GASTRIC BYPASS

The Connection Between Sleep and Weight

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

It is well known that losing weight—or regain after bariatric surgery—is hard. Keeping weight off and maintaining can be just as challenging. There are few studies out there in the medical community still trying to straighten out the connections between sleep and weight, but there are some which emphasize the potential weight loss benefits of a good night’s sleep and negative health impacts of sleep deprivation.

New research suggests that adults who are better rested consume significantly fewer calories than those who are chronically sleep-deprived. A study published by JAMA Internal Medicine finds that people who sleep less consume more calories and foods that are high in calories. This is compared with people who sleep for longer periods.¹

The study concludes with the participants who slept an hour longer each night consumed an average of 270 fewer calories each day and lost about a pound compared to control group participants, who gained just under a pound on average.

The Link Between the Stomach and Your Appetite

True or false: Your appetite is linked to your stomach. Answer: False. Your appetite is actually controlled by the neurotransmitter’s ghrelin and leptin, not your stomach. The hormone ghrelin promotes hunger and increases appetite. The hormone leptin contributes to the sensation of feeling full. The body will naturally increase and decrease the levels of these neurotransmitters throughout the day, signaling the need to consume calories.²

Obesity and Sleep Deprivation

Depending on the cause, chronic sleep disruptions increase the risk of high blood pressure, heart attack, stroke, and irregular heartbeats.³

Past studies show that people who get less than 6 hours of sleep at night are more likely to be diagnosed as obese, though it’s difficult for these studies to determine cause and effect.⁴ Obesity in itself can cause an increase risk of developing conditions that interfere with sleep, such as sleep apnea. Though it’s unclear if not getting enough sleep is the cause of obesity, and/or if obesity is causing people to sleep less. Commonly, sleep-deprived individuals tend to choose foods that are high in calories and carbohydrates.⁵

Sleep and Losing Weight

Research shows that not getting enough sleep while trying to lose weight can sabotage the amount of weight lost and encourage the tendency to overeat.⁶ When treating obesity in adults, medical experts encourage improving sleep quality.

Sleep and Physical Activity

When you aren’t getting enough sleep, it can result in having less energy for exercise and physical activity. Exercise is essential and necessary to maintain weight loss and overall health. For example: walking, running, weightlifting, dancing, swimming, sports, etc. Listen to your body to see what time of day works best for you when working out in response to how well you sleep. For some individuals, exercising too late in the day can interfere with how well they rest at night.

Ways to Help Improve Sleep

It’s important to try and get adequate sleep, as well as quality sleep, as part of a healthy weight plan. Here we have put together some tips and suggestions that could help improve your sleep:

Keep to a regular sleep schedule
Sleep in a dark room; purchasing blackout curtains can help with blocking out light and noise
Don’t eat right before bed
Reduce stress
Become an early bird
Keep a sleep log
Monitor sleep times with wrist actigraphy devises such as smartwatches
Limit use of electronic devises at least 1 hour before bed
Turn temperature to a comfortable number
Exercise regularly

Healthy Looks Different for Everyone

Remember that good health and healthy looks and feels different for everyone. Health is a lifelong journey that includes not only healthy habits and eating nutritious foods, but by also having a healthy relationship with your body. Work closely with your doctor’s guidance, as well as keeping your own personal decisions in mind.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Resources

Esra Tasali, MD, Kristen Wroblewski, MS, Eva Kahn, MS, et al Jennifer Kilkus, MS, RDN, Dale A. Schoeller, PhD, “Effect of Sleep Extension on Objectively Assessed Energy Intake Among Adults with Overweight in Real-life Settings”, JAMA Intern Med., 2022; 182(4):365-374. Doi:10.1001/jamainternmed.2021.8098, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2788694
Karine Spiegel, Esra Tasali, Plamen Penev, Eve Van Cauter, “Brief Communication: Sleep Curtailment in Healthy Young Men is Associated with Decreased Leptin Levels, Elevated Ghrelin Levels, and Increased Hunger and Appetite”, Ann Intern Med., 2004 Dec 7; 141(11):846-50, doi: 10.7326/0003-4819-141-11-200412070-00008, https://pubmed.ncbi.nlm.nih.gov/15583226/
“Losing Weight, Especially in the Belly, Improves Sleep Quality, According to a John Hopkins Study”, https://www.hopkinsmedicine.org/news/media/releases/losing_weight_especially_in_the_belly_improves_sleep_quality_according_to_a_johns_hopkins_study
Yili Wu, Long Zhai, Dongfeng Zhang, “Sleep Duration and Obesity Among Adults: A Meta-analysis of Prospective Studies”, Sleep Med, 2014 Dec; 15 (12):1256-62, doi: 10.1016/j.sleep.2014.07.018, https://pubmed.ncbi.nlm.nih.gov/25450058/
Stephanie M Greer, Andrea N Goldstein, Matthew P Walker, “The Impact of Sleep Deprivation on Food Desire in the Human Brain”, Nat Commun, 2013;4:2259, doi: 10.1038/ncomms3259, https://pubmed.ncbi.nlm.nih.gov/23922121/
Marie-Pierre St-Onge, Andrew McReynolds, Zalak B Trivedi, Amy L Roberts, Melissa Sy, Joy Hirsch, “Sleep Restriction Leads to Increased Activation of Brain Regions Sensitive to Food Stimuli”, Am J Clin Nutr, 2012 Apr;95(4):818-24, doi: 10.3945/ajcn.111.027383, https://pubmed.ncbi.nlm.nih.gov/22357722/

Daniel R.’s Gastric Bypass Story

Feb 8 By rmap nurse

My journey started earlier in the year when I ended up at the ER for high blood pressure. I wasn’t feeling good and went to urgent care, and my blood pressure was at 299, so they sent me to the ER where I spent the night. After that, I set up an appointment to establish a regular doctor.

