Benefits of Planning Your Meals

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

Does meal planning or prepping give you anxiety or make you want to yawn? Do you think it’s too time consuming? What about too much needs to go into it? Maybe you don’t know where to even begin? It might comfort you to know that you are not alone! Still, even though it might take some beginner organization skills, the benefits of meal planning and prepping are important to you—and your family!—and your weight loss journey.

Research shows that when you prep and plan your meals ahead of time, you are less likely to deviate off track.¹ This can help you with your weight loss, avoid weight regain, and help prevent you from going off track by impulsive eating.

These nine benefits of meal planning, as well as these three suggestions on how to get started, will support you to do meal prepping and planning. Once you get into the routine and habit of this and have a better understanding as to why, it will be easy!

Benefits of Meal Planning

It can save you money. By planning ahead, you can avoid eating out and set expectations for the week.
It can reduce stress. You can plan to use leftovers for lunch or a quick dinner when you are in a hurry.
It can save time. Freezing food/meals is also a great way to save time when it comes to meal planning. Just take it out of the freezer, warm it up, and you’re good to go!
It can help avoid wasting food. When you create a meal plan, you can make a grocery list of only the ingredients you need. This also helps you avoid buying things you don’t need.
It can help you make healthier food choices. When you know what you’re going to eat, you’re less likely to choose unhealthy foods when you’re hungry.
It can help with portion control. Meal planning allows you to buy specific quantities of food, so you can control how much you eat and avoid overeating.
It can eliminate impulsive eating. Some find that a structured balanced meal plan can help reduce some of the decision-making stress related to eating. It can satisfy your physical needs while leaving less room to act impulsively or emotionally.
It can aid in weight loss. When you plan your meals in advance, you are in control of what you prepare your meals with, choosing fresh, healthy ingredients.
It can help regulate regular eating times. A meal schedule can help you eat at regular intervals and early enough in the day. Eating too late at night can cause sleep disturbances, raise blood sugar, and increase the risk of obesity.

How to Get Started

Organization is Key

Firstly, you will need to pick a day that works best for you to plan your meals and/or snacks, should it be on Sunday afternoon or Wednesday after dinner. Look at your calendar of events to see how many meals you will need to prep and how much time you will have to prepare the meals.

Knowing when you will be eating is just as important as knowing what you will be eating. You can use the guides below to create your meal plan to see what meals you will be eating on which days. Also, don’t forget to utilize your freezer! This is an excellent space to put your leftovers or prepped meals for easy last-minute meals.

Implement a Grocery List

You will need to know what your recipe ingredients are, so write them down! Check your fridge and pantry for missing ingredients or items you are getting low on, and start making a list.

It’s crucial that you never grocery shop on an empty stomach. Being hungry while shopping permits your cravings or hunger to determine what foods you buy instead of sticking precisely to your grocery list.

Utilize Apps

Apps such as Baritastic, Lose It, and MyFitnessPal are useful to keep track of protein and fluids, log nutrients, reminders to eat and drink, plus so much more. Rocky Mountain Associated Physicians (RMAP) is working with St. Mark’s Hospital for pre and post support using the Baritastic app! If you would like to join, use code 25921 or scan the QR code from the picture below. All RMAP patients are welcome to use this code.

Remember that practice makes accuracy! There are so many different advantages of meal prepping and planning. This will become easier over time, developing into a new habit, just like the other habits and behavioral changes you made after bariatric surgery.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1521 East 3900 South, Suite 100
SLC, UT 84124

Resources:
1. Pauline Ducrot, Caroline Mejean, Vani Aroumougame, Gladys Ibanez, Benjamin Alles, Emmanuelle Kesse-Guyot, Serge Hercberg, and Sandrine Peneau, “Meal planning is associated with food variety, diet quality and body weight status in a large sample of French adults”; 2017 Feb 2: 10.1186/s12966-017-0461-7; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288891/

Bariatric Nutrition and Exercise

May 8 By rmap nurse

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

Engaging in physical activity is one of the keys to success after bariatric surgery. Once cleared by your medical team to start exercise after surgery, you should have a regular routine in place that includes both cardiovascular and resistance training. It plays an extremely important role in building muscle, improving metabolism, keeping excess weight off, and of course, it is good for your mental and physical health! We encourage you to experiment with different types of exercise to find something that you truly enjoy and will continue to do long-term.

You have likely heard the saying, “You can’t out-exercise a poor diet.” The same is true after bariatric surgery. The majority of fat loss is still achieved from a low-calorie intake and healthy diet. Make sure that you do not make the error of thinking that exercise is a free pass to eat whatever you want.

Exercise recommendations from the American College of Sport Medicine (ACSM) Physical Activity Guidelines for Americans are 150-300 minutes per week of moderate intensity aerobic activity or 75-150 minutes per week of high intensity aerobic activity, and at least 2 days of strength training exercises that work all muscle groups. If you are curious about how to monitor your exercise intensity, you can review this infographic from the ACSM for more information here.

Plan Meals and Snacks Around Your Exercise Schedule for Optimal Benefit

For most, eating 3 consistent meals with 1-2 snacks daily and following the dietary guidelines as recommended should be sufficient to fuel you through exercise 60 minutes or less in duration. The goal of your post-workout meal or snack is to help you recover and maximize your workout’s benefits, which means repairing and building muscle, as well as replenishing glycogen (i.e. energy) stores. Rather than adding extra foods to your meal plan, schedule a meal or a snack within 1-2 hours after exercise. For example, hit the gym after work, then plan to have dinner when you get home.

If you are working out at a high intensity for longer than 60 minutes (long distance running or cycling, playing a sport, body building, training for a competition or race, etc.), the energy and/or protein needs and timing of intake required to fuel these types of activities become increased and more specific. There are currently no set nutrition guidelines as research is emerging on bariatric athletes. You should remember that there will be some trial and error involved as everyone is unique.

