August 2008 Spring Newsletter

Booth's Babble

August Spring Newsletter 2008

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Welcome to the spring newsletter. We have all returned safely from a brief but informative conference in Washington in late June.

Nutrition guidelines have now been published by the American Society of Metabolic and Bariatric Surgery. They make for some interesting reading and Nikki has written about them. Lyn and Catherine will be covering aspects of the conference in our Christmas newsletter.

It was a long flight to Washington, prolonged by an unplanned overnight stop in San Francisco and then being diverted from Washington and spending 3 hours on the tarmac at Richmond, Virginia before arriving safely in Washington nearly a day late. By that stage our hotel bookings had been cancelled but eventually accommodation was found and we settled into the conference. The Convention Centre was a 2500 room hotel on the edge of the Potomac River! Rather large would be an understatement.

There was good material on what is required to establish a Centre of Excellence for Bariatric Surgery in the USA. Much of it is pertinent to our practice in New Zealand and am pleased to report that we are performing well on most counts! There is always room for improvement however!

I have noticed the increasing interest in gastric sleeve resections as primary treatment for weight loss. We have had some good results in the short term but long term follow-up is currently lacking and this needs to be taken into account when making a decision. There was some 5 year follow-up data for sleeve gastrectomy presented from San Francisco. Weight loss was generally very good, however they were making an exceedingly narrow sleeve which resulted in significant early food intolerance and a re-admission rate of 17% with nausea and dehydration! These results have given me a little more confidence as to the longer term efficacy of gastric sleeve resection.

However as you all know, the further out you get from surgery, the less important is the operation that you have had than your ability to sustain a diet and exercise programme.

Support Group...

Great support often leads to greater success following weight loss surgery but not everyone can access the type of support that they need from family and close friends. For that reason, support groups are invaluable in providing a place where you can discuss the changes that occur after surgery; changes in diet, appearance, behaviour, identity, socialising and relationships. Support groups provide access to people who understand what is happening, are supportive with the issues that you may be struggling with and have been successful themselves. The groups are run by Catherine Kissel, psychologist and either Lyn Pearless, nurse or Nikki Talacek, dietitian who can also offer advice and support.

The dates for 2008 for the Takapuna based group at the Waitemata Specialist Centre in Shea Tce are:

Wednesday 27th August, 08
Wednesday 24th September, 08
Wednesday 22nd October, 08
Wednesday 19th November, 08
Wednesday 17th December, 08

Many men have suggested providing a men's only group, which are common overseas. This provides men an opportunity to ask questions and discuss issues that focus on a men's perspective of weight loss surgery. Therefore we now have the resources to have a monthly group for men that will be at the Remuera clinic at 81 Remuera Rd. These are the 2008 dates:

Wednesday 3rd September, 08
Wednesday 1st October, 08
Wednesday 5th November, 08
Wednesday 3rd December, 08

Please let us know that you are coming by phoning Sarah or Sandra on (09) 623 3098 or 0508 934 448.

Washington Trip...

Microwave Muffin...

1 whole egg
1/4 cup flax seed meal
1/2 teaspoon baking powder
1/2 teaspoon cinnamon
1 tablespoon Marg
1 tablespoon light cream cheese
1 teaspoon olive oil

Break the egg in a coffee cup, then add the remaining ingredients. Mix well and cook for one minute in the microwave. When done, invert the cup on a plate to dislodge the muffin.

If it isn't fully firm just let it sit for another minute. Occasionally, I'll add a few blueberries in the mix, or top it with sugar free raspberry preserves after it is done. A couple of "spritzes" of butter spray gives it a great flavour as well.

For those who use the sugar free syrups, use those as a topping.

This muffin really swells up so please be sure to use a large coffee cup.

Dietitian's Direction...

Weight Loss Surgery Nutrition Guidelines

We have been eagerly awaiting the release of the nutrition guidelines from the American Society of Metabolic and Bariatric Surgery (who are considered the world leaders in weight loss surgery) for the last couple of years, and this year they were released. This outstanding document was produced by dietitians in the USA, who have been working in the weight loss surgery industry for a long time, and as a result have a wealth of knowledge they have kindly agreed to share with the rest of the world. One of the most encouraging pieces of knowledge I have returned with is, mainly thanks to my predecessor Elizabeth, the nutrition advice provided by Surgical Weight Solutions is in line with the ASMBS recommendations. The importance of adequate protein, and lifelong commitment to taking the prescribed multivitamins was emphasised as two of the most important actions to take to ensure sustained nutritional health in the long term.

