Your Bariatric Dietitian

The television advertisements may sounds enticing; “Double beef, double cheese…” but what they neglect to mention is that you will be eating triple the fat.

Have you ever heard that dark chocolate is good for you? It tends to be a message we remember (and want to believe). Would you expect it to contain a similar amount of fat and sugar to milk chocolate, white chocolate and other common chocolate bars?

How many teaspoons are there in that 600ml bottle of juice you buy at the corner store or service station? It is likely to be more than 12 teaspoons of sugar. (Yes, that is the no added sugar variety.)

Feel sluggish after lunch at the pub? With over 17 teaspoons of fat in a typical schnitzel and chips, it’s no surprise.

Confused as to which is the best milk, or yoghurt, or cheese, or muesli bar to buy?

With the right information at hand, you can make some simple swaps to the products you buy and the food you prepare. These small, maintainable changes to your diet will result in a steady, sustainable weight reduction. If you are smart about the changes you don’t have to feel hungry, deprived or eat less - you just need to modify what you are already doing.

Spoons for Thought is an innovative publication containing over 250 colour photographs of individual foods, meals and drinks with the teaspoons of unsaturated fat, saturated fat and sugar they contain.  In addition to these high impact images, it contains hundreds of practical tips.
 
Authors Justine Hawke and Sally Johnston are Accredited Practising Dietitians and Accredited Nutritionists with a combined experience of over 16 years in patient counselling. Our experience has been harnessed in this simple publication that is relevant to anyone who buys or eats food!

Read more at www.spoonsforthought.com.au and feel free to share with friends, family and colleagues.

The silly season has arrived! For many of us the social calendar will be filling up with all sorts of occasions and events. Lots of events can pile up those sneaky calories, making it hard to manage our weight through the Christmas period and into the new year. It is important to enjoy the festive season, but there is no need to go overboard.

Christmas Day it is just one day. If you start stocking up on Christmas goodies the moment they arrive in the stores, or when the parties start in late November, you are setting yourself up a month (or two) of indulging. If you find it hard to resist your favourite Christmas foods, keep them out of the house until Christmas day.

On Christmas day or at special functions, don’t deprive yourself of your favourite foods. Research tells us that the more you deprive yourself of a food, the more you are likely to crave it, and often, overeat it. Allow yourself the foods you enjoy. Choose small portions and eat mindfully. Save your indulgences for the foods or drinks you really enjoy. If fruit mince pies take your fancy, then make sure you enjoy them. For me, I'd rather skip the pies for the glass of bubbly!

Many Christmas indulgences are however foods that can be eaten regularly in a healthy diet. Succulent leg ham, fresh seafood and seasonal fruit such as mangoes and cherries can all be enjoyed regularly without the calories of highly processed snack foods.

Come the new year, many of us end up with a pantry full of gifts from well meaning family and friends: shortbread, chocolate coated nuts and boxes of chocolates. Some people then feel the need to eat them until they are gone. Pace yourself and spread them out, savouring small amounts. If you eat small amounts over a longer period of time it extends the pleasure.

Look for opportunities over the festive season to share gifts of food and drink with others. Whenever you go a social event, take gifts you are given to share to avoid them stockpiling. Avoid the temptation to have to eat them all at once to get rid of them and spread out over time. Start a new tradition of giving by reading the inspiration for this months feature recipes.

For many, Christmas is one time of the year to take some well earned time off work and spend with family and friends. Too often relaxing can mean sitting, eating and drinking. Look for opportunities over your Christmas break to be active. Start a family game of backyard cricket on Christmas day. Make sure the children are given some active gifts in their stocking such as balls, flippers or a kite.

Obesity is a well-established risk factor for Type 2 Diabetes, high blood pressure, elevated cholesterol, heart disease, stroke, sleep apnoea, hip and knee replacements, and even some cancers. These obesity-related conditions can have a major financial impact on an individual.
The cost of a gastric band procedure is an important consideration for patients contemplating surgery. But a recent American study shows that the cost of a gastric banding procedure is offset by reductions in medical costs associated with obesity. In this study, the obesity-related medical costs of patients who didn’t have a gastric banding procedure continued to rise whereas for those who did have surgery, medical costs reduced. The study looked at healthcare claims data from over 7,000 patients who had undergone gastric banding compared with claims from a similar number of obese people who did not have surgery.
Importantly, within 4 years all gastric banding patients had broken even financially. Gastric banding patients with Diabetes broke even financially in 2¼ years. The results emphasise the important effect gastric banding can have on keeping healthcare costs down.
So although there is an initial financial outlay for a gastric banding procedure, the benefits in terms of reduction in healthcare costs can be significant within a short period, meaning it may be a cost effective option for weight loss and restoration of good health.


Reference: Finkelstein et al. Financial implications of coverage for laparoscopic adjustable gastric banding. Surgery for Obesity and Related Diseases 7 (2011) 295–303.

It is with great pleasure that I welcome Dr Justin Bessell to the newsletter. Dr Bessell is a General and Upper Gastrointestinal Surgeon who is highly experienced in Bariatric surgery. A keen follower of research in the area of weight loss surgery, he will provide guest reports and updates on the latest research. For more on Dr Bessell please visit his profile.

