Weight Loss & Well-Being, Winter/Spring 2017
Finding His Way
Miguel's Refusal to Give Up Results in 344-pound Weight Loss
By Linda Trainor, RN, BSN, and Christie Roy, BIDMC staff
It has been a tough road for Miguel Rodriguez, full of difficulties that would make many want to give up. But Miguel has nonetheless traveled this road with the utmost determination, overcoming struggles and sadness to reach the goals he set for himself.
His hard work has resulted in what he calls a renewed chance at life.
“I was depressed. Discouraged, sad, hopeless,” Miguel says. “But I did not give up.”
Miguel initially came to the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center in 2014 and learned that he was not a candidate for surgery. At that time, he weighed 612 pounds, and was told he would need to lose 112 pounds in order to qualify for a bariatric procedure.
“I really could not function at all,” Miguel says. “I did not go anywhere, I had trouble showering and finding clothes to wear. My wife did everything for me. I was essentially bedridden and totally dependent on others. But I set small goals for myself, and after I lost the first 20 pounds I began to feel a little better.”
Over the next eight months, Miguel worked with a nutritionist and diligently followed a supervised diet. His hard work translated into a 120-pound weight loss.
Then, his road took an unexpected turn: Miguel and his family suffered the heartbreaking loss of his wife, Glenda, to a heart attack.
Suddenly a single father to two teenagers, Miguel was no longer sure he wanted to pursue weight loss surgery, fearing something would go wrong during or after the procedure.
“It was not an easy decision, but my kids encouraged me to have surgery if I could,” says Miguel. “I had done well so far, but I was still at very high risk for health problems. I was taking medication for arthritis and diabetes, and dealing with sleep apnea. The bariatric team at BIDMC was very supportive to me and encouraging as well.”
Miguel’s determination again took hold. He went through pre-surgical screening, this time meeting the necessary qualifications, and underwent a Roux-en-Y gastric bypass with Dr. Daniel Jones at BIDMC on January 12, 2016.
“My surgery was smooth sailing,” Miguel says with a smile. “I was up and about a lot sooner than expected.”
Fourteen months after his procedure, Miguel has lost a total of 344 pounds — and counting. His blood pressure is in the normal range. He no longer needs treatment for diabetes or sleep apnea.
It wasn’t long ago that Miguel felt there was no hope for his future. Now, he finds that his road through life has taken more turns for the better: he is happier, active and more sociable. His kids are thrilled with his success. His family and friends are impressed not only with his physical change, but with his determination to succeed in the face of adversity.
“I’ve worked hard,” he acknowledges. “It’s those small things that many people take for granted: tying your shoes, bathing, getting dressed, walking without shortness of breath — these things are so much easier for me now and I will never take them for granted.
“I’m so grateful to everyone who has helped me meet my goals,” he adds. “I’m determined to stay on track and remain healthy. Now, I have a lot of hope for the future.”
Photos courtesy of Miguel Rodriguez
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Time-Saving Tips for Healthy Eating
By Kate Otto, RD, LDN
Bariatric Dietitian at BIDMC
Let’s face it — there never seem to be enough hours in the day. Our fast-paced, on-the-go lifestyle sometimes means we sacrifice the quality of our food choices and end up having to prioritize other commitments over being healthy. The truth is, weight loss surgery unfortunately doesn’t break a lot of the barriers we encounter in our everyday lives.
Here are some time-saving tips to help you maintain a healthy lifestyle no matter how busy your schedule gets.
Make a list before you hit the grocery store.
Take the guess work and impulsivity out of your shopping trip.
- Take inventory to make sure you have all the ingredients for meals you plan to make for the week to avoid additional shopping trips later.
- Reduce your bill by buying produce that is in season.
- Pick up healthy grab-and-go or minimal prep items you can enjoy throughout the week, like frozen steamer bags of veggies or whole grains, healthy frozen meals, individual bags of nuts, pre-cut fruits and veggies, and pre-cooked protein foods (grilled chicken, chicken sausage, rotisserie chicken, lean deli meats, canned tuna, salmon or chicken).
Prep once, enjoy multiple times.
- Carve out an hour or two to cook in bulk, portion into individual containers, refrigerate and reheat later in the week.
- If you appreciate more variety, freeze to enjoy in the future.
- Take advantage of grilling weather when you can; the large cooking surface can allow you to make a fully balanced meal at one time.
Get creative and reinvent leftovers for variety.
- Roast a pan of veggies and enjoy as a side dish, a salad topper, in a wrap with some lean protein for lunch, or added to your morning eggs for a veggie scramble.
