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Fall 2016 edition

Making Your Goals Attainable


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Back on Track

From Size 18 to Size 6, Julie Moves Toward a Healthy Future


By Linda Trainor, RN, BSN

At 24 years old, Julie’s life is now back on track — and filled with hope and excitement for the future.

“I never thought I would be that type of a person, who would be excited to exercise,” she says.

But after having weight loss surgery and losing 76 pounds in the last year, Julie enthusiastically goes to the gym even on the days she is tired.

Julie Enriquez before and after having weight loss surgery

Julie underwent a sleeve gastrectomy, performed by Dr. Benjamin Schneider, in the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center in October 2015. Her decision to have the procedure was partly because she had been overweight since she was eight years old.

“I feel like I have struggled with weight my whole life, going on so many diets, losing weight only to regain it,” she says. “Many of my close family members have also struggled with obesity."

Over the years, Julie saw her relatives develop other conditions, such as diabetes and hypertension, as a result of being overweight. She herself began suffering from sleep apnea and worsening asthma.

Julie was fearful that if she kept gaining weight, her health would be even further impacted by obesity. She decided not to wait, and took a big step on a path to better health.

“I am so pleased with my decision to have weight loss surgery at a younger age because I really wanted to decrease my risks of having health problems later in life,” Julie explains. “My family was very supportive — many of them have also had successful weight loss surgery, which was helpful and encouraging to me.”

Julie credits the weight loss surgery staff at BIDMC, from outpatient to inpatient, for making her feel comfortable and “setting me up for success.”

“Dr. Schneider was exceptional,” she adds. “He was very supportive and answered all of my questions and concerns before and after surgery.”

In addition to the gastric sleeve, Julie attributes much of her success to keeping her scheduled appointments with the multidisciplinary team at BIDMC, taking her required vitamins, exercising and — most importantly — practicing healthy habits on a daily basis.

“I take it one day at a time so I can have a life full of healthy habits,” she says. “No food is off limits, but now with a smaller stomach, my portions are smaller and I make better choices, so I feel normal when I go out with my friends.”

Julie also loves shopping for fashionable clothes with her friends, now that she has dropped from a size 18 to a much smaller size 6.

“Now I can buy clothes that not only fit, but are stylish, too,” she notes.

That’s just one of many things Julie says she could not do a year ago, before having surgery.

“It may sound simple, but now I can run to catch the bus, whereas before I would have to wait awhile for another one to come my way,” she adds.

Now faster and more sophisticated than ever, Julie is willing to try all kinds of new things with her increased self-esteem and vitality. The wait is over for her and her healthy future.

Photos courtesy of Julie F. E. Gonzalez

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Nutrition Corner

Falling for the Flavors of Fall


By Michelle Mamis, RD, LDN
Bariatric Dietitian at BIDMC

Saying good-bye to summer is always hard (farewell, sandals and beach days!), but the beginning of fall can be exciting, too. Not only does fall provide us with cooler (but not freezing) temperatures and beautiful foliage, it is also full of wonderful seasonal produce.autumn basket with apples and pears

While most people think about summer as the best time of year for produce, there are many seasonal options in the fall with a variety of preparation methods. Here are some popular choices as well as tasty recipes to try.

Apples

  • Popular varieties include Honeycrisp (great for eating and adding to salads), Golden Delicious (great for eating, adding to salads and baking), Empire (great for eating and making apple sauce), Granny Smith (great for eating, cooking and baking).
  • Rich in vitamin C and some B vitamins as well as fiber.
  • Tips for Picking*
    • Look for firm, vibrantly colored apples with no bruises.
    • Skins should be tight and smooth.
  • Recipe: Chicken Thighs with Roasted Apples & Garlic

Pears

  • Popular varieties include Bartlett (great for eating and canning), Anjou (great for eating and cooking) and Bosc (great for baking and cooking).
  • Rich in vitamin C and some B vitamins as well as fiber.
  • Tips for Picking*
    • Test for ripeness by applying light thumb pressure near the pear's stem. If it is ripe, there will be a slight give.
  • Recipe: Roasted Beet Salad with Pears & Almonds

