have as parents, friends, and coworkers)
  • An increased risk to general health

If you have any questions about how B.E.D. may be impacting you, talk to your health care provider.

Managing Binge Eating Disorder (B.E.D.)

What Can Be Done to Help Manage B.E.D.?

There are various ways your health care provider may recommend to help you manage Binge Eating Disorder. Working with your health care provider team (which may include primary care physicians, mental health professionals, and nutritionists) is the first step to managing B.E.D. Some adults with B.E.D. may benefit from psychotherapy, while others may benefit from medication. Psychotherapy (also known as counseling, psychosocial therapy, or just therapy) is a general term that refers to treating a psychiatric disorder by talking to a psychiatrist, psychologist, or other mental health provider. Examples of some of these therapies are below. Be sure to talk with your health care provider to see which type of therapy for B.E.D. might work for you.

Cognitive Behavioral Therapy (CBT)

  • One of the most widely studied therapies used to treat individuals with B.E.D. It encourages individuals to regulate their eating habits by:
    • Setting realistic goals
    • Using self-monitoring when eating
    • Modifying negative self-perception
  • CBT may also help reduce the frequency of eating binges.

Interpersonal Therapy (IPT)

  • IPT may be used for those who binge eat to cope with an underlying social problem. It helps individuals recognize this problem so they can better manage negative feelings without turning to food as a way to cope.

Dialectical Behavior Therapy (DBT)

  • DBT may be used for those who binge eat to cope with a painful emotional experience. It helps patients with B.E.D. develop certain skills to reduce binge eating habits.

A Real Medical Condition

  • Binge Eating Disorder (B.E.D.) is not just overeating. It is a real medical condition that was formally recognized in 2013. B.E.D. is the most common eating disorder among US adults. So, if you think you might be struggling with the symptoms of B.E.D., know that you are not alone.
  • E.D. can be diagnosed only by a health care provider, and only when specific criteria are met. So be sure to talk with your health care provider about any concerns you may have about your eating.

Source: Shire (2015)

After talking it over with your Shawnee Mission Health Bariatric team doctor (Dr. Saradih, MD or Dr. Sabapathy, PhD, contact me for help.

Kathi Williams, MA, LMFT-T, Shawnee Mission Health-Prairie Star, (913) 676-8675


Evolution of Gastric Bypass Surgery

Gastric Bypass Weight Loss Surgery

As part of our ongoing Kansas City weight loss series, we would like to share a little history for those interested in Kansas City Gastric Bypass procedures.   The following information was written by the Obesity Coverage group in an article titled, “The Experts Guide to Gastric Bypass”.  It provides an illustration of the evolution of the Gastric Bypass procedure since the first bypass performed in 1954.  We’ve come a long way in perfecting the Gastric Bypass procedure and believe many will find this information to be helpful and informative. Please keep in mind, though, that the type of bariatric surgery recommended by our surgeons for any patient of The Bariatric Center of Kansas City is always determined based on the unique medical facts related to the patient’s health history.  Gastric Bypass surgery may be a more suitable option for some, but not all patients.  Keep searching our site for more information on Laparoscopic Gastric Bypass. Feel free to discuss this surgical option further with your Bariatric Surgeon to gain a better understanding of whether it’s the right bariatric procedure for you.

The first two approaches for weight loss surgery were significantly different. One used restriction techniques that limited calorie intake. The other used malabsorption techniques which kept the calories from being absorbed by the body. First attempted in 1954, the second technique resulted in nutritional deficiencies. Because of this, different procedures including Duodenal Switch, Gastric Bypass, and Bilio Pancreatic Diversion were developed. By incorporating restriction and malabsorption, the risk of nutritional deficiencies was reduced as well as the stomach size, limiting the amount of food intake.

The first Gastric Bypass surgery was performed at the University of Iowa in 1967. According to the article, the history was a journey of momentous efforts, modified almost five decades, ultimately leading to today’s laparoscopic gastric bypass, which “has been performed hundreds of thousands of times. Its outcomes have been studied, its risks and benefits evaluated, and often covered by insurance.”

