Setting and Acheiving Your Fitness Goals

As the New Year approaches, many people begin to create "resolutions" on things we want to do or improve in our lives as the new year arrives.  Although we have a couple of months, 60 days to be exact, to think about these resolutions it can be difficult to plan for what we really CAN accomplish. 


Here are 10 tips to stay motivated in achieving your fitness goals:

• Set Goals - start with simple goals and work up to long range goals
• Start Slowly - if you start too fast or hard, you are at risk for injury
• Think Variety - your body gets used to repetition, change things up often
• Have Fun - exercise doesn't have to be drudgery, find something you enjoy
• Daily Routine - schedule workouts, be creative, be active all the time
• Put it On Paper - stay motivated by seeing your results in writing
• Seek Support - you're not in this alone, find a workout buddy or class
• Track your Progress - keep a log to show progress & improvements needed
• Reward Yourself - internal and external rewards keep you motivated
• Be Flexible - if you need a break, take one. But get right back on track!

SMART Goals

Specific
Measurable
Attainable
Realistic
Timely


Here's an example sheet to help keep up with your Goals weekly and also to encourage rewarding or not if those goals are met! Click here for the worksheet! Make sure you make copies and share with friends or family!


Never act until you have clearly answered the question: "What happens if I do nothing?" ~ Robert Brault

Walk From Obesity



Here's some background information for the upcoming Walk From Obesity being held at the Vidant Wellness Center in Greenville NC on 10/27/12 at 9:00am. Registration starts at 8:30am

Walk to Make a Difference!

YOU can really make a difference in the lives of those touched by obesity. While advances have been made in the prevention and treatment of obesity, more remains to be done. It is estimated that nearly 93 million Americans are affected by obesity and that number is predicted to climb to 120 million in the next five years.

There is hardly a family anywhere that hasn't in some way been affected by obesity related illnesses. The Walk from Obesity combines an enjoyable event with the potential to raise significant sums for the fight against obesity.

You do not need to walk to participate - you can cheer on the walkers as well. Please take a moment and browse our Web site. The "Resources" section contains information on hosting a walk, the Walk from Obesity cookbook and much more. If you have any questions, please email us at info@walkfromobesity.com. We thank YOU for your support of the Walk from Obesity!



Physicians East Surgical Weight Loss Center will forming a team to walk in the event and will be posting more information soon on how to join our team or you can create your own team by visiting www.walkfromobesity.com and signing up on their website.

We look forward to seeing you all at the Walk from Obesity and remember EVERY STEP DOES COUNT!!!

Dumping Syndrome: What It Is and How To Avoid It!

If you're planning gastric bypass surgery you need to know what dumping syndrome is and how to avoid it!

This lovely sounding syndrome results from the rapid passage (or "dumping") of undigested food into the small intestine, causing a rapid shift of fluid as the body tries to "dilute" the contents of the intestine. This shift in fluid causes cramping and diarrhea and can also result in a drop in blood pressure, causing weakness and sweating.

Why does gastric bypass make this possible?

Well, as a result of the surgery, you no longer have the valve that regulates how fast food empties out of the stomach. The surgery also causes food to enter the gastrointestinal tract at a point lower down than it's supposed to due to the first part of the small intestine having been "bypassed."

That first part of the small intestine is where sugars normally are metabolized. So basically you're now dumping sugar lower in the intestines, where they aren't equipped to handle it. The result: your body rebels!

Translation...

...eat the wrong thing and you can feel really really sick for many hours.

Here's one patient's account of what dumping syndome feels like:

Shortly after eating a food I don’t tolerate (sugar, milk, sugary milk products or starchy carbs) I begin to feel a bit disoriented, maybe dizzy and then an overall sense of confusion or panic takes over my mind and body. This is a mild state of delirium. Then I begin sweating. Profuse sweating that can completely soak my hair, my clothes; it drips and glistens on my skin. During this state of sweaty panic I feel like I’m out of my mind! A few times during extremely dramatic dumping episodes I literally thought I was dying, the state of distress was that severe.

Dumping syndrome can cause diarrhea, nausea, vomiting, increased heart rate, sweating and cramping. Symptoms can occur immediately ("early dumping") or 1-3 hours after eating ("late dumping").