Pumpkin

  • Popular varieties for cooking/eating purposes include sugar pumpkins or pie pumpkins.
  • Rich in vitamins A, C, E andsome B vitamins as well as potassium.
  • Pumpkin seeds are rich in protein, fiber and heart healthy fats, as well as zinc and magnesium.
  • variety of pumpkins and squashTips for Picking*
    • Look for pumpkins that are small, about 5 to 8 pounds, with tough skin. 
  • Recipe: Pumpkin Pancakes

Winter Squash

  • Popular varieties include acorn, butternut and spaghetti.
  • Rich in vitamins A and C as well as some B vitamins.
  • Tips for Picking*
    • The tastiest winter squashes will be solid and heavy with stems that are full and firm, with a corky feel.
    • The skin of the squash should be deeply colored with a matte finish. Avoid squash with cracks, soft spots, and moldy areas.
  • Recipe: Spaghetti Squash with Meat Sauce

Brussels Sprouts

  • Rich in vitamins A, C and some B vitamins as well as fiber.
  • Can be shredded raw and added to salads or cooked by sautéing or roasting.
  • Tips for Picking*
    • Look for small, firm sprouts with compact, bright-green heads — the smaller the head, the sweeter the taste.
    • Avoid soft, wilted, puffy, or dull-colored heads, as well as those with loose or yellowish leaves.
    • Choose sprouts of similar size so they'll cook evenly.
  • Recipe: Brussels Sprouts with Lemon & Pecans

*Tips for picking from CookingLight.com

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On the Lighter Side

A Healthy Campaign to Change


By Linda Trainor, RN, BSN

Vote: Healthy Campaign to Change buttonNow is the time to make this 2016 election year all about you!

Actively campaign for the body that is just right for you. Ease away from any campaign trail that demoralizes, criticizes, contrasts, or compares your body with that of any other candidate — your neighbor, family, friends or supermodels.

If you are sick and tired of the same old rhetoric, then now is the time for new, positive leadership that makes your health a priority to build a better future.

If your body is burdened with comorbidities related to being overweight, then now is the time to change for the health of it.

If your self-esteem is in the gutter because you feel uncomfortable in your own skin, then now is the time to champion Chief Executive Confidence with a “Yes I Can” attitude.

Become President of Your Body 

Focus first and foremost on the fundamental issue: your eating habits.

Take a bipartisan approach and elect healthy foods, no matter which side of the table you’re on. Think about the questions you will be asked and practice the answers that will win your future debates about health and wellness:

  • When I am faced with a hot fudge sundae, will I flip-flop?
  • Will I stop after eating just one helping, or will I increase the total deficit for others? 
  • Will I allow anyone or anything to affect my healthy policy? 

Drum Up Some Self-Support 

When you awaken each morning, practice a “good for you” constitutional pledge before a corrupt legislative committee can hold meetings in your mind to veto your picks throughout the day.

Make top-level decisions on your healthy campaign trail each day based on the facts: Eating fewer calories and moving more is the honest answer to achieving a healthy weight.

When others challenge your healthy decisions, remain true to your values. Stay confident, calm and committed to your personal health and wellness platform. Since you are not the subject of the public polls this November, do not allow anyone to cast a vote on your life except you.

Countless distinguished leaders have said that change is not easy, because there is always an army of soldiers determined to stand in the way. The same holds true for your Healthy Campaign to Change.

But let there be no debate about it: unlike the deadline for those other campaigns we’ve been hearing about, you have the rest of your life to judiciously act and exercise your right to create a winning strategy for your own personal health!

click to download and print your "ballot" for your Healthy Campaign to Change (PDF)

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Signature Series

Meet Marianne Lynch, Bariatric Inpatient Nurse


Marianne Lynch, RN, BSN, has been taking care of weight loss surgery patients at Beth Israel Deaconess Medical Center since 2007, when she joined the staff of Farr 9, Marianne Lynch, RN, BSNthe hospital’s inpatient floor for bariatric, hepatobiliary, pancreatic, thoracic and general surgery patients.

