This is part two of several on the questions that should be considered when looking into a weight loss program. The National Institute of Diabetes and Digestive and Kidney lists the following questions they feel you should ask as you search for a weight loss program.
What are the staff qualifications?Because
Clarian Bariatrics is a surgical weight loss program, this is not as big an issue as it would be in a weight loss clinic. You can be sure here that you are followed by qualified, board certified medical doctors and nurses who are well trained and have a great deal of experience in surgical weigh loss.
Who supervises the program?Terri Hohlt, MSN, RN, is the Program Administrator. Terri has 30 years of nursing experience with Clarian Health. Her role is to keep an overview of the whole program. She hires the staff, keeps the program on budget, makes sure the physicians and staff have what they need provide top of the line care to our Indiana bariatric patients. Terri continually monitors all aspects of the program to assure we provide the quality care each person deserves.
The medical director of the program is Samer Mattar, MD, who is board certified surgeon. Dr. Mattar has received special training in advanced laparoscopy surgery at Emory University Hospital. He is also a member of the American College of Surgeons, the American Society of Bariatric Surgeons, and several other professional organizations. The medical director's role is to ensure that all patients receive the highest quality medical care available.
In addition to the above, the Clarian Bariatrics surgery program provides a “complete package” program with weight loss support provided by a full staff of highly trained, licensed, board certified Dietitians who specialize in weight loss and the health problems caused by obesity. We also have a Bariatrics Behavioral Medicine department headed up by Clinical Psychologist William Hilgendorf, PhD, HSPP. His staff helps to support your surgical weight loss effort with a variety of group sessions geared specifically to bariatric patients.
What type of weight-management training, experience, education, and certifications does the staff have? You can see from the list above that this program is serious about providing you top of the line quality care. In addition to the above highly trained staff, other members of the team are patients of this bariatric surgery center with the deepest understanding of the program, and patients concerns, and struggles. They have insights that only someone who has been there can provide, that adds to their qualifications for the position they have at this Indianapolis Weight loss clinic.
Want to learn more? Then join us at a FREE informational seminar. Dates can be found by clicking on the image at the right of this post.
Just a reminder that we will be holding support group at the Indianapolis clinic this week.
When: Tuesday August 18
Time: 6 p.m. – 7 p.m.
Location: Clarian Bariatrics (6625 Network Way, Suite 100 - Indianapolis)
Group Topics:
Band: “Managing Cravings”
New Bypass and Sleeve: “ Body Image: Living your Personal Before and After Picture”
> 1 Year Bypass and Sleeve: “Recipe and Food Tip Exchange” (Come with an idea or recipe to share!)
Don't forget that we also have our weekly "Walk the Talk" support group each Friday that is free to all patients. More information can be found on our
Web site in the "Ongoing Support" section. See you then!
Did you know that blueberries contain phytochemical’s anthocyanin, proanthocyanidins, flavonols and tannins, which inhibit mechanisms of cancer cell development and inflammation? Other studies have found that blueberry consumption lowered blood cholesterol and total
blood lipid levels, which may decrease risk of heart disease.
Half a cup or 3 ½ ounces of blueberries contain 60 calories, a very small amount of fat and protein, 2.4 grams dietary fiber, and 10 mg vitamin C. Choose fresh blueberries over blueberry juice – juice is a concentrated sweet that may cause dumping in Roux-en-Y patients. Also, avoid the snack foods that contain blueberries (muffins, pie, etc) since those foods are high in calories.
Blueberries may not be a part of your meal plan depending on where you are at in the process of weight management. If you decide to incorporate fruit into your meal plan limit to ½ cup a day and discuss any questions or concerns with a dietitian.
Are you struggling with cravings? Do you know you shouldn’t eat certain foods, but struggle to say no? If you do, this group if for you!
Managing CravingsSpeaker: Dr. William Hilgendorf
When: Tuesdasy, August 4
Time: 6 p.m.
Location:
Clarian Bariatrics outpatient clinic
See you there!