On the first visit, the doctor said with my weight, sleep apnea, prediabetes, and high blood pressure, that he recommended weight loss surgery. I told him I had already considered that and was looking into going to Mexico to do it. He told me that a lot of insurances cover [weight loss surgery] if it was medically necessary, and so I put in my paperwork with his recommendation. Part of that was to lose weight on my own first, which I lost 40-ish pounds in about a month. I saw a dietician and psychologist at St. Mark’s and then I got approved. I was super excited and nervous. I wanted to better my health so I can be around longer for my son, Daniel Cruz.

I finally got my surgery date, and a week before, my wife and I found out we were expecting a second child! That just backed up my decision even more that I was doing the right thing.

The week right after surgery, I ended up at the ER twice because my blood pressure dropped down to 43 and got severely dehydrated. I tried my hardest to stay hydrated, but it is very difficult to consume water for the first few weeks. It gradually got easier. At that point, I got taken off all my medicine and no longer needed my sleep apnea machine to sleep. I no longer snore while sleeping either! I only take my multivitamins and calcium chews!

I quickly started losing lots of weight and dropping sizes in clothes. Before I knew it, I went from using 5XL shirts and size 50 jeans to my current L-XL shirts and size 34 jeans. I can sit and put one leg on top of the other, which I had not done for over 20 years!

I also started being able to go on long walks and not be suffocating trying to catch my breath. I have been implementing better behaviors for my son as well.

I really enjoy playing with my children and being able to do more activities with them that I was not able to before. It’s always crazy and fun seeing people I had not seen for a long time, and seeing their reaction to my drastic changes.

For me, the only complications I had was the first week post-surgery, like I mentioned before. Besides that, I have been very blessed and lucky with my results. My goal the first year was to lose 150 pounds, and I hit that goal. This year, I am trying to lose another 30-50 pounds so that I can do skin removal surgery, then I want to get back into bodybuilding like I did when I was fresh out of high school!

There are times when I feel like I don’t recognize the person I see in the mirror, but inside, I am the same person, but better and healthier than before my surgery.

–Daniel R.
Surgeon: Dr. Rodrick D. McKinlay
Surgery: Gastric Bypass Roux-en-Y
Surgery Date: 12/13/21
HW: 433
SW: 397
CW: 253
TWL: 144

Bariatric Surgery Aftercare

Jan 11 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

The surgeons and staff here at Rocky Mountain Associated Physicians (RMAP) want to see our patients achieve their goals, as well as have a lifetime of success with their new tool and healthy behaviors we have educated them on. We seek to be a partner in your journey for health, not just for the first year of weight loss, but for life. This could be means of annual bloodwork, support groups, continuing education of the bariatric world, and annual follow-ups. We want to help keep you on track and provide a place for you, our patients, for when you feel overwhelmed. Bariatric surgery is life changing, and it will change your way of living for the rest of your life!

Your follow-up care with us is important! It is to help us monitor your health and weight status, but also assist you in establishing patient-selected incremental goals as well as long-term goals.

There are numerous reasons as to why you should continue to follow-up with your surgeon and bariatric clinic after weight loss surgery. Here we have listed three of the top reasons why:

Annual Bloodwork: Bloodwork is important after bariatric surgery so that we can monitor your vitamin levels and overall health. We can see if anything looks amiss, causing unusual symptoms you might be experiencing, any deficiencies developing, or the reason why some unexplained or unwanted weight loss or gain could be happening.

We have our patients do annual bloodwork every year after surgery. Your family physician or our office can order them once to two weeks before your annual visit. The tests you need are:

Comprehensive Metabolic Panel
Lipid Profile
CBC with diff
Vitamin B-12 level
Thiamine (Vitamin B1) level
Folate
Hemoglobin A1c

***You must be fasting 6 hours prior to blood draw.

Duodenal Switch patients
Get all of the labs listed above PLUS

Vitamin A level
Vitamin D level
Protime

Mail or fax a copy of these tests to our office. The tests will be reviewed by your surgeon and placed in your chart. Fax number: (801) 268-3997.

Keeping You on Track: After the weight loss stage, it can be easy to lose focus of the guidelines and education materials we have provided for you. Understanding that the necessary adjustments to your present behaviors are yours to make, we are here to help in any way we can! Having someone else following your achievements and setbacks could help you stay on track with your weight loss results and maintenance goals. We could provide education and our professional advice if you find yourself straying, getting off track, or becoming overwhelmed with the anatomy changes of weight loss surgery.

Your Overall Health: In addition to getting bloodwork done annually, our surgeons and medical staff members like to follow our patients to continue monitoring their health in general; the positives—no more CPAP, remission of diabetes, doing activities you were unable to do before—but also the complications that can occur after surgery—vitamin deficiencies, gas, diarrhea, bowel blockage, hernias, excess skin. Additional testing could be necessary after surgery, so keeping your follow-up appointments with us is essential.

Post-Op Visits

You should schedule an appointment to see your surgeon/assistant for follow-up visits at:

3-4 weeks (scheduled at the time of your surgery orientation class)
2 months
4 months
6-8 months
1 year or additionally as requested by your surgeon
Annually thereafter

Bariatric surgery is undoubtedly a major lifestyle change, and it takes strong determination and commitment to have long-term success. Your surgeon, nurses, and health staff are your unified team with your best interests in mind. We want you to reach improved health and experience an enriched quality of life. We want to be a partner in your health and along for your weight loss journey.