Decreased energy intake and lower carbohydrate tolerance after weight loss surgery can lead to earlier fatigue, poor recovery, and decreased performance. Those engaging in endurance exercise will likely benefit from meeting with a dietician to discuss specific goals and needs to create an individualized plan that will allow optimal performance while continuing to maintain weight loss goals.

What You Eat Matters: Protein and Healthy Carbohydrates

As with the bariatric diet, protein is a central piece of exercise nutrition as well. Exercise triggers muscle protein breakdown, and it is important that you follow a workout with a high protein meal or snack that will help repair and build your muscle mass. The minimum recommendation for protein intake is 1 gram or protein per kilogram of body weight, and more than this if you are seriously strength training. Protein needs vary based on several factors such as type and frequency of exercise, and the size of an individual, among other potential factors.

If you have reached weight maintenance and it is appropriate for you, consuming a small amount of complex, high fiber carbohydrate along with protein at a meal or snack following exercise helps both with replenishing glycogen stores and with protein synthesis. Make sure that you do not count exercise as a free pass to eat any carbohydrates you want or replace your protein intake with carbohydrates as these habits contribute to weight regain.

Here are some quick and easy ideas to help you with your post-workout meals and snack planning:

Post-Workout Meals

Post-Workout Snacks

· Tuna salad on ½ slice whole grain bread with carrot sticks

· Baked pork chop with green beans and roasted sweet potato

· Salmon with potato/cauliflower mash

· Turkey deli meat, cheese, and vegetables on small low carb tortilla

· Egg and vegetable scramble with oatmeal

· Power bowl with grilled chicken, roasted vegetables, and brown rice

· Greek yogurt with berries

· String cheese and a few whole grain crackers

· Apple slices with peanut butter

· Mini cheese and bean quesadilla on small corn or whole grain tortilla

· Hardboiled egg and melon cubes

· Cottage cheese and pineapple

· Snaps peas and carrots with Greek yogurt ranch dip or hummus

Don’t Forget About Hydration

Both water and electrolytes are lost through sweat during exercise. Drinking plenty of water both before, during, and after your workout will help optimize your recovery and performance and prevent dehydration. Staying hydrated allows your muscles to contract properly and to regulate your core temperature. Electrolyte drinks can be beneficial, however; Be aware that many sports nutrition products have a lot of added sugar which can cause dumping syndrome, hypoglycemia, or diarrhea. Look for low sugar options such as Gatorade Zero or Nuun Sport Hydration electrolyte tablets or powder packets. Signs you may benefit from electrolyte supplementation include intense exercise, sweating heavily, muscle cramping/spasms, persistent fatigue, or headaches.

Each Person is Unique

When it comes to nutrition, each person has different needs, health and lifestyle factors, and preferences that must be considered. Your nutritional intake should reflect the level of activity in which you are engaging. These recommendations are generalized and what works well for one person may not work well for you. Please contact your team at RMAP is you would like more information or assistance with creating a plan as we are here to support you and your goals.

About the Author:
Juliana Betker, MS, RDN, CD, is a registered dietitian nutritionist who joined Rocky Mountain Associated Physicians (RMAP) in 2023 as a Registered Dietitian Nutritionist specializing in weight management and bariatrics. She graduated with her BS in Food Science and Human Nutrition from Clemson University and her MS in Kinesiology from the University of North Carolina Charlotte. She supports patients both before and after surgery by providing nutrition education, helping to manage food-related issues, and encouraging a balanced and positive relationship with food as they navigate their new lifestyle.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1521 East 3900 South, Suite 100
SLC, UT 84124

Recognizing Your Hunger Signals: Is It Actual Hunger?

Mar 25 By rmap nurse

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

Regrettably, weight regain can happen after bariatric surgery. It’s actually quite common! Just know that if you have experienced weight gain, you are not alone. Many people fall back into old habits or find themselves still tempted by foods you know won’t help you reach or maintain your goal weight.

Fortunately, with a little help and willpower—as well as determination and commitment—there are ways you can develop a more deliberate mentality and stay on track with your dietary choices. People who tend to “fall off the wagon” or mindlessly consume unhealthy meals routinely, should stop and take a moment to ask themselves these questions first:

Are you physically hungry? If you are physically hungry, there will be true hunger cues to look for. Such as stomach growling, low energy, shakiness, headaches, and problems focusing.
Are you angry or stressed with someone or a situation? There really is such a thing called stress eating. When upset or stressed, people tend to turn to food to relieve those emotions. The nervous system sends signals to the adrenal glands on top of the kidneys to pump out adrenaline (also known as epinephrine). This hormone helps trigger the body’s fight or flight response—a supercharged physiological response that puts delays eating. But if these upset or stressed feelings persist, another hormone called cortisol is released as well, which motivates to eat. Cortisol levels should decrease once the stressful or angry episode is over, but if those feelings don’t go away, cortisol stays elevated.¹
Are you actually bored? When people are bored, studies have shown that we attempt to distract ourselves from boredom with food.² Boredom snacking in between meals leads to consuming more food than your body needs, which sequentially, turns to weight gain.
Are you emotionally eating? Emotional eating is “eating as a way to suppress or soothe negative emotions, such as stress, anger, fear, boredom, sadness and loneliness.” Fore most, turning to food to cope with emotional eating creates guilt and shame—more hard feelings to navigate.

Misinterpreting Hunger Cues

Listening to your body’s natural cues helps you become more well informed and mindful of what your body really needs. Pay attention to the types of foods you are eating and the amount. Sugary, high saturated-fats, and processed foods aren’t filling, and you will find yourself hungry faster than should you eat unprocessed foods that are high in protein and fiber.

Hunger Vs. Thirst

It may be possible that you are misinterpreting your body’s thirst signals as hunger. Our bodies send the same signal when we are hungry or thirsty, so before you go snacking, try drinking some water and staying well hydrated throughout the day. You should be drinking a minimum of 64 ounces of water daily.

Eating Regularly

Life can get hectic, and it’s true! It’s easy to either forget a meal, or skip a meal simply because of not being prepared. Skipping meals—intentionally or not—often results in being starving later, which can make you more likely to make poor food choices and/or to overeat. Ensuring that you are eating three meals a day is important to keep your energy up so your body performs the tasks of daily living.