The benefits of Gastric Bypass surgery.

  1.  You will lose weight. On average, you will lose 70% of your excess body weight in the first 18 months after surgery. * This study shows 77.5% of excess weight loss after 18 months. (Journal Of Obesity, 2013)
  2. You will not be able to eat large meals (restricted pouch/stomach size).
  3. You will get sick from eating too much sugar and/or carbs (dumping syndrome).
  4. You will absorb less calories from food (bypassed intestines).
  5. You will improve and/or eliminate type 2 diabetes.
  6. Medication for high blood pressure and/or high cholesterol may be eliminated.
  7. Your hormones may adjust from significant weight loss, increasing testosterone and improving metabolism. (ASMBS)
  8. Long term weight loss success – most studies show that 90% of patients maintain at least 50% of excess weight loss after surgery.


original article –

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Kansas City Weight Loss – 7 Ways To Optimize Your Cortisol Levels

Kansas City Weight Loss - Optimize Cortisol Levels

“Kansas City Weight Loss” Series – KC Bariatric dietitian, Laura Hernandez, has identified key information about optimizing cortisol levels from an important article written by Elizabeth Millard titled, “The Cortisol Curve“. After Bariatric surgery, it is important to take care of your waistline. As part of our “Kansas City Weight Loss” series, we have come up with seven tips to keep Cortisol levels in check.

Kansas City Weight Loss Tip #1 – Exercise Routine: Time Your Workouts 

Intense exercise such as a spin class raises cortisol levels, which is great if you’re looking for an extra energy boost in the morning or mid-afternoon. But an evening or nighttime workout is not so beneficial if it’s prompting insomnia or anxiety. Recognize that a schedule shift could help you reset your cortisol. Observe how specific types of exercise make you feel, and whether they affect your sleep or energy levels.  

Exercise and Stress Management Balance  

Exercise: 30-45 minutes of both anaerobic (resistance training) and aerobic (jogging, cycling) every other day. Plan intense exercise routines ideally mid-morning to mid-afternoon. 

Meditation/relaxation: 15-30 minutes daily. Ideally in the evening time. 


Kansas City Weight Loss Tip #2 – Stay Hydrated

The body is more likely to become dehydrated under stress. Feeling anxious raises heart rate and triggers faster, heavier breathing, both of which lead to fluid loss. Even if drinking plenty of water, you can still get dehydrated when stressed because we urinate more frequently. If you notice that you urinate within minutes of drinking, it can be a sign that you’re not getting the benefits of hydration.  

Recommendation: Add some trace minerals or amino acids to your water. Vitamin Water Zero and Protein Water such as Protein 2O are good suggestions.


Kansas City Weight Loss Tip #3 – Sleep!


Rest is key to restoring a healthy cortisol curve. As little as 2 hours of sleep change will cause changes in cortisol patterns in less than two weeks. Sleep is the indicator of whether your efforts to reset your cortisol patterns are working.  

How? Cortisol and Melatonin (hormone that regulates sleep and wake cycles) work together. When Cortisol drops, Melatonin takes over and makes you sleepy. When asleep, relatively low levels of Cortisol allow your cells to repair and heal. If Cortisol levels stay elevated, your body can’t make those repairs and you wake up feeling fatigued.



Kansas City Weight Loss Tip #4 – Supplement Your Nutrition

Omega-3 Fatty Acid: It helps lower morning cortisol levels. Based on research, it inhibits the adrenal activation produced by mental stress through effects at the level of the central nervous system.  Recommendation: Take 1-4 gm/day. 

Vitamin C: Research has shown that it helps reduce Cortisol levels.  Recommendation: Take 1,000 mg-3000 mg daily. 

Vitamin B5 (pantothenic acid): Nickname: “the anti-stress vitamin”. It helps our bodies control the secretion of cortisol and it helps keep our adrenal glands functioning as they should.  It helps improve the ability to deal with and withstand stressful situations.  Recommendation: 5 mg/day  

Phosphatidylserine: Studies have shown that phosphatidylserine is able to cut elevated cortisol levels induced by mental and physical stress and helps manage stress-related disorders. Recommendation: Take 300-800mg/day. 

