Weight Debate

• Weight loss surgery, called bariatric (bair-ee-AT-rik) surgery, is an option for people who are severely obese and cannot lose weight by traditional means or who suffer from serious obesity-related health problems.
• Bariatric surgery promotes weight loss and reduces the risk of type 2 diabetes by restricting food intake and, in some operations, interrupting the digestive process to prevent the absorption of some calories and nutrients.
• Recent studies suggest that bariatric surgery may even have a favorable impact on mortality (death) rates in severely obese patients. Weight loss surgery reduces diabetes related deaths by 80 percent, and some procedures can even cure diabetes in over 90 percent of the cases.

Only consider surgical treatment for weight loss if you:

• Have a Body Mass Index (BMI) of 40 or higher.
• Have a Body Mass Index (BMI) of 35 or higher and weight-related health problems.
• Have not had success with other weight-loss methods.

Common Types of Bariatric Surgery:

• Roux-en-Y (RYGB) gastric bypass - Prounced ROO-en-WEYE – Surgical staples are used to create a small stomach pouch. This limits the amount of food you can eat. The pouch is attached to the middle part of the small intestine. Food bypasses the upper part of the small intestine and stomach, reducing the amount of calories and nutrients your body absorbs.

• Adjustable Gastric Band - Food intake is limited by placing a small bracelet-like band around the top of the stomach to produce a small pouch about the size of a thumb. The outlet size is controlled by a circular balloon inside the band that can be inflated or deflated with saline solution to meet the needs of the person.

• Biliopancreatic diversion (BPD) - Pronounced bil-ee-oh-pan-kree-at-ik- A large part of the stomach is removed, leaving a small pouch. The pouch is connected to the last part of the small intestine, bypassing other parts of the small intestine.
• Biliopancreatic diversion with a duodenal (doo-AW-duh-nul) switch (BPD-DS) - Less of the stomach and small intestine are removed. This surgery reduces the amount of food you can eat and the amount of calories and nutrients your body absorbs from food. This surgery is used less often than other types of surgery because of the high risk of malnutrition.

• Vertical Sleeve Gastrectomy (VSG) – Some people who undergo a VSG can actually lose significant weight and avoid a second procedure, but it is not known how many people need a second procedure. A VSG operation restricts food intake and does not lead to decreased absorption of food. However, most of the stomach is removed, which may decrease production of a hormone called ghrelin. A decreased amount of ghrelin may reduce hunger more than other purely restrictive operations, such as gastric band.

Bariatric surgery may be performed through:

• Open Bariatric Surgery
  The open approach makes abdominal incisions in the traditional manner. People who are extremely obese, who have had previous abdominal surgery, or have complicating medical problems may require the open approach.
• Laparoscopic Bariatric Surgery
  The laparoscopic approach uses sophisticated instruments that are inserted through 1/2 inch incisions and guided by a small camera that sends images to a television monitor. The laparoscopic approach requires a smaller cut, creates less tissue damage, leads to earlier discharges from the hospital, and has fewer complications, especially postoperative hernias. Not all people are suitable for the laparoscopic approach.

The best results of weight loss surgery are:

• Following the doctor’s directions as you heal.
• Committing to a lifetime of healthy eating.
• Committing to a lifetime of regular physical activity.
• Taking vitamins and minerals if needed.

Side effects and risks of weight loss surgery may include:

• Infection.
• Leaking from staples.
• Hernia.
• Blood clots in the leg veins that travel to your lungs (pulmonary embolism).
• Dumping syndrome, in which food moves from your stomach to your intestines too quickly.
• Not getting enough vitamins and minerals from food.

Bariatric procedures, on average, cost from $20,000 to $25,000. Medical insurance coverage varies by state and insurance provider.

Remember:
There are no guarantees for any method, including surgery, to produce and maintain weight loss. Success is possible only with maximum cooperation and commitment to behavioral change and medical follow-up – and this cooperation and commitment must be carried out for the rest of your life.

Sibutramine Hydrochloride (Meridia) – pronounced si-BYOO-tra-meen.

Sibutramine is a prescription drug that suppresses your appetite. Sibutramine was approved by the Food and Drug Administration (FDA) in 1997 for the management of obesity, including weight loss and maintenance of weight loss, in conjunction with a reduced calorie diet.

Warnings about Sibutramine
When using sibutramine, people with a history of cardiovascular disease have an increased risk of heart attack and stroke, including:

• History of coronary artery disease – for example – heart attack, angina.
• History of stroke or transient ischemic attack (TIA).
• History of heart arrhythmias.
• History of congestive heart failure.
• History of peripheral arterial disease.
• Uncontrolled hypertension – for example – 145/90 mmHg.

