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Fall 2012 edition


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Our Staff Makes the Difference ... But Our Patients Tell the Story

Casey Hill's Clear Results: Nothing to Debate

By Linda Trainor, RN, BSN 

Why did Casey Hill, after several years of struggling with weight issues, decide to have weight loss surgery? For her, the answer is clearly connected to many years of dieting since childhood without significant or lasting results.

"I struggled with weight since I was nine," says Casey. "I remember losing 30 pounds with a formalized diet only to gain 60 pounds within a short period of time. I needed to find a viable solution."

Following many frustrations with dieting and being burdened by an excess weight of 130 pounds, Casey opted to have surgery at Beth Israel Deaconess Medical Center's Weight Loss Surgery Center. Familial tendencies of obesity, coupled with chronic health problems, prompted 25-year-old Casey to make her decision.

Casey Hill in July 2011 (left) and October 2012 (right)"I know that being overweight contributes to health issues. I wanted to prevent diabetes and cardiac disease," she explains. "Having the Roux-en-Y gastric bypass was one of the best things I ever did for myself."

Observers of Casey's success cannot dispute the fact that since she elected to have weight loss surgery, she not only has changed her physical demeanor but her entire lifestyle and outlook on life.

At 375 pounds, "I felt stuck inside my own body," Casey says, aware that a sedentary job, coupled with a sedentary lifestyle, were major contributors.

"I couldn't do any type of work that required me to be active at 375 pounds," she adds. "I worked as an operator, sitting most of the day."

Casey also admits to poor food choices and eating much of the time at fast food restaurants. "It's not a good sign that I was on a first-name basis with the Papa Gino's staff."

Casey's social life was also impaired by her weight. She speaks of isolating herself from friends and family on numerous occasions.

"I would turn away opportunities to do fun things all the time. I was missing out on life," she says.

Casey rationalized being at home all the time when not at work by "fooling myself into believing that I was a homebody, but the real truth and hard fact was that I was afraid and embarrassed."

Questioned about her fears, Casey offers a candid response: "I was afraid that I wouldn't be able to fit in a chair at the movie theatre, restaurant or rides at an amusement park."

Casey specifically recalls a time going to an amusement park with friends and family.

"I would tell everyone that it was fine for me to watch those enjoying rides on the roller coaster and other fun rides, but it really wasn't so," she adds.

Casey Hill and friends at Canobie Lake Park

In a post-surgery turnaround, Casey recently went to Canobie Lake Park in New Hampshire and went on ALL the rides, just because she could.

"It was a blast!" she raves.

After losing 120 pounds, Casey is no longer on a roller coaster ride with food — just a straight road to success. As a child, Casey also loved horseback riding; once on the journey through her new life, she was ready to enjoy it again.

"When I met my 100 pound goal, I went horseback riding," Casey says with glee.

Casey HillSince fall is the perfect time for outdoors exercise, you may even find Casey out in cornfields, briskly walking just for the fun of it.

Casey not only is having fun these days in the cornfield, but working hard at her new job. With a trimmed body, she was able to be gainfully employed in a position that enables her to walk a lot throughout her day. In addition, she has more one-to-one social contact with people. Casey seizes every opportunity to be fit.

"Since my job entails seven floors in a building, I make it a habit to walk the stairs several times a day," she adds.

Casey reflects upon a time when, at just 14 years old, she barely could walk up one flight of stairs. It was then that she began her quest to learn more about the risks and benefits of weight loss surgery. By age 25, Casey was fully informed about weight loss surgery after completing her multi-disciplinary screening process by BIDMC's bariatric team.

"It was the perfect time in my life to have weight loss surgery, because I was not only knowledgeable, but I built up sick time [at work], had great support and was ready to move forward to the next phase of my life," Casey explains.

Her post-operative bariatric recovery period experience was medically uneventful.

"I really don't remember any intense pain, I recovered quickly, my hospital experience was great," Casey says.

One year after her surgery, Casey still remains in contact with her hospital roommate from Farr 9 and has plenty of praise for those who took care of her.