We sent out this information earlier in the week, and I wanted to share it with you. We are thrilled at all the changes coming to Clarian Bariatrics, and we realize it would not be possible without your continued support! You guys are the best!
Exciting changes are in store for Clarian Bariatrics this summer as the program announced the addition of two full-time surgeons and a move to a new 30,000 square foot outpatient clinic to better accommodate the rapidly growing program, which has experienced double digit growth the past three years.
Dr. Daniel T. McKenna will join the surgical team of Clarian Bariatrics, a designated Center of Excellence by the American Society for Metabolic and Bariatric Surgery (ASMBS), on August 10. Dr. McKenna joins the programs five other bariatric surgeons who completed nearly 400 surgeries at Clarian North Medical Center in 2008.
A Wisconsin native, McKenna comes to Clarian Bariatrics from Dartmouth Hitchcock Medical Center in Lebanon, N.H., where he completed his minimally invasive surgery fellowship. He is a graduate of Creighton University in Omaha, Neb., where he earned a Bachelor of Arts in American Studies and his Doctor of Medicine. McKenna was a categorical resident in general surgery at the University of Utah and the University of Wisconsin.
In April, Dr. Jack Ditslear joined the Clarian Bariatrics staff full-time after working on a part-time basis with the program since its launch in 2004. A Noblesville native, Dr. Ditslear graduated with honors in chemistry at Miami University of Ohio and then graduated from the Indiana University School of Medicine. He completed his general surgery residency at Methodist Hospital in Indianapolis. Dr. Ditslear carries a vast amount of experience in bariatric surgery. He is a member of the American Society of Bariatric and Metabolic Surgeons, and is also accredited as a Bariatric Center of Excellence Surgeon by the Surgical Review Corporation. Additionally, Dr. Ditslear is certified by the American Board of Surgery and is on the teaching staff for the Indiana University General Surgery Residence program.
“We are thrilled to have Drs. McKenna and Ditslear join the surgery staff at Clarian Bariatrics on a full-time basis,” Jonathan Goble, FACHE, President & CEO of Clarian North Medical Center, said. “The addition of these two skilled surgeons will aid in the successful implementation of many exciting programs.”
Among those initiatives is the launch of a non-surgical division for the weight loss program and an adolescent bariatric program. In addition, an exercise program championed by Erin Light, a certified personal trainer, will begin in August and provide patients an educational approach to personally-tailored exercise programs. Also, William Hilgendorf, PhD, Manager of Bariatric Behavioral Health, has implemented a behavioral program that will increase the coping skills of post-operative patients and improve patient outcomes.
These new patient support opportunities fit with the already established and popular weekly support groups and quarterly cooking classes. Programs like these have led Clarian Bariatrics to be nationally recognized as a robust program that enjoys some of the best weight loss outcomes in effectiveness and durability.
Due to the ongoing program growth, the Clarian Bariatrics outpatient clinic will move from its current location in building 11 of Intech Park to a 30,000 square foot space in building 10 of Intech Park, located on the northwest side of Indianapolis. This move will provide staff with more exam rooms, dedicated exercise rooms and additional meeting space for support groups and the non-surgical weight loss program.
“The growth our program has experienced over the past five years has been remarkable and humbling,” Samer Mattar, MD, FACS, Medical Director of Clarian Bariatrics, said. “Our staff, surgeons and patients have helped us create a unique program that is only beginning to reach its full potential.”
“Fitness- If it came in bottle, everybody would have a great body” - CherIn a national omnibus survey of 1,000 people conducted in March 2009 by the American Heart Association:
- 57 percent said the economy has affected their ability to take care of their health.
- 32 percent have made a change in the last six months to save money, such as delaying preventive care appointments, not taking medications or skipping the dentist.
- 25 percent of those with gym memberships have cancelled in the previous six months.
- 42 percent plan to make changes in the next six months that may impact their health, such as buying fewer fruits and vegetables.
Results of the study spell trouble for Americans’ overall well-being and heart health in particular, said Timothy Gardner, M.D., President of the American Heart Association.
