Bariatric Specific Safety Guidelines - Kaiser Permanente

Bellevue BariatricProgramJune 2018Bari at ric Sp ecific Saf et y Gui deline s This month we’re focusing on the importance of BariatricSpecific Safety Guidelines with: Bariatric Misconceptions and Truthsfrom ASMBS (Association of Metabolic Bariatric Surgery) Breeze through Summer by AvoidingSocial Pitfalls Safe Summer Snack Recipe:June Issue: National SafetyMonthNational Safety Month . . .1Important Announcements . . .2Quarterly Support Group . .2Bariatric Surgery Misconceptions andTruths . . . .3-5Breeze Through Summer by AvoidingSocial Pitfalls . .6-8Edamame Cucumber Salad Recipe andIngredients . .9Contact Info .10

Important Announcements: The Bariatric Step’s to a HealthierFuture is available online. As weupdate the booklet, we will post themost recent version on: They’re also available onlinethrough their website. Type in promo code KAISER and get a discount and free shipping.https://wa.kaiserpermanente.org/ bariatric-patientsWe want to hearfrom you!We encourage you Kaiser Permanente BellevuePharmacy will now be carryingBariatric Advantage Vitamins. Buythem at your convenience after theBariatric Education class or yourfollow up visits! Celebrate Vitamins are also available at our Bellevue Pharmacy!Kaiser Permanente BellevueQuarterly Support Group:to give our newBellevue SupportGroup a try. OurUpcoming: WednesdayJuly 18, 2018new group willmeet on a quarterlybasis, with a varietyof speakers anddemonstrations. Ifyou have topics,speakers or demonstrations that youwould like for us toconsider, pleasedon’t hesitate toreach out to us foryour suggestions.Following: WednesdayOctober 17, 2018Time: 6:00pm- 8:00pmLocation: Kaiser PermanenteBellevue. Conference RoomE101/105 (right by the elevatoron the first floor, follow thesigns)Registration: is not needed.See you there!2

Bariatric Surgery MisconceptionsMisconception: Most peoplewho have metabolic and bariatricsurgery regain their weight.Safety of BariatricSurgeryThanks to improved patientcare protocols and the laparoscopic approach, mortalityrates after bariatric surgeryhave fallen by 80% in thepast decade. Data involvingnearly 60,000 bariatric pa-Truth: As many as 50 percent of patients may regaintients from American Societyfor Metabolic and Bariatrica small amount of weight (approximately 5 percent) twoSurgery (ASMBS) Bariatricyears or more following their surgery. However, longi-Centers of Excellence data-tudinal studies find that most bariatric surgery patientsbase show that the risk ofmaintain successful weight-loss long-term. ‘Successful’death within the 30 days fol-weight-loss is arbitrarily defined as weight-loss equal tolowing bariatric surgery av-or greater than 50 percent of excess body weight. Often,erages 0.13%, or approxi-successful results are determined by the patient, by theirperceived improvement in quality of life. In such cases,the total retained weight-loss may be more, or less, thanthis arbitrary definition. Such massive and sustainedweight reduction with surgery is in sharp contrast to themately one out of 1,000 patients. This rate is considerably less than most other commonly performed operations,including gallbladder (0.7%)and hip replacement surgeryexperience most patients have previously had with non-(0.93%). The data showssurgical therapies.that the chance of dying frombariatric surgery is excep-*Success and Healthy Habits taught by ourBariatric Team go hand in hand with longterm success. If you have further questionstionally low and it is saferthan gallbladder and hip replacement surgery.or need support please don’t hesitate to reachRead the rest -bariatricsurgery3

News and InformationOverload: Safety Tips In this day and age it’seven more important to bediligent and make sure thatthe bariatric informationyou’re reading is in alignment with your KP Bariatric Program and is from alicensed healthcare provider. Please review Steps Toward a Healthier FutureBariatric Binder. Try and differentiate factsfrom opinion. Is this article/study evidenced based?Misconception: The chance of dying from metabolic and bariatric surgery is more than the chance ofdying from obesity.Truth: Consider the Source. Is thisa reputable information? Note the date of the articleand see if it’s current.If there’s any informationthat requires further clarification, feel free to reachout to us via MyChart (ifyou’re active on there.) Ifnot, you can also reach outto us via telephone. 4As your body size increases, longevity decreases. Individuals withsevere obesity have a number of life-threatening conditions that greatlyincrease their risk of dying, such as type 2 diabetes, hypertension andmore. Data involving nearly 60,000 bariatric patients from AS-MBS Bariatric Centers of Excellence database show that therisk of death within the 30 days following bariatric surgery averages 0.13 percent, or approximately one out of 1,000 patients.This rate is considerably less than most other operations, including gallbladder and hip replacement surgery. Therefore, inspite of the poor health status of bariatric patients prior to surgery,the chance of dying from the operation is exceptionally low.