“Shortly after I began working here, I realized how much I love surgical nursing,” Marianne says. “Farr 9 is a very complex medical/surgical unit, and I enjoy working with patients and their families to provide ongoing education catered to their specific plan of care. This really helps to optimize my patients’ hospital experience, and their continued recovery at home.”

Once a bariatric patient is out of surgery and brought to Farr 9, Marianne and her colleagues help manage their post-operative care plan. A lot of education about proper nutrition is involved: patients need to follow a specific diet for several weeks after surgery, and an overall healthy eating plan is key to both short- and long-term success.

“I love that I get to educate patients about creating a healthy lifestyle,” she says, “but I also often need to provide support to patients about emotional and psychological issues related to obesity and weight loss. We direct patients to the available resources outside of the hospital to help them on their weight loss journey once they go home.”

Caring for bariatric patients is unique, Marianne acknowledges, due to the fact that they are electing to have surgery in order to better their health.

“It is nice knowing that my weight loss surgery patients are leaving the hospital a lot better than when they came in — meaning they are getting a fresh start at making positive changes to their health and wellness,” she notes.

Before she became a nurse, Marianne originally wanted to work as a speech pathologist, and even spent a year as a paraprofessional in a high school’s special education department. She is a UMASS graduate with a bachelor’s degree in psychology and biology, and obtained her BSN from Regis College in 2007.

Marianne joined BIDMC as a new nursing graduate and is proud to be going on 10 years a staff member.

“I love knowing that I work at one of the best hospitals in Boston with the top technology and resources,” she says. “I am constantly learning new things and building on my own skills as a clinical nurse. I have the ability to work with some of the best doctors out there, and we get referrals and transfers from all over — our patients just love the care they receive here at BIDMC.”

She and her Farr 9 colleagues recognize that their teamwork plays a big part in providing all of their patients with a positive hospital experience and high-quality care.

“I work with an amazing team and we work so well together,” Marianne says. “There have been so many days that I have left work and been really grateful for the help of my peers. Sometimes I don’t know how I would have made it through a shift without them!”

Marianne stays busy when her shifts end, too, but often brings home the wellness education she provides to her bariatric patients. She and her husband of seven years are the parents of three healthy kids — ages 5, 2 and 9 months — as well as a yellow Lab.

“We enjoy trips to the beach, going for walks, bike-riding in the park or visiting the playground, zoo and aquarium,” she says. “We try to promote a healthy and active lifestyle for our family.”

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News

Nonsurgical Weight Loss Procedure Available at BIDMC


Weight loss surgery has become a more common way for people to not only lose weight, but to do so in a healthy manner. To qualify for weight loss surgery, Balloon In Stomach Orberapatients must meet certain requirements, such as having a body mass index (BMI) of 40 or above, being a minimum of 100 pounds overweight, and having a serious medical condition related to their weight (diabetes, heart disease or sleep apnea).

But if you need to lose weight and do not quite meet these requirements, a different procedure may help.

The intragastric balloon is a nonsurgical, endoscopic weight loss procedure, meaning it involves the insertion of a flexible tube with a camera attached into the digestive tract through the mouth. The intragastric balloon is best suited for individuals who have a BMI between 30 and 40 and will benefit from a comprehensive weight loss program. Patients must also meet specific requirements as established by the National Institutes of Health.

The Digestive Disease Center at Beth Israel Deaconess Medical Center now offers the intragastric balloon procedure (IBP). Renowned gastroenterologist Ram Chuttani, MD, Director of Endoscopy and Chief of Interventional Gastroenterology at BIDMC, performed one of the first intragastric weight loss balloon procedures in Boston.

“This balloon weight loss procedure is a great way to achieve healthy weight and adopt a healthy lifestyle,” Chuttani says. “It is an outpatient, non-surgical procedure and most patients go home within a few hours. Most are thrilled with the results. And, they are really happy to have the support of our team over the next year — we are on this weight loss journey together.”

