This past Friday, the Health First LifeShape program and the Melbourne Same Day Surgery Center were inspected by a surgeon inspector from the American College of Surgeons. This is part of the College’s Center of Excellence in Bariatric Surgery Program. (COE). We attained provisional status a few months ago and Donna, Judy, and the whole LifeShape team have been working hard to prepare for the inspection. Donna is standing behind a whole rack of binders that describe every facet of our program. The inspection went very well. The inspector has recommended us for approval and the final determination will occur within 60 days. The inspector was very complimentary about our program in general, but more than anything, gushed over the quality and dedication of Donna and the staff at Health First LifeShape and Melbourne Same Day Surgery Center. Of course, I knew that and feel very privileged and fortunate to have such an excellent staff.

Image curtesy of www.pixelperfectdigital.com

As those of you who have had lap-band surgery with LifeShape may remember,we often have Pharmacy students who are rotating at the surgery center. This rotation is with our exceptional PhD Pharmacist Norm Tomaka. One of his more industrious students has compiled a blog post that lists all the medications that are sometimes used to treat obesity. This is brought to you curtesy of:

Recently, several studies have shown that the use of the Lap-Band in lower BMI patients can be both effective and safe. One of these studies was published in the journal Obesity last month. Led by Dr. Robert Michaelson, bariatric surgeon in Washington State, the study involved 149 patients who had a BMI of 35 to 39.9 and did not have an obesity-related condition or who had a BMI of 30 to 34.9 with at least one related condition. The findings supported extending the use of the Lap-Band to patients with a lower BMI, as a mean to treat patients before they go on to develop serious conditions related to obesity.

The researchers reported that one year after undergoing the procedure, nearly 85 percent of the patients had lost at least 30 percent of their excess body weight, with an average excess weight loss of 65 percent. About two thirds percent of the patients were no longer obese – a substantial milestone to achieve. In addition, many patients with obesity-related conditions experienced improvement; Sixty-four percent of those with high cholesterol, 59 percent of those with high blood pressure and 85 percent of those with diabetes had improvement at one year. Highlighting the safety of the procedure, reported side effects were overall mild to moderate, and resolved within a month. We are pleased to see ongoing research on the potential for the band to help lower BMI patients, as well as those with higher BMIs.

At Lifeshape, we specialize in outpatient laparoscopic adjustable gastric banding. We offer both the Allergan AP LAP-BAND system. We also offer the Pleated Band (also known as the i-Band, i-Lapband, or the Plicated Band) and Laparoscopic Gastric Plication. You can learn more about our surgical weight loss options–and whether surgery may be a good option for you–by attending one of our free informational seminars. You can register online here.

In the News section this month, I share information of how weight loss surgery, specifically the LapBand, can offer patients a significant overall improvement of metabolic syndrome (NEWS). I still find it amazing the change LapBand can offer a person regarding quality of life, longevity and overall health.

In the Nutrition section, our LifeShape Dietician Kristine shares the details of the much debated fruit and fat: the avocado. Learn about the wonder fruit’s health benefits (NUTRITION). And in our Exercise section,  LifeShape Trainer Beth Whalen, CPT, shares motivation through the importance of embracing forbearance and discipline in respect to your health (EXERCISE). Also in LifeShape Fitness Center news, Christie will be leaving the fitness industry to pursue other goals. We wish her the best of luck in her future endeavors.

In our Featured section this month, we have a guest health contributor, Sarah Fudin, from George Washington University’s online public health Masters program, offering a helpful guide to online information resources for weight loss (FEATURED).

LifeShape is here to offer you a way to achieve long-term weight loss success, while regaining your health. As a multidisciplinary full service weight loss center, LifeShape offers a surgical program specializing in the Adjustable Gastric Band, a medical program utilizing Optifast ®, and personalized fitness programs at the LifeShape Fitness Center in a private and supportive environment. Our team will provide you with the support you need to achieve your weight loss, fitness and wellness goals.

We have lots of Seminars to choose from. Please remember to check the schedule below if you are interested in attending (EVENTS).

I hope you enjoy our helpful tips. We hope to inspire you with motivation, encouragement and support to begin your journey today!