Keep in contact with us, and attend the weekly support groups we provide for our patients regularly.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Investing in Bariatric Benefits at the Workplace

Dec 13 By rmap nurse

Investing in Bariatric Benefits at the Workplace
By: Caitlin Kennington, Insurance Specialist

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

In 2013, the American Medical Associated declared obesity a disease, which currently affects 41.9% of the United States population.¹ All over the internet you will see ads for fitness programs, weight loss regimes, fad diets, fat-burning supplements, and prescription drugs all aimed at fighting the continual rise on the collective body mass index of consumers. However, when it comes to treating the morbidly obese, which is defined as those with a BMI of over 40, the only scientifically proven long-term effective and durable option is through metabolic and bariatric surgeries (weight loss surgery). These surgeries include the Gastric Bypass Roux-en-Y, Sleeve Gastrectomy, and the Biliopancreatic Diversion with Duodenal Switch.

Obesity is a disease that takes an emotional toll on those who suffer but also significantly impacts employers through increased health spending and in decreased productivity from less healthy employees. Due to these negative implications of obesity, more employer groups have begun recognizing the benefits of surgical weight loss and adding bariatric riders to their insurance plans. These riders are extremely effective additions to the policies as they allow access to more durable weight management options which cure and prevent obesity-related health conditions, which are very costly, and therefore provide a good financial investment. Additionally, surgery adds to better workplace productivity by increasing the number of healthy employees who are then more active and engaged in the workforce and are less likely to engage in medical-related absenteeism or require short-term or long-term disability.

Obesity, especially morbid obesity, is a very misunderstood disease with those who are affected being viewed as too lazy to stick to a healthy diet and exercise routine. Many employers feel that obesity in the workplace is a matter of a lack of lifestyle discipline.² As such, their efforts to fight the rise in obesity have been focused solely on providing fitness facilities, incentivizing weight management programs, or providing healthier cafeteria options. However, despite these workplace efforts, the obesity rates in the country have continued to rise, growing 11.4% from 2000-2022.³ Obesity is more complex than calories in and calories burned, with a great number of metabolic factors contributing. It is in treating the metabolic factors that bariatric surgeries are so much more effective in creating a more effective and durable weight treatment option than just lifestyle modifications.

In a long-term study by the Swedish Government those who were on a monitored and controlled program of lifestyle modifications only lost 2% of their body weight or an average of 15 lbs. over a period of ten years.⁴ In contrast, the University of Utah found that those who had the Gastric Bypass surgery lost and maintained a 26.9% weight loss or an average of 80.2 lbs. in the 14 years following surgery.⁵ Employers who give the option of opting into bariatric surgery benefits, therefore, will find that those who do will find more long-term success.

Oftentimes, employers will cite cost as the primary factor in choosing not to offer bariatric surgery benefits. However, the belief that it is too expensive of an option to offer is based on a lack of understanding of the long-term effect surgery has on chronic conditions and the financial implications thereof. It has been found that bariatric surgery pays for itself within 2 years.⁶ The primary cause for such a quick return on investment can primarily be attributed to the effects that surgery can have on chronic and expensive medical conditions.

It is estimated that hypertension, osteoarthritis, chronic back pain, and Type 2 Diabetes cost $1.7 trillion per year, with 18% of the cost being attributed to Type 2 Diabetes alone.⁷ Per the CDC, Type 2 Diabetes affects roughly 35 million Americans. Bariatric surgery has a particularly strong and immediate effect on Type 2 Diabetes with reports of insulin resistance dropping between 34-51% depending on the surgery, within the first 1-2 weeks following surgery.⁸ In the long-term, at 2 years 75% of patients undergoing Gastric Bypass found their diabetes in remission. At 6 years 65% of patients remained in remission, and at 12 years 51% of patients had maintained the remission of their diabetes.⁹

Because the treatment for and economic impact of Type 2 Diabetes is so high, the resulting remissions from surgery account for significant health cost savings. This estimates the huge impact of just one medical condition. Indeed, the cost benefits will only increase as inflation and exorbitant mark-ups on medication continue to drive the price up for treatment. Surgery has also been shown beneficial in treating hypertension, sleep apnea, hyperlipidemia, and Non-Alcoholic Steatohepatitis, as well as preventing obesity-related cancers and degenerative joint disease.

With all the costs associated with these conditions, obesity is estimated to cost $1.39 trillion per year in medical expenses, making it a wise financial decision to invest funds into paying for addition bariatric surgery riders on employer-provided group health plans.¹⁰

Finally, investing in the bariatric benefit allows patients to access care that will give them years of improved health, which is more likely to keep these employees in the workforce by reducing absenteeism, worker’s compensation claims, and short-term and long-term disability. Obesity is hard on the body, which results in more physical limitations, more musculoskeletal injuries, decreased mobility, and longer healing times from injuries. All these factors contribute to decreased productivity, and more requested leave being taken medical concerns.

Indeed, obese workers have been found to have a higher number of missed workdays, lower productivity, and a 76% higher rate of short-term disability claims.¹¹ Additionally, obese workers are more likely to leave the workforce entirely due to medical concerns associated with obesity. Those who are obese make up 43% of new Social Security Disability applications, while those in a healthy BMI range made up 23%.¹² All-in-all, healthier employees are more engaged, more present, and more effective employees and weight is a significant factor negatively impacting the workforce.