Misconception: Surgery is a ‘cop-out’. To lose andmaintain weight, individuals affected by severe obesity just need to go on a diet and exercise program.Truth:Individuals affected by severe obesity are resistant to long-term weight-loss by diet and exercise. The National Institutes of Health Experts Panel recognize that ‘long-term’ weight-loss, or inother words, the ability to ‘maintain’ weight-loss, is nearly impossible for those affected bysevere obesity by any means other than metabolic and bariatric surgery. Bariatric surgeries are effective in maintaining long-term weight-loss, in part, because these procedures offset certain conditions caused by dieting that are responsible for rapid and efficient weightregain following dieting. When a person loses weight, energy expenditure (the amount of calories the body burns) is reduced.With diet, energy expenditure at rest and with activity is reduced to a greater extent than can be explained by changes in body size or composition (amount of lean and fat tissue). At the same time, appetite regulation is altered following a diet increasing hunger and the desire toeat. Therefore, there are significant biological differences between someone who has lost weight bydiet and someone of the same size and body composition to that of an individual who has never lostweight.5

Summer is a great time to take a vacation, connect withfriends and enjoy the sun. It’s also a time packed with foodladen events. With 3 major holidays, graduations, weddings,family & class reunions, weekend BBQs,picnics, and vacations, summer time canbe a danger zone for healthy habits andyour waistline.The attitude of “what theheck” can run rampant when on vacation or faced with tables loadedwith typical summer foods: hamburgers, hot dogs, chips, potato salad, brownies, pies and free flowing alcohol. Instead,with a shift in mindset and a bit of preparation, you canstill enjoy special events and eat healthy. While it doestake some planning but it’s well worth the effort!VeggiesLoad up on the abundance of deliciousfresh vegetables available in the summer:tomatoes, green beans, peas, zucchini,carrots, and herbs. Try making broccolislaw instead of coleslaw. Toss in shredded carrots and other favorite veggies andtoss with a light yogurt dressing.6

GrillingSwap proteins. Instead of mystery-meat hotdogs and greasyhamburgers, grill up some shrimp kabobs, herbed chickenthighs or salmon. High protein, low fat and calories and de-lish!Make sure to add some veggies to the grill too. Vegetables suchas portabella mushrooms, red peppers, onions, and zucchinimake a great side dish. Just toss the veggies with your favoritelight vinaigrette and cook it on the grill.SnacksVeggies make an easy snack. Cutcucumbers, carrots, bell peppers, jicama,daikon radish and celery into spears foreasy on the go snacks. Add in some cherrytomatoes to pop in your mouth. For ahealthy high protein dip, make the highprotein ranch dip recipe attached in thenewsletter.Fresh seasonal fruits are abundantso grab them while you can. Fresh nectarines, watermelon, peaches, and berries aregreat finger food at a picnic. Try cuttingup your favorite fruits and tossing themwith sugar free yogurt to add some pizzazzand a bit of protein.FluidsIt’s easy to become dehydrated when the temperaturesstart to soar. Make sure to have your water bottle close by. Foradded flavor, make a jug of fruit and herb infused water such asstrawberries and mint or pineapple, mint & ginger.7

A couple more tips:Get moving. Plan a vacation that involves being active; walks, hiking, swimming. Take a walk, get on the dance floor or play withthe kids. Being active will burn some calories and keep your mindoff food.Be social. Instead of focusing on the food, connect with yourfriends and family. Move away from the food table so it’s out ofsight, out of mind.High Protein Ranch Dip1 pint nonfat or low fat (1%) cottage cheese1 packet dry Uncle Dan’s Ranch mixNonfat milkPlace cottage cheese and Uncle Dan’s Ranch dry mix into blender or food processor.Add enough milk to your desired consistency.It can be used as dip, sauce or dressing.For ¼ cup*45 calories7 protein grams*based on 1% fat cottage cheeseIf using Hidden Valley seasoning packet it is 65 calories for ¼cup.Note: you could also substitute the cottage cheese with nonfat plain Greek yogurt, lightricotta cheese or tofu; though cottage cheese will provide the best calorie to protein ratioand cheesy flavor.8

IngredientsSalad3 English cucumbers, spiralized or very thinly sliced2 cups frozen shelled edamame, thawed1 large red bell pepper, chopped1 jalapeno pepper, seeded, deveined andchoppedDressing¼ cup extra virgin olive oil¼ cup seasoned rice vinegar2 Tablespoons toasted sesame oil1 Tablespoons low sodium soy sauce1 ½ teaspoons ginger paste1 teaspoons Dijon mustard1 teaspoons fresh garlic½ teaspoon red pepper flakesGarnish with 1 teaspoon each toasted sesame seeds and black sesame seedsDirectionsThinly slice or spiralize the cucumbers.Soak up excess liquid from cucumberwith a paper towel so they are no so wet.Toss the cucumbers, edamame, red bell pepper and jalapeno in a large bowl. Setaside.In a small bowl, add all ingredients for thedressing and whisk well.Pour dressing into the cucumber mixture and toss well. Sprinkle withsesame seeds.Cover and refrigerate for at least 2 hours. Serve within 24 hours for bestresults.9

Bariatric TeamContact UsWe want to hear from you!Nurse: 425-502-3454Listen to the Prompts.Bariatric Surgeons: Dr. Gupta MD, FRCSC,FACS,FASMBS Dr. Landers, MD, FACS, CDR-USN (RET)Press 3.Bariatric ARNP/PAs:Routine Appointments: 425-502-3454 Listen to the Prompts Consulting Nurse:1-800-297-6877 Kat Cozza, PA-CLynda Crescenzi, PA-CLori Gokee, ARNPTravis Sears, PA-CHeather Vincent, PA-CWilliam Young, PA-CBariatric Team Email:Bariatric RN Case Managers:bariatricpatients@ghc.org Sarah Chan, BSN, RN Melissa Darragh, BSN, RNCall the ConsultingNurse line if after 4:00and weekends, withany symptoms/concerns.Medical Assistant: Tamara SimanicBariatric Dietitian: Lisa Stariha, RDNClinical Operation Manager: Anna Withee, BSN, y-misconceptions

rates after bariatric surgery have fallen by 80% in the past decade. Data involving nearly 60,000 bariatric pa-tients from American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric Centers of Excellence data-base show that the risk of death within the 30 days fol-lowing bariatric surgery av-erages 0.13%, or approxi-