Sibutramine may cause side effects:

• Raise your blood pressure and heart rate.
• Dry mouth, hoarseness, or sore throat.
• Headache.
• Constipation.
• Anxiety, nervousness, extreme excitement, or restlessness.
• Trouble sleeping.
• Change in appetite.
• Heartburn.
• Weakness.
• Back pain.
• Stomach pain.
• Chest pain.
• Runny nose.
• Flu-like symptoms.
• Flushing.
• Painful menstrual periods.
• Confusion.
• Nausea, or vomiting.
• Depression.
• Dizziness, lightheadedness, or fainting.
• Uncoordinated or abnormal movement.
• Muscle stiffness.
• Shaking hands that you cannot control.
• Seizures.
• Shivering.
• Excessive sweating.
• Fever.
• Large pupils, change in vision, eye pain, or swelling of the eyes.
• Hives, or skin rash.
• Itching.
• Difficulty breathing, swallowing, or speaking, or shortness of breath.
• Swelling of the face, tongue, throat, lips, hands, or lower legs, ankles, or feet.
• Unusual bleeding or bruising.

Before taking Sibutramine, talk with your doctor about the benefits and the side effects. You should not take Sibutramine if you have a history of high blood pressure, heart problems, or strokes.

With herbs, spices, garlic, and onions, you can make your food spicy and delicious without using sodium or salt. Experiment with these and other herbs and spices by using small amounts at first to find out if you like them. Here are some great ideas to try:

• Basil - Use in soups, salads, vegetables, fish, and meats.
• Cinnamon - Use in salads, vegetables, breads, and snacks.
• Chili Powder - Use in soups, salads, vegetables, and fish.
• Cloves - Use in soups, salads, and vegetables.
• Dill Weed and Dill Seed - Use in soups, salads, vegetables, and fish.
• Ginger - Use in soups, salads, vegetables, and meats.
• Marjoram - Use in soups, salads, vegetables, beef, fish, and chicken.
• Nutmeg - Use in vegetables, snacks, and meats.
• Oregano - Use in soups, salads, vegetables, snacks, and meats.
• Parsley - Use in salads, vegetables, fish, and meats.
• Rosemary - Use in salads, vegetables, fish, and meats.
• Sage - Use in soups, salads, vegetables, meats, and chicken.
• Thyme - Use in salads, vegetables, fish, and chicken.

Some facts about dry beans and peas:

• Dry beans and peas are mature forms of legumes, or plants which have pods with rows of seeds inside.
• Some popular varieties of dry beans and peas include kidney beans, pinto beans, lentils, black beans, split peas, and garbanzo beans (chickpeas). Only a few types, such as string beans, green beans, baby green lima beans, and fresh soybeans (edamame) are not considered dry beans.
• Dry beans and peas are part of the vegetable food group and the meat and beans food group on the Dietary Guidelines for Americans Food Guide Pyramid.
• Because of their high nutrient content, consuming dry beans and peas is recommended for everyone, both vegetarians and non-vegetarians.
• As part of a healthy diet, dietary fiber from dry beans and peas (legumes) helps to lower the risk of heart disease.
• Dry beans and peas are excellent sources of plant protein and fiber.
• Dry beans and peas provide other nutrients such as iron, potassium, magnesium, folate, and zinc.
• Dry beans and peas are naturally low in sodium and fat.
• Dry beans and peas have no cholesterol or saturated fat.
• 1 cup of dry beans has about 16 grams of protein.

The 2005 Dietary Guidelines for Americans recommend eating 3 cups of beans a week, based on a 2,000 calorie meal plan.

Rinsing and draining pre-cooked canned beans reduces the sodium content. Or, soak and cook bagged dry beans without adding any salt.

Choose the easiest form by using canned, pre-cooked beans, they need no soaking and they reduce your cooking times. Also, try to prepare dry beans and peas without added fats.

Try these:

• Beans and rice.
• Split pea soup.
• Three bean salad.
• Pinto beans and salsa in a chef salad.
• Red beans in rice pilaf.
• Wrap black beans in a tortilla with low-fat cheese and salsa.

A person with anorexia, also called anorexia nervosa, has an intense fear of gaining weight, thinks about food a lot, and limits the amount of food they eat. With anorexia, you don’t get the energy from foods that you need, so your body slows down. Anorexia affects your whole body and your health in many ways.