Obesity is a hugely impactful issue with the effects being widespread and detrimental. Many employer groups have recognized the benefits of encouraging weight loss in their employees; however, it is those who recognize the durability and effectiveness of bariatric surgeries who are more likely to see their employees lose more weight and maintain their weight loss. Those same employers who add the bariatric surgery rider will also find that as employees take advantage of the option, they will lower their health insurance costs. Finally, they will also see more employees maintain their health and stay engaged and productive in the workforce.

In conclusion, due to the overall positive impact these surgeries have for both the employer and the employee, these insurance riders are extremely beneficial and an effective tool in battling the obesity epidemic.

About the Author:

Caitlin is one of Rocky Mountain Associated Physicians (RMAP)’s insurance specialist by verifying patient’s insurance coverage and helping them with insurance criteria benefits. She was raised in Brigham City, Utah and Las Vegas, Nevada along with five of her siblings. She studied Art History at the University of Utah and is a Certified Gemologist and Jeweler. Caitlin enjoys reading, making jewelry, and spending time with her family, especially her husband, son and daughter.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Resources

Centers for Disease Control and Prevention. (2022, May 17). Adult obesity facts. Centers for Disease Control and Prevention. Retrieved November 25, 2022, from https://www.cdc.gov/obesity/data/adult.html
Gabel, J. R., Whitmore, H., Pickreign, J., Ferguson, C. C., Jain, A., KC, S., & Scherer, H. (2009). Obesity and the workplace: Current programs and attitudes among employers and employees. Health Affairs, 28(1), 46–56. https://doi.org/10.1377/hlthaff.28.1.46
Centers for Disease Control and Prevention. (2022, May 17). Adult obesity facts. Centers for Disease Control and Prevention. Retrieved November 25, 2022, from https://www.cdc.gov/obesity/data/adult.html
Sjöström, L. (2013). Review of the key results from the Swedish obese subjects (SOS) trial – A prospective controlled intervention study of bariatric surgery. Journal of Internal Medicine, 273(3), 219–234. https://doi.org/10.1111/joim.12012
Adams, T. D., Davidson, L. E., Litwin, S. E., Kim, J., Kolotkin, R. L., Nanjee, M. N., Gutierrez, J. M., Frogley, S. J., Ibele, A. R., Brinton, E. A., Hopkins, P. N., McKinlay, R., Simper, S. C., & Hunt, S. C. (2017). Weight and metabolic outcomes 12 years after Gastric Bypass. New England Journal of Medicine, 377(12), 1143–1155. https://doi.org/10.1056/nejmoa1700459
Cremieux PY, Buchwald H, Shikora SA, Ghosh A, Yang HE, Buessing M. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008 Sep;14(9):589-96. PMID: 18778174.
Weighing down America: 2020 update. Weighing Down America: 2020 Update. (n.d.). Retrieved November 25, 2022, from https://milkeninstitute.org/report/weighing-down-america-2020-update
Rao, R. S., Yanagisawa, R., & Kini, S. (2011). Insulin resistance and bariatric surgery. Obesity Reviews, 13(4), 316–328. https://doi.org/10.1111/j.1467-789x.2011.00955.x
Adams, T. D., Davidson, L. E., Litwin, S. E., Kim, J., Kolotkin, R. L., Nanjee, M. N., Gutierrez, J. M., Frogley, S. J., Ibele, A. R., Brinton, E. A., Hopkins, P. N., McKinlay, R., Simper, S. C., & Hunt, S. C. (2017). Weight and metabolic outcomes 12 years after Gastric Bypass. New England Journal of Medicine, 377(12), 1143–1155. https://doi.org/10.1056/nejmoa1700459
Weighing down America: 2020 update. Weighing Down America: 2020 Update. (n.d.). Retrieved November 25, 2022, from https://milkeninstitute.org/report/weighing-down-america-2020-update
Dor, A., Ferguson, C., Langwith, C., & Tan, E. (2010, September 21). A heavy burden: The individual costs of being overweight and obese in … GW Himmelfarb Health Sciences Library. Retrieved November 25, 2022, from https://publichealth.gwu.edu/departments/healthpolicy/DHP_Publications/pub_uploads/dhpPublication_35308C47-5056-9D20-3DB157B39AC53093.pdf
Hyde, J. S. (2016, January 30). The Prevalence of Obesity Among Recent Applicants to Federal Disability Programs. Washington, DC: Center for Studying Disability Policy, Mathematica Policy Research. Retrieved November 25, 2022, from https://www.mathematica.org/publications/the-prevalence-of-obesity-among-recent-applicants-to-federal-disability-programs.

Celebrating the Holiday Season

Dec 13 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

When the holidays roll around each year, it can be a very stressful and difficult time for bariatric patients. You get into a routine with your new and healthy habits, have your meals planned out, and have a new balance with your week ahead. But start to throw in family arriving from out-of-town, or perhaps it’s you who will be traveling this holiday season. Sometimes situations like eating out, going to parties, alcohol and liquid calories start coming up, and you might find yourself throwing in the towel.

Don’t panic! We have five important tips and tricks that could help you navigate this holiday season while still enjoying the celebrations of the holidays with those important to us.

Tips and Tricks to Celebrate

Plan Ahead and Accordingly: Use a calendar to mark the days you will have a special event. When you see what the month will look like, it will help you to navigate what you need to do. One the “special occasion” dates, it could be work parties, family or friend gatherings, and/or events at facilities or restaurants where you aren’t able to bring in food, be sure to plan ahead by looking at online menus, keeping the 70/30 rule in mind when choosing meals: 70% protein, 30% vegetables. Make food choices that will benefit your small stomach to ensure you are getting all of the nutrients and vitamins that you need!