- Boil eggs; enjoy with fruit for breakfast, on a salad for lunch, as a stand-alone for a snack, or mash into egg salad.
- Cook lean ground beef, turkey or chicken breast and add to chili, make tacos, or throw into a salad for a higher protein option to keep you satisfied.
Use a slow-cooker.
- Slow-cookers require minimal time and effort, and typically these recipes reheat well.
- On a meal-prep day, you can combine most of your ingredients in a plastic freezer bag, freeze, and add to your slow-cooker when ready.
Pack breakfast and lunch the night before.
Allow yourself a few extra minutes of snooze time without having to hit the drive thru.
- Keep your filled lunch bag in the fridge; grab and go in the morning.
- Try this easy recipe for overnight oats, or enjoy a protein shake or protein and fruit smoothie rather than skipping breakfast. These are easy to make and enjoy during your commute.
- To help your shake keep you full longer, be sure to include a protein source like protein powder or Greek yogurt. Add some bulk with frozen fruit and a sprinkle of uncooked oats for more fiber.
Plan your week ahead.
- Schedule workouts, fitness classes and grocery shopping ahead of time and record it on your calendar.
- Keep the appointments you set for yourself: they are just as important as your other obligations!
Squeeze in activity.
- Walk to errands nearby, or park further away. Do a lap around the store before you start shopping.
- Get off the train or bus a stop early.
- Try doing some stretches, yoga, body weight exercises or jumping jacks for a few minutes before you get into the shower.
- Consider doing a workout DVD at home or check out your cable company’s built-in fitness options when you have a few extra minutes to spare.
Make informed decisions & stock up on snacks.
- If you have to grab food while out or on the road, pinpoint a few healthier menu items at fast food places near home or work. Look up nutrition facts online or brainstorm with your RD.
- Know that you are choosing a more nutritious option, even if you are grabbing something on the fly.
- If you are ravenous by the time you get home from a long commute, keep healthy snacks around so you can stick to your plan for dinner.
- Individual bags of nuts, fruit, cheese sticks, and protein or fruit and nut bars can get you from one meal to the next and end up saving you calories later.
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Remembering Dr. George Blackburn
George Blackburn, MD, PhD, Director of the Center for the Study of Nutrition Medicine at Beth Israel Deaconess Medical Center and a well-respected clinician and researcher in the fields of nutrition and weight loss surgery, passed away on February 20, 2017, at age 81.
In 1973, Dr. Blackburn was among the first in New England to perform Roux-en-Y gastric bypass surgery for treatment of morbidly obese patients. He later developed the first evidence-based guidelines for weight loss surgery, which led to the formation of accreditation bodies and standards for certification of weight loss surgery centers and providers across the United States.
Dr. Blackburn trained more than 100 fellows and countless residents during his career; in the early 2000s, when Drs. Daniel Jones and Benjamin Schneider took over the bariatric surgery program at BIDMC, Dr. Blackburn served as their mentor.
“George was truly an amazing person,” Dr. Jones, Director of the Weight Loss Surgery Center at BIDMC, says. “He was the most thoughtful investigator and selfless mentor. I will miss him.”
Dr. Blackburn was a member of the Department of Surgery at BIDMC for 45 years, beginning his career at New England Deaconess Hospital. Since 1998, he held the S. Daniel Abraham Professorship in Nutrition at Harvard Medical School. He also served as the Director of the Feihe Nutrition Laboratory in the Department of Surgery at BIDMC.
In 2014, the Department of Surgery at BIDMC renamed the bariatric surgery service the Blackburn Surgical Service in his honor.
Dr. Blackburn pioneered the development of intravenous hyperalimentation formulations, introduced novel formulations containing branch chain amino acids, and established the first multidisciplinary Nutrition Support Service in the U.S. for the safe delivery of total parenteral nutrition (TPN). More recently, Dr. Blackburn highlighted a novel link between diet and cancer, demonstrating that reducing dietary fat intake improves disease-free survival among breast cancer patients.
“I had the pleasure of meeting Dr. Blackburn in the late 1970s at Boston City Hospital and began working with him at BIDMC when I completed my fellowship in surgical nutrition and hyperalimentation in 1996,” says Dr. Edward Hatchigian, Medical Director of the Weight Loss Surgery Center at BIDMC. “I was honored to work with him to establish a comprehensive multidisciplinary team approach for the treatment and management of obesity. Dr. Blackburn’s contributions in research, clinical care and surgery have been instrumental to the field of obesity. Not only will his mentorship be fondly recalled, but his search for excellence and enthusiasm for life will long be remembered.”