“We’ve made dramatic gains in recent years in our fight against heart disease and stroke, but trends like these threaten to reverse these gains. We need to remind people that even in hard times their health is important. Physical activity, in particular, is an easy, inexpensive way for people to prevent heart disease and manage their stress—another byproduct of a tough economy.”
The American Heart Association encourages walking because it’s the most accessible form of physical activity and it has the lowest drop out rate among Americans. The association supports the federal government’s recently revised guidelines for physical activity, which focus more on a cumulative amount of activity over a week, rather than a specific amount each day.
“The message now is that physical activity can be worked in any time, anywhere,” said Gardner. “The important thing is to make sure you are getting at least 150 minutes of moderate-intensity physical activity each week. We encourage people to incorporate regular walking into their normal routines, such as during the work day.”
Do you ever feel overwhelmed with all you have to do in a day, not only for others but for yourself? Often we do for others before we take care of ourselves. Here are some tips that might help you manage your time more wisely so that you can do things for yourself like go to the gym, plan a meal, pack your lunch with healthy foods, etc.
- Realize that time management is really a myth….. there are always only 24 hours in a day. Time doesn’t change. We can only manage ourselves and what we do with the time that we have.
- Find out where you are wasting time….are you spending too much time reading email, making personal phone calls, surfing the internet, etc. Track you daily activities to find out where your time is wasted.
- Create time management goals…..remember this is changing your behavior not the time. Set goals which are specific, measurable, realistic and achievable.
- Prioritize
- Use a “to do list”
- Be flexible….allow time for interruptions and distractions.
- Avoid being a perfectionist
- Establish routines and stick to them as much as possible….for example; every morning at 5 a.m. walk on the treadmill.
- Learn to say “no”
- Don’t waste time waiting…..at the dentist in the waiting room do things like balance your checkbook, make a grocery list, write your agenda for the next big meeting, check email on Blackberry, make a phone call, etc.
- Reward yourself! Celebrate the achievement of your goals.
Clarian Bariatrics is composed of staff and surgeons who specialize in the advanced surgical treatment of clinically severe obesity, a condition recognized by medical authorities as a major health problem in the United States today. In fact, obesity is the second leading cause of preventable death in the United States, surpassed only by cigarette smoking.
The surgeons of Clarian Bariatrics are highly skilled, experienced professionals backed by the vast network of Clarian specialists, affording you the latest in proven medical techniques. These include laparoscopic gastric bypass surgery, resulting in shorter hospital stays; advanced pain management techniques; and long-term support and follow-up. Patients can and do achieve major weight loss, a healthful and vigorous body and long-term weight control.
Want to learn more? Then join us at an upcoming FREE informational seminar.
Click here to learn about upcoming seminar dates.
I have recently spoken with several
Clarian Bariatrics patients who are working to manage cravings. Are you familiar with that struggle? Does the thought of having to say “no” to one of your favorite foods preoccupy you? Do you give in to a craving for unhealthy foods?
A recent article in the
Wall Street Journal stated, “Certain foods seem to fuel the appetite like pouring gasoline on a fire.” I like that quote. What the author of the
Wall Street Journal article was talking about, after her review of recent research, was that foods high in unhealthy fat and high in refined carbohydrates sets up a kind of “fullness resistance.”
A dietician can explain why these foods tend to satisfy us for only a short time and promote further eating. A dietician can also recommend alternatives to these types of foods. Take a moment to list several ways you can fight your cravings. Each time you withstand a craving, the easier it will be for you to withstand the next craving.
Do you ever feel overwhelmed with all you have to do in a day, not only for others but for yourself? Often we do for others before we take care of ourselves. Here are some tips that might help you manage your time more wisely so that you can do things for yourself like go to the gym, plan a meal, pack your lunch with healthy foods, etc.
- Realize that time management is really a myth….. there are always only 24 hours in a day. Time doesn’t change. We can only manage ourselves and what we do with the time that we have.
- Find out where you are wasting time….are you spending too much time reading email, making personal phone calls, surfing the Internet, etc. Track you daily activities to find out where your time is wasted.