Dr. Mark A. Fusco
Medical Director
LifeShape Advanced Bariatric Center of Florida
Office: 321-728-7553
www.lifeshape.net
If you have received this email from a friend, and would like to receive the LifeShape Wellness Newsletter monthly, subscribe by clicking here!

The 50 patients included in the study had a body mass index (BMI) of between 30 and 40, with an average of 35 and at least 1 obesity-related co-morbidity. Almost half of the patients met metabolic syndrome criteria at the start of the study, and most had resolved at one year post-surgery and persisted throughout year 5. In addition to great improvement in metabolic syndrome, the study reported great weight loss results, with the mean BMI dropping from 35.1 to 27.9 at 5 years. Total cholesterol, LDL cholesterol, triglycerides, and HDL cholesterol all improved at years 1 and 2 and fasting blood glucose was significantly reduced and sustained out to 5 years. The researchers concluded that “laparoscopic gastric banding produces significant weight loss and resolution of metabolic syndrome by improvement in multiple diagnostic criteria and reduces use of diabetes and blood pressure medications. These changes persist over 5 years following surgery.”

Dr. Christine Ren Fielding of NYU was involved with the study. She explained that the purpose was to examine the effect of early intervention bariatric surgery, specifically using the Lap-Band, on metabolic health in obese patients with BMI 30-40. She said, “Many people, including some physicians, have felt that bariatric surgery should be reserved for people with a BMI well over 40. However, as bariatric surgeons we know that people with a BMI as low as 30 suffer from metabolic syndrome and benefit from bariatric surgery.”

The image on the right is a poster that was produced by a company to hang in exam rooms to educate waiting patients about the metabolic syndrome. Interestingly, I once met the man pictured in the poster. Subsequent to the production of the poster, he underwent successful lap-band surgery and resolved his metabolic syndrome.

LifeShape Advanced Bariatric Center of Florida specializes in laparoscopic gastric banding. You can learn more about laparoscopic adjustable gastric banding on our website, or by attending one of our free informational seminars held at various site around Brevard and Indian River counties, and in Orlando.

The following seminars will be held at the MIMA location:
1130 Hickory Street
Melbourne, Fl

Wednesday, June 5th, 2013 at 6:30 PM
Thursday, July 11th, 2013 at 6:30 PM

For all other upcoming seminar dates and locations click here: http://www.lifeshape.net/contact_us_for_free_seminar.html

For questions and registration, please contact Kerry Owens by calling 321.728.7553 or by emailing kerry.owens@mima.com.

And remember as a LifeShape Patient, you have the opportunity to attend our monthly support groups. Call us to learn more and to find out dates at 321.728.7553.

There’s a saying that a journey of a thousand miles begins with a single step. Fortunately, you don’t have to take that journey on your own when it comes to weight-loss. There are helpful online resources that provide information and inspiration to get you started on the right foot.
Here are five weight-management websites that offer some of the best resources available online:

ChooseMyPlate
In 2011, the U.S. Department of Agriculture introduced the “Choose My Plate” initiative as a replacement for its Food Pyramid. Instead of illustrating a balanced daily diet in pyramid form, My Plate shows a plate divided into four sections: proteins, grains, fruits and vegetables, with dairy represented as a glass to the side. The Choose My Plate website explains the My Plate concept and provides interactive tools for assessing your nutrition, counting calories consumed and determining how many calories are burned by different types of physical activity. In addition, the website provides links to a variety of other health-related resources.

WIN
The Weight Control Information Network website provides science-based information on nutrition, weight control, obesity and physical activity. Sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, the website is a clearinghouse for current information related to weight management. Publications are categorized according to their target audience (the public, healthcare professionals, legislators or the media) and can be viewed online or downloaded. Print copies can also be ordered, with up to 10 copies of each publication provided free of charge.

Keep the Beat – Deliciously Health Eating
You can read articles, watch videos, find healthy recipes and download cookbooks on this website, which is sponsored by the National Heart Lung and Blood Institute (part of the U.S. Department of Health and Human Services). Links to publications related to the prevention and treatment of heart and vascular diseases are also provided. In addition, the website features tools for community organizers who want to plan a healthy eating event.

USDA Food and Nutrition Information Center
Sponsored by the U.S. Department of Agriculture, this website provides links to dozens of healthy lifestyle resources. A wealth of food-related information for both the general public and health care professionals is provided. An “Interactive Tools” section of the website provides access to tools that help you assess your knowledge, check your health risks and design a healthy diet. Links to calculators for counting calories, tracking exercise, determining body mass index and other health indicators are also provided.