Keep Snacking Healthy

Sometimes you do need a little snack in between meals, and that’s okay! Snacks can help manage hunger, stabilize blood sugar, and energize you. Keep your snacks focused on protein and veggies. Eating salty or sweet snacks can make you bloated and hungry faster, and ultimately lead to weight gain.

Overtime you will notice patterns and discover your personal body cues once you get into the habit of listening to your body. It can be a slow process, ending an old habit, but it’s not impossible. Perfection is never the goal, especially at the beginning.

Links to related articles:
Hunger Between Meals
Tips to Help with Hunger
Weight Regain: Living with Fear and Dread

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1521 East 3900 South, Suite 100
SLC, UT 84124

Resources:

Harvard Health Publishing, “Why stress causes people to overeat”; Harvard Medical School; https://www.health.harvard.edu/staying-healthy/why-stress-causes-people-to-overeat
Andrew B. Moynihan, Wijnand A.P. van Tilburg, Eric R. Igou, Arnaud Wisman, Alan E. Donnelly, and Jessie B. Mulcaire; “Eaten up by boredom: consuming food to escape awareness of the bored self.”; 2015 Apr. 1. Doi: 10.3389/fpsyg.2015.00369; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381486/

Body Shaming Hurts More Than Just You

Mar 13 By rmap nurse

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

Anyone else have the old saying, “Sticks and stones may break my bones, but words will never hurt me,” engraved into them from elementary school? If only this adage had more truth to it, right?

Overweight people can have a number of physical or psychological complication that can impact their body. For example, some medical conditions and medications can contribute to weight gain. Any kind of trauma and abuse can trigger the development of eating disorders. Even factors where perhaps one is unable to afford quality whole foods, and then this can lead to relying on “fast-foods,” or “cheap foods.”

All in all, we don’t always know everyone’s story, or what they are going through. Words do hurt. They hold meaning. And when those words are used to shame someone else’s body image, the harm can go much deeper than the feeling of hurt.

What is Body Shaming?

The dictionary defines body shaming as to “mock or stigmatize (someone) by making critical comments about the shape, size, or appearance of their body.” This can be about your own body or someone else’s. Body shaming can even go as far as harmful commentary on a person’s age, hair, clothes, or the level of perceived attractiveness.

Research shows that exposure to weight stigma triggers physiological and behavioral changes connected to poor metabolic health and increased weight gain.¹ Cortisol—the body’s main stress hormone—will spike, self-control decreases, and the risk of binge eating increases.

Effects of Body Shaming

Body shaming has countless negative and sometimes damaging consequences on a person’s health. Such as:

Youths who are body shamed have a considerably elevated risk of depression.²
Research has shown that body shaming can lead to eating disorders.³
Weight stigmas can worsen the outcomes for obese women attempting to overcome binge eating.⁴
Dissatisfaction with one’s body caused by body shaming can cause low self-esteem.⁵
It can also include mental health concerns like anxiety, body dysmorphic disorder, depression, higher risk of self-harm or suicide, poorer quality of life due to body dissatisfaction, and psychological distress.

Ways You Can Help

Speak up, and stand up, when you see or hear any act of body shaming. Making it a point about not engaging in various types of shaming can lead to improved mental wellness.

Stop Commenting on Other People’s Bodies

Unfortunately, body size comments, even those that are meant to be harmless or innocent, can lead to a more negative body image in children and adults. Notice your thoughts and acknowledge your own conditioning, bias, and/or judgements. Practice to expand and strengthen respect, care, and compassion for yourself and others. Make it an intentional effort to notice what you like, appreciate, or admire about yourself and others.

Change Your Self-Talk

Our culture can put so much emphasis on what is wrong with us and needs improvement. This can feel like a huge challenge to speak positively about ourselves and our bodies. But by practicing positive speech within ourselves and our bodies, and by noticing qualities about ourselves and others that we admire and appreciate, we can strengthen enhance our care, compassion, and connections with others and with ourselves.

Speak Up

This is the same as with all other instances in life, that when you see someone else causing harm, you will speak up and help—provided it’s emotionally and physically safe for you to do so.

How to Cope with Body Shaming

It’s important to know that no one should feel ashamed about how they look. If you are someone experiencing body shaming, you are not alone. There are things you can do to take care of yourself:

Be Aware. A lot of marketing companies like to promote the “perfect body.” Be aware of the language used in these ads, and help identify—and stop—any body shaming you’ve internalized and may be repeating to yourself.
Positive Self-Talk. Observe when you start criticizing your body. Word that conversation differently and consider something that you love about yourself and praise it. Try to focus on how your body feels, and thank it for all it does for you.
Celebrate Your Body. Do something that you love to do! Actively appreciating your body can go a long way in helping you to love your body you live in.
Get Support. You don’t need to be subjected to body shaming alone. Talk to someone you love and trust. If you need more help, talking to a licensed professional who specializes in body inclusivity can help.

Appreciate the human body for all it is and does!

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1521 East 3900 South, Suite 100
SLC, UT 84124

Resources:

Lauren Vogel, “Fat shaming is making people sicker and heavier.”; 2019 Jun 10; 191(23): E649; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565398/
Alexandra A. Brewis, Meg Bruening; “Weight Shame, Social Connection, and Depressive Symptoms in Late Adolescence.”; 2018 May 1; 15(5): 891; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981930/
Alexandra A. Brewis, Meg Bruening; “Weight Shame, Social Connection, and Depressive Symptoms in Late Adolescence.”; 2018 May 1; 15(5): 891; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981930/
Lara Palmeira, Jose Pinto-Gouveia, Marina Cunha; “The role of weight self-stigma on the quality of life of women with overweight and obesity: A multi-group comparison between binge eaters and non-binge eaters.”; 2016 Oct 1; 1:105:782-9; https://pubmed.ncbi.nlm.nih.gov/27423819/
Patricia A. van den Berg, PhD MPH, Jonathan Mond, PhD, MPH, Marla Eisenberg, ScD, MPH, Diann Ackard, PhD, LP, and Dianne Neumark-Sztainer, PhD, MPH, RD; “The link between body dissatisfaction and self-esteem in adolescents: Similarities across gender, age, weight status, race/ethnicity, and socioeconomic status.”; 2010 May 4; 47(3): 290-296; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923488/

Changing Your Relationship with Food

Feb 13 By rmap nurse

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

Many people will blame food for their weight gain, using food as a source of emotional comfort to celebrate, relax, and manage stressful and emotional situations, as well as boredom. But in reality, that food item didn’t force you to eat it. It is solely up to you with what you eat, not food.