Eat Before You Go: Do not starve yourself before going to an event. This could lead to “binge” eating or overeating when you get there. Eat your protein and veggies that will fill you up before you go.

Take a Water Bottle: This will also remind you to keep sipping water throughout the day. Even through the holidays it’s important to get your 64+ ounces of water in every day. Having your water bottle in hand while mingling can help keep your hands busy and away from the extra nibbles you don’t need. It wouldn’t hurt to move away from the food areas as well if you can.

Make the Time Special: Remember the special time we have with our loved ones and make it a day to remember. Instead of focusing on the food, gather your family and go sledding! You can watch your favorite Christmas movies, look at Christmas lights, volunteer at the shelter or a church function. You can set up a fun scavenger hunt for the kids that is Christmas themed. Exchange gifts with a fun game, go caroling, play board games or card games, play charades or Pictionary and have a laugh. There are countless things to do to stay active and moving to create special memories to always remember.

Walk it Off: Don’t forget that exercise is important during the holidays too. There’s no disagreement that the holidays are a busy time of year, but be sure you are still getting up and moving your body. Ways you could incorporate exercise into your day while preparing for the holidays is to take a walk around the neighborhood to admire the decorations. Make shopping for gifts and preparations an activity. Do a few laps around the store, take the stairs instead of the escalator, park further away from the shops.

Remember the reason for the season, whatever that may be for you. Family time, religion, love, laughter, connection, joy, etc. Take time to reflect and take care of yourself. Your life is a gift. You are a gift. Take the time to make memories and spend time with your loved ones. That’s something special to celebrate!

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Overeating Triggers and Tips

Dec 7 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

After bariatric surgery, it takes effort, persistence, and discipline to lose the weight and maintain that weight loss. You have to be willing to put forth the effort to make healthy decisions and choices, to say “no” to those tempting sugar-filled foods and tasty treats. It is a lifetime change, and it will take daily persistence to not “give in” to old habits and behaviors.

Knowingly or unknowingly, many people are simultaneously dealing with two chronic, potentially fatal diseases: the disease of obesity and disease of addiction. Both diseases affect every area of a person’s life and can leave a person feeling powerless and out of control.

Everybody manages stress differently; unfortunately, the majority of us carry stress-filled lives. We all seek distractions from stress and pain. In a 2013 survey by American Psychological Association (APA), 38% of American adults overeat due to stress. Of them, half say they overeat at least once a week.¹

Bariatric surgery is merely a powerful tool to help with weight loss. Identifying your personal triggers for overeating is the first step toward changing your mindset and habits to keep the weight off and maintain your health.

Modifying Eating Habits

There are numerous reasons why you might find yourself reaching for food. It could be due to emotional reasons, boredom, head hunger—where you “think” you’re hungry, but actually not, or actual hunger due to not filling up on the right kinds of food. The following are tips to help with modifying old habits and having more mindful eating practices.

Don’t Skip Meals: When you skip a meal, you can find yourself hungrier later in the day, which could then make you more likely to choose poor food choices or overeat. You have probably heard the saying “breakfast is the most important meal of the day.” Breakfast turns your metabolism on and kick-starts the function of your energy supply.

Breakfast Ideas:

Deli meat with melted cheese on top

Scrambled egg, grated cheese, cooked mild tomato salsa

Low-fat low-sugar yogurt

Poached eggs, canned tomatoes

Snack Time: If you’re eating at regular intervals throughout the day and still find yourself eating, stop and ask yourself if you truly are hungry. Remember that the “hunger sensation” may also be due to a lack of water. If you still find your stomach growling, it’s okay to reach for a protein-dense snack. Appropriate snacking (only twice a day) can help boost your metabolism and keep your energy levels high.

Change of Scenery: Eating in front of a television trains our minds to think about eating food every time we sit down to watch something. It can also distract you from realizing to stop eating because you’re full. Sit at a table and focus on the food and your feeling of fullness.

Chew, Chew, Chew: It could take 20-30 minutes for your brain to get the message that you are full. Slow down, and chew your food well. Chewing about 30 times before you swallow allows you to pace yourself. Use a small plate, eat slowly, and put your utensils down between bites. Try to resist the urge to clean your plate completely if you start to feel full.

Journaling and Tracking: Keeping track of your food may help you notice patterns in your habits. Try starting a journal or using an app like MyFitnessPal or Baritastic to record your food and beverage intake. You may have emotional or environmental triggers for overeating. Are you hungry, bored, frustrated, angry, happy or sad? Documenting your emotions to identify your areas of weakness can be very beneficial and can help you develop new strategies for health.

Meal Plan: It’s well-known that restaurant portions are very large. If you ate out regularly, you could have been overeating without really realizing it. Plan your meals out in advance to avoid dining out when you think you have “nothing to eat.” Save dining out for special occasions, and remember, you can take leftovers home! You don’t have to eat everything on your plate.

Drink More Water: We can’t stress enough how important drinking water and staying hydrated is. You should be drinking a minimum of 64 ounces of water each day. Dehydration can also make you think you’re hungry when really all you need is a drink of water.

