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Craving sushi? You likely will not be able to tolerate your favourite sushi rolls because of the rice and seaweed wrap, however there are several other equally satisfying options on every Asian-style restaurant menu to consider. Indulge in an order of tartar or sashimi. These rice-less options are easier to digest. Don’t be afraid to ask if your favourite sushi rolls can be made with a cucumber wrap instead of the traditional seaweed wrap. This is often a ‘low carb’ option on sushi menus. Order a side of edamame beans. These soybeans are not only a good source of protein, but they are also rich in fibre. Try a protein rich Asian soup. Asian-style restaurants often have a traditional soup with eggs, tofu, chicken, and/or shrimp. Prioritize the solid pieces and leave most of the broth behind. Salmon or tuna salad. Most sushi restaurants have a simple green salad with a seared piece of fish and a flavourful salad dressing. Sandwiches & Wraps· Choose a sandwich on toasted bread. If it is a large sandwich, remove the top piece of bread. Great options include: chicken salad, egg salad, tuna salad and deli meats. Wraps are also a good option. Opt for baked chicken rather than crispy chicken. Breakfast egg sandwiches Choose a breakfast wrap or a toasted english muffin sandwich. Skip the bacon and sausage. Salad Almost all restaurants now have a green salad with chicken. Again, opt for grilled chicken instead of crispy chicken. Other high protein options include: taco salads, chickpea salads and bean salads. Chili Whether you choose the vegetarian or meat version, chili packs a lot of protein. They are also very easy to digest making them the perfect option if you have recently transitioned to solid food. Here are some other helpful tips to challenge those old fast food habits: Skip the combo option… yes, even if it’s cheaper! Don’t order a drink. You will be less tempted to drink and eat at the same time if you don’t have a refreshing beverage staring you down during your meal. Eat in the restaurant instead of in the car. If you are driving and eating, food is more likely to block. You can’t be mindful if you are multitasking! Choose foods described as: grilled, baked, sautéed, broiled, steamed, boiled, etc. more often. These cooking methods are lower in calories. Many corner stores and gas stations now have ‘grab and go’ options in their fridges such as sandwiches, salads, protein shakes, yogurt parfaits, etc. Next time you get gas, make a mental note of 3 appropriate meal options you could choose if you were in a pinch. Bon appétit!- Lisa & Monica

Finding unflavored protein in a single serve packet will allow you to sample a brand without having to buy the larger container first. Single serve packets of whey protein isolate are available online with Bariatric Fusion, Jay Robb and Unjury. Whey protein powder is also found in the bulk bins at Sprouts Farmers Market. You can buy a small amount to taste test. Our patients have also liked the larger containers of unflavored whey protein by brands like Inspire , Isopure (GNC, online) and online (online). Keep in mind, whey protein must be kept under 140 degrees, otherwise, it will curdle. Soy protein isolate is also available. Brands include GNC and brands like NOW Foods and Genisoy, which are available online and some natural foods stores. These will be in larger containers. Sprouts Farmers Market also has soy protein in their bulk bins, so that you can buy a small amount to taste test. Sometimes you can get a sample taste of unflavored protein in stores that sell natural foods, supplements and sports nutrition products. Ask about the return policy if you don’t like the product. There are many other brands of unflavored protein powders on the market. If you have a group of bariatric buddies, perhaps the buddies can buy different brands to try and share. This cuts the cost of taste testing. May your protein status be awesome!

Another helpful addition is “Added Sugars”, which is found under the carbohydrate information. Naturally occurring sugars are primarily from fruit (fructose) and dairy (lactose). Vegetables and grains can also contain a small amount of naturally occurring sugar. For added sugars, look for the words sugar, syrup, agave, molasses, juice, beet sugar, brown sugar, turbinado and honey. Now that we have the total and added sugars, you can determine if the food or beverage is something you can work into your eating. While there are no formal guidelines, limiting foods and fluids to products that have less than 5 grams of added sugar is a starting point. A rule of thumb for carbohydrate foods is to eat the food that is closest to the farm. That means the least processed the better. For example, a peeled apple is better for you than applesauce. Applesauce is better for you than juice. One hundred percent real fruit juice is another way to say “sugar water” for bariatric patients. The Nutrition Facts Label will list naturally occurring sugars, but you won’t see added sugars listed. So, juice is a high sugar item. Your dietitian will assess your activity level, blood sugar readings, body composition and tolerances to help you find a healthy carbohydrate goal to work into your eating. We now have a better tool to hunt down the added sugars in our foods and beverages. Happy hunting!

