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Your Guide to Holiday Eating After Bariatric Surgery

Your Guide to Holiday Eating After Bariatric Surgery

The end of Halloween marks the unofficial start of the holiday season (is it getting earlier every year, or is it just us?). The holidays are a time for friends, family and—frequently—food. Having weight loss surgery can mean a drastic lifestyle shift and change to eating patterns. Bariatric surgery patients may worry that either they’ll slip into old, unhealthy habits, or they won’t be able to enjoy the holidays to their fullest.

If you’ve had bariatric surgery, you don’t have to worry about the holidays. Having a plan and some rough guidelines going into a Thanksgiving or end-of-year holiday meal can mean the difference between overeating and sticking to the program.

Here are our best tips for healthy holiday fun.

Avoid the Eggnog

Bariatric surgery alters how your body processes alcoholOne of the easiest ways to stay on track this holiday season is to drink only water. At Advanced Laparoscopic Associates, we counsel our bariatric patients to stick to water year-round, but it is especially important during the holidays. You’ll be surrounded by rich, heavy foods, so even if you indulge a bit, you’ll be saving calories by skipping the hot chocolate.

Additionally, an important point to remember is that some types of bariatric surgery—gastric bypass especially—change the way your body processes alcohol. It might be because liquids empty from the gastric pouch quickly, or that bypassing the stomach means alcohol is absorbed into the bloodstream faster.

Studies suggest that alcohol gets processed faster, becomes more concentrated in the bloodstream and leaves the body slower in people who have had gastric bypass surgeries. Add on all the empty calories in alcoholic drinks and you’ve got plenty of reasons to stay away from it this holiday season.

Practice Mindful Eating

After you’ve had bariatric surgery, you need to be more aware of what you put in your body. Portion control is one of the most important aspects of post-bariatric-surgery life. It is just so easy to overeat during big family dinners, though.

Here are some tricks to help you be mindful:

  • Stay away from the buffet—If you’re standing up by where the food’s laid out, you may be more prone to mindlessly snacking. Grab a plate and sit down instead.
  • Say no to seconds—Take enough on the first plate to keep you full. Start with protein, then fill most of the rest of your plate up with veggies. Protein and fiber will help you feel sated so you’re not as tempted to go back for seconds. If you do want seconds, give it 20 minutes or so; since it takes about that long for your brain to get the message that your stomach is full.
  • Make time to eat—Just like standing too close to the buffet, socializing and snacking can cause you to overeat. Sitting at a table can help you focus on food and be mindful of what you’re putting into your mouth.

Keep Consistent Eating Patterns

You may be tempted to “save up” some calories by not eating all day. This is a mistake. You don’t want to go completely crazy just because it is a holiday meal. You should eat normally throughout the day of your holiday celebration, and keep tracking your intake.

It is ok to indulge a little at the feast, but be mindful of how many calories you’ve already consumed. Also, be realistic: Don’t try to lose weight during the holiday season, but instead try to maintain weight (i.e., try not to gain).

The one caveat to keeping your eating patterns consistent is this: It might be wise to eat a little something before you go to your party. That way you might be less hungry and less inclined to overeat.

The holidays can be a time of fellowship and togetherness. People bond over food; they always have. There’s no reason for that to change for you after you’ve had bariatric surgery. Weight loss surgery is a massively positive change in your life, but it is a change nonetheless. Remember that your needs are different now, follow our tips and have a happy, healthy holiday season.

Don’t Overindulge

Some bariatric surgery procedures are restrictive, so you can't eat too much without feeling poorlyIt is tempting to pile on the food from the buffet or the dessert table, but for people who have had certain weight loss procedures, that can get downright uncomfortable. Remember that if you’ve had a gastric bypass or gastric sleeve, your stomach has been modified to handle less food.

With a gastric band, eating too much risks dumping syndrome. That’s when too much food enters your small intestines at the same time. It can cause:

  • Diarrhea
  • Dizziness
  • Nausea
  • Sweating
  • Vomiting

Similar symptoms can happen if you overeat when you have an adjustable gastric band. If you eat too much, too fast or don’t chew enough, food can get stuck near the band opening. To prevent that, chew slowly and thoroughly, at least 20 times per bite, and take about 30 minutes to finish your meal.