Importance of multivitamins

Due to the very action of weight loss surgery, specifically when a bypass is performed and food does not travel through part of the bowel, protein as well as vitamins and minerals are malabsorbed. This means that what you eat is not what your body is able to use and some passes through undigested. Our need for these nutrients does not decrease after weight loss surgery; however our intake needs to increase to compensate for the decreased absorption. If you have had an adjustable gastric band or sleeve gastrectomy, this does not mean that focusing on these nutrients is any less important, as due to volume restriction, we need to ensure you are getting enough of the essential nutrients in the small amount of food you are eating.

Vitamin D

I found it interesting to see recorded in the literature what we as a practice have noticed regarding some deficiencies seen prior to surgery. Some of you may have noticed me digressing at times from diet (and exercise) and talking about sun exposure. This seems like a bit of a far fetched topic for a dietitian to talk about, however sun exposure is the best way for you to ensure you have enough vitamin D. Studies have shown that up to 60-80% of individuals who have weight loss surgery have a deficiency in vitamin D prior to surgery. As you may already know, vitamin D is needed for calcium metabolism and bone health, but you may not know that a deficiency in vitamin D actually creates an environment which favours fat accumulation in the body. For this reason, it is important to aim for at least 30 minutes of sun exposure daily (at non-peak UV times) without sunscreen to ensure you are giving yourself the best chance for optimal weight loss. Provided you are careful not to get burnt, this level of sun exposure has not been known to be associated with an increase in skin cancer risk.

Iron

Iron deficiency has also been commonly found pre-surgery in the literature. Iron deficiency hinders energy use, and hence ability to lose weight. Red meat, provided it is lean with all visible fat removed, is not fattening, and in fact can aid with weight loss. It is unfortunate that many people eliminate red meat from their diet when trying to lose weight as this can actually make weight loss harder.

Pre-op Multivitamins

To ensure you are in the most optimal state of health prior to surgery, commencement of Centrum multivitamins is recommended after your initial appointment with us.

Exercise

And of course, what spiel from the dietitian would be complete without getting in a final word about exercise. This is what is going to ensure success with your weight loss long term. Without exercise, you are likely to be disappointed with your weight loss, and may in fact not reach your full weight loss potential.

Key Points

• Take your multivitamins daily as prescribed by the practice (this can be up to 2 per day)
• Focus on an adequate protein intake (60-80g per day)
• Aim for 30 minutes of non-peak time sun exposure (without sun screen) per day for vitamin D
• Include plenty of lean red meat in your diet
• Exercise at least 5 days per week for at least 30 minutes

Nikki
nikki@wisefood.co.nz

Appointments...

We request that patients wanting appointments phone the rooms rather than email requests through. The increased number of email requests are becoming unmanageable and the delay in replies mean appointment slots have been taken in the interim period. Our Auckland based patients can call 623 3098, for those based in other regions use our toll free number, 0508 934 448.

Tricks for hunger...

• Drink water or flavoured water to curb hunger pangs
• Ignore the hunger and acknowledge that you will survive
• Establish a predictable and consistent eating schedule so your body becomes accustomed to when you will eat
• Eat protein first thing in the morning and again at lunch and dinner
• Minimize visual cues that trigger hunger pangs (avoid/ignore media advertising, place snack foods in closed cupboards, avoid the office break room, etc)
• Take a brisk walk before giving in to hunger (this will rev your metabolism)

Information Evenings...

Many of you have been along to the information evenings we have been providing for interested people over the last year. We welcome any suggestions as to how these may be improved and do appreciate those of you who have given your time to come along and provide prospective patients with your personal experiences. It never ceases to amaze us how well our patients speak and how entertaining you can all be! Start times are 7.30pm, please phone or email for bookings. Up coming dates:

Shea Terrace :

Monday 8th September, 08
Monday 3rd November, 08
Monday 15th December, 08

81 Remuera Rd :

Thursday 28th August, 08
Thursday 18th September, 08
Thursday 16th October, 08
Thursday 27th November, 08

Contact Details

Phone 09 623 3098 0508 Weight (934 448)
Fax 09 441 2759

Email info@surgicalweightsolutions.co.nz
Website www.surgicalweightsolutions.co.nz

This website is being continuously updated and any comments or suggestions are much appreciated.

We always look forward to seeing you all for follow-up. If you have any comments or suggestions or would like to write a piece for the next newsletter, please let us know.

Opportunity may knock
only once,
but temptation leans
on the doorbell

August Spring Newsletter 2008

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