70/30 Rule: Your meals and snacks should be following the 70/30 rule; 70% protein-dense foods and 30% vegetables. Avoid any simple carbohydrates and sugars as they can slow weight loss, stop or interfere with maintenance, and if you had the Gastric Bypass, they could induce the “dumping syndrome.” You want to ask yourself what the food item you are going to eat is going to do for your body. What is the nutritional value? Does it provide you with what you need? Does this item contribute to the 70/30 rule?

Measure Your Food: Bariatric patients should never consume more than 1 cup (8 ounces) at any meal. You should be consuming 2-4 ounce meals. This should be measured in volume, not weight. If you have questions about what you should be eating and when, please review the big blue binder that was given to you at your Surgery Orientation Class prior to surgery as to what stage you are in. If you still have questions or are unsure, please call us at (801) 268-3800.

¼ cup = 2 ounces	½ cup = 4 ounces	1 cup = 8 ounces
4 tbsp. = 2 ounces	8 tbsp. = 4 ounces	16 tbsp. = 8 ounces

Bye-Bye Carbonation and Caffeine: Most carbonated drinks are high in sugar and caffeine, which can interfere with your long-term weight loss. Carbonation distends even normal size stomachs and delays the sensation of fullness. Caffeine can be an appetite stimulant, a known diuretic, and can cause gastric distress. Our surgeons recommend staying away from carbonation and caffeine for these reasons.

You won’t ever have the opportunity to relive the first rapid weight loss months again. Dedicate yourself to staying within the guidelines we set out for you from the start and develop the habits that support long-term success that can last a life time.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

org/news/press/releases/stress/2013/eating (American Psychological Association (APA))

Kristy R.’s Gastric Bypass Story

Nov 23 By rmap nurse

I have struggled with my weight my entire life. I gained weight from medications and found the food comforting when times got tough. I had health issues come and go. I watched my family members go through similar struggles and just assumed I was destined to be the same way.

Months before my last pregnancy, I found out I was Type 2 Diabetic. I started a medical diet program that worked around my increasing number of medications. My pregnancy was rough from start to finish. Strict diets, insulin shots, so much counting and stress. I still gained lots of weight. At delivery, I was 287 lbs.! I was 29 years old and almost 300 lbs. I felt shame; I felt ugly. My daughter was born early and rushed to the NICU. I found myself just snacking away and crying as I felt like a horrible mother, but I was also in denial that my diabetes would remain.

Three weeks after my emergency delivery, my mother-in-law was hospitalized. The doctors stated it was complications from her Type 2 Diabetes. She was still in her early 50’s. We drove out of state with our newborn on oxygen with us. We stayed a week and left after the doctors stated she was improving. Upon our return, we found our oldest cat (my therapy kitty) was starving himself from depression. He was 15 years old and was declining quickly. We immediately started working on improving his chances. There was so much stress and pain. I again ignored my eating knowledge and continued eating through my feelings. Within days of arriving home, we received the phone call that my mother-in-law had passed away due to her complications of diabetes. We were devastated. I was on the verge of a breakdown.

It didn’t end there for us; our kitty also took his last breath. Within the first two months of 2018, I had three traumatic events happen. I was terrified! I WAS LOST. I didn’t know what to do. I finally decided I wanted to live longer than the next 20 years. I wasn’t going to allow my diabetes to take me away from those I love. I restarted working with my doctors, the diets no longer helped, and I was exercising and exhausting myself.

After months of hardly any success, my doctor recommended weight loss surgery. I completed the seminar that summer. I worked with my doctors and insurance to complete all the necessary steps. I chose Dr. Rodrick McKinlay as my surgeon. His explanation made me feel comfortable with my decision. My starting weight before surgery was 249 lbs. in September 2019.

After my Gastric Bypass surgery, my diabetes didn’t change as I had hoped. I again felt defeated and lost. I wanted to cheat on my diet and just give up. I was still early in the process. Dr. McKinlay and his staff ensured I was supported and reminded me I needed to trust the process. I stuck to the “blue bible.” I researched different recipes. I found a new love of cooking and trying new foods, not because I knew it would taste great but because I knew it would FUEL my body. I started treating my body better.

Slowly I was off all medications. I reversed my Type 2 and hit my goal weight by my 10-month mark. I had cut out all bad foods, sodas, snacking, etc. I found it easier to watch my protein intake and measure my fuel in volume and not weight. I kept my portion size to the recommended size.

A year later (almost to the date), I had an extended panniculectomy. They removed 5 lbs. of loose skin from my midsection. I will not lie, that hurt me more than any of my children’s births! I healed much slower and started having fainting and dizzy spells. It turned out I had developed reactive hypoglycemia. My blood sugars would spike and then crash within 45 minutes of eating carbohydrates. I mean, I would almost pass out from eating bell peppers if I didn’t eat double the amount of protein with them. I had to learn a new fuel process. I had to add some small carbs back in. I struggled with self-image at that point. Fat brain is a real thing, and it takes time to heal. I felt ugly again.

I started daily affirmations, participating in the group chats, taking photos and only saying positive things about them. I went on two women’s retreats to learn to love myself. You can retrain your brain. You can do hard things. You need to be patient with yourself and forgive yourself. I have learned so much; I have healed so much.

I am now three years out from my Gastric Bypass. I still struggle with reactive hypoglycemia, but I am managing it with my diet. I have not gone back to bad eating habits! I mean, after losing my job in 2020, I tried, and it made me sick, so lesson learned. It’s true, you do gain a little weight back, and then your body settles. I have maintained my weight of 128 lbs. for almost two years now. My lowest weight was 115 lbs. I didn’t feel healthy then. My original goal weight was 125 lbs.