- Create time management goals…..remember this is changing your behavior not the time. Set goals which are specific, measurable, realistic and achievable.
- Prioritize
- Use a “to do list”
- Be flexible….allow time for interruptions and distractions.
- Avoid being a perfectionist
- Establish routines and stick to them as much as possible….for example; every morning at 5 a.m. walk on the treadmill.
- Learn to say “no”
- Don’t waste time waiting…..at the dentist in the waiting room do things like balance your checkbook, make a grocery list, write your agenda for the next big meeting, check email on Blackberry, make a phone call, etc.
- Reward yourself….celebrate the achievement of your goals.
When you decide to change a habit, the best of intentions may not be enough to stay on track. Have you considered what it is that has prevented you from sticking with the changes you have decided to make regarding bariatric surgery? Events in your life can derail your efforts at establishing new habits. The environment around you might tempt you into giving up your diet or exercise routine. Maybe some friends unwittingly sabotage your efforts.
What do all of these have in common?
Each is a barrier we may face when trying to establish new habits. Research has shown that people who anticipate barriers and develop plans to manage these barriers are more likely to overcome the barriers. Those who plan for barriers tend to be more successful at sticking with their new behaviors. Imagine what might derail your efforts and decide what you will do, when you will do it, and how you will know if you are succeeding. Following these three steps will help you plan for barriers.
One question that we (dietitian’s) hear at
Clarian Bariatrics often is, “Give me recipes for the liver reduction diet or for post-operative weight loss surgery life.”
We often reply there are no exact cookbooks or recipes specifically written for the protein based diet that you must follow. You can adapt any recipe to meet the low carbohydrate-protein based diet guidelines.
Understanding basic cooking techniques, ingredient interaction, having the right equipment or utensil and most importantly not being afraid to experiment are keys for long term weight management.
This blog is full of recipes by dieticians and former patients that can help you add variety to your diet. Simply type in "Recipe" on the "Search this Blog" function to the right to view them all. Later in the week, I will post some cookbook recommendations!
My next step was to meet with the team of professionals at
Clarian Bariatrics, meet their requirements and receive their approval. I met with a surgeon, dietitian and psychologist. I had a sleep study performed, pre-op testing and had to meet with the hospitalist to get his approval for surgery.
Once all of my tests came back I gathered the results and my five years of medical history and gave it all to the insurance department and everything was forwarded to my insurance company. I gave it a week and contacted my insurance company. Apparently the first round of paperwork seemed to have been misplaced. My paperwork was re-faxed and re-mailed. I again waited a week and contacted my insurance company and was initially told they had no record of my paperwork.
I was HOT! After some investigation my paperwork turned up in someone’s "IN" box. I was told the paperwork would be forwarded to the correct department for review and a decision so again more waiting time for me. I waited about a week again, contacted my insurance company and was told I was DENIED.
I was flabbergasted and didn’t know how to react. I received the letter which stated the documentation does not support the patient has failed conservative medical management for her co-morbidities. There is no evidence of the patient has participated in a physician-directed weight loss program for 18 consecutive months with bi-weekly weights, treatment and discussion. WHAT? ARE YOU KIDDING ME? I had five years of medical history, all of my tests and results and this wasn’t enough.
Have you run into a similar problem while trying to have weight loss surgery? Then leave me a comment below and I'll see how I can help out!
I started gathering all of my medical records from every doctor I had seen in the past five years. I printed off a list of all medications I had been on for the past few years along with an Excel spreadsheet had had kept for months showing my diet history.
March 1st came and I could not wait the anticipation of calling my insurance carrier. Believe it or not I gave the policy a few days to come into effect and waited until March 5th! I was told to get my information together and forward it to a contact at utilization management who would review my history and pass it along to the proper department.
I hung the phone up, called the insurance department at
Clarian Bariatrics and was starting the process of getting approval. WOO HOO! The excitement was overbearing. I could not wait to get the phone call/letter stating that I had been approved. I was so prepared with all of my paperwork and research I was completely on the right track.