One of the benefits of having a gastric sleeve is that it physically prevents you from eating a lot. What happens when you try anyway? You risk your stomach stretching out, which negates one of the main purposes of the gastric sleeve. Since you’ll produce less ghrelin, a hormone that tells your brain that your stomach is empty, you’ll feel full faster, so it is important to listen to your body.

If you need help managing your holiday eating after bariatric surgery, request an appointment at Advanced Laparoscopic Associates. Our Registered Dieticians can help you plan for a healthy, enjoyable holiday that won’t pack on the pounds.

Better Diabetes Care Advances Have Not Yielded Better Treatment Results

Better Diabetes Care Advances Have Not Yielded Better Treatment Results

Diabetes is a worldwide health problem affecting just under 10 percent of the United States population, according to the American Diabetes Association. Though there have been many advances in diabetes care over the past decade, these advances have failed to translate into more patients meeting treatment goals.

The Journal of the American Medical Association recently published a population-based study that suggests only one in four adults with diabetes achieved their treatment goals – a composite of various personal “targets.” The study demonstrated no significant improvement in any individual treatment targets being realized between 2005 and 2016.

Even with advances in insulin pump technology, medications, bariatric surgery and lifestyle modifications, diabetes care still has not meaningfully improved for diagnosed patients on a societal level. But individually, it doesn’t have to be like that. At Advanced Laparoscopic Associates, we aim to give our patients both the treatments and the tools they need to control or even beat their diabetes.

Barriers to Diabetes Management

Treatment and management of type 2 diabetes cannot be a one-size-fits-all approach. It’s more complicated than that, and it’s going to be different for each patient. But, similar barriers to successful diabetes management show up in the JAMA study and others. Here are two of the most common.

Cost of care. This factor plays a major role. According to JAMA, “Having health insurance was the strongest predictor of linkage to diabetes care.” This same predictor played out in other studies. Patients who lacked health insurance, drug insurance, or financial resources were unable to meet their treatment outcome targets. According the American Diabetes Association, in 2017, average medical expenses among people with diagnosed diabetes were 2.3 times higher than what their expenses would have been if they didn’t have diabetes.

Not only the cost of care comes in to play; the cost of a proper diet is also a barrier, and healthy foods required for diabetic management can be. Patients with obesity are particularly at risk for a cost of food barrier.

Patient self-management. Even with proper clinical support and advances in health care, patients bear the burden of managing their disease day-to-day. Optimal self-management is affected by a multitude of personal factors for each patient, including their access to care, their experience with medical care (positive versus negative), their financial status, the presence of co-morbidities and general health status, and other personal circumstances.

Patients’ adherence to their treatment plan, attitude, cultural and personal beliefs, and knowledge about their disease all may affect whether they meet their outcome targets. None of these factors are under the control of the treating clinician, who may be unaware of them.

Obesity and Diabetes

Obesity is the leading risk factor for developing type 2 diabetes, and over 90 percent of patients with diabetes are also overweight or obese. Both obesity and diabetes are also independent risk factors for the development of cardiovascular disease, which remains the leading cause of death for women in the United States.

Weight gain and obesity worsen insulin resistance. Losing weight slows the progression of diabetes complications. Though clinicians may provide options for counseling and behavioral management or referral to weight loss programs, these do not address some of the challenges obese patients face. Medication management becomes more complex and exercising is more difficult, or sometimes contraindicated, in obese patients. Additionally, options such as bariatric surgeries need to be examined, as their role in decreasing other health risks such as diabetes and depression are now starting to be realized.

We Can Help

At Advanced Laparoscopic Associates, we specialize in getting our patients down to a healthy weight through surgical or nonsurgical means. Bariatric surgery should be—and increasingly is—considered a first-line treatment for diabetes in addition to obesity.