You might have tried numerous strategies and diet plans to work through the relationship you have with food. If this is you, it’s vital to know that you are not alone! This journey to a healthier relationship with food doesn’t need to be traveled down alone.

By regarding and changing your relationship with food in a healthy way, you can lead a healthy and nourishing life. Weight loss surgery is merely a tool. How you utilize this tool given to you by your surgeon is your decision.

When you value your physical health, you can learn to ask yourself, “Will this get me to my goal?” before you dig into sugary or salty snacks/food. You are worth of both physical and emotional health. You are capable and have the ability to manage and express your emotions in healthy ways.

Your Relationship with Food

So, what kind of relationship do you have with food? What does that look like? It can go beyond labeling foods as only “good and bad.” It can impact not only your physical health, but your mental health as well. Having a good relationship with food will make you feel good, both mentally and physically. Think about food as a source of nutrition and energy instead of something to relieve stress, emotions, or to be avoided.

What Does an Unhealthy Relationship with Food Look Like?

Feeling guilty before and/or after eating
Avoiding foods labeled as “bad” for you
Making long lists of food you can and cannot eat
Ignoring the natural hunger cues of your body
Stress and anxiety levels rising around social settings
Fearing being judged for food choices
Using calorie apps in a restrictive way

In short, feeling any kind of stress, fear, shame, or guilt regarding any food choices, can be a sign of an unhealthy relationship with food.

Making the Change

It can seem easier said than done, which is understandable. A lifetime of habits can be hard to change, but it’s not impossible!

Distinguish Why You’re Eating

Are you eating because you feel emotionally drained due to a bad day?
Did you have an argument with someone close to you?
Are you eating because you feel bored?
Are you rewarding yourself with food because of an achievement?

If the answer to any of these questions is yes, you could have an unhealthy relationship with food. Changing these habits and practicing mindful eating is key to maintaining your weight loss after bariatric surgery. Knowing your state-of-mind before, during, and after your food choices is important.

Having bariatric surgery is hard. There’s no if’s, and’s, or but’s about that statement. Maintaining that weight loss can also be just as challenging, if not harder. If your habits and mindset remain the same as pre-surgery, weight regain could happen once again. It could be beneficial to meet with a therapist who works with food-related therapy, or a dietician who can educate you further on healthy food habits and nutrition. This can help you find the root cause as to why you reach for food to comfort your emotions.

If you feel those cravings coming on that aren’t driven by actual hunger, try doing one or more of these suggestions to help curb that feeling:

Read a book
Write in a journal
Call a friend
Soak in a hot bath
Take a walk
Meditate
Hit a punching bag

How You Can Start

Eat Regularly
Skipping meals can lead to you being very hungry and can make you more likely to overeat. It also ups the odds you’ll choose sugary foods, or foods that are fast and high in fat.

You’ve heard it before, and we’ll say it again, eat your breakfast! A morning meal kickstarts your metabolism and can help curb hunger throughout the day.

Keep it Clean
Keeping your fridge and pantry free of foods high in sugar and fat will help keep your meals and snacks healthy and clean. You’ll be more likely to reach for healthier snack options that are nutritious for your body to refuel.

This in an opportunity to make healthy changes not only for yourself, but for your whole family. Encourage participation in meal and snack planning and preparation. Enjoy the flavors, colors, and textures of whole, fresh foods and challenge yourself to learn more about healthy flavors and cooking techniques.

Ask for Help
Don’t be afraid or ashamed to ask for help if you are struggling with your relationship with food. We are here to help! It’s what we are here for.

Medical Weight Loss Experts:
Stacy Parry, FNP
Elizabeth Hanna, DNP

Registered Dietitian
Juliana Betker, RDN

Social Workers:
Erika Olson, LCSW
Amber Hall, CSW

Give our office a call at (801) 268-3800 to get scheduled for an appointment with one of our providers.

Join a Support Group
We believe the success of our patients is due to the hard-work and determination they have, supported by dedicated surgeons and staff. One way we provide the necessary support to our patients after bariatric surgery is through monthly support groups. We have support groups that are held every month via Web-Ex virtually. We believe it very beneficial to our patients to provide group therapy for all patients who wish to be supported in this way.

These groups are designed to help you in every stage after weight loss surgery. We have teamed up with our nurse practitioner, Lissa Hutchings, MSN, APRN, RNP-C, and also Erika Olson, CSW, along with various guests to provide specialized groups following weight loss surgery.

To learn more about our support groups, please visit us here.

Be Aware of Mindful Eating
Be present when you are eating your food/meals. Focus on what you are eating, chew your food thoroughly, and simply be present. Put your phone away, turn the TV off; remove yourself from any distractions while eating. Being distracted while you eat can lead to overeating and missing your body’s natural “hunger cue” of when you are full and when to stop eating.

Remembering that food is fuel to provide the energy and nutrition you need to survive is one step closer to a healthy relationship with food.

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

Cancer and Obesity

May 15 By rmap nurse

Cancer and Obesity
By: Sarah Christensen, PA

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

The effects of obesity on health have long been studied. It is not surprising that many types of cancer seem to be associated with obesity. One 16 year study from the American Cancer Society followed nearly 900,000 people and found that men with a BMI greater than 40 had a 52% increase in risk and death from cancer whereas women had a 62% increase with similarly high BMI.