• You can’t think right.
• You are sad, moody and irritable.
• You have a bad memory.
• You can faint.
• You have changes in brain chemistry.
• Your hair gets thin and brittle.
• You have low blood pressure.
• You have a slow heart rate.
• Your heart can flutter – heat palpitations.
• You can have heart failure.
• You can have blood problems and anemia.
• Your muscles are weak.
• Your can have swollen joints, bone loss, and fractures.
• You can get osteoporosis.
• You can get kidney stones.
• Your kidneys can fail.
• Your body fluids can be low on potassium, magnesium, and sodium.
• You have constipation, and bloating.
• Your periods stop.
• You stop growing.
• You have trouble getting pregnant.
• If you are pregnant, you have a higher risk for miscarriage, or deliver your baby by C-section, or your baby can have a low birthweight, and you can have post partum depression after your baby is born.

You Can Get Help
Eating disorders can cause serious problems. Getting help early is important!! Treatment involves monitoring, mental health therapy, nutritional counseling and sometimes medicines. Make an appointment to talk with your doctor.

If you eat regular meals and healthy snacks in moderation, you are less likely to overeat and gain weight, so don’t skip meals or go for long periods of time without eating, have a healthy snack in between. Some healthy snack ideas:

• Baked potato chips or tortilla chips with salsa.
• Bagels with tomato sauce and low-fat cheese for a low-fat version of a pizza.
• Flavored rice cakes (like caramel or apple cinnamon).
• Pretzels – lightly salted or unsalted.
• Air popped popcorn.
• Veggies with low-fat or fat-free dip.
• Low-fat frozen yogurt.
• Peanut butter spread on celery sticks and topped with raisins.
• Low-fat milk shake made with skim milk, orange juice or pineapple juice, and sliced strawberries or bananas.
• Low-fat cottage cheese topped with fruit or spread on whole-wheat crackers.
• Gingersnaps, or vanilla wafers.
• Graham crackers, or animal crackers.
• Frozen fruit bars.
• Angel food cake topped with strawberries or raspberries and low-fat whipped cream.
• Fig bars, or raisins.
• Microwave or toast a soft tortilla with low-fat cheese, mushrooms, and sliced peppers to make a mini-burrito or quesadilla.
• Trail mix made with 1 cup of whole-grain toasted oat cereal, 1/4 cup chopped walnuts, and 1/4 cup dried cranberries.

Do you like broccoli? Broccoli contains more nutrients than any other vegetable!

Broccoli is full of good stuff, including:

• Vitamin A – in the form of beta-carotene.
• Vitamin C – 100 grams (approximately 3.5 ounces) of broccoli contains 75 percent more vitamin C than an equal amount of oranges.
• Vitamin D
• Dietary fiber – one of the highest among vegetables.
• Calcium – in just 1/2 cup of broccoli, there is 21 mg (milligrams) of calcium.
• Antioxidants – foods high in antioxidants can help protect against cancer and heart disease.
• Folate.
• Iron.
• Potassium and other vitamins and minerals.

Reports on the link between broccoli and the compound sulforaphane, a potent anti-cancer chemical, have been in the news since researchers at Johns Hopkins University began releasing study results in 1992.

Broccoli helps strengthens bones, is good for your eyesight, has cancer-fighting abilities, protects your heart, and helps controls your blood pressure.

Selection

• When you buy broccoli, choose bunches that are dark green, this indicates high nutrient value.
• Florets that are bluish green, purplish, or dark green contain more vitamin C and beta-carotene than paler or yellowing ones.
• Buy bunches of broccoli with stalks that are very firm. Stalks that bend or seem rubbery are of poor quality.
• Avoid broccoli with open, flowering, discolored, or water-soaked bud clusters and tough, woody stems.
• Store broccoli unwashed, in an open plastic bag and place in the crisper drawer of your refrigerator.
• Broccoli is best if used within a day or two after purchasing.

Fresh versus Frozen
Packaged frozen broccoli differs from fresh in its nutrient content. The flower buds or florets are richer in beta-carotene than the stalks. Manufactures typically cut off most of the stalk before packaging, so frozen broccoli may contain 35 percent more beta-carotene by weight than fresh broccoli. The downside is that frozen broccoli has twice as much sodium as fresh (up to 68 mg per 10 oz. package), about half the calcium, and smaller amounts of iron, thiamin, riboflavin, and vitamin C.

Cooking
The best way to cook broccoli is to steam it, microwave it, or stir-fry it with a little broth or water. If you boil it, some of the vitamins and minerals are lost from the broccoli and end up in the boiled water. Cooked broccoli should be tender enough so that it can be pierced with a sharp knife, but still remain crisp and bright green in color.