If you have diabetes and a body mass index (BMI) of 35 or greater, you may be a candidate for bariatric surgery. If you don’t qualify, you still have options. We are dedicated to helping people live their best and healthiest lives, so request an appointment at ALA. Our bariatric experts will be with you every step of the way, from initial consultation to treatment, surgery, recovery and beyond.

Obesity and Mental Health: The Psychological Effects of Obesity

Obesity and Mental Health: The Psychological Effects of Obesity

Recent studies both in the U.S. and other countries show an alarming link between obesity and depression. Obesity and mental health effects, specifically depression, are associated with many health risks, including diabetes, cardiovascular disease, cancer and limitations on the ability to function in normal day-to-day activities. Not only does the research suggest higher rates of obesity in people with depression, but the converse is also true: People who are obese have a greater risk of depression.

Obesity and Depression: the Psychological Link

Being overweight or obese, and even the perception of being overweight, increases psychological distress in people. In both the United States and Europe, appearing as the socially defined version of “thin” is considered the ideal body image. Social acceptance and cultural factors play a role in the link between depression and obesity.

Being obese may increase dissatisfaction with body image and decrease self-esteem, both of which are risk factors for depression. These factors increase stress and anxiety. Eating disorders and disturbed eating patterns are also known to increase the risk of depression. In addition, the physical pain individuals suffer as a direct consequence of being obese adds to the risk of depression.

The Genetic Link Between Depression and Weight Gain

Research recently published in the International Journal of Epidemiology suggests that the psychological effects of obesity—not other obesity-associated illnesses such as diabetes—cause depression. To show this, the researchers used a genetic approach. The psychological aspect of being obese was separated from the impact of obesity-related health issues by using genes that predispose certain individuals to a higher body mass index (BMI), but a lower risk of diseases like diabetes.

The findings suggested that these genes were as strongly associated with the risk of developing depression as they were with a higher BMI and diabetes. This genetic component suggests that being overweight causes depression, whether the individual has obesity-related health problems or not, especially in women. Being overweight not only increases the risk of chronic diseases, but can also lead to depression.

Can Depression Cause Weight Gain and Vice Versa?

According to the Centers for Disease Control:

  • Research shows 43 percent of adults with depression being studied were obese.
  • Adults suffering from depression are also more prone to obesity than adults without depression.
  • As the severity of depressive symptoms increases in adults, the proportion of adults with obesity rises as well.
  • In all age groups, women suffering from depression are more likely to be obese than women without depression.
  • Race and ethnicity have an impact on the relationship between obesity and depression among women. Obesity rates are higher for white women of non-Hispanic ethnicity with depression compared with white women of non-Hispanic ethnicity without depression.
  • Obesity was present in fifty-five percent of adults with moderate to severe depressive symptoms who were also taking antidepressant medication.

According to the Journal of the American Medical Association (JAMA):

  • The overall association between obesity and depression is stronger among Americans; however, the mean adult BMI is higher in the United States compared with different European countries, which may account for this difference. The exact cause is unknown.
  • Being overweight is associated with depression in persons 20 years or older, but not in younger individuals.
  • A clinical interview is key to making the association between depression and obesity. The overall association is shown to be stronger when depression is assessed with a diagnostic clinical interview by a medical professional rather than when individuals provide a self-reported list of symptoms.
  • When persons experiencing depression are exposed to depression for a longer period (≥10 years), the risk of obesity increases. Studies showed obese persons had a 55 percent increased risk of developing depression over time, whereas individuals with depression experienced a 58 percent increased risk of developing obesity.
  • The association between depression and obesity is stronger than the association between depression and being overweight.
  • Time may play another role in the association between depression and obesity between men and women. Initial short-term research effects show the association only in women. However, when long-term data is examined, a reciprocal association between obesity and depression is found in both men and women.

Expert Help for Depression and Obesity

Seeking medical help as early as possible for either or both issues is key for patients. Understanding the relationship between depression and antidepressant usage and obesity is key for clinicians, as it may help them form the best treatment and prevention strategies for both conditions.