The President’s Challenge
This is the official website for the President’s Challenge Program, a national physical activity and nutrition initiative sponsored by the President’s Council on Fitness, Sports and Nutrition. The goal of the program is to help Americans increase their physical activity and improve their fitness. Founded in the 1960s to help children and teenagers become physically fit, the program has been expanded to include all ages. In addition to providing information about fitness, the website features tests for measuring physical fitness in children and adults, tools for setting and tracking exercise goals, and the opportunity to win awards for completing different challenge programs. Resources for schools and teachers who want to implement a Presidential Youth Fitness Program are also available.

Sarah Fudin works in community relations for the George Washington University’s online public health Masters program which provides students the opportunity to earn their MPH degree online. In her free time, Sarah enjoys running, reading, and connecting with people passionate about making positive change to the world.

Facebook | Twitter: @GWonlineMPH

Time appropriate for the month of May since avocados are associated with Cinco de Mayo celebrations as well as May being International Mediterranean Diet Month! Avocados and other healthy fats are an integral part of the Mediterranean Diet. For meal plans, recipes and more info on the Mediterranean Diet, click here.

Avocados provide nearly 20 essential nutrients, including fiber, potassium, Vitamin E, B-vitamins and folic acid. A 1-ounce portion consists of 2 Tbsp or 2-3 thin slices (or ~1/5 of an avocado) and contains 50 calories, 4.5 g total fat (3 g of monounsaturated fat), 0 mg cholesterol, 0 mg sodium, 3 g total carbohydrate, 2 g fiber, 0 g sugar. It’s a tasty spread to use in place of butter or margarine and packs a powerful nutrition punch. So get creative with your avocado. While guacamole is delicious, there are many other ways to serve up this creamy green fruit. Here are just a few to get you started:

-     spread mashed avocado on whole grain toast in place of butter or jam

-     use as a spread in place of mayo on a sandwich or wrap

-     add diced avocado to your salads

-     add to smoothies or soups

-     add chopped avocado and veggies to your eggs or omelets

-     use to make deviled eggs (in place of yolks), see recipe

-     eat with whole grain crackers or as a dip with veggies for a snack

-     avocado makes a great first food for babies & a fun food for toddlers; click here for recipe ideas

-     avocado for dessert? Yes! Try them as a fat replacement in baking; here’s a couple recipes

Kristine Van Workum, RD, CSSD, LDN
LifeShape Registered Dietitian & Owner of Brevard Nutrition (www.brevardnutrition.com)

May 2013 Recipe – Baked Eggs in Avocado

Source: http://whiteonricecouple.com/recipes/baked-eggs-avocado/ 

Ingredients:

·     1 medium or large avocado

·     2 small eggs

·     2 sliced of bacon, cooked then crumbled

·     2 slices of toast

·     sea salt, to taste

·     fresh cracked black pepper, to taste

·     hot sauce, optional

·     fresh chopped tomatoes, optional

Directions:

·     Pre-heat oven to 425 degrees

·     Crack the eggs in a medium bowl, careful to not puncture the yolks & set aside

·     Cut avocado in half and carefully remove seed. Depending on how big the seed is, the hole in the avocado should be big enough for one small egg. But if the hole looks too small, scoop out a little at a time till it matches the amount of egg.

·     In a medium baking dish, try to rest the avocado half inside the edge of the dish so that the avocado doesn’t tilt over. You need to keep the avocado from tilting so that the raw egg does not spill out.

·     You can crack the egg directly in the avocado, but it might overflow and make a mess. So this technique will be useful: With a medium spoon, gently scoop out one of the yolks and place it into the hole of the avocado. Then continue spooning the egg whites into the avocado hole till it’s full. Repeat for both avocado halves.

·     Add salt and fresh cracked black pepper on top of the eggs, to taste.

·     Gently place the baking dish in oven and bake for about 15 minutes. Baking time will vary depending on how much egg you have and how big your avocado is. So keep checking the egg to see if it’s cooked to your desired consistency.

·     Sprinkle crumbled bacon on top. Spread the avocado/egg onto toast. Add addition