I am so happy and healthy now! I love camping, hiking, chasing my kids, cooking, baking, and the challenge of trying new, healthy foods. I even make my coffee healthy! I have improved my quality of life and my family life. If you are starting this journey, be nice to yourself and trust the process. Don’t be afraid to ask questions, to reach out for anything you need help with. If you are maintaining or even getting back on track, you got this, and keep pushing forward!

–Kristy R.

Surgeon: Dr. Rodrick D. McKinlay
Procedure: Gastric Bypass Roux-en-Y
Surgery Date: 8/19/19
SW: 249
CW: 128
TWL: 121

Preparing Emotionally for Bariatric Surgery

Nov 23 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

While bariatric surgery is a powerful surgical tool to help with weight loss, so much more than the weight loss occurs for patients post-operatively. It is a lifechanging decision bariatric patients make that requires commitment. While it can be an exciting time, it can often be scary to make such a lifechanging decision. Surgery is not “an easy fix” nor is it “the easy way out.” So many bariatric patients comment on how they prepared themselves for the physical changes that come with weight loss surgery, but they found themselves less prepared for the emotional changes.

Most insurances will have criteria for patients to meet before surgery in order for them to grant approval. It can sometimes take anywhere from 3-12 months to get approved! Because of the number of steps than can be required and the prolonged time it can take for them to complete, many patients find themselves getting discouraged. However, instead of viewing the insurance requirements as a set-back or getting discouraged, this can prove an excellent time to mentally prepare yourself for all the changes in food selection, habits, and anatomy changes that will come following bariatric surgery.

We want all of our patients to understand and be aware of the changes that comes with bariatric surgery, which is why we have our patients attend so many educational classes! The more our patients know and understand, the better long-term success they will have. Sometimes patients are under the impression that everything will be easy and perfect after surgery, that surgery will instantly take away your appetite or the weight will melt right off and you can never gain it back. This way of thinking is the foundation for failure and can lead to feeling deceived or let-down. It is important to understand that weight gain can happen, unhealthy habits and cravings can come back and that while surgery is a lifechanging surgery tool in order for it to work most effectively, there must be a commitment towards hard work and consistency…for life!

Habits you have held throughout your life are hard to break and rewiring your brain to think differently is hard. Breaking those unhealthy habits requires actively working on them.

Emotional Eating

The topic of emotional eating is popular among our patients. Many have said how much they “miss food.” Many things can be a “trigger” for emotional eating such as life stressors, relationships, self-image and doubt, boredom, bad days, so on and so forth. Inevitably, life still happens after bariatric surgery.

Identifying those stressors that could trigger emotional eating could help benefit your weight loss journey and maintenance success. Figuring out the root problem and actively working it prior to surgery, either by getting help from a therapist, nutritionist, or dietician, could benefit your success post-surgery.

Support from Friends and Family

For most patients, bariatric surgery is a positive change that friends and family will support. Unfortunately for some, relationships are negatively affected. Your relationship with food is changing, and sometimes friends and family might not fully understand those changes. Some might even knowingly try to sabotage your success.

Many food-centric events such as family get-togethers, dinner dates, holiday feasts, and even lunch breaks will start to look different due to your new habits and changed anatomy. Preparing your family and friends for these changes by sharing with them the knowledge and tools, given to you in the education classes, can better prepare them to support your decision.

Weight Loss Equals Body Changes

It is no secret that with weight loss will come some body changes. For some, the attention can be exciting, while for others it can be a little overwhelming. Some see the changes and are proud of what they see, while others only see the markings of extreme weight loss and excess skin that can happen which can be alarming to them. You should always be proud of your hard work! That doesn’t mean you should feel shameful or embarrassed for those changes.

Our clinic can provide a list of several plastic surgeons or even psychologists to help you with these changes. We also have support groups for our patients to reach out to one another, share their journeys – the good, the hard, the triumphs and the setbacks– for emotional support from others who might be going through or have overcome the same things.

For more information on our support groups or on how to join, please click here. We are all here to support, listen, and help you through your journey! We want you to succeed and live a full, happy, and healthy life. In order to do so, we caution against thinking that weight loss surgery will fix all of your problems in your marriage, with self-image or self-esteem, with your mental health, or with unhealthy eating habits. Getting in front of those problems prior to surgery and working on them constantly can help set you up with a healthy mindset ahead of the new changes that come following surgery.

Bariatric surgery is undoubtedly a major lifestyle change, and takes strong determination and commitment to have long-term success. It is a decision you make for a healthier you: physically, mentally, and emotionally. It is common to have setbacks and doubts, but that does not mean you are a failure or that you have ruined your tool for weight loss. Refocus, reevaluate, and set realistic goals for yourself.

Stay in contact with your surgeon and team, do your annual bloodwork, attend our monthly support groups, and continuously work on understanding your new anatomy, building your new healthy habits, and reflecting on the emotional side of bariatric surgery.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

A Thanksgiving Gratitude Attitude

Nov 9 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Americans are notorious for centralizing holidays around bountiful feasts and abundant meals with dishes that we love and have grown up with. Thanksgiving could be the first holiday that comes to mind when asked this! The holiday has become known as a celebration of the harvest and food, food, food. However, Thanksgiving is so much more than just about food.

Thanksgiving History

In 1621, the Plymouth colonists and the Wampanoag shared an autumn harvest feast that is acknowledged present day as one of the first Thanksgiving celebrations. In 1863, President Abraham Lincoln proclaimed a national Thanksgiving Day be held each November.