Serves – 3
Serving size – 1 and 2/3 cups soup and 1 lime slice

Ingredients
2 teaspoons olive oil
1/2 cup frozen chopped onion
1 teaspoon bottled minced garlic
1 teaspoon ground cumin
1/2 teaspoon dried oregano
1/4 teaspoon black pepper
1 cup frozen whole-kernel corn
1 (14 ounce) can fat free, low sodium chicken broth
1 (15 ounce) can black beans, drained
1 (14.5 ounce) can diced tomatoes with green chiles, undrained
3 lime slices

Directions
1. Heat oil in a large saucepan over medium heat.
2. Add onion, garlic, cumin, and oregano. Saute 1 and 1/2 minutes. Stir in pepper, corn, beans, broth, and tomatoes and bring it to a boil.
3. Reduce heat and simmer for 10 minutes. Serve with lime slices.

Nutritional Information Per Serving (mg = milligrams)
Calories – 241
Total Fat – 4.2 grams
Saturated Fat – 0.5 grams
Cholesterol – 0.0 mg
Sodium – 722 mg
Carbohydrate – 44.7 grams
Dietary Fiber – 12.4 grams
Protein – 12.7 grams

Some Food Substitutions

• Instead of french fries eat baked potato.
• Instead of cheese (cheddar, Swiss, or jack) eat reduced calorie cheese, low-calorie processed cheeses, fat-free cheese.
• Instead of whipping cream eat imitation whipped cream made with fat-free or skim milk.
• Instead of white rice eat brown rice.
• Instead of mashed potatoes eat boiled potatoes.
• Instead of apple pie eat an apple.
• Instead of creamed corn eat steamed corn.
• Instead of cream cheese eat low fat cottage cheese.
• Instead of creamed spinach eat spinach salad.
• Instead of regular margarine or butter eat light spread margarines, diet margarine, or whipped butter, tub or squeeze bottle.
• Instead of butter or stick margarine for sautéing use cooking spray, low-sodium chicken broth, or a small amount of olive oil or vegetable oil, and as a substitute for oil or butter, use applesauce or prune purée in baked goods.
• Instead of regular mayonaise eat light or diet mayonnaise or mustard.
• Instead of regular salad dressings eat fat-free or reduced calorie salad dressings, lemon juice, or plain, herb-flavored, or wine vinegar.
• Instead of tomato juice eat whole tomatoes.
• Instead of danish pastry eat raisin bread or a bagel.
• Instead of chocolate cake eat angel food cake.
• Instead of candied yams eat baked yams.
• Instead of fried chicken eat broiled chicken.
• Instead of whole milk drink fat free milk.
• Instead of ice cream eat frozen yogurt.
• Instead of ground beef eat lean ground turkey or chicken.
• Instead of bacon eat canadian bacon or lean ham.
• Instead of butter or margarine on toast or bread eat jelly, jam, or honey on bread or toast.

Also called: Folacin, Folate, Pteroylglutamic acid, and Vitamin B9.

Folic acid and folate mean the same thing. Folic acid is a manmade form of folate.

We all need the B vitamin folic acid everyday. Our bodies use it to make healthy new cells daily for hair, nails, skin, and other parts of our body, and it also helps keep our blood healthy.

Some Food Sources of Folate

• Cooked dry beans and peas
• Deep green leaves like spinach and mustard greens
• Oranges and orange juice
• Whole grains
• Some cereals have 100 percent of the daily value of folic acid in each serving

Especially Important!!
Most women don’t get all of the folic acid they need through food alone. It is very important for women who can get pregnant to make sure they get 400 micrograms (400 mcg) of folic acid every day, starting at least one month before getting pregnant. If a woman has enough folic acid in her body before and during pregnancy, it can help prevent major birth defects of the baby’s brain and spine – anencephaly and spina bifida – by 50 to 70 percent.

Two easy ways to get enough folic acid each day are:

• Take a multivitamin everyday that contains 400 micrograms (400 mcg) of folic acid. Or you can take a small pill (supplement) that has only folic acid in it each day.

OR

• Eat a bowl of breakfast cereal that has 100% of the daily value of folic acid every day. Not every cereal has this amount. Check the label on the side of the box, and look for one that has “100%” next to folic acid.

Anencephaly Pronounced an-en-SEF-uh-lee
Anencephaly happens when most or all of the brain does not develop. Babies with this problem die before or shortly after birth.

Spina Bifida Pronounced spy·nuh bif-i-duh
Spina bifida is the most common birth defect in the United States. It is a type of neural tube defect (NTD). The neural tube is a narrow channel that folds and closes during the third and fourth weeks of pregnancy to form the brain and spinal cord. Spina bifida happens if the portion of the neural tube that forms the spinal cord does not close completely during the first month of pregnancy. As a result, the nerves that control leg movements and other functions don’t work. Children with spina bifida often have lifelong disabilities, and they may need many surgeries.

Remember:
For folic acid to help prevent major birth defects, a woman needs to start taking folic acid at least one month before she becomes pregnant and while she is pregnant.