Causes of Dumping Syndrome

• Eating sweets or foods high in sugar
• Eating too much at one meal
• Having solids and fluids together
• Eating foods that are fried, fatty, or greasy

How To Avoid Dumping Syndrome

• Avoid/limit concentrated sugars like cookies, cake, pies, sugar, and syrup.
• Read food labels for sugar content. Avoid foods with sugar listed among the first three ingredients.
• Eat six small meals daily instead of three large meals.
• Eat slowly.
• Avoid eating and drinking at the same time. Wait 30 minutes before and after a meal to drink fluids. Drink low sugar beverages only.

A Note About Sugar

"Sugar Free" foods and drinks often contain sugar alcohols which may not be well tolerated either. So note:

Words ending in -ose are generally forms of sugar.

The following is a list of sugars and sugar alcohols to try to avoid:

• barley malt
• brown sugar
• cane sugar
• confectioner's sugar
• corn syrup
• corn sweeteners
• dextrose
• fructose
• glucose
• granulated sugar
• honey
• high fructose corn syrup
• invert sugar
• isomalt
• lactose
• lactitol
• levulose
• maltose
• mannitol
• maple syrup
• molasses
• raw sugar
• sorghum
• sucrose
• sorbitol
• turbinado
• table sugar
• xylitol

While dumping sydrome is certainly no fun to experience, the negative feedback is often a convincing motivator to stick to your post weight loss surgery diet guidelines! If you'd always wished your dentist could have just pulled out that "sweet tooth," this could be the next best thing.

I've had patient after patient tell me how their addiction to sugar was instantly broken after experiencing dumping syndrome.

Foods Best Tolerated After Gastric Bypass Surgery

• Grains: plain breads, buns, bagels, and crackers, unsweetened cereals, pasta, rice
• Vegetables: All
• Meats/meatless protein: meat, poultry, fish, beans, peanut butter, protein powder/protein shakes
• Dairy: 1%, 2% or skim milk, lowfat buttermilk, lowfat cheese, sugar-free pudding, yogurt sweetened with sugar substitute.
• Fats: butter, cream, margarine, oils, fats, mayonnaise, salad dressings...IN MODERATION
• Sweets: sugar-free gelatin or custard, sugar free ice cream, sugar substitutes.
• Beverages: water, tea, coffee, diet soda, sugar free beverages

Foods Less Tolerated After Gastric Bypass Surgery

• Grains: sweetened cereals; donuts and sweet rolls.
• Fruits: frozen or dried fruit, fruit cooked or canned with sugar, sweetened fruit juice, prune juice
• Vegetables: none
• Dairy: Whole milk, malted or chocolate milk, sweetened custard, pudding, or yogurt
• Fats/Oils: Okay, but easy does it!
• Sweets: Cakes, cookies, pies, pastries, puddings, sherbert, ice cream, milkshakes, gelatin, candy, sugar, jams, jellies, honey, syrup (you know...all the yummies!)
• Beverages: regular soda, sweetened drink mixes and tea, Koolaid, fruit drinks, and punch

Hair Loss After Gastric Bypass: Tips For Losing Less And Regrowing More Faster

One of the biggest concerns many people have – especially ladies – about having gastric bypass surgery is hair loss.

It can be very traumatic to see clumps of hair in the shower drain, or to run your fingers through your hair and come out with a handful. Especially since for many of us, our hair was one of the few things we really liked about ourselves before surgery.

We wonder: How much hair will I lose? Will I go bald or have bald spots? And how quickly will it grow back?

Most importantly: What can I do to minimize hair loss and maximize regrowth?

How To Minimize Hair Loss After Gastric Bypass Surgery

Since the biggest reason we lose hair after surgery seems to be a lack of nutrients getting to our hair follicles, then it makes sense that getting more nutrients to our hair will minimize hair loss.

Nothing will keep you from losing any hair at all. Even without weight loss surgery, you lose a certain number of hairs every day. Afterwards, you’re going to lose more. It cannot be prevented.

But there are things you can do that seem to help. First off, be sure you’re getting all of your protein. We recommended 60 grams or more a day. We've found 80 to be a better number, both for weight loss and for your hair. (Many other doctors recommend 80 as a minimum.)