With IBP, you not only benefit from a simple procedure, but a registered dietitian and RN Health Coach will work with you as you make diet and lifestyle changes for achieving long-term success.

From a Patient

“I am a 28-year-old female who has struggled with my weight for a couple of years. I have literally tried every fad diet out there and diet pills, but could not lose the weight and would give up because I wasn't getting the results that I wanted. Then I stumbled upon the intragastric balloon and it gave me the tool I needed to lose more than 50 pounds. I went from a size 14 jeans and worked my way down to a size 6 in the short amount of time that I had the balloon in. It was not the easiest thing for me and I had some challenges, but the staff that worked with me was fantastic and helped me out so much along the way. I would definitely recommend the intragastric balloon.”

How it Works

On the day of your procedure, you will first receive sedation from an anesthesiologist. The deflated intragastric balloon is placed into your stomach with the use of an endoscope. The balloon is then filled with saline, partially filling your stomach, so you feel full faster and eat less.

The 20- to 30-minute procedure is considered minimally invasive and is performed on an outpatient basis. The balloon will remain inside your stomach for six months.

While the balloon is in place, you learn how to eat smaller portions. You also receive coaching and guidance about diet and exercise at regular visits with your dietitian and RN Health Coach. Some of these sessions can be done over the phone.

“Like weight loss surgery, the balloon is a tool to help you reach your weight loss goals,” says Kelly Moore, RD, LDN, a bariatric dietitian who works with balloon patients. “Behavior modification around healthy eating and physical activity is really the key to losing weight and keeping it off.”

Moore, a nutrition educator, says she is a partner in each of her patients’ lifestyle change.

“I meet with patients pre-procedure and then at least monthly, if not more often, after the balloon is placed,” Moore explains. “Between Sheryl Smith, the program nurse/health coach, and me, we develop a personalized plan for weight loss and improved health. This might include finding ways to keep active, consuming a variety of foods that are enjoyable yet nutritious, or limiting mindless eating.”

A Team Approach

After six months, the intragastric balloon is removed with another endoscopic procedure. You will continue to receive the support of your dietitian and RN Health Coach for an additional six months to help you maintain your healthier lifestyle.

Benefits of IBP include lowering the potential risk of heart disease, high blood pressure, type 2 diabetes, gastroesophageal reflux disease (GERD), high cholesterol and sleep apnea. With a dedicated team of specialists working together with you, the potential for successful long-term results is high.

Patients who have already undergone a bariatric surgery procedure (RNY gastric bypass, LAP band, sleeve gastrectomy) are not eligible for IBP. Additionally, at this time IBP is not covered by insurance.

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In the Kitchen

An Autumn Abundance


By Michelle Mamis, RD, LDN
Bariatric Dietitian at BIDMC

Cooking with fresh produce doesn't have to end when summer does; an abundance of autumn fruits and vegetables can make for a flavorful fall season.

Chicken Thighs with Roasted Apples & Garlic

Serves 6 to 8

roasted chicken thighs with applesIngredients

5 cups chopped apple (about 1 1/2 pounds)
1 tsp chopped sage
1/4 tsp ground cinnamon
1/8 tsp ground nutmeg
4 garlic cloves, chopped
1/2 tsp salt, divided
Cooking spray
8 skinless chicken thighs (about 2 pounds)
1/4 tsp black pepper
Chopped parsley (optional)

Directions

Preheat oven to 475°F. Combine first 5 ingredients. Add 1/4 teaspoon salt; toss well to coat. Spread apple mixture on a pan coated with cooking spray.

Sprinkle chicken with 1/4 teaspoon salt and pepper, and arrange on top of the apple mixture. Bake for 25 minutes or until chicken is done and apple is tender. Remove chicken from pan; keep warm.