Casey Hill pumped for her surgery"The inpatient hospital staffs, outpatient staff and Dr. Jones have been terrific," she says. "I am so grateful for the entire bariatric team."

There are many newfound activities in Casey's life today.

"I never thought I would be the kind of person that would jog unless someone was chasing me," she says with a grin.

Casey also has goals to switch her career to law enforcement, preparing for this new career as she did with her successful marathon with weight. She is getting ready to take the civil service exam in the near future.

"I knew that I could not physically take the exam at my previous weight because I could barely walk, now I can not only walk but run," she says.

Casey never fails to recognize her responsibility in changing her eating habits, exercising and filtering stress to other activities. She believes that many people have misconceptions about weight loss surgery that need to be addressed.

In her own experience, Casey has noticed feeling fuller faster; before weight loss surgery, she would mistake not being full for hunger. Now she says she feels hungry at the appropriate meal times.

But, she is also very much aware of the risks of weight re-gain if old habits are reemployed.

"Weight loss surgery is only a tool," Casey points out. "It will not fix all your problems. You have to be prepared, and be ready for the change, along with knowing the side effects of changing your eating habits.

"Eating is a very comforting act. I actually miss the physical act of eating when watching TV, or being with people," Casey adds.

That fuels her strong suggestion that one needs to find substitute activities to fill the void of eating.

"Finding other substitutes to occupy myself are absolutely worth the efforts, as the rewards are incredible," says Casey.

Casey has done an excellent job at becoming the executive director of her own health, with critical fact checking and investigative behavior. She believes she made the right decision, to have the right surgery, at the right time, for all the right reasons. She has raised her voice for unmistakable personal and professional life changes, addressing her struggles to build a bridge from poor health to vibrant health.

"I only hope what I went through will not only help myself," she says, "but at least help one if not many others."

All photos courtesy of Casey Hill

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Research News

Weight Loss Surgery May Get a Boost ... Through Brain Currents

By Miguel Alonso-Alonso, MD, MPhil, Department of Neurology

tDCS procedureBariatric surgeons and neurologists at Beth Israel Deaconess Medical Center are joining forces in a research study that will test the effects of brain modulation on enhancing weight loss following bariatric surgery. Recent investigations suggest that part of the ability to lose weight after bariatric surgery may be related not only to the gut, but also to the brain. Specifically, there is a link within the brain circuits that support inhibitory control of eating behavior.

This particular study involves transcranial direct current stimulation (tDCS), a noninvasive procedure (meaning it does not enter the body) that uses weak electrical currents applied to the head in order to enhance brain activity. We expect to find that enhancement of brain circuits related to inhibitory control of eating behavior may help optimize the amount of weight loss after surgery.

tDCS has not been approved by the FDA for any therapeutic applications. Thus, treatments are considered an "off-label" application. The procedure involves a battery-like device connected to a pair of cables with soaked sponge pads. The stimulation is performed by applying these pads to the scalp and passing a low intensity current between them for 20 minutes. Usually, people who receive tDCS feel a slight itching or tingling on their scalp.

We are currently enrolling men and women between the ages of 20 and 55 who do not have diabetes or any unstable medical condition, and do not have any contraindications to receive tDCS (such as damaged skin on the scalp or epilepsy). The protocol consists of a baseline visit, 10 daily sessions of tDCS, and brief follow-up visits at one, three, six and 12 months after surgery. During these visits, participants are weighed, asked to fill out questionnaires, and perform computer tests.

This study began in July and is funded by the Boston Nutrition and Obesity Research Center (BNORC). Further details can be found at ClinicalTrials.gov.

For More Information

Please contact Greta Magerowski at (617) 667-2654 or by e-mailing gmagerow@bidmc.harvard.edu.