Hair is built with protein. That’s what it’s made of. So making sure you’re taking in enough protein will help keep your hair healthy. At least, healthier.

The two most effective supplements for hair regrowth (at least according to the buzz on WLS forums and message boards) are Silica by Puritans Pride and Biotin.

The two most effective supplements for hair regrowth (at least according to the buzz on WLS forums and message boards) are Silica by Puritans Pride and Biotin.

The bottom line is that you’re going to lose some hair after gastric bypass surgery. But you really can minimize that loss, and help regrowth happen faster by taking good care of your hair.

 

Why We Lose Hair After Weight Loss Surgery

First of all, everyone loses hair every day as part of the natural cycle of hair growth.

But after weight loss surgery, our bodies are forced to live on drastically lower amounts of calories. To compensate for the reduction, all the remaining nutrients are channeled to the organs that need them most. And our hair isn’t one of them.

So suddenly, our hair must do without the nutrients it needs to grow. And it also has to compensate for that loss. It sends more strands into “resting” phases and temporarily suspends production of new strands.

Not to mention the fact that hormones go haywire after surgery and while all that fat is being metabolized. That just doesn’t help matters.

The upshot: hair starts falling out.

Fun Recipes for Summer....And Easy Too!!

One of the best parts of summer is being able to roll out the grill and pick items from the garden to eat that are yummy and still healthy. Here are some easy and delicious recipes for you to try at home for your friends and family.

Salmon with Gingered Teriyaki Sauce
by Lucinda
Page 136, Neighborhood Cookbook
nonstick cooking spray
2 Tablespoons teriyaki sauce
1/2 teaspoon ground ginger
3 teaspoons fresh cilantro, chopped
4 (4-ounce) salmon filets, about an inch thick
4 (1-inch thick) slices fresh pineapple, cut in half
Preheat oven to 450F. Lightly coat a large shallow banking pan with nonstick cooking spray. In a small bowl combine teriyaki sauce, ginger and cilantro. Set aside. Rinse fish; pat dry with paper towels. Place salmon and pineapple in baking pan. Brush with teriyaki mixture. Bake uncovered for 10-12 minutes or until fish flakes easily with a fork.
Nutrition: serves 4. Per serving: 194 calories, 24 grams protein, 4 grams fat (1 saturated) 15 grams carbohydrate and 1 gram dietary fiber.


Fresh Tomato and Cucumber Salad
2 1/2 cups cucumbers -- peeled, quartered and cut in 1/2" cubes
1 1/2 cups tomatoes -- quartered and cut in 1/2" cubes
1/4 cup fresh chives -- minced
1/4 teaspoon salt
1/4 teaspoon freshly ground black pepper
1/2 cup Italian dressing, low fat
Mix together all ingredients and chill at least one hour before serving. There are so many things you can add to this deliciously fresh salad. Any fresh vegetable that you like either raw or blanched like asparagus or broccoli, red onions, chopped baby green beans (also known as Haricot Verts), sprouts of any kind and the list goes on and on. For the dressing, try your favorite. In my house, this is the classic "Spring Salad" that lets everyone know it is time for great, tender vegetables on the table.
Makes 4 servings, each serving provides: 24 Calories; trace Fat (10.8% calories from fat); 1g Protein; 5g Carbohydrate; 1g Dietary Fiber; 0mg Cholesterol; 142mg Sodium. Exchanges: 0 Grain(Starch); 1 Vegetable; 0 Fat.

For more great recipes like these make sure to visit this website,  Living After Weight Loss Site. Have a great weekend!

EXERCISE AND BARIATRIC SURGERY



Exercise is an important part of a successful gastric bypass surgery. Done properly and under supervision, exercise speeds healing and recovery. Getting started on any post surgical exercise program is difficult. It may be even more difficult for people who were unaccustomed or unable to exercise previously due to excessive weight. If you create an exercise program based on your likes and dislikes and work at it a little each day, you will be more likely to stick with it over the long haul.  Here are some helpful tips to create your own personal exercise program to assist with your weight loss success:

1. Discuss all exercises, from the first day of stretching onward, with your doctor. You will want to exercise as soon as possible, but don't rush into against your doctor's advice.
2. Acknowledge that lack of exercise may have contributed to your weight problem.
3. Commit to making a daily exercise program part of your lifestyle after gastric bypass surgery.
4. Start slowly. With your doctor's consent, try a few light stretches in bed the morning after your surgery.
5. Begin to exercise as soon as possible. Barring complications, you should be up and taking a few steps the day after your surgery.
6. Walk, walk, walk during the initial recovery period. Walk several times a day, even if you can only last for two or three minutes. Until your doctor gives the OK, walk on flat even surfaces, not grades.
7. Avoid abdominal exercises until they have been approved by your doctor--usually at least four to six weeks after surgery.
8. Burn fat, not muscle. Your body will be getting fewer calories after your surgery. To replace the lost energy, a sedentary body may burn muscle rather than fat. Exercise will burn fat.
9. Create a multi-front plan that keeps you interested and provides comprehensive exercise, including cardiovascular, aerobic, flexibility and endurance portions.
10. Lift weights after your doctor has informed you that your wounds are sufficiently healed. Gastric bypass patients are at greater risk for osteoporosis. Weight bearing exercise is a great way to battle bone loss
11. Enroll in a water aerobics class after your doctor has released you to be in water. Swimming really works the abdominal muscles, so delay actually doing that until you have received the go ahead from your physician.

Read more: How to Create an Exercise Program After Gastric Bypass Surgery | eHow.com http://www.ehow.com/how_2052201_create-exercise-program-after-gastric.html#ixzz1v2r1IbS4

Vitamin/Mineral Supplement for Bariatric Surgery Patients

Gastric Bypass and other types of Bariatric Surgery dramatically alter your body's ability to absorb vitamins, minerals, and nutrients from the smaller amounts of food you are eating. The resulting vitamin and mineral deficiencies can have serious medical implications.

Vitamins and minerals contribute to your post bariatric surgery health in a number of ways, including the regulation of the metabolism and helping with the release of energy from the food you digest. In comparison to nutrients like protein, carbohydrates and fat, vitamins and minerals are needed in much smaller amounts by your body. Vitamins are classified as either water-soluble or fat-soluble. Water-soluble vitamins cannot be stored in the body and must be taken every day. Water-soluble vitamins include the B vitamins and Vitamin C. On the other hand, fat-soluble vitamins are stored in the body's fat and include vitamins A, D, E and K. Minerals are needed by your body for the proper composition of body fluids, maintaining healthy bones and teeth, formulation of healthy blood, regulation of heart, muscle and nerve functions.

As a bariatric surgery patient, it is absolutely essential that you take a good quality multiple vitamin and mineral product daily, for the rest of your life. You will also need to take additional calcium, Vitamin B-12 and perhaps Iron supplements. In some cases, Vitamin C and Zinc (optional) supplementation may also be appropriate. Although the specific amounts and types of vitamin and mineral supplements may vary by bariatric practice, bariatric surgeons and dietitians agree that these supplements are necessary to prevent vitamin and mineral deficiencies after bariatric surgery.

There are a variety of high quality vitamin and mineral supplements that will meet the needs of the bariatric surgery patient. If you have difficulty tolerating any of the supplements, make sure to call your dietitian of surgeon for suggestions. Consult with your bariatric health care provider before taking vitamin and mineral supplements.