Partially mash apple mixture with a potato masher, and serve with chicken. Sprinkle with parsley, if desired

Recipe adapted from CookingLight.com

 

Roasted Beet Salad with Pears & Almonds

Serves 4 to 6

beet saladIngredients

4 large red beets
2 pears (recommended: Anjou)
3 to 4 Tbsp balsamic vinegar
Extra virgin olive oil
Kosher salt
2 cups baby arugula (washed)
1/4 cup almonds, coarsely chopped
1 bunch chives, finely chopped

Directions

Preheat the oven to 375°F. Place the beets on a sheet tray and roast until fork tender, about an hour. Remove and let cool.

Peel the beets. Grate the beets and the pears on the largest hole of a box grater. Toss with the balsamic, olive oil and salt.

Divide the arugula between 4 to 6 salad plates, spoon some of the beet-pear mixture onto the arugula, and top with the chopped almonds and chives.

Recipe adapted from FoodNetwork.com

 

Pumpkin Pancakes

Makes 3 to 4 pancakes

pumpkin pancakesIngredients

1/2 cup pumpkin puree
1 tsp vanilla (optional)
2 large eggs, whisked
1 Tbsp whole wheat flour
1/4 tsp cinnamon
1/4 tsp ground ginger
1 tsp pumpkin pie spice

Directions

Combine eggs with pumpkin and vanilla. In a separate bowl, combine flour and remaining ingredients.

Add the flour mixture slowly into the pumpkin mixture, stirring until smooth.

Heat a large nonstick griddle over medium-high heat. Spoon 1/4 cup batter per pancake onto a nonstick griddle. Cook for 3 minutes on each side.  

Recipe adapted from CookingLight.com

 

Spaghetti Squash with Meat Sauce

Serves 4 to 6

spaghetti squash with meat sauce and basilIngredients

1 1.5-lb. spaghetti squash
1 cup finely chopped onion
8 oz. 93% lean ground beef
6 garlic cloves, minced
8 oz. mushrooms, finely chopped (recommended: cremini)
1 (14.5-oz.) can unsalted diced tomatoes
1 Tbsp unsalted tomato paste
1/2 tsp dried oregano
1/4 tsp crushed red pepper
3/4 tsp kosher salt
1/4 tsp freshly ground black pepper
2 Tbsp finely grated Parmesan cheese (optional)

Directions

Cook the spaghetti squash: preheat oven to 350°F and halve squash. Remove seeds and membrane. Place each half cut-side down in a large casserole dish and fill with 1/2 cup of water. Cook for 45-50 minutes. Remove the squash from oven, turn cut side up and let cool for 10 minutes. After squash has cooled, scrape down the sides of the squash with a fork and move into a bowl.

While squash cooks, heat a large skillet over medium-high heat. Coat pan with cooking spray. Add onion, beef, and garlic; cook 4 minutes, stirring to crumble beef. Add mushrooms; cook 10 minutes or until most of liquid evaporates, stirring occasionally.

Place tomatoes in a food processor; pulse 4 times or until almost smooth. Add tomato paste, oregano, and red pepper to pan; cook 1 minute, stirring frequently. Stir in tomatoes; reduce heat, and simmer for 5 minutes or until slightly thickened. Stir in salt and black pepper.

Serve sauce over squash and top with cheese.

Recipe adapted from CookingLight.com

 

Brussels Sprouts with Lemon & Pecans

Serves 4 to 6

Brussels sprouts with lemonIngredients

1 tsp olive oil
1/4 tsp dried thyme
1 1/2 cups chopped onion
1/3 cup fat-free, low-sodium chicken broth
1 lb. Brussels sprouts, halved
1/4 cup chopped pecans
2 tsp grated lemon rind
1 Tbsp fresh lemon juice
1/4 tsp black pepper

Directions

Heat olive oil in a large skillet over medium-high heat. Add thyme and onion to pan; sauté 3 minutes.

Add broth and Brussels sprouts; bring to a boil. Cover and simmer 6 minutes or until tender.

Stir in pecans, lemon rind, lemon juice, and black pepper.

Recipe adapted from CookingLight.com

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All content provided by the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Originally posted November 2016