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Expert Advice

Weight Loss Surgery, Alcohol and the Holidays:
What You Should Know

By Christie Roy, BIDMC staff

In the coming weeks, many of us will undoubtedly find ourselves attending — maybe even hosting — the dinners, parties, and social events that help make up the holiday season. It's no secret that plenty of these get-togethers will offer beverages of the alcoholic variety. If you have had weight loss surgery, it's likely that your body is now a bit more sensitive to alcohol. So when choosing to imbibe at a holiday function, it's a good idea to keep in mind these tips from the bariatric clinicians at Beth Israel Deaconess Medical Center:

  • First and foremost, never drink and drive.
    It's not worth risking your life — or anyone else's.
  • Don't guzzle your drinks.
    After a gastric bypass operation, just one glass of wine can be enough to put your blood alcohol level over the legal limit due to the alcohol being absorbed so quickly.
  • Don't go overboard.
    If you're also trying to avoid multiple trips to the buffet table, drinking too much may lower your self-control. Remember, it's always much easier to gain weight than it is to take it off.

Especially for those who have had bariatric surgery, it's important to be aware of the effects of alcohol on your system and also on your life after surgery. Research has shown that, most notably in patients who have undergone a Roux-en-Y gastric bypass, one's tolerance for alcohol decreases after having the surgery.

Alcohol-Free Holiday Drinks »


In one such study, published in the Journal of the American Medical Association last June, researchers say that this correlation actually puts the patient at greater risk for alcohol abuse. Their findings show a significant increase in the number of alcohol use disorders among patients two years after having weight loss surgery. Related article »

Another small study, recently published in the Archives of Surgery, had similar findings. The authors theorized that the rise in alcohol abuse two years removed from surgery stemmed from patients receiving "strict instructions" for their immediate recovery, but perhaps not quite as much guidance as follow-up visits became fewer and farther between. Related article »

"While our clinicians always try to make the potential dangers of alcohol clear to our current and prospective patients, we are striving to better educate our patients on all of these findings and are working to build even better relationships with post-op patients to help in this regard when needed," says Linda Trainor, RN, BSN, Bariatric Nurse Coordinator in the Weight Loss Surgery Center at BIDMC.

glasses of wineIn light of these studies, researchers here at BIDMC decided to take somewhat of a different approach. In a forthcoming study, they look closely at alcohol use by prospective patients who were considering weight loss surgery, and whether their alcohol use — social or more problematic — had any bearing on their decision to even proceed with the surgery.

The study's authors include Daniel Jones, MD, Director of the Weight Loss Surgery Center, and George Blackburn, MD, PhD, Director of the Center for the Study of Nutrition Medicine. Publication is expected in early 2013.

"We were seeing the occasional patient lose 150 pounds and then gain it back by drinking alcohol," Dr. Jones says of his interest in taking part in this particular study. "Despite information sessions explaining concerns, patients are getting through the screening process without the team knowing about their drinking until after it becomes a problem."

Pre-operative bariatric surgery patients at BIDMC undergo a health screening that includes questions regarding their personal alcohol use and any history of alcoholism, as well as their family history of alcohol use or abuse. But if a patient doesn't offer accurate information, it's harder for the clinicians in the Weight Loss Surgery Center to determine whether they are dealing with someone who has a potential alcohol problem.

"Weight loss surgery can really help people drop weight and improve their health," Dr. Jones adds. "But alcohol is something we need to remind our patients about, especially during the holiday season."

So on that note, remember that you can still enjoy that holiday time with family and friends by sipping some festive and delicious alcohol-free beverages. BIDMC's bariatric nutritionists Michelle Davis and Kate Otto offer these recipes for their favorite holiday drinks (which are also low in calories!):

Skinny Peppermint Mocha

Serves 1

Ingredients

1/2 c coffee
2 drops peppermint extract
1/3 c nonfat milk
2 tbsp sugar-free dark chocolate syrup

Directions

Brew coffee of your choice (or use one package of instant coffee) and pour into a mug. Stir in peppermint extract and chocolate syrup. Taste and adjust to your liking. Stir in nonfat milk.

Adapted from Shape.com

Spiced Cider Punch

Serves 2 (8 oz. each)

Ingredients

1 c light/diet apple juice
1 c water
1/2 of one orange, squeezed
1/2 of one lemon, squeezed
1 tsp non-calorie sweetener
1/4 tsp ground nutmeg
1/4 tsp ground ginger
2 whole cloves
2 cinnamon sticks

Directions

Combine the first seven ingredients together in a slow cooker. Tie cloves and cinnamon sticks in a cheesecloth bag and place in slow cooker. Cover and cook on low heat for 3 to 4 hours or until fully heated. Remove spice bag. Garnish with additional cinnamon sticks if desired.