Multiple studies show that obesity contributes to a significant number of cancer-related deaths each year. In 2014 it was estimated that obesity contributed to 40% of cancer in the United States. Cancers associated with obesity include:

Endometrial cancer
Cervical cancer
Ovarian cancer
Breast cancer
Colorectal cancer
Esophageal cancer
Liver cancer
Pancreatic cancer
Kidney cancer
Gallbladder cancer
Thyroid cancer
Prostate cancer
Leukemia
Non-Hodgkin’s lymphoma
Multiple myeloma

One study suggests that obesity causes up to 90,000 cancer deaths per year. As the BMI increases, so does the risk of death from cancer.

Recent studies show a similar correlation with reduction in weight and reduction in cancer-related deaths. A 7 year study of 9,949 patients who underwent bariatric surgery had a 60% reduction of cancer related deaths compared to a control group. As cancer treatment continues to improve with surgery, chemotherapy, radiation and other forms of treatment, it is important to note the impact of obesity treatment to aide in reducing the risk of cancer related deaths.

As we continue the fight against cancer, we cannot ignore the benefits of weight loss. Out late Dr. Sherman Smith, MD, stated, “We remain hopeful that other successful bariatric procedures will carry this same kind of highly favorable impact upon future wellness of those who choose surgical treatment of this very difficult condition.”

About the Author:

Sarah Christensen joined Rocky Mountain Associated Physicians as a Physician Assistant in August 2015. She attended Brigham Young University in Provo, Utah with both academic and musical scholarships and earned a Bachelor of Science degree in Biology in 2009. She then completed her Master of Science in Physician Assistant Studies at Idaho State University in Pocatello, Idaho in 2011. Prior to joining Rocky Mountain Associated Physicians, Sarah spent 3.5 years working in liver transplant, managing end-organ failure and post-transplant care. She is certified by the National Commission for Certification of Physician Assistants.

References:

ASMBS, The Impact of Obesity on Your Body and Health. Retrieved from https://asmbs.org/patients/impact-of-obesity
Calle, Eugenia E., et al. “Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults.” New England Journal of Medicine 348.17 (2003): 1625-1638
Steele CB, Thomas CC, Henley SJ, et al. “Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity – United States, 2005-2014.” MMWR Morb Mortal Wkly Rep 2017; 66: 1052.
Adams, Ted D. Gress, Richard E. et al. “Long-Term Mortality after Gastric Bypass Surgery.” New England Journal of Medicine 357 (2007): 753-761.
Mackenzie H, Markar SR, Askari A, et al. “Obesity surgery and risk of cancer.” Br J Surg 2018; 105: 1650.

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

The Real Deal on Obesity, Part 1

Mar 21 By rmap nurse

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

Some of the causes of obesity may be attributed to some of the following factors:

Abundance of food
Environmental
Emotional eating
Genetics
Inactive lifestyles
Lack of awareness
Portion distortion / Super-sized portions

Although the cause of obesity is not clearly understood, it is known that obesity is a result of an energy imbalance over a long period of time. Energy balance is like a scale, when calories consumed are greater than calories used weight gain results.

Basic differences in people’s genetic predisposition may partly explain why some remain lean in the current cultural environment of fast food and huge portion sizes, while others are hundreds of pounds overweight. However, food choices and lifestyle behaviors cannot be discounted. Emotional eating is the largest factor with poor food selection and preparation coming in 2^nd and genetic factors coming in 3^rd.

In January of 2003 John Hopkins University released a study on the years of life lost due to obesity. They found the following information:

People with a BMI over 45 can expect their lives to be significantly shorter.
Women could expect to lose 5-8 years of life.
Men could expect to lose 12-20 years of life.

To see that the years of life lost could be as much as 20 years lost clearly demonstrates that:

Obesity is not a benign condition but a killer!

A report from the Surgeon General’s offices detailed that approximately 300,000 deaths per year can be associated with obesity. That becomes a startling statistic when you compare it to the 400,000 deaths per year that are associated with cigarette smoking. Obesity is now the second leading cause of preventable death in the United States.

Obesity is a chronic progressive life impairing disease of excess fat storage with multiple negative health effects termed co-morbidities. The excess weight can so severely impact your body that you may develop major health problems leading to premature death.

Medical professionals view morbid obesity as a disease with serious medical, physical, social and psychological effects, not as a lack of will power or self-control. There are at least 23 genes discovered that affect obesity.

Morbid Obesity

Defined as an individual being greater than 200% of ideal weight, or 100 lbs. overweight, or a body mass index (BMI) greater than 40.
Chronic disease process characterized by:
- Severe accumulation of fatty tissue in the body and organs
- Minimal response to dietary management

Body Mass Index
BMI is the standard that medical professionals use to measure the relationship (or ratio) of weight-to-height. The BMI is more highly correlated with body fat than any other indicator of height and weight. The BMI has replaced the Ideal Body Weight tables, which vary from country to country.

If you have a BMI of 40 or greater, BMI of 35 or greater with co-morbidities, or 75 to 100 pounds or more overweight, you are one of over 4 million Americans who have the disease of Morbid Obesity.