Time is of the essence in treatment and prevention for both patients and clinicians. The link between depression and obesity is reinforced by duration. The longer obesity or depression is experienced, the greater the risk of the developing the other. Clinicians of depressed patients must monitor them closely, as weight gain is shown to be a later consequence of depression. For the overweight or obese patients, mood must be closely monitored.

Awareness of this link by both patient and clinician can lead to prevention, early detection, and treatment for those who have already developed obesity and depression. For at risk patients, being cognizant and vigilant about medical follow-up care could ultimately reduce the burden of both conditions. Whether the clinician or the patient, the best strategy is speaking up and dealing with these conditions as early as possible.

If you are obese and ready for a change, request an appointment at Advanced Laparoscopic Associates. We can get you back on the road to health through many conservative and surgical treatments, including medically monitored weight loss and bariatric surgery.

Weight Loss Surgery for Teenagers And Adolescents

Weight Loss Surgery for Teenagers And Adolescents

It is no secret that obesity is an epidemic in the United States. More than 93 million Americans—that’s nearly 40 percent—were overweight or obese in 2015 and 2016, according to the Centers for Disease Control and Prevention.

And, if you think children and teens are immune to obesity, think again. One in five teens between the ages of 12 and 19 are obese.

Obesity is the top cause of preventable death, resulting in more life-years lost than even smoking. It increases the risks of a host of diseases—some deadly—including:

  • Heart disease
  • Diabetes
  • Obstructive sleep apnea
  • Some cancers
  • Osteoarthritis
  • Fatty liver disease
  • Kidney disease

…and more.

If you are overweight or obese, it is never too late to start getting healthy…or too early.

Bariatric Surgery for Teens and Adolescents

There are multiple guidelines for bariatric surgery in teens and adolescents. Patient selection is one of the most important parts, and most teens must meet fairly rigorous criteria to be considered for bariatric surgery. Some of these include:

  • A high body mass index (BMI) of 40 or more
  • Fully grown or nearly so
  • Failed at least six months of conservative weight loss attempts
  • Pass a psychological screen
  • Have an obesity-related condition such as type 2 diabetes, hypertension or obstructive sleep apnea

The US Preventive Services Task Force recommends screening for obesity in children and adolescents.

In 2018 American Society for Metabolic and Bariatric Surgery published guidelines in pediatric weight loss surgery and concluded that metabolic and bariatric surgery is a proven, effective treatment for severe obesity disease in teenagers and adolescents and should be considered standard of care.

Pediatricians and primary care providers should recognize that children with severe obesity should be referred to a center with advanced treatments and support as soon as possible.

Healthy Weight for Teens

Bariatric surgery is the most effective method for long-term weight loss, but there are many other tactics people can use to lose weight if they do not want or do not qualify for weight loss surgery. Candidates for bariatric surgery must generally meet one of the following requirements:

  • A BMI of 40 or more
  • A BMI of 35 or more, plus an obesity-related health condition such as high cholesterol, high blood pressure, type 2 diabetes or obstructive sleep apnea

BMI is a ratio of height to weight. Use the BMI calculator on our home page to determine yours. Calculating BMI is different for children and teenagers, but teenagers with a BMI greater than 30 are likely obese.

Teens who want to lose weight or maintain a healthy weight should start in much the same way as adults: getting plenty of activity and moderating food intake. The CDC recommends a minimum of 150 minutes of moderate exercise per week. A food diary or app such as MyFitnessPal can help teens estimate and limit the number of calories they consume every day.

If you or a loved one wants to lose weight and may be a candidate for bariatric surgery, request an appointment at Advanced Laparoscopic Associates today.

Can Exercise Cut the Risk of Dementia?

Can Exercise Cut the Risk of Dementia?

Humans were made to move. Exercise is so good for the body that the Centers for Disease Control and Prevention (CDC) recommends everyone get 150 minutes per week of moderate exercise. Regular exercise reduces the risk of a long list of diseases and risk factors, including:

  • Diabetes
  • Obesity
  • High blood pressure
  • High cholesterol
  • Stroke
  • Certain cancers

…and even death from any cause. And, Alzheimer’s disease may soon be added to that list.