The author of more than 400 original peer reviewed research publications, Dr. Blackburn also edited nine books and wrote numerous professional educational materials, guidelines and reports. A true visionary and innovator, his contributions to the fields of surgery, metabolism, nutrition, and obesity have positively affected the lives, health and well-being of thousands of patients.
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A Bariatric Nurse's Hints to Staying Well
By Erin Hogan, RN, BSN
The weather in New England can be pretty unpredictable this time of year, but cold and flu germs have yet to go away. No matter the temperature or type of precipitation falling from the sky, take time to focus on your health and ensure you’re doing everything you can to stay healthy.
Even if you fell off track during the holidays, get back to eating well-balanced meals and planning ahead in order to prevent over-indulging or unhealthy choices. Proper nutrition gives you more energy, helps to fight off colds and viruses, and keeps you healthy overall.
It’s important to get enough fluid year-round. Set an alarm reminder to drink consistently throughout the day, or keep a bottle of water on your desk. Water is good for your skin, prevents fatigue, gives you more energy, and helps curb your appetite. Try adding some fresh fruit or different herbs, like rosemary and lemon, to enhance the flavor.
Washing your hands is the number one way to prevent the spread of germs. If you’re not able to use soap and water, keep hand sanitizer with you. Avoid spreading germs through shared food and utensils/cups. And don’t forget about door handles and light switches when wiping down surfaces.
With chaotic schedules and busy lives, it’s easy to forget to stop and breathe. Reduce your stress level by practicing deep breathing, listening to music you enjoy, taking a lunch break, and avoiding stressful situations whenever possible. Decompress at the end of a long day with an exercise class, a hot shower, or anything that puts your mind at ease. Managing stress means your immune system will function better, you will sleep better and have more energy to concentrate on other priorities. Try treating yourself to a massage, practicing meditation, aromatherapy, or taking a restorative yoga class.
Being compliant with vitamin and mineral supplementation after weight loss surgery is a key to staying healthy. Vitamins can help prevent multiple medical issues, reduce fatigue, and replace certain nutrients that you may be missing in your diet (but should never replace a well-balanced diet). Follow up with your doctor and dietitian to ensure you’re taking the appropriate supplements and doses.
It’s easier said than done, but allowing yourself enough time to unwind and rest is essential to good health and well-being. Adequate sleep helps with better immunity, improved mood, less pain, and less stress. For a restful night’s sleep, clear your mind with deep breathing, calming music, and positive thinking before lying down. If you tend to stay awake worrying about things you need to do, keep a notebook at your bedside to jot it down. If you struggle to fall asleep, get into bed at least 30 minutes before you want to be asleep.
Staying healthy and keeping your immune system strong is much easier when you participate in regular exercise. Walking, indoors or out, is great for post-bariatric surgery patients. Try a Zumba video in your living room or get toned with resistance bands. Have limited mobility or pain? Find activities that can be done from a seated position, or look into water aerobics (you may be able to get a prescription for aquatic therapy from your doctor).
Stay on Track
Don’t beat yourself up if you’ve added a few extra pounds recently; just try to set small goals that you’ll be able to accomplish. Don’t set yourself up for failure by creating unrealistic expectations; start by working towards small victories and gradually look towards the bigger picture of a happy, healthy you!
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On the Lighter Side
Fake Diets: Alternative Weight Loss
By Linda Trainor, RN, BSN
Anyone who has ever tried to lose weight is familiar with fake fad diets that promise an alternative to healthy weight loss.
Many of these fake fad diets deceive you into thinking that you will lose a tremendous amount of weight in a very short period of time. They also showcase false success stories with frumpy “before” pictures next to fabulous “after” pictures.
The basic premise of a "fake" diet is to lead you to BELIEVE in falsehoods. Fake diets often pose potential serious health problems by undermining the professional advice from credible dietitians to eat from five basic food groups.
Buyer Beware: Don’t be duped by trusting any of these types of diets that promote long-lasting “healthy” weight loss:
- Eat All You Want diet: lose 7 pounds in 7 Days by taking “Super X” vitamins
- 30-Day Cleansing Diet: Go green to be lean
- Eat Only “Pink Food” diet: Lose 20 pounds by Spring
- Poppy Seed Diet: Just a few sprinkles = big weight loss results
Let’s face it: we would all like to chew Willy Wonka’s three-course dinner chewing gum to easily remove unwanted pounds. However, the fact remains that continuous effort leads to change. There is no magic gum, pill or fake food group that will provide desired weight loss. Quite the contrary! “Fake” diets are super extreme, fast and furious — and can lead to considerable weight regain, once you stop drinking the KoolAid.