Believe it or not, Thanksgiving meals did not feature pumpkin pies, cakes, or other desserts as meals in present day have become known for. Things like stuffing, mashed potatoes, and cranberry sauce didn’t become popular until later throughout the centuries.

What is Thanksgiving?

So what does the word “thanksgiving” mean to you? To some, it means the act of expressing or feeling thankfulness. There might be people in your life that have helped you, become apart of your life, taught you valuable lessons, or have made an impact on you that you might want to celebrate and give thanks to.

Thanksgiving might look differently to you after having bariatric surgery. With your new tool your surgeon has provided to you, and with your changed anatomy, food will be portioned, measured, and focused on high-protein, veggies, and low-carbohydrates. Below we have put together a list of ways to still make your Thanksgiving special and memorable, and about more than just the food!

Get Outside: Move your body by being active in a Turkey Trot, flag football tournament, or any kind of outdoor activity.
Volunteer: Spare your time by helping with a food drive or serving food at a soup kitchen or shelter.
Give a Meal to Someone Less Fortunate: There are many who are less fortunate and some who might not be able to get out and prepare a meal for themselves. Why not prepare a meal and deliver it to those in need?
Watch Movies: Gather together and watch Thanksgiving-themed moves!
Play Games: Break out the board games, trivia, card games, or charades and have a good laugh with your family and/or friends.
Go for a Drive: If it hasn’t snowed, Utah’s autumn season is filled with vibrant-colored leaves and stunning mountain views. You don’t even need to leave the warmth of your car! See the beautiful sights by taking your family for a leisured drive.
Just Be Thankful: Create a list of all the things you are thankful for and grateful to have as a part of your life.

However you spend the Thanksgiving holiday this year, remember to give thanks by celebrating with more than just food. We have much to be grateful for! It could be our improving good health, to do activities and move our bodies, our friends and family, our home, our job, education, and let’s not forget our fury or scaly friends (pets)! Embrace the gratitude attitude for your health and wellness, not just on Thanksgiving Day, but 365 days of the year.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Food Addictions and Habits

Nov 2 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

It’s no secret that food is essential to human survival. Not only does it provide necessary sustenance, it can also be a gratification component of pleasure and enjoyment through many different tastes, smells, and textures. However, for many individuals, food can become a very serious addiction.

What is Food Addiction?

Food addiction (FA) is loosely defined as the eating behavior in which the consumption of highly palatable foods, such as foods high in salt, fat, and sugar, in quantities beyond homeostatic energy requirements.¹ Food addiction is similar in symptoms with other eating disorders, such as binge eating. When foods high in fat and sugar are consumed, it triggers a chemical reaction in the brain that induces the feelings of pleasure and satisfaction.

A study led by Dr. Magalie Lenoir found that cocaine-addicted rats chose sugar when given the option to consume cocaine or sugar. 94% of the addicted rats showed a preference for sugar over cocaine.² Dr. Lenoir concluded during the demonstration that, “intense sweetness can surpass cocaine reward, even in drug-sensitized and addicted individuals…The supranormal stimulation of [sweet] receptors by sugar-rich diets, such as those now widely available in modern societies, would generate a supranormal reward signal in the brain, with the potential to override self-control mechanisms and thus to lead to addiction.”

Physical and Mental Health Distress

It can be a complex ferocious cycle when we consume copious amounts of certain foods. It affects not only our physical health, but our mental health in ways we might not expect. We might experience guilt, shame, and disgust about our inability to control our eating habits and the foods we eat. When sugar is consumed, it causes a temporary rush of dopamine (hormone), which then is followed by a sugar crash, and in turn leads to more cravings. As mental health declines, another sugar fix is needed, angst and self-disgust sets in, and the vicious cycle continues.³

Signs and Symptoms of Food Addiction

Eating food even when no longer hungry
Eating in secret, isolation
Going out of your way to obtain food, obsession
Difficulty to function at work
Decreased energy, chronic fatigue
Spending significant amounts of money of foods
Difficulty concentrating
Sleeping habits change, such as insomnia or oversleeping
Irritability
Headaches
Depression, low self-esteem
Self-harm, suicidal ideations
Digestive disorders
Denial about an issue with food

Ways to Get Help

The only way to defeat the vicious cycle of food addiction is to get to the root cause of the problem. There are many outlets for help:

If you need help with food addiction, nutrition, or help with overcoming old habits, don’t feel ashamed to ask for help. We can give you referrals to dieticians and psychologists who can help! Give our office a call at (801) 268-3800.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

https://www.sciencedirect.com/science/article/abs/pii/S0074774216301106 (Science Direct, Chapter Four – Psychological and Neurobiological Correlates of Food Addiction, E. Kalon, J.Y. Hong, C. Tobin, T. Schulte)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0000698 (PLOS ONE Journals, “Intense Sweetness Surpasses Cocaine Reward,” M. Lenoir, F. Serre, L. Cantin, S.H. Ahmed)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235907/ (National Library of Medicine, “Evidence of Sugar Addiction: Behavioral and Neurochemical Effects of Intermittent, Excessive Sugar Intake,” N.M. Avena, P. Rada, B.G. Hoebel

The Connection Between Sleep and Weight

Daniel R.’s Gastric Bypass Story

Bariatric Surgery Aftercare

Investing in Bariatric Benefits at the Workplace

Celebrating the Holiday Season

Overeating Triggers and Tips

Kristy R.’s Gastric Bypass Story

Preparing Emotionally for Bariatric Surgery

A Thanksgiving Gratitude Attitude

Food Addictions and Habits

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