What Is Alzheimer’s Disease?

Alzheimer’s disease, the sixth-leading cause of death in the United States, is the most common and best-known form of dementia. Dementia is an umbrella term for a number of diseases that cause degeneration of mental processes that can result in wholesale memory loss, drastic personality changes and a breakdown in cognition.

Much remains unknown about how and why Alzheimer’s takes hold and progresses, but prevailing theories revolve around abnormal brain structures known as amyloid-beta plaques and tau tangles. Plaques are protein snippets that build up between brain cells (neurons), whereas tangles are misfolded proteins that form within the neurons themselves.

A healthy brain clears these structures on a regular basis. A brain with Alzheimer’s cannot do so, and plaques and tangles accumulate. It is thought that plaques and tangles contribute to the destruction of neurons over time.

Brains with Alzheimers have abnormal protein structures

Alzheimer’s is both progressive and incurable. Symptoms start subtly and progress slowly. Some memory loss is a natural part of aging. It crosses into the territory of mild cognitive impairment (MCI)—a precursor to dementia—when it begins to affect daily life. On average, people with Alzheimer’s disease live between 3 and 11 years after diagnosis.

Exercise and Alzheimer’s: How It May Help

Exercise is good not just for the lungs, heart and other muscles, but evidence is mounting that exercise may have both a protective effect against Alzheimer’s and may mitigate its effects.

A 2017 review in The Lancet examined a number of studies on the benefits of exercise for people with mild-to-moderate dementia. While it found few well-designed studies on exercise and Alzheimer’s, most of the studies included in the review showed improvements in cognition for those who exercised compared to control groups. According to one of the studies, higher intensity exercise (greater than 70 percent of the maximum heart rate) produced stronger results.

The authors stated that, “Exercise programmes [sic] for people with mild-to-moderate dementia are feasible and well-tolerated, and exercise offers positive small effects on function for people with dementia, but whether it helps cognition is unclear.”

More recently, a study published in JAMA Neurology in July 2019 looked at data from more than 180 people. The results suggest that higher levels of physical activity are associated with slower amyloid beta-related cognitive decline, as well as a slower rate of brain matter loss. Additionally, it suggests that healthier blood vessels—one of the benefits of regular exercise—was also associated with slower cognitive decline.

Finally, an ongoing clinical trial called the EXERT study is attempting to quantify the effects of exercise on the prevention of Alzheimer’s disease. Participants are adults aged 65 to 89 who are physically inactive and showing signs of MCI. The goal of the study is to see if exercise can slow the progression of cognitive decline.

Obesity has recently passed smoking as the top preventable cause of life-years lost. If you are committed to getting to a healthy body mass index, request an appointment with Advanced Laparoscopic Associates. We can determine if you qualify for weight loss surgery, as well as help you decide which procedure is right for you.

The Gastric Sleeve Diet: How to Eat Before and After Your Gastric Sleeve Surgery

The Gastric Sleeve Diet: How to Eat Before and After Your Gastric Sleeve Surgery

Bariatric surgery is the most proven way to lose weight and keep it off long-term, but it’s only the beginning. A surgery like the gastric sleeve—the most popular weight loss surgery in the United States—requires a fundamental lifestyle shift, including how you eat.

Getting weight loss surgery is a big change, but that doesn’t mean it has to be difficult. At Advanced Laparoscopic Associates, we specialize in setting our patients up for success. That’s why we’ve put together this gastric sleeve diet guide. By following a sensible diet before and after gastric sleeve surgery, you won’t have to let your weight or your health hold you back from the life you deserve.

The Importance of Nutrition for Gastric Sleeve Surgery

The gastric sleeve procedure (also known as vertical gastric sleeve and sleeve gastrectomy) is a restrictive weight loss procedure. It works by removing approximately 80 percent of the stomach, leaving it roughly the size and shape of a banana.

