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!  

GET UP AND GET MOVING!

Exercise is an important key when it comes to bariatric surgery and weight loss.  Its something you love or hate but regardless you have to do it to be successful in reaching your weight loss goals.  Some patients turn to gym memberships and use the equipment as their source of exercise or hire a personal trainer to assist them in learning what to do and having to "answer to someone" is the only way they will definately get it done.  Then there are individuals who want to exercise in a more fun, nontraditional way and attend classes for Pilates, Zumba, Kickboxing, and Aerobics similar to the craze of Jazzercise back in the 80s and 90s but with a kick! Check out some videos I found giving examples of a few ways you can lose weight and make it fun!

Zumba

Check out your local gyms for classes in your area.

Pilates

Check out local gyms to find classes in your area.

Regardless of how you decide to work out it is important to come up with a plan that works for you and your body.  Those individuals who work out after bariatric surgery has a larger success rate and weight loss after surgery then those individuals who do only the minimal requirements. Remember bariatric surgery is a LIFESTYLE CHANGE not a quick fix, and is only as successful as you allow it to be!

Finally I leave you with a few tips for becoming more active:

• Use a Pedometer it helps you track how many steps you take in a day, also giving you  a goal to reach of 10,000 steps per day - If you are a patient of ours we offer these to you free, just ask!
• Find a workout buddy to keep you motivated
• Mix it up - do different things to keep it fun!
• If you have joint pain, consider water aerobics and working with a physical therapist to find a way to be active that won't cause pain or injury.

Tell us how your staying active before, during, and after bariatric surgery.