Determining Your Body Mass Index (BMI)
Formula: weight in pounds X 703 ÷ height (inches) ÷ height (inches)

Underweight                          <19
Healthy Weight                      20-24
Overweight                             25-29
Obese                                      30-34
Severely Obese                       35-39
Morbidly Obese                     >40

Co-Morbidities Related to Obesity

Medical Co-Morbidities Related to Obesity
· Respiratory dysfunction · Cardiac Dysfunction · Arthritis · High Cholesterol · Bladder Control · Menstrual Irregularities · Gallbladder Disease · Diabetes Type II · High Blood Pressure
Physical Co-Morbidities
· Personal hygiene · Mobility · Sexual limitations · Difficulty tying shoes · Limited clothing choices, selection, availability and prices · Furniture weight bearing incapacity · Theater seats, planes, buses, restaurant booths, toilet & shower cubicles · Limited access to chairs, passage ways, stairs and difficulty walking
Psychological Co-Morbidities
· Approximately 89% of morbidly obese individuals suffer from Clinical Depression · Poor self-esteem, depression, guilt and self-hate · Social withdrawal · Neurotic & Anxiety disorders · Major psychiatric illnesses are the same as the rest of the population
Economic Co-Morbidities
Employment discrimination · Getting hired · Promotions · Special projects or accounts	Education discrimination · Select schools and Universities	· Cost of special devices necessary to perform daily acts of living · Cost of weight loss programs · Denial of insurance coverage
· Greater than 140 billion dollars is spent each year battling obesity · Over 30 billion dollars in personal costs · Over 68.8 billion dollars on medical care · Unknown costs to business
Social Co-Morbidities (Discrimination)
· Weight harassment, prejudice and “fatism” · Studies show society has low respect for morbidly obese (Same as for alcoholics and drug addicts) · Many have limited number of friends · Dating and marriage is less common

To learn more about Weight Loss Surgery and see if it is right for you, sign up to attend our FREE informational seminar that is taught by one of our Bariatric Surgeons. He will go over all of the Risks and Benefits of each procedure and answer any questions or concerns you might have. To sign up, click HERE or go to www.RMAP.com or call (801) 268-3800.

For The Real Deal on Obesity, Part 2, go here.

Find more answers to Frequently Answered Questions here.

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

Building Evidence Basis for Bariatric Surgery

May 7 By RMAP Nurse

Building Evidence Basis for Bariatric Surgery
By: Dr. Sherman C. Smith, MD, FACS

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

It’s been a pleasure to review the latest publications relative to bariatric surgery, establishing a foundation of science from which we can apply major benefit to patients suffering from severe clinical obesity. First, it would be appropriate to first review the currently recognized and effective surgical treatments.

Laparoscopic Adjustable Gastric Band (LAP-BAND, Realize Band)

The laparoscopic adjustable gastric band (LAP-BAND, Realize Band) involves the use of a restrictive device placed just caudal to the esophagogastric junction. The restrictive effect is adjustable by filling an access port by needle on the anterior rectus sheath. It requires adjustments over time to achieve the maximum weight loss benefit. The weight loss at five years ranges from 35-60% loss of excess body weight (EBW), the outcomes largely dependent upon patient compliance with follow up. It is the safest of all surgical procedures in this group, and the 30 day mortality is 0.05%. It is less expensive, reversible and usually only involves an outpatient surgical experience.

Of course there are some disadvantages. The weight loss is slower and patients lose less weight overall on average than with the other procedures. Long term follow up in Europe has been disappointing, and about 40% of the patients have had to have the device either removed, surgically adjusted, or the patients have had unacceptably low amounts of weight lost. Preliminary studies in the U.S. are more promising, but long term studies are still pending.

Laparoscopic Sleeve Gastrectomy

The laparoscopic sleeve gastrectomy involves removing 80% of the stomach leaving a thin “sleeve” along the lesser curve. Some of the antrum is usually preserved. There is no foreign body involved and the small bowel is not altered in this operation. Patients tend to lose about 60% of EBW within a year, and seem to maintain that profile through the first five years post-operative years. There is a risk of leak from the staple line in 1-3% of the cases, and stricture at the incisura will occur 1-2% of the time. These are difficult problems to correct and sometimes result in conversion to gastric bypass. Early post-operative heartburn can also be problematic. Mortality at 30 days is 0.2%. This procedure may be performed as the first stage of a biliopancreatic diversion with duodenal switch, with plans to return to perform the malabsorptive bowel stage after considerable weight loss in the more massively obese patients. For patients who have had previous bowel surgery for obstruction, or a colostomy, this approach offers the advantage of not having to deal with the adhesions involving the bowel. Patients with ulcerative colitis or Crohn’s disease, and immunocompromised patients may prefer to pursue a sleeve gastrectomy.

Laparoscopic Roux-en-Y Gastric Bypass (RYGB)

The laparoscopic Roux-en-Y Gastric Bypass (RYGB) has restrictive, metabolic and malabsorptive effects. The best long term data is available with this procedure since it was first done as an open procedure in 1965 with a sling loop, and was converted to a Roux-en-Y in 1973 with markedly improved results with respect to bile reflux gastritis. It remains the most frequently performed procedure in the U.S., and is now most often performed laparoscopically. EBW loss of 60-80% is seen at five years. The 30-day mortality is 0.2%. Diabetics see improvement in their disease within days of the operation, long before significant weight loss has occurred, consistent with a significant metabolic effect through a change in the incretins released from the bowel. This operation is difficult to reverse and may have malabsorption issues particularly with iron, B12 and calcium. Protein malnutrition is extremely uncommon. The dumping syndrome can occur. Anastonotic leaks develop <1% lifetime risk of bowel obstruction is 5%, and anastomotic strictures requiring endoscopic dilation are seen in 5% of patients.

Biliopancreatic Diversion with Duodenal Switch

The biliopancreatic diversion with duodenal switch involves a sleeve gastrectomy, a duodenoenterostomy with preservation of the pylorus, and a short segment common channel in which nutrients are absorbed. This operation is highly malabsorptive, has restriction and is very powerful metabolically. It is suited for those who have a BMI >50, and/or high triglyceride levels. These patients lose 70-90% EBW and diabetes resolution is seen in over 90%, again, as early as 1-2 weeks. Although the true dumping syndrome is not seen, steatorrhea and foul-smelling flatus can be problematic. There are considerable nutritional and vitamin deficiency risks, but most conscientious patients can safely avoid them. Anastomic leaks are seen in 1%, bowel obstruction in 5%, and protein malnutrition in as many as 25%.