Adapted from Shape.com

Spicy Bloody Mary

Serves 1

Ingredients

3 oz. tomato juice
1/2 oz. lemon juice
1 dash of Worcestershire sauce
celery salt
ground pepper
hot pepper sauce to taste
celery stalk and/or pickle spear for garnish
lemon and/or lime wedge for garnish

Directions

Add the liquid ingredients to a tall glass over ice cubes and mix well. Add the seasonings to taste. Garnish with the lemon and/or lime wedge and celery stalk.

Adapted from Cocktails.About.com

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Nutrition Corner

iced coffee drink

Think Your Drink!


By Michelle Davis, RD, LDN

New York City recently passed a rule banning the sale of big sodas (larger than 16 oz.) and other sugary drinks at restaurants, concession stands and other eateries. This is another example of America making changes to help the fight against obesity. Many of you may have already cut these types of drinks of out of your daily routine in an effort to make healthy changes and work towards weight loss. But this can be difficult to do with the advertisements bombarding us, especially with the upcoming fall and winter holidays.

We can find sodas and other sugar-sweetened beverages anywhere, from the drugstore and supermarket to a coffee shop or restaurant. Keep in mind that these drinks can add many calories to your day and are common culprits behind hitting a weight loss plateau and even weight re-gain. Many of these drinks can also cause dumping syndrome after Roux-en-Y gastric bypass surgery.

Here are some shocking nutrition stats on common sugary beverages available both seasonally and year round:

Drink Calories Sugar
Arizona Iced Tea
16 oz.

180 48g
Coca Cola
16 oz.

200 54g
Gatorade G Series
16 oz.

100 28g
McDonald's Sweet Tea
21 oz. (medium)

180 45g
McDonald's Frozen Strawberry Lemonade
16 oz. (medium)

250 65g
McDonald's Strawberry Banana Smoothie
16 oz.

260 60g
Starbucks Pumpkin Spice Latte
16 oz. (grande)

380 49g
Starbucks Salted Caramel Mocha
16 oz. (grande)

420 56g
Dunkin Donuts Hot Chocolate
14 oz. (medium)

320 44g
Dunkin Donuts Pumpkin Coffee (with cream)
14 oz. (medium)
240 34g

Stay smart when quenching your thirst and make these sugar-sweetened drinks an occasional treat instead of a main part of your diet. When in doubt, keep in mind these guidelines: low sugar drinks should have 8 grams of sugar or less per 100 calories. Remember, non-carbonated, low-sugar beverages will help hydrate without the added calories!

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On the Lighter Side

Flip-Flop Dieting: Time to Champion a Healthy
Campaign to Change

By Linda Trainor, RN, BSN

Vote: Healthy Campaign to ChangeNow is the time, prior to the holiday feasts, to actively campaign for the body that is just right for you. Alleviate any campaign trail to criticize, contrast, or compare your body to that of your neighbor, family, friends or Gisele Bündchen.

To become the president of your body, focus on the fundamental issue: your eating habits. Even though you are not at the public polls when critical votes need to be cast, no absentee ballots are allowed. When you show up to vote at the kitchen table, refrigerator, or restaurant, stop flip-flopping and just vote for your health!

This election year 2012 is all about YOU. If you are sick and tired of being sick and tired, it's time for new leadership that makes your health a priority to build a better future. NOW is the time for change!

If your body is burdened with comorbidities related to being overweight, then NOW is the time for change! If your self-esteem is in the gutter because you feel uncomfortable in your own skin, then NOW is the time for change!

Print your own ballot and hang where ever you need a healthy reminder »


Vote for Your Health

Over the years, many leaders have alluded to change not always being easy, because there is always someone or something determined to stand in the way. The same holds true for your Campaign to Change. So think about the critical, decision-making moments that really matter in your campaign:

  • When I am faced with a hot fudge sundae, will I flip-flop?
  • Will I stop after eating just one small piece of candy, or will I increase the deficit for everyone else who passes by the jar?