Our specially formulated Journey Bariatric Supplements will also aid in the waistline fight while helping to ensure your optimal bariatric health!


Kansas City Weight Loss Tip #5 – Cycle Your Carbs Efficiently

A low-carb diet can support weight loss, but small amounts eaten at the right time help manage cortisol levels. Carbs elevate blood sugar, pancreas produces more Insulin, and Insulin decreases cortisol output. To keep it simple: blood sugar goes up, cortisol gets pushed down. 


Kansas City Weight Loss Tip #6 – Relieve Stress with Adaptogens

Adaptogenic herbs can relieve stress and help restore cortisol levels to their natural curve. These herbs support the adrenal and pituitary systems, helping them operate more efficiently. With those systems functioning properly, cortisol is more likely to be released when it should be. 

Rhodiola rosea: 100-200 mg/day, standardized extract.  

Ginseng: 100-300 mg/day, standardized extract.  

Ginkgo biloba: 100-200 mg/day, standardized extract.  


Kansas City Weight Loss Tip #7 – Stress Management

The job of adrenal glands is to protect you when you feel endangered. They’ll pump out cortisol whenever you feel agitated and threatened. Learn to calm the mind and regain a sense of control. Find a practice that’s easy to do and makes you feel connected and centered. Relaxation practices are beneficial any time of day but they are especially helpful in the evenings to promote better sleep. 

As Laura says, “Belly fat contains four times the cortisol receptors as fat elsewhere in the body. Manage your Cortisol levels and keep belly fat at bay.”

July 23, 2016 – Anti-inflammatory Foods

Bariatric Support Group

Date: July 23, 2016

Facilitator:  Laura Hernandez, MBA, RD, LD 

A large percentage of our patients take or have taken NSAIDS (non-steroidal anti-inflammatory drugs) like Advil and Aleve for inflammation in their joints.  When you have surgery, those are no longer an option except on a very rare occasion or with approval of the surgeon.  There are a number of foods that can be very helpful in reducing inflammation, and some that increase inflammation.  Some of the foods that cause inflammation are sugar, corn, saturated fats, trans fats, omega 6 fatty acids (you need more Omega 3’s), and refined carbohydrates.  Your processed foods tend to have more of those.  Avoid items with high fructose corn syrup.

Laura brought some of the better anti-inflammatory foods and made smoothies using them – she brought spinach, parsley, dark cherries, coconut water, almond mild, turmeric, ginger, cinnamon, walnuts and other flavorings.  The first smoothie combined almond milk with spinach, pineapple for sweetness, cinnamon, lime, turmeric, and a handful of walnuts.  She blended those and passed around samples, which almost everyone liked.  Then she made one with the cherries, coconut water, turmeric, walnuts, cinnamon and lime.  After blending, most of the group preferred this one strained, and not quite as much as the first one.  She also brought a pre-mixed green smoothie you can buy that contained a lot of the same ingredients, and you add a couple of your own items to change the flavor. 

Omega 3 fatty acids from salmon, sardines, cod and other fatty fish are excellent anti-inflammatories and antioxidants.  Another source is walnuts and extra-virgin olive oil.  (California Ranch is the best sold in this country) and increasing your fiber intake from fruits, vegetables and whole grains is also advised.  There are a lot of anti-inflammatory diets on the internet, and the Mediterranean Diet, which contains a lot of fish, olive oil, whole grain pasta and dark leafy green vegetables is a great anti-inflammatory diet to use.  All of these are also great for your heart!

Turmeric, ginger and cinnamon are all good anti-inflammatories, and turmeric has no flavor, so add it to everything you cook and get that additional anti-inflammatory action in all your meals.  As you lose weight, the addition of some of these items will help you to have less joint pain and hopefully wean off the anti-inflammatories which are so harsh to the lining of your stomach!