A smaller stomach can hold less food, but what makes the sleeve gastrectomy different from another procedure, such as a gastric bypass or gastric band, is what gets removed during a sleeve gastrectomy. The true benefit to a gastric sleeve is the removal of cells that produce a hormone called ghrelin.

One of the roles of ghrelin, sometimes known as the hunger hormone, is signaling to your brain that your stomach is empty. In addition to causing feelings of hunger, it also promotes fat storage.

Losing ghrelin can make sticking to a diet easier, but because you’ll very likely be eating less, eating the right foods become all the more important. A small 2011 study found that up to 48 percent in the study were at risk for certain vitamin imbalances. Deficiencies included:

  • Anemia
  • Folic acid
  • Vitamin B12
  • Vitamin D

Getting and staying healthy, both before and after gastric sleeve surgery, means eating right. We’ll show you how.

Gastric Sleeve Pre-op Diet

Your pre-surgery weight and body mass index (BMI) may influence your gastric sleeve’s success, according to a 2015 study published in Bariatric Surgical Practice and Patient Care. Researchers found that patients who had a BMI of less than 50 had kept more excess weight off at one year after a gastric sleeve procedure.

If you are obese, you should focus on losing as much as you can before you get to the operating room. Weight loss is a simple—though not easy—equation of calories in, calories out: If you burn more calories than you consume, you’ll lose weight. That usually means a combination of diet to reduce the number of calories you consume and exercise to increase the number of calories you burn. At Advanced Laparoscopic Associates, we have a team of nutritionists who can make sure your weight loss efforts are safe and effective.

Post-op Diet Phases

It can be helpful to think of a post-gastric sleeve diet in stages or phases based on the amount of time that has passed since the surgery. Although the number of stages differs from source to source, a good rule of thumb is four phases, lasting from immediately after the surgery until about a month later.

Phase One Diet

Phase one diet will begin in the hospital and last for approximately a week. It is a clear liquid diet plan that takes into account the possible effects of anesthesia and the discomfort that’s possible after abdominal surgery.

A clear liquid diet can include:

  • Broth
  • Decaf tea or coffee
  • Jello
  • Sugar-free popsicles

Alcohol, caffeine and excessive sugar should be avoided, as should any food that requires chewing.

Phase Two Diet

Most people are not hungry immediately after gastric sleeve surgery. When they do become hungry—about a week after surgery for most people—phase two begins. Phase two consists mostly of liquids with some very soft foods as well.

Protein is extremely important to the healing process. People in phase two should aim for between 60 and 80 grams of protein per day.

Foods to eat in phase two include:

  • Protein shakes
  • Thin soups
  • Soft noodles in soup
  • Diluted juice
  • Applesauce
  • Greek yogurt
  • Mashed potatoes
  • Pureed chicken or tuna
  • Baby food
  • Thin oatmeal
  • Fat-free, sugar-free ice cream or frozen yogurt

Phase Three Diet

Phase three begins the transition to solid foods. All foods from phases one and two are safe to eat. Protein continues to be important, so keep drinking your protein shakes.

New additions include:

  • Eggs
  • Soft vegetables
  • Heartier soups
  • Cheese
  • Soft fish
  • Deli meat

Phase Four Diet

Four to six weeks after surgery, most patients are ready to return to their (new) normal eating patterns. Solid food is safe by now, but to achieve the success you want from your gastric sleeve surgery, you should avoid:

  • White bread
  • Fried food
  • Soda
  • Sweets
  • Processed food
  • High-fat, -sugar and -calorie foods

Eat Right for Results

The four-phase gastric sleeve diet will have you well on your way to meeting your goals. It takes discipline and commitment, but you don’t have to do it alone.

Advanced Laparoscopic Associates surgeons are pioneers in the field of laparoscopic weight loss surgery. We will be by your side every step of the way, from initial consultation to recovery and beyond. Our team of clinicians and nutritionists are always available to answer questions and make sure your weight loss is effective, safe and sustainable. Request an appointment today.