Feeling like there is not enough time for exercise is probably the biggest reason why people choose not to exercise. There simply are not enough hours in the day for everything I need to do. I can say that I am a very busy person.
I am married, have two children, work a full time job, my commute to work is one hour each way, I cook at home every night so my family can eat healthy meals, my daughter is in dance and gymnastics, my son plays baseball, basketball, football, and soccer, but I still find time to exercise.
I wake up early, usually about 4:30 a.m., and go to bed around 10 p.m. I am able to fit in cardio twice daily every day (morning and night) and lifting weights three times/week. You just have to make the decision that this is something that you want to do for you! Make it happen!
Time management is the key. When I first started I had to write down a timeline on paper to see that I could actually make everything fit. Then I stuck to it. You can do it too! Good Luck!
Ruthanne gave me two typed pages – that was it just two. She said if you follow this, I am sure you will lose weight. Home I went with my two pages and showed it to Mike who said it is like the Atkins and South Beach diets and that I had tried both of them without any luck. I told him what Ruthanne said, he told me to try but not to get my hopes up.
Topping the scale at 256 pounds and not wanting to get any larger, on Labor Day weekend 2008 I started the Liver Reduction Diet. Why is it called the Liver Reduction Diet? Why does a bariatric weight loss surgery center have a diet plan?
Some patients – not all, are asked to lose weight prior to bariatric surgery because they carry more weight around the area of the surgery and their liver. If they can reduce this weight even slightly it reduces the risks of surgery. This diet targets that area and the liver itself shrinks in size further reducing risks.
Two pages are restrictive, however, she told me to eat as much as I wanted of the items on those two pages. Never let myself get hungry, and drink, drink, drink, lots of water, so it begins another attempt as weight loss (hoping that it does not end with weight gain as so many others ended.)
Lean meats chicken, turkey, fish, steaks, pork, eggs lean dairy, and vegetables. Keep a journal she told me. I hated that part, but thanks to another staff member it became easier with the help of
www.Sparkpeople.com since they have a place to record meals. I will type all day but hate to make a list on paper, so I recorded everything onto the computer pages. What I drank, ate, and did for exercise (which by the way was nothing! Bad me, and not recommended)
The first week was easy (as they always are) and I lost four pounds. The second week not bad and I lost five pounds. Now we are moving into week three and four and the things that were good about weeks one and two are now going to get boring if I don’t find a way to mix things up.
I was not the only associate in the office attempting this diet, and in talking to a co-worker I got ideas for things I had not thought of on my own. Armed with her thoughts on variety and the encouragement of two weeks weight loss I went into weeks three and four ready to keep losing, but also worried as I was close to my 12 pound limit (the most I managed to lose on other plans).
Many patients will ask, “How much will I lose with the gastric band?” The amount of weight that you will lose is dependent on multiple factors. You will need to be committed to your new lifestyle. Making good food choices with emphasis on protein foods (lean meats, dairy products, eggs, etc) and vegetables over starchy foods (breads, pasta, rice, etc), snack foods and any foods that are liquid or liquid when swallowed.
Daily activity is critical for both short and long term weight management. Following all of the rules related to gastric band placement, e.g. no liquids with meals, eating slowly, chewing at least 20-25 times before swallowing, etc.
Lap Band System reports 61 percent of patients lost at least 25 percent of excess body weight, 52 percent of patients lost at least 33 percent of excess body weight, and 32 percent lost greater than 50 percent of excess body weight.
In addition, two percent of patients gained some weight and five percent maintained their weight. The average weight loss will be about one to two pounds per week depending your food choices, activity level and ability to follow the 10 rules for gastric band patients.
Do you have an additional question about Lap Band surgery, other types of weight loss surgery or bariatric weight loss in general? Then feel free to ask me a question by clicking on comment below.
I hope that everyone had a Merry Christmas, and enjoyed some time with friends and loved ones. Last week, I posted some tips on managing maladaptive eating that was discussed at the December gastric band support group. I wanted to expand on that posting with some solutions for maladaptive eating, which are beneficial to weight loss surgery patients.