Paralleling the increasing use of bariatric surgery, there is a high demand for body contouring through plastic surgery. If you’re just beginning down this path, the questions are many. Who will do my surgery? How is recovery? What can I expect? Choosing and Evaluating a Plastic Surgeon Many of the surgical procedures performed on the massive weight-loss patient are complex and labor-intensive. The wide spectrum of body contour deformities that can follow massive weight loss often exceed the magnitude of what plastic surgeons have traditionally addressed. That is why weight-loss surgery patients need to work with a surgeon who specializes in bariatric plastic surgery. Dr. Joseph F. Capella, a plastic surgeon in New Jersey, affirms: Post-bariatric body contouring is a relatively new area within the field of plastic surgery, in that bariatric surgery only has become popular in the last 10 to 15 years. And because of that, many surgeons have come through their training not having been exposed to post-bariatric body contouring. Because of that these surgeries are not considered traditional procedures, in the sense that they’ve been honed over decades like many of the other plastic surgery procedures. And so what plastic surgeons may do is use these more traditional procedures and apply them to the post-bariatric patient, which often will lead to sub-optimal results. So, it’s very helpful then, in that regard, to go to a plastic surgeon who has committed to this kind of surgery and does this surgery frequently — and this would be true for any kind of plastic surgery, for that matter. But what’s different about post-bariatric surgery contouring is it is relatively new, and probably greater than 50% or more of plastic surgeons out there right now did not have any exposure to it in their training. Obviously there are on-going conferences to educate surgeons but there’s a difference with having it as part of your training rather than learning about it from a lecture. Read Dr. Capella’s comprehensive list of criteria for choosing and evaluating a plastic surgeon. Healing Body and Mind After a Post-Weight Loss Body Lift Once you’ve removed the loose skin and sagging, is the journey over? Are you obstacle-free? Well, not quite. The Plastic Surgery Center in New Jersey says: You’ve been through a life-altering experience, and with that, your body and mind need time to heal and adjust. It’s important to acknowledge that, so you can assist in your own recovery and eventually move on … Recovery from body lift surgery is extensive, which sometimes catches people off guard. And it can be painful, depending on the extent of the surgery and your perception of pain. You should be prepared for swelling (or even numbness) that can last for weeks and sometimes even months. In fact, most surgeons say that complete recovery and final results take up to a year. Of course scarring is a fact of body lift surgery, and scars are particularly distinct up until the first year following the procedure. Many (if not most) people experience strong emotions following plastic surgery. While excitement and elation are a natural result of such a positive life change, it is also customary that an entire range of feelings can result, including a phenomenon called post-plastic surgery depression which can resemble post-partum depression. Recovery creates the time and opportunity to focus on these emotions. On the plus side, the surgical results of a body lift are apparent almost immediately. They will remain permanent if you are able to maintain a stable weight (although normal aging obviously results in physical changes). And, depending on the person, the body’s healing process should mitigate scarring. Read The Plastic Surgery Center’s great advice for healing body and mind after a post-weight loss body lift. Plastic Surgery Improves Appearance, Mobility, Health and Emotional Well-Being People may not be fully aware of the many benefits of plastic surgery after weight loss. There are aesthetic refinements in the appearance and improvements in functional mobility, as well as an increased sense of emotional well-being. Dr. Edward Domanskis, a plastic surgeon in California, says: I think that the benefits of plastic surgery after weight loss are tremendous. When you’re massively overweight it’s one problem. When you lose the weight I think a lot of times the patient doesn’t realize that the problems don’t really go away; it’s just a different problem. It’s a problem of all this hanging skin. And to some people that can be almost as much of a problem as being overweight and having all this excess fatty tissue — physiologically for sure. In my experience I think it [plastic surgery after weight loss] is a very, very satisfying type of surgery not only to the patient but also for the physician to see the transformation in the patient. To see the reaction of their friends and family to what they’ve gone through and how their overall appearance and psyche tend to change. There’s no question that these procedures are very. very beneficial to the patient. Watch Dr. Domanskis’ video segment, “What to Expect: Improving Appearance, Mobility, Health and Emotional Well-Being through Bariatric Plastic Surgery.”