Since we can count on many awkward emotional moments in life, you will have plenty of opportunities to practice the answers that will win future debates by taking a bipartisan approach to eating. When challenged, be committed to your answer; remain calm and confident.

Practice when you awaken each morning, before the committee holds meetings in your mind throughout the day. Make decisions on your healthy campaign trail during the day based on the facts: Eating fewer calories and moving more is the answer to achieving a healthy weight and obtaining the body that is just right for you.

Unlike the November 6 deadline for those other campaigns we've been hearing about, you have the rest of your life to be the president of your goals. Since you are not the subject of the public polls this November, do not allow anyone to vote on your life except you.

No debate about it. Devise your very own dream team. Help rally for your own health and that of our nation!

Print your own Healthy Campaign to Change ballot! (PDF)




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Signature Series

Meet Our Bariatric Nurse Practitioner

By Linda Trainor, RN, BSN

Leigh-Ann Berk, ANP-BC, MSN, RDLeigh-Ann Berk, ANP-BC, MSN, RD, joined the Weight Loss Surgery team at Beth Israel Deaconess Medical Center in 2010 as a Nurse Practitioner.

She performs post-operative clinical assessments and manages bariatric patients in the acute setting on Farr 9 at BIDMC. An integral part of our multi-disciplinary team in the Weight Loss Surgery Center, Leigh-Ann participates in interdisciplinary rounds and provides support and education to staff, patients, and their families.

Leigh-Ann began her career at BIDMC in 2000 as a dietetic intern and returned in 2002 as a clinical dietician, providing medical nutrition therapy to inpatients. Additionally, she was a primary resource for medical staff regarding nutrition therapy in an acute care setting.

It was during this point in her career that Leigh-Ann returned to school for nursing and became a staff nurse at BIDMC in 2007. After gaining experience in an acute care setting as a registered nurse, Leigh-Ann earned her Master's in nursing from Boston College in 2009, and advanced her role to nurse practitioner a year later.

"I like working as an NP in the bariatric acute care setting because I enjoy caring for these patients very much," Leigh-Ann says. "Working in this specific setting affords me the opportunity to combine my background in nursing and nutrition to help patients who have had bariatric surgery."

It is easy for anyone who meets Leigh-Ann to easily recognize her passion to assist patients as they start a new, exciting, lifelong journey concentrating on health and nutrition.

Leigh-Ann's pride and joy are her two young children. She and her husband enjoy the many moments they share with their kids, and says her family keeps her very active when she is not working.

Even though Leigh-Ann is often pressed for time, she stays fit by using her at-home elliptical machine and walking whenever she has the opportunity.

"Although I don't have much time for anything these days, with small children and work, I try and make time for my favorite hobbies, which are gardening and reading," she says.

Leigh-Ann is also an avid football fan. Her favorite team? "The New England Patriots, of course!"

Just as the Patriots have Tom Brady as their quarterback, BIDMC's bariatric team has Leigh-Ann Berk. Whether you require a physical assessment, nutritional advice or just a bit of comfort, Leigh-Ann is poised and ready to assist you.

Leigh-Ann can be contacted through the Weight Loss Surgery Center at 617-667-2845.

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Ask the Trainer

Fall is a super season for shaping up!


Q. With the cold and holidays approaching, is there any point to starting outdoor exercise right now?


People walking in fall foliageRick DiScipio, Med, CSCS, NSCA-CPT, NASM-PES: Of course there is! You may have stayed in vacation mode all summer, but not to worry. Fall is a great time to start a fitness program because you will begin to develop good habits for the holiday season and the cold winter months ahead. So don't wait any longer — get going with these simple tips.

Take advantage of the weather

Fall can be a treat for the senses: the crisp air, apple picking, pumpkin carving, a gorgeous canopy of fall foliage, and the crunch of leaves underfoot. These months are a great time to exercise outdoors and enjoy cooler temperatures. Discover park trails and take in some new scenery, whether you're walking, biking, or hiking.