Bariatric Surgery May Be Helpful in Paediatric Population

Bariatric surgery may be effective in obese children and adolescents, but a cautious approach is warranted, according to the results of a systematic review reported online March 3 in Clinical Obesity.
 
The investigators included 37 studies with a total of 831 children or adolescents younger than 19 years, spanning 36 years. Among 13 studies of gastric banding, mean decreases in body mass index (BMI) ranged from 8.5 to 43, with weight gain reported in 1 case study. Mean BMI reductions ranged from 9 to 25 in 8 studies of gastric bypass (RYGB).
 
(Other forms of bariatric surgery, including sleeve gastrectomy, vertical banded gastroplasty, biliopancreatic diversion, or a combination of procedures, were reported in 14 articles. These procedures resulted in mean BMI decreases ranging from 9 to 24, weight regain in several cases, and 3 deaths related to surgery.)
 
One Australian project studied cost-effectiveness, and results reported that laparoscopic adjustable gastric banding (LAGB) is cost effective for adolescents.
 
The authors stated that existing evidence … suggests that bariatric surgery in older children results in significant weight loss and improvements in comorbidities and quality of life.
 
The authors cautioned that, postoperative complications, compliance and follow-up may be more problematic in adolescents than adults, and availability of long-term data on safety, effectiveness and cost-effectiveness remains largely unknown. The authors suggested a cautious approach to child and adolescent bariatric surgery is warranted, and reversible techniques are advisable compared to approaches that permanently alter anatomy.
 
The authors went on to say that lifestyle modification is crucial to the long-term success of bariatric procedures.
 
Prevention was also considered important; they recommended development of practical lifestyle programs for overweight and obese children.
 
The project that led to this study was funded by the WHO Health Evidence Network of the World Health Organization. The study authors have disclosed no relevant financial relationships.
Clin Obesity. Published online March 3, 2011.

For those in Adelaide I am excited to introduce an innovative cooking and nutrition workshop specifically for people who have had weight loss surgery!

Nutritionist and chef, Mel Haynes has teamed with a weight loss surgery “insider” to help you improve your success with healthy eating after surgery and give you inspiration in the kitchen.
 
Be part of these exciting cooking classes and see fresh ideas for creating easy and delicious meals that you can enjoy with your family and friends.
 
Enjoy not only a delicious culinary experience, but professional nutrition advice from qualified nutritionists and time to share your experiences with other weight loss surgery insiders!
 
All recipes prepared have been developed in consultation with those who have had weight loss surgery.

Morning and afternoon classes are available, or a discounted rate for the full day. The first classes will be held on Saturday 21st May.
 
For more information and to register head to www.melhaynes.com 

In 2011 Knife, Fork and Band will be relaunched in a new user-friendly format. Due to feedback from those using the book I have arranged a new, durable spiral bound format for easier use in the kitchen. The new edition will sit flat on the kitchen bench or recipe book holder to enable you to read the recipes more easily.

For those of you in the Northern Territory we are pleased to announce the arrival of Nutrition NT. Nutrition NT is a new Darwin based company providing quality nutrition and dietetic advice. Formed with alliances to Innovations Health Care, Bodyfit NT and Your Bariatric Dietitian, Nutrition NT is now servicing the Territory.

Why do we test your Vitamin D levels?

At Adelaide Obesity Surgery and Innovations Healthcare we routinely check Vitamin D levels before and after bariatric surgery.

Vitamin D helps the body to absorb calcium to maintain healthy bones, muscles and teeth.

Low vitamin D levels and vitamin D deficiency may have no obvious symptoms, but can increase the risk of bone and muscle pain, as well as osteomalacia, which are soft, weakened bones. Osteomalacia results in bones becoming misshapen and fracturing easily. Low vitamin D levels can also contribute to osteoporosis.

More recently a lack of vitamin D has also been linked to chronic diseases, such as diabetes, cancer and osteoporosis. Vitamin D is also thought to help the immune system and may have positive effects on mood and depression in some people.

Some foods contain small amounts of vitamin D, but this provides little of what we need. Some vitamin D is found naturally in fish and eggs. Some is added to margarine and some varieties of low fat milk, however most Australians are unlikely to get enough Vitamin D from their diet.

Ultraviolet (UV) radiation from the sun is the best natural source of vitamin D. Skin cancer is a risk for all almost Australians and is not recommended that you deliberately expose yourself to the sun when the UV Index is 3 or above. Exposing your face, arms and hands to the sun for 10 minutes in summer, 15-20 minutes in spring and autumn and 30 minutes in winter should give you enough vitamin D. The best time to expose your skin is either side of the peak UV times - 10am-2pm or 11am-3pm in daylight saving time.

The Cancer Council report that during short periods of exposure (10 minutes in summer, 15-20 minutes in spring and autumn and 30 minutes in winter) you should not need to worry about sun protection such as wearing sunscreen and a hat, unless the UV Index is 3 or above, or you plan to be in the sun for a longer period of time. This is not an excuse to sun bake!

If your blood tests indicate you are low in Vitamin D, our GPs will recommend Vitamin D replacement on an individual basis.

Welcome to the Bariatric Bites blog. We will have lots of upcoming content to keep your taste buds jumping!