Supplement	Type	Function	Schedule	Interactions
Multi-Vitamin and Mineral	Chewable or complete one-a-day multi vitamin/mineral supplement.	Multi-vitamin/mineral supplements ensure that you are getting enough of all of the micronutrients you need.	Take one to three times a day with meals or as directed by your doctor.	None
Vitamin B-12	Sublingual Vitamin B-12 tablet, (at least 500 mcg per tablet) each day, or injectable B-12 (1,000 mcg) per month.	Helps with proper blood cell formation and nerve function. Deficiency may cause certain types of anemia.	Take one sublingual tablet daily, or as directed by your doctor. Allow tablet to dissolve in under the tongue.	None
Calcium	Chewable or crushable Calcium Citrate (500 mg, two to three times a day) Calcium Citrate is recommended due to it's superior absorption, without requiring stomach acid. A calcium citrate supplement that includes Vitamin D will also aid absorption.	Builds and maintains bone strength. Also helps the heart pump and muscles contract properly. Helps with proper blood clotting and aids in the repair of soft tissue.	Take 500-600 mg doses two to three times per day for a total of 1,000 to 1,800 mg per day, or as directed by your doctor. Take one hour apart from other vitamins and minerals (especially iron).	Do not take at the same time as iron. Calcium competes with iron for absorption. Caffeinated products, spinach and whole wheat products may also decrease absorption.
Iron	Tablets, chewables or liquids.	Vital to the formation of red blood cells tht provide oxygen to the human body. Prevents anemia.	Take daily as directed by your doctor. Take with vitamin C to aid in absoption.	Do not take at the same time as calcium. Iron competes with calcium for absorption.
Vitamin C	500 mg tablets or chewables.	Promotes wound healing and reduces chance of infection. Aids in body's calcium levels and bone formation. Enhances iron absoption.	Take as directed by your doctor. Take with iron.	Certain antacids may interfere with absorption.
Zinc	Optional. Tablets or lozenges.	Helps with wound healing and supports the immune system. Loss of hair may indicate a Zinc deficiency.	Take 10 to 20 mg per day or as directed by your doctor.	Too much zinc may interfere with the absorption of other nutrients.

Information provided from http://www.bariatricchoice.com/

10,000 Steps a Day Helps Keep the Pounds Away

Did you know an average person's stride length is approximately 2.5 feet long? This information was researched on a website known as The Walking Site to see the health benefit of walking 10,000 steps a day and different ways to use a pedometer to help improve your overall health. 

A sedentary person may only average 1,000 to 3,000 steps a day, but a reasonable goal for most individuals is 500 steps per day until you reach 10,000 steps per day. 



Wearing a pedometer is an easy way to track your steps each day, and you can obtain one for free by asking a staff member in the surgery department of Physicians East.   Start by wearing the pedometer every day for one week starting first thing in the morning when you get up and wear it until bedtime.  Record your daily steps in a log or notebook to keep track of your daily number to reach that goal of 10,000 steps daily. 

There are many ways to increase your daily steps. Some examples are:

• take a walk with your friend, child, or spouse
• Walk the dog
• Use the stairs instead of the elevator
• Park farther from the store
• Get up to change the channel instead of using the remote
• Window shop
• Plan a walking meeting
• Walk over to visit a neighbor
• Go outside and walk around the garden or do a little weeding

Continue to track your daily steps and mileage, and keep notes on how you feel and your progress being made each day.  If you are in very poor physical health and feel you progressing too rapidly slow down and try smaller increases or check with your physician prior to starting your exercise routine.

Information provided from The Walking Site at www.thewalkingsite.com/10000steps.html

Six Success Habits for Weight Loss Surgery

These 6 habits will help encourage appropriate behaviors to increase the likelihood of a long term weight loss success.

PERSONAL ACCOUNTABILITY

• Measuring and recording weight on a regular basis (Use the journal provided at your preop appt or come by our office to pick up one for FREE)
• Setting appropriate weight loss goals

PORTION CONTROL

• Stomach size changes
• Recognizing satiety
• Adopting good eating habits
• The dangers of grazing

NUTRITION

• The power of protein
• The value of veggies
• Understanding carbohydrates
• The skinny on fat

FLUID INTAKE

• Eating and drinking at the same time
• Guidelines around alcohol consumptions
• The importance of water
• The dangers of dehydration
• The dangers of carbonation

REGULAR EXERCISE

• Target heart rate
• Exercise frequency
• Exercise for what ails you

VITAMINS & MINERALS

• Vitamins (Check out Medical Park Pharmacy for our list of vitamins recommended)
• Understanding the need for calcium
• The importance of B12
• Annual check up and bloodwork

As always making sure you can make wise decisions on what is best for your body and individual situation with weight loss will affect your success. You are the one who controls how successful you will be! Happy weekend!

Healthy Restaurant Meal Planning

 vs     

You know which one is the better choice, but most times patients have difficulty making the right choice when it comes to the temptations when eating out in restaurants. Here are some helpful tips from our nutritionists, Bridget Turrone and Mary Warner, to assist with planning a healthier meal when eating out.