Unfortunately, false advertising and deceptive marketing from con-artists trying to sell new gimmicks will continue to pop up and convince plenty of trusting people. To avoid becoming a victim, become “media literate” — learn to differentiate between fact and fiction.
When you see the next fake fad diet on the cover of a magazine (coincidentally just inches away from the photo of a luscious chocolate cake), remember that if it sounds too good to be true, it probably is.
The fact is that you CAN handle the truth: Eat more calories than you need and you will gain weight; eat fewer calories than you need and you will lose weight.
Most importantly, check your belief system to stop engaging in fake fad diets. Perhaps it is as simple as A + B = C (Action + Belief = Consequence).
Watch your thoughts about food, as these thoughts become your actions with food. Watch your actions with food, as these become your food habits. Watch your habits with food, as these result in consequences to your body.
In the final analysis, throw fake fad diets into the garbage.
Make your thoughts about food healthy thoughts. Make your actions match your beliefs, and healthy habits will become second nature to help create vibrant health and a healthy body that is just right for you.
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In the Kitchen
Quick & Easy Cuisine
By Kate Otto, RD, LDN
Bariatric Dietitian at BIDMC
Simple to prepare yet chock-full of the nutrients you need, these breakfast and dinner recipes will save you time, whether you’re grabbing and going or need a break from washing dishes.
A higher-fiber, higher-protein way to enjoy a hearty bowl of oatmeal. Make right before bed and enjoy at home or take it with you in the morning.
1/4 - 1/2 cup uncooked rolled oats
1/4 - 1/2 cup fat free or low fat milk, or unsweetened nut or soy milk
2 spoonfuls of your favorite Greek yogurt (about half of an individual serving) — optional
Add-ins: fresh or frozen berries, sliced banana or apple chunks, 1-2 Tbsp defatted peanut flour, 1 Tbsp. chopped nuts, cinnamon, nutmeg, pumpkin pie spice, etc.
Combine oats, milk, and yogurt in a bowl, plastic container, or mason jar. Place in the fridge overnight. Add fruit at night or in the morning depending on your texture preference.
In the morning, sprinkle on your preferred toppings. Stir and enjoy!
*Adjust the amount of milk/yogurt to your liking. More yogurt will make a creamier version; less or no yogurt will be thinner, like traditional oats.
Blueberry Oatmeal Cookie Protein Smoothie
1 scoop vanilla protein powder*
2 spoonfuls of your favorite Greek yogurt (optional)
1/3-1/2 cup frozen wild blueberries
2 Tbsp uncooked rolled oats
3-4 ice cubes
Splash of water or milk to thin
Combine all ingredients in a blender, mix until combined. Pour into a to-go cup and enjoy.
*Ideally, the protein powder should have at least 15 grams of protein and less than 8 grams of sugar per 100 calories.
Honey Soy Salmon
1 1/2 Tbsp lower-sodium soy sauce or tamari
3 tsp olive oil, divided
1 Tbsp honey
1 Tbsp fresh lime juice (from 1 lime)
2 cloves garlic, minced and divided
1/2 tsp freshly grated ginger
4 (5 oz. each) skin-on salmon fillets
2 1/2 cups butternut squash, peeled and cubed
12 oz. Brussels sprouts, trimmed and halved
1/2 tsp kosher salt
1/2 tsp freshly ground black pepper
1/4 tsp smoked paprika
1 Tbsp sliced green onion
1 tsp sesame seeds
Preheat oven to 400°F. Coat a 13 x 18-inch half sheet pan with cooking spray.
Combine soy sauce, 1 tablespoon of the olive oil, honey, lime juice, 1 clove of garlic, and ginger in a large bowl. Add salmon and toss to coat. Set aside.
In a separate bowl, combine remaining 2 tablespoons of olive oil, remaining clove of garlic, butternut squash, Brussels sprouts, salt, pepper, and paprika. Toss to coat. Spread on baking sheet; avoid overcrowding. Bake for 12 minutes. Stir vegetables and push to edges of pan, creating an open center.
Place marinated salmon fillets in the open center space of pan. Pour any leftover marinade over salmon. Bake for 15 minutes. Top salmon with green onion and sesame seeds. Serve with squash and Brussels sprouts.
Recipe 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.