A review of some recent publication will be helpful in making an assessment as the value of these aggressive approaches to obesity and its comorbid conditions. The first is “Health Benefits of Gastric Bypass Surgery After 6 Years.”¹ This was a prospective study involving three groups. Groups I of 418 patients underwent RYGB, Group II of 417 patient sought RYGB but didn’t have it, and Group III of 321 patients were randomly selected from a population based sample of obese patients not seeking surgery. With a 93% follow up in all groups, there was a 27.7% total body weight (TBW) loss in Group I, 0.2% TBW gain in Group II, and 0% TBW gain in Group buy phentermine low price III. Additionally, 94% of Group I patients has at least 20% decrease in TBW at 2 years and 76% of the patients had at least that amount of weight loss at 6 years.

Diabetes remission defined as a normal HgbA1c was seen in 62% in Group I, 8% in group II, and 6% in Group III. (Remission odds ratios 16.5, p<001 vs. Group II and 21.5, p<.001 vs Group III) The diabetes incidence in Group I = 2%, Group II = 17%, and Group III = 15%.
Hypertension remission/incidence was 42%/16% in group I, 18%/31% in Group II, and 9%/33% in Group III.
Triglyceride remission/incidence was 71%/3% in Group I, 33%/25% in Group II, and 34%/28% in Group III.
Low HDL remission/iincidence in Group I was 67%/5%, in Group II 34%/32%, and in Group III 18%/38%.
Mortality in the groups was comparable with 3% in Group I, 3% in Group II and 1 % in Group III. Suicides and poisonings were not statistically significant in group comparison.

Two randomized controlled trials (RCT) were published in the spring of 2012. The first came from the Cleveland Clinic, “Bariatric Surgery versus intensive Medical Therapy in Obese Patients with Diabetes.”² This study compared RYGB to sleeve gastrectomy (SG) and to medical therapy. All patients had uncontrolled Type 2 Diabetes Mellitus (DM2) with average HgbA1c=9.2%. The primary end point was HgbA1c of <6.0% after 12 months of treatment. There were 50 patients in each group and a 93% follow-up noted. 12% of the medical group, 42% of the RYGB group, and 37% of the SG group reached the endpoint. The difference between the medical group and the two surgical groups were statistically significant, but between each of the surgical groups they were not. There was improved glycemic control in all groups with an average HgA1c of 7.5% in the medical group, 6.5 in the RYGB group, and 6.6% in the SG group. The medical group lost 5.4 kg, the RYGB group lost 26 kg and the SG group lost 25 kg. Use of medication to control blood pressure, lower lipids, and decrease glucose increased in the medical group, but it decreased in the surgical groups. There were no deaths, but four of the surgical groups’ patients required reoperation.

The next study came out of Cornell University and Rome, Italy and is titled “Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes.”³ This was also RCT involving 60 patients with HgbA1c >7.0%. The Roux-en-Y Gastric Bypass (RYGB) group, the Biliopancreatic Diversion (BPD) group, and the medical group, each had 20 patients. The end points to define DM2 remission were a FBS of <100mg%, and a HgbA1c<6.5% without pharmacologic therapy. The very impressive rates of remission at 2 years were 0% for the medical therapy group, 75% for the RYGB group and 95% for the BPD group. Total body weight loss was 4.74% of the medical group, 33.3% for the RYGB group, and 33.81% for the BPD group.

Changes in blood pressure were not statistically significant. Decreases in LDL from baseline in the medical group were 20%, RYGB group 17%, and BPD group 57%. Increases in HDL from baseline were 6% in the medical group, 30% in the RYGB group, and 13% in the BPD group. Decreases in the triglyceride levels from baseline were 18% in the medical group, 21% in the RYGB group, and 57% in the BPD group.

Accumulation of this kind of evidence, especially the quality of evidence in RCT’s, confirms the significant decrease in weight, control of Type 2 Diabetes Mellitus, decrease in cardiovascular risk due to lipid factors, and improvement in hypertension control following bariatric surgery, when compared to medical therapy. The offset of surgical risk has to be considered in these analyses as well, but there are several retrospective studies which point to a lower risk of death for the obese patients, if that patient undergoes bariatric surgery.^4,5,6,7,8

Sherman C. Smith, M.D., FASMBS is a general surgeon specializing in bariatric surgery at Rocky Mountain Associated Physicians (RMAP), and performs surgery at LDS and St. Mark’s Hospitals in Salt Lake City, Utah. He is a former assistant clinical professor of surgery at the University of Utah and retired Lt. Colonel in the U.S. Army Reserves, having served as a surgeon in operation Desert Storm.

Article was presented at Collegium presentation October 5, 2012.

REFERENCES:

T. Adam, LE Davidson, et al, “Health Benefits of Gastric Bypass Surgery After 6 Years” JAMA, September 19, 2012 – Vol. 308, Nov. 11 pp.1122-1141
PR Shauer, et al, “Bariatric Surgery versus intensive Medical Therapy in Obese Patients with Diabetes.” NEJM, March 26, 2012
G Mingrone, S Panunzi, F Rubino, et al, “Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes.” NEJM, March 26, 2012
Sjostrom L, Lindroos AK, Peltonen M, et al. “Lifestyle, Diabetes and Cardiovascular Risk Factors 10 Years After Bariatric Surgery.” NEJM 2004; 351:2683-93
Adams TD, Gress RE, Smith SC, et al, “Long-Term Mortality After Gastric Bypass Surgery.” NEJM 2007; 357:753-761
Sjostrom L, Narbro K, Sjostrom CD, et al, “Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects.” NEJM 2007; 357:741-752.
“The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative Safety in the LABS.” NEJM 2009;361445-54
Buchwald H, Estok R, Fahrbach K, et al. “Weight and Type 2 Diabetes After Bariatric Surgery: Systematic Review and Meta-Analysis.” Am J Med 2009; 122(3);248.e5-256.e5

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

Childhood Obesity: The Link to Drinks

Jan 23 By RMAP Nurse

Childhood Obesity: The Link to Drinks
By: Rodrick D. McKinlay, MD, FACS

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

“Data indicates that soft drinks account for 13 percent of a teenager’s caloric intake – by far the largest source of calories in his or her diet.”