¨ Use the following websites and resources to help determine the nutrition content of various restaurant foods:

¨      The Calorie King Book, Allen Borushek-  May be purchased at Barnes and Noble

¨      http://www.calorieking.com/

¨      If you own a Smartphone use can download free restaurant apps





¨  Select  lean protein foods first at all meals and snacks.  Trim Visible fat from meat and remove the skin from the poultry. 

¨      Try and have your meal planned before you go out to eat so you will not be tempted to make an unhealthy food choice once you get to the restaurant.

¨  Ask the server to pack up half of the meal before he or she brings it to you. Remember that even half of a restaurant sized-meal may be too much food for you after surgery.  Recommend no more than 1 cup per meal.

¨      Obtain a Restaurant Card from Physicians East Bariatric Coordinator or Registered Dietitian. - 252-413-6683 (Nutrition Dept)

¨  Share the meal with a friend or family member.

¨ Have your server put all sauces and dressings on the side because these may be high fat or high sugar.

¨ Avoid the chips or bread before the entrée arrives since these are a low in protein.  If you fill up on starchy foods you will not leave enough room in your stomach for healthy protein foods.

¨ Select moist and tender foods.   Dry, tough foods are difficult to tolerate.

¨ Do not try new foods for the first time while eating out. Try these at home to prevent an uncomfortable situation.

¨  Avoid any breaded and fried foods as they will provide extra calories and fat.

¨      High Fat Terms to Avoid include: 

Battered

Fried

Basted in it’s own Gravy

Hollandaise Sauce

Beer Battered

Cheese Sauce Sauté

Crispy

Pan-fried

¨      Low Fat Terms to choose from: 

Broiled or Baked

Roasted

Grilled

Steamed

Charbroiled



All these are great tips to help patients to successfully eat healthy at restaurants, but it takes will power as well and picking locations ahead of time that you know you can pick items on the menu that are appropriate to your weight loss plan.  If you or anyone you know would like more information on healthy meal planning please schedule an appointment with our nutritionists, Bridget Turrone or Mary Warner, at 252-413-6683.  Good luck and healthy eating!!



FOOD LABELS: HOW TO READ AND UNDERSTAND THEM

Have you ever tried to chose foods that are good for you by reading the labels located on the back or side of foods?  If you have then you know how frustrating and confusing it can be to figure out what you should be looking for.......calories, fat, or fiber???  Here's is an article our nutritionists, Bridget Turrone and Mary Warner,  provided to help you read and understand food labels better when it comes to chosing the right foods to help you with your weight loss. 

Serving Size/Servings Per Container:  Look at this very carefully!  In many cases the package will contain more than 1 serving.  For example: in the food label below, if you ate 4 crackers, you are eating 2 servings and will have to multiple the calories, fat, etc by 2. 

                                                                                                                                               

Calories:  Check the calories to see if this food item fits into your total daily calories.  Your Dietitian or Surgeon will determine the amount of calories you are to have after Bariatric Surgery.  In most cases, we recommend no more than 1200 calories per day one year post operative.

Protein:  Make sure to always check grams of protein on the food label.  Try and consume 60-80 grams of protein per day!

Total Fat:  Recommend no more than 8-10 grams of total fat per meal.   Limit amounts of saturated, trans fats, and cholesterol as these are unhealthy. 

Sodium:  Limit to no more than 1500-2000 mg per day. 

Total Carbohydrate:  Most patients should not exceed 25-30 grams of carbohydrates per meal, 10-15 grams of carbohydrates per snack, and no more than 5 grams of carbohydrates per beverage.   Avoid simple carbohydrates such as candy, pie, cake, etc as they may promote dumping syndrome.

Sugars:  Avoid any products with added sugars.  Avoid foods with 5-10 grams of sugar per serving to help prevent dumping syndrome or hypoglycemia. 

Sugar Alcohols (i.e. sorbitol, xylitol):  Limit to no more than 10 grams per serving because these may have a laxative effect.

Dietary Fiber: Aim for products that have at least 3-5 grams of fiber per serving.

If you are interested in meeting with one of our wonderful nutritionists to assist in helping you with information like this please 252-413-6683 to schedule an appointment with Bridget Turrone, RD, LDN & Mary Warner, RD, LDN, Physicians East Registered Dietitians. They look forward to assisting you in reaching your weight loss goals!