Be an active TV watcher

Many people get geared up for the fall premieres of their favorite television shows. If you're going to sit down and watch hours of TV, get moving! While you watch, you can walk or run in place, or do standing lunges. During commercials, do push-ups or sit-ups. If you're watching a one-hour show, you'll have about 20 minutes of commercial interruption to fill with fitness.

Deal with darkness

The best way to enjoy fall is to exercise outdoors, but as it gets darker earlier, be smart and safe. If you're walking or running outdoors, wear a reflective vest (or at least light-colored clothing) and carry a flashlight. If cycling, affix a light to your helmet or bike. If possible, use trails or a local school track to avoid vehicle traffic.

Dress in layers

When exercising outside, layer your clothing. Before your body warms up, you may feel chilled. DriFit gear is a type of fabric that wicks moisture away from your skin. And don't forget the sunglasses if it's still light out; UV protection is important year round.

Find your motivation

People are motivated by different things, so it's important to first discover what your individual goals are. Choose something you'll enjoy doing and will be likely to keep up, whether it's walking or hiking with a friend, working with a trainer, or taking part in a "boot camp" class. Creating a challenge for yourself will motivate you to keep going.

Please consult a physician before starting any exercise program.

Rick DiScipio is an Exercise Physiologist at BIDMC's Tanger Be Well Center.

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Ask the Dietitian

fruit smoothieSmoothies vs. Whole Fruit and Vegetables


Q. Are fruit and veggie smoothies in a blender good for you (no sugar added)?
- Bill S.


Kate Otto, RD, LDN: In general, it is best to eat your fruits and veggies, rather than drink them. While both are beneficial from a vitamin and mineral standpoint, solid fruits and vegetables fill us up with less, and therefore help us consume fewer calories.

For example, most smoothies contain several servings of fruits and vegetables, which will result in significantly higher calories vs. eating a single serving of fruit or vegetables. And, simply juicing fruits and vegetables results in a zero fiber, high sugar beverage. Remember, hunger-curbing fiber in whole fruits and veggies keeps us satisfied longer, and helps slow the release of glucose into our bloodstream, preventing a spike in blood sugar.

bowl of fruitEspecially after weight loss surgery, it is most beneficial to stick with solids for better satiety. Most of us do not realize the additional calories we consume throughout the day with beverages. So check out this high fiber, high protein, low-calorie recipe for a simple nutritious snack!

Please note: If you are having trouble tolerating fresh fruits and vegetables on stage 5, please contact your dietitian for further guidance.

Greek Yogurt Fruit Dip

1 serving

Ingredients

6 oz. plain, nonfat Greek yogurt
One packet non-nutritive sweetener
yogurt with fruitGround cinnamon to taste
½ to 1 cup fresh fruit

Directions

Combine yogurt, sweetener and cinnamon to taste. Serve as dip with fresh fruit and enjoy. (Our favorite dipper this time of year is apple or pear slices!)

Kate Otto is a bariatric nutritionist in the Weight Loss Surgery Center at BIDMC.

Bonus Recipe: Seasoned Sweet Potatoes


Teresa Yi, Dietetic Intern 2012-2013

And, to help you enjoy your vegetables throughout the fall and during the holidays, try this dish! These sweet potatoes are a delicious combination of flavors and an easy go-to choice for warming up on a cool day. Adjust the seasoning as needed to fit your taste.

sweet potatoesIngredients

(4 to 6 servings)
2 sweet potatoes, scrubbed, peeled and cut into 1-inch chunks
2 Tbsp extra virgin olive oil
1 tsp cumin
½ tsp cinnamon
¼ tsp salt
¼ tsp cayenne pepper

Directions

Preheat oven to 375° F. Place potatoes in a 13X9-inch baking dish. Mix oil and spices together in a small bowl and drizzle over top of the potatoes; toss to evenly coat. Cover the dish with foil and bake 30-35 minutes or until fork tender.

Enjoy with a lean protein and steamed vegetables for a nourishing, well- balanced meal. The potatoes will keep nicely in the refrigerator for several days.

Recipe adapted from CookusInterruptus.com

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Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Originally posted November 2012