Childhood obesity rates have doubled throughout the past 30 years in the United States for children ages 2-5 and 12-19, and tripled in the age group of 6-11. Obesity for children is defined as a body mass index (BMI) at or above the 95^th percentile for similar age and gender youths.

Social and Environmental Pressures
Many social and environmental pressures lead to greater obesity in children. Chief among these influences is the wide variety and availability of sugar-sweetened drinks that contain little to no nutritional value. These beverages include:

Soft drinks
Sports drinks
Fruit drinks
Flavored teas and coffees
Energy drinks

Throughout the past 10-15 years, these drinks have exploded on to the consumer scene, flooding grocery stores, gas stations, convenience stores and vending machines.

Americans have doubled their consumption of soda pop in the last 25 years, a trend that closely follows the obesity epidemic. The average American drinks.¹ 6 cans of soda pop a day, more than 500 cans a year. Soda drinking is particularly rampant among teenagers. Data indicates that soft drinks account for 13 percent of a teenager’s caloric intake – by far the largest source of calories in his or her diet. For decades, milk was the most common beverage consumed by children, but by the mid-1990’s, boys and girls were drinking twice as much soda pop as milk.

One recent, independent peer-reviewed study from Harvard demonstrated a strong link between consumption of sugar-sweetened beverages and childhood obesity.² Although some studies conflict regarding the causality between sugar-sweetened beverages and obesity, a number of research studies confirm the Harvard group’s findings that increased soft drink and sugar-laden beverage consumption is a risk factor for obesity.³ Not only do sugar-sweetened drinks likely lead to obesity, they are also associated with tooth decay and weakening bones.

Energy Drink Emergence
In the past decade, energy drinks have exploded into the marketplace. In 2006 alone, 500 new energy drinks were launched. Energy drinks, which typically contain large amounts of sugar and caffeine, are equally if not more dangerous to children. Although the target market for energy drinks is young adults aged 18-35, teenagers are consuming significant quantities of these beverages.

Caffeine by the Can
The amounts of caffeine found in such drinks as Red Bull or Rock Star are about 10 grams per ounce. With that in mind, take a look at the amount of caffeine found in other beverages:

Red Bull (8.3 oz. can) = 83 grams
Rock Star (16 oz. can) = 160 grams
Coca-Cola Classic (12 oz. can) = 34.5 grams
Pepsi-Cola (12 oz. can) = 38 grams
Coffee (8 oz. cup) = 57 grams

Most experts recommend that children consume well under 100 grams of caffeine per day.

Effects of Caffeine on Children
Pharmacologic effects of caffeine are notable in children, most commonly seen as hyperactivity, sleep disturbances and restlessness. Drinking large amounts of caffeine can also be associated with high blood pressure and frequent headaches.

Researchers have reported that a new practice among college-age students is the simultaneous consumption of energy drinks and alcohol, which allows greater consumption of alcohol since alertness is perpetuated by the energy drink.⁴ In addition, the sugar content of energy drinks is comparable or higher than most soft drinks. For example, an 8 oz. Red Bull contains 27 grams of sugar and a 16 oz. Rock Star has 60 grams of sugar, while the typical non-diet soft drink contains 40-45 grams of sugar.

How to Combat the High-Calorie Beverage Craze
So what can be done to limit the amount of nutritionally-poor liquid calories that children and adolescents are consuming? On an individual-basis, the best approach is simply to replace soda and sports drinks with water or low-fat milk in children’s diets. Water is the best hydrator available. Low-fat milk not only hydrates, but delivers calcium, protein and vitamin D.

Children should be monitored at home with their choice of liquids. A glass of 100% fruit juice per day is beneficial, but excessive soda, sport drinks or energy drinks is unhealthy. What happens at school to eliminate vending machines that sell soft drinks and energy drinks in favor of bottled water.

Moderation in guiding children, of course, is appropriate. Children who are constantly deprived of treats are more likely to binge eat or drink. Also, parental modeling is important. Studies suggest that children who are raised by parents who exert excessive dietary restraint may be more likely to become obese.⁵

Children possess the ability to internally regulate their caloric intake. If they see their parents struggle with alternating dis-inhibited eating (abandoning the effort to control food or drink intake) and restrained eating (conscious decision to restrict intake to control weight), they may pattern their own eating and drinking behavior after their parents instead of allowing their internal energy regulation to guide them. This, in turn, seems to lead to greater obesity in children.

Conclusion
Parents should adopt healthy eating and drinking patterns, limiting consumption of soft drinks and other sugar-sweetened drinks, and to do so without obsession. Helping children develop a love for the refreshing taste of water or a cold glass of milk will pay immediate health rewards for children as well as dividends for their future health and weight control.

About the Author:

Dr. Rodrick D. McKinlay, MD, FACS, is a certified Center of Excellence bariatric surgeon with Rocky Mountain Associated Physicians in Salt Lake City. Dr. Rodrick D. McKinlay has been performing weight loss surgery since 2004, including: Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, Duodenal Switch (DS) and Gastric Banding procedures.

References:

Childhood Obesity in the United States: Facts and Figures, Fact Sheet 2004, Institute of Medicine.
Ludwig et al, Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001; Feb 17; 357 (9255): 505-8.
Wolff et all, Medscape J Med 2008; 10(8): 189.
Malinauskas et al, Nutrition Journal 2007; 6:35.
Hood et al, International Journal of Obesity 2000; 10: 1319-1325.

Childhood Obesity: The Link to Drinks also appeared OAC Your Weight Matters magazine here.

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

Benefits of Planning Your Meals

Bariatric Nutrition and Exercise

Recognizing Your Hunger Signals: Is It Actual Hunger?

Body Shaming Hurts More Than Just You

Changing Your Relationship with Food

Cancer and Obesity

The Real Deal on Obesity, Part 1

Obesity is not a benign condition but a killer!

Morbid Obesity

Co-Morbidities Related to Obesity

Building Evidence Basis for Bariatric Surgery

Childhood Obesity: The Link to Drinks

Contact Information

Procedures Offered

quickLINKS