Changing maladaptive eating behavior requires a commitment. Some solutions to the most common types of maladaptive eating are:
1.
Relying only on gastric band adjustments for fullness. Solutions:
- Goal: Limit to three meals per day – avoid snacking
- Limit to 1 to 1 ½ cups of food at meals – 4 ounces of protein and ½ cup fruit at breakfast, and 4 ounces of protein and 1 cup of vegetables at lunch and dinner.
- No liquids 30 minutes before, eat for 30 minutes, and no liquids for 60 minutes afterward.
2.
Eating too much!Solutions:
- Limit to 1 to 1 ½ cups of food at meals – 4 ounces of protein and ½ cup fruit a breakfast, and 4 ounces of protein and 1 cup of vegetables at lunch and dinner.
- Understanding and accepting a little hunger is okay.
- Understanding and accepting that stomach growling is okay.
3.
Making inappropriate food choices or eating the wrong type of food, examples are:
- Choosing foods that are liquid or liquid when swallowed, e.g. ice cream, shakes, sweets.
- Using the choking as an "EXCUSE" to eat sweets and ice cream.
- Using children and family members as reasons for having ice cream, shakes, and sweets.
- Choosing a specific food due to the texture of food to accommodate eating.
It is sometimes difficult for bariatric weight loss surgery patients to adjust to this new lifestyle and way of eating, but it is absolutely essential to control maladaptive eating to have long term success. Look for part two tomorrow!
Yesterday, I posted some information from our gastric bypass surgery support group from December. We had an important discussion on maladaptive eating, which should be controlled in order for weight loss surgery success. Below are a few tips to overcome one of the many causes of obesity:
Band adjustments are key for fullness but just as important is making good food choices and understanding a little hunger is okay and part of weight management. Three potential zones for fullness:
1. Yellow Zone – Gastric band is too loose. You are hungry, both portion and total meal size are getting larger, small meals do not satisfy you, and weight loss is below expected level.
2. Green Zone – Ideal area in which small meals are satisfying and provide fullness. Vomiting and heartburn are rare. Staying in this zone requires you to follow dietary guidelines and rules.
3. Red Zone – Gastric band is too tight and may cause difficulty with eating, swallowing, vomiting, heartburn, and food choices are more liquid e.g. ice cream, shakes, candy, chocolate bars, rather than solid.
Key reasons that lead to maladaptive eating:
1. Relying only on adjustments for fullness
2. Eating too much resulting in discomfort
3. Making inappropriate food choices or eating the wrong type of food,
4. Improperly chewing foods resulting in choking or vomiting
5. Want versus Need
Remember,
Clarian Bariatrics will provide monthly support group for
gastric bypass weight loss surgery patients on the third Wednesday of
each month from 6:00 to 7:30 p.m. Patients may bring family and/or
support members to the meetings.
Those of you who read the December issue of Indianapolis Monthly magazine may have a seen a brief question and answer with me that addresses some frequently asked questions about bariatric surgery. I wanted to post a few of the questions to help you better understand bariatric weight loss and causes of obesity.
Q: Are men or women more likely to suffer from obesity?
A: Actually, both genders suffer equally. But women tend to seek out and undergo bariatric surgery at a much higher rate than men. This might be a result of women having a more pronounced physical awareness, and a better understanding of the need for weight management.
Q: For people suffering from obesity, is bariatric surgery the only option?
A: No. There are a great deal of non-surgical treatments and weight management programs available. The key is to seek professional help, and to let those professionals assess the best approach for weight management and improved health.
Q: How common is morbid obesity in Indiana?
A: It is estimated that 5% of the population, about 300,000 Hoosiers, are considered "morbidly obese" and only a small percentage of those people recognize it. It is very important for these people to understand the dangers of being overweight or obese, and to seek medical help.
Q: Why is obesity so prevalent?
A: For the most part, it is a function of the society we live in. First, we have easy access to an abundance of high-calorie, low-nutrition food. In addition, our society does not place enough emphasis on physical activity and exercise. Children who engage in relatively little physical activity tend to grow into adults who engage in less physical activity.
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