Almost everyone needs protein supplements right after weight loss surgery. Protein shakes and powders give you the protein you need when you’re not allowed to eat solid foods. But which types should you choose? And should you keep using them when you’re eating solid foods and surgery is long behind you? Protein for the Liquid Phase of the Post Weight Loss Surgery Diet Progression After a day or two of sticking to clear liquids, you progress to a full liquid diet. You can be on this diet for a few days, if you’re a lap-band patient, or a couple of weeks, if you have the gastric sleeve or gastric bypass. Protein sources include the following. Non-fat milk, with 90 calories and 8 grams of protein per 8 ounces. Non-fat milk powder, with 100 calories and 10 grams of protein per ounce. Low-sugar protein powder, with 110 calories and 25 grams of protein per ounce. Low-sugar protein shakes, with 100 or more calories and 15 or more grams of protein per 8 ounces. Without supplementing your diet with protein shakes and powders, you’re not going to be able to hit your 60 to 80 grams of protein. Protein Powders and Shakes in the Pureed Foods Phase This phase is really a transition phase. You’re adding foods back into your diet, but aren’t yet ready to eat chewy, sticky, crunchy, or other solid foods. Protein foods include the following. Non-fat cottage cheese, with 12 grams of protein per half-cup. Non-fat ricotta cheese, with 5 grams of protein per half-cup. Egg whites, with 4 grams of protein per extra-large white. Non-fat Greek or regular yogurt, with 8 to 14 grams of protein per container. During this phase, your surgeon will probably have you start to decrease your use of protein shakes and powders, but will probably recommend keeping them in your diet to help you get to 60 to 80 grams of protein per day. You might need one or two shakes a day, plus powder in foods such as oatmeal, yogurt, or pureed potatoes. Be Wary of Protein Supplements in the Long-Term Protein shakes and powders can be convenient, but they’re not your best bet for long-term weight loss. As you progress from pureed foods to semi-solid and then solid foods, your surgeon will probably recommend that you stop drinking shakes and focus instead on solid sources of protein. They’re more substantial and satisfying than liquid shakes. They take longer to eat than drinking shakes. They’re easier to fit into a real-life eating plan. You won’t be “drinking your calories.” They have more natural nutrients than processed shakes and powders. Most weight loss surgery patients can get enough protein just by choosing one or two high-protein foods for each meal. You’ll get 60 to 80 grams with the following foods. Breakfast: 2 scrambled egg whites with ½ light English muffin and some fruit. Lunch: ½ cup fat-free cottage cheese and a green salad with 3 ounces of canned light tuna. Dinner: 3 ounces of chicken breast and steamed spinach. Snack 1: 1 low-fat cheese stick. Snack 2: 1 6-ounce container of plain low-fat yogurt and ½ cup carrot sticks. When Protein Supplements Are Okay Still, some weight loss surgery patients may still need protein shakes and powders in the long term. That’s often the case for vertical sleeve patients if your sleeve fills up too quickly to allow you to eat enough solid protein throughout the day. Talk to your surgeon to find out whether you should still use shakes and powders. Your surgeon might suggest that you include one or two protein shakes a day as snacks or mix protein powder into your yogurt, cereal or other foods. Protein supplements can still come in handy even if you’re able to meet your protein requirements on your daily weight loss surgery diet. If your routine gets interrupted, you might come up short. Consider the protein you can miss if you need to change your regular plans for a meal or snack. 10 grams of protein if you run out the door without grabbing your yogurt in the morning. 22 grams of protein if you forget to pack your tuna for lunch. 26 grams of protein if you’re stuck in a meeting instead of cooking your chicken dinner at home. When you’re stuck in the car or too busy to plan ahead, protein shakes can be lifesavers. On vacation, you can take protein powder with you so you’re always sure to have a source when you need it. You could also try Unjury Protein’d Cheese Sauce on steamed vegetables for an extra 21 grams of protein. Read the Nutrition Facts Panel to Find Protein Content The Food and Drug Administration lets food manufacturers call a food “a good source of” protein if it has at least 5 grams of protein. If a serving has at least 10 grams of protein, a food can be labeled “high,” “rich in,” or “an excellent source of” protein. That doesn’t do you much good if you’re trying to find a shake or powder with at least 15 to 20 grams of protein per serving. Don’t rely on a claim on the front of the label when you’re looking for a protein supplement. You could end up with a “high-protein” shake with only 10 grams of protein! Instead, check the nutrition facts panel to see how many grams of protein the food or shake has per serving. Check the Label for Calories and Sugar Protein shakes and powders can be high in calories and sugar. A bottle of Special K Protein has only 10 grams of protein, but 190 calories and 18 grams of sugar. A Pure Protein Frosty Chocolate Shake has 15 grams of protein, but 190 calories and 25 grams of sugar. A can of Boost High Protein drink has 15 grams of protein, 240 calories and 27 grams of sugars. No matter which stage of your weight loss surgery diet you’re on, you can’t afford to eat too many calories or too much sugar. The only way to protect yourself is to read the labels. Protein supplements can be great choices for boosting your intake to 60 to 80 grams a day. Shakes and powders can get you through the liquid and pureed foods stages of the post-surgery diet progression, and they can have a place in your diet even when you reach your long-term weight loss surgery diet plan. Just make sure not to overuse them if your surgeon is concerned, and to choose low-sugar options.

If so you might be an EMPATH. An empath is a person with the ability to sense the mental or emotional state of another individual. An empath can psychically feel the emotions, feelings, energy and even thoughts of others. A few common traits of an empath: Highly intuitive Emotionally sensitive (often labeled by others as “overly sensitive” or “too emotional”) Can feel in their own bodies the emotions of others Often absorb other people’s energy Frequently feels overwhelmed in crowds Typically have accurate initial gut feelings about people/situations Need a lot of alone time Have big hearts and can be taken advantage of Because they can see and sense problems (and what needs to be done to resolve them) in other people’s lives they often feel responsible to fix them. What’s all this got to do with food? If you are an empath there is a good chance you are not using food to manage YOUR energy but to manage OTHER PEOPLE’s energy. It’s like you are psychic/energy sponge who absorbs other people’s energy throughout the day, whether it be the co-worker who is cranky, the happy giggly girl in line at Target, your good friend who is going through a break up, or the heated political debates on television. When you unknowingly absorb these energies you can be left feeling anxious, drained, depressed, overwhelmed, and even confused by the end of what seemed to be a normal, productive ‘uneventful’ day. Such feelings can be a trigger to overeat. If you are familiar with emotional eating you KNOW that overeating is a good way to escape or calm such emotions. So what’s an empath to do to stop from picking up and taking on everyone else’s emotions? Start to notice energy. Notice how you feel in different situations, around various people. Connect to your body: does your body feel calm and relaxed around this person or uptight and anxious, do you have a knot in your stomach, are your shoulders scrunched, do you feel the need to be defensive, or do you feel calm and safe? Notice how you feel in a cluttered room vs. a bare room, how you feel listening to different music, how you feel when you wear certain colors, etc. Protect your energy; before you leave the house in the morning imagine yourself being protected by a sparkly white or golden bubble and the only thing that can penetrate this bubble is love and healing energy, no negative energy can get through this beautiful circle of light. If you’ve been around someone who’s uptight anxious or angry literally brush their energy off your body with your hand. Hold your hands about and inch away from your body and brush around your head, down your opposite arms, down your chest stomach and legs. Or even just shaking your hands down by your side with the intent of shaking off their energy can help. If you are in a conversation with someone who is angry or anxious you can imagine you are behind a one way mirror and everything they say just bounces right back to them, or imagine you are wearing a suit of teflon and everything they say just slides right off. Stretch your body (we hold emotions in our muscles… when you stretch it helps release stored emotions). Spend time in nature. Walk barefoot in the grass. Take a bath in epsom salt. Create a transition ritual for when come home from an event, or work, or school, etc. It can be something like deciding to change your shirt and while changing your shirt ask that any energies that you've absorbed that are not yours be released saying ”I now release any energies that I may have absorbed that are not mine. I send them to be transmuted to light and love and sent back to their rightful owner!” Spend time near water. Meditate. I am seeing this more and more in my practice that energy sensitive people often struggle with food or some other addiction as a way to manage all the intense emotions of the world these days. If this article resonates with you it is important to understand that this is very real and that you begin to truly honor your intuition and energy sensitivities. Then set out to learn positive self nurturing rituals to protect and heal you own energy. I will be offering Zoom groups to discuss emotional eating, eating as a reflection of self love and respect, and learning to notice and protect your energy. If you have any questions or comments do not hesitate to contact me!

Pumpkin also delivers a punch of potassium, a comely amount of copper, an interesting bit of iron, a pleasing amount of magnesium and a fair amount of fiber. A caution for bariatric patients is the 10 grams of carbohydrates found in a ½ cup pumpkin puree. And who doesn’t love carving Jack-O-Lanterns with your children (or just for you) for All Hallow’s Eve? Who has not posted adorable pictures of their kiddos in your local Pumpkin Patch? You can prepare your own pumpkin puree or stock up on the canned type. Perhaps our greatest love of pumpkin awaits us at Thanksgiving with our beloved pumpkin pie. One estimate says Americans eat 50 million pumpkin pies at Thanksgiving. Alas, a pie is known as a confection loaded with sugar and fat. What is the bariatric patient to do? Modify the recipe, of course! Lower the sugar and fat and pump up the protein is the goal. Try the Pumpkin Pie pudding recipe on the BariatricPal website. If you need a pumpkin treat before Thanksgiving, there are many pumpkin-flavored protein shakes, protein bars and yogurts in the stores right now. So, pumpkin can be a health partner this season. Enjoy!

With the New Year comes the New Year Resolutions. For many people, one of the largest resolutions is a change in lifestyle - that includes losing weight! I remember my resolution in 2012 was to lose weight and get healthy. And I was able to do that with the help of the vertical sleeve. 2015 is going to hold that for many people and thousands of people undergo weight loss surgery to help them achieve their healthy goals for the new year. For those of you that are just thinking about surgery, I want to encourage you to know that you are not alone! You have a wealth of resources at your fingertips. I wanted to take a moment to share with you some amazing resources that you may find helpful on your journey! Websites BariatricPal.com Of course, BariatricPal is one of the very best websites to find information and support. Here there are “rooms” geared for each surgery as well as pages for recipes, articles, and much more. You will find information on everything you might want to know from before surgery to years after. I suggest checking out the Before/After pages for a good dose of motivation and inspiration! 7BitesShow.com 7 Bites is the first cooking series on YouTube geared specifically toward the bariatric community. The website has videos, recipes and blog posts. weightlosssurgerychannel.com Weight Loss Surgery Channel has a collection of videos on everything WLS related weather it be health, food and recipes, and more. BariatricFoodie The Bariatric Foodie has some great recipes for those that still love food, but want to stay on track TheWorldAccordingToEggface Eggface is one of the most popular of the bariatric cooking blogs. You will find great recipes, blog posts and giveaways on her blog. BariatricCookery.com This is a great resource page for everything from recipes to products. Books The “Big Book” series by Alex Breacher and Natalie Stein. There are four books in the series and all are great reads. They have a wealth of information on everything you need to know before, during and after surgery. The very best thing about these books is that they include personal stories from people that have been there. Breaking The Chains: A Guide To Bariatric Surgery by Jennifer DeMoss and Suzette Munson. The ladies of 7Bites pull from their and others’ experiences with weight loss surgery to provide a simplified, but comprehensive guide. Information on everything from how to pick your surgery and doctor to how to survive the first two weeks after surgery are included. The Sleeved Life by Pennie Nicola. This book tells about Pennie’s experience with the Vertical Sleeve procedure and discusses the ins and outs of the surgery from start to finish. Weight Loss Surgery For Dummies. The everything you ever wanted to know and then some guide to all things weight loss surgery. Many, MANY doctors and nurses recommend this book to their patients. Another great resource not listed here is your local bariatric support group! If you haven’t found one yet, contact your Surgery Center of Excellence or your nutritionist, they should be able to give you a good idea of one or two in your area. Or you can check out the list here on Bariatric Pal - it’s a very comprehensive list of support groups around the world!

The 3rd Annual National Obesity Care Week (NOCW), October 29th through November 4th, seeks to ignite a national movement to ensure anyone affected by obesity receives respectful and comprehensive care. [Insert your organization’s name] is proud to join the Campaign, which was founded by The Obesity Society, the Obesity Action Coalition, Strategies to Overcome and Prevent Obesity Alliance and the American Society for Metabolic and Bariatric Surgery. All NOCW supporters recognize the 5 Reasons to Care: Obesity is a serious disease. Weight bias is faced by many. Healthcare providers need to have positive, helpful conversations about weight with their patients Science-based weight management options are available for treatment. We need your help passing the 2017 Treat and Reduce Obesity Act (TROA). Although we must educate people about these 5 reasons to care, we must also address barriers to care, such as weight bias in both society and among the medical community. We need more voices – your voice – to reach our goal of achieving better care. You can join us and take action to change the way that you care about obesity by taking the Take 5 Pledge. The Take 5 Pledge is intended to inspire action by addressing the 5 reasons to care and encourage us to change the way that we care about obesity. More information about National Obesity Care Week and their Take 5 Pledge, including information and resources, is available on www.ObesityCareWeek.org. Mark your calendars, and join us in recognizing National Obesity Care Week, October 29th – November 4th.

The Struggle Often Continues For some patients, Weight Loss Surgery can lower your interest in food, so you are not constantly thinking about it. There’s no question Weight Loss Surgery can help you gain control of your eating, but it’s unlikely to eliminate your struggles with food disappear. A few lucky Weight Loss Surgery patients really do stop being tempted by food. The rest, who make up the vast majority of Weight Loss Surgery patients, continue to struggle. You still may be hungry, enjoy salt, fat, starch, or sugar, or be tempted to use food as an emotional crutch. Your family members may continue to insist on keeping high-calorie foods in the house, or pressure you to eat things you shouldn’t. Your friends may still be going out to eat and inviting you to join them in ordering high-fat, high-sugar items. “Why Me?” Isn’t Appropriate It’s easy, even natural, to think of yourself as unlucky. Why should you have to struggle with food? Why should you have to monitor every bite you take, while some people don’t? The fact is, almost everyone does. Ask almost any skinny person how they stay skinny, and you’ll get some variation of the same answer: “I work hard for it.” Just like you, they are aware of what goes into their bodies. They sometimes may be hungry; they sometimes may want to eat more than they should. But they, like you now, take responsibility for their decisions. They may: Skimp on portions if they over ate at the previous meal. Choose healthy foods first. Have a strategy for dealing with emotions and boredom that doesn’t involve eating. Have a support system that promotes healthy behaviors. Accept It and Manage It If you find you still have a rocky relationship with food after weight loss surgery, don’t conclude that WLS didn’t work for you. Instead, accept that you will need to fight the cravings and urges for months, years, or life, and start making a plan. Don’t be afraid to ask for help in developing strategies – whether you ask other BariatricPal members or an always-thin person you admire! Persist in Order to Get the Answers You Need We all want to be able to trust our doctors. You want to believe your surgeon takes care of all aspects of your Weight Loss Surgery, including your post-op, long-term nutrition. But it doesn’t always happen like that. Nutritional counseling may not be part of your surgery package, or you may only get a limited amount of generic information. Or, your surgeon may simply not know how to help you nutritionally. Remember that many doctors have no more than an hour of nutrition education in medical school. To become a weight loss surgeon, doctors need to learn surgery. There is no dietary education requirement. If you need help finding strategies to satisfy hunger – physical or head hunger – and your surgeon and primary care doctor are not able to help, keep looking. A session with a nutritionist may be more affordable than you think, and worth every penny. Your Emotional Support System and Your Relationship with Food The support system you built so carefully can come in handy right about now. Take advantage of your ability to talk to a therapist or psychologist if you have one to bring up your concerns. Discussing your ongoing struggles with portion sizes, food choices, and over-frequent nibbling with a mental health professional can help you come up with some strategies that work for you. Group sessions are also appropriate forums to talk about food struggles and strategies. Though it may feel embarrassing at first to admit you’re still thinking about food a lot, you will find nearly everyone in that room did or does have that same experience. Most Weight Loss Surgery patients do not find their surgery instantly eliminates their food struggles. You can take months or years to come to terms with a food addiction, and it may be something you need to learn to live with for life, but in a healthier manner than before Weight Loss Surgery. Be honest with yourself and those around you, and be open to suggestions, and you can figure out strategies that work for you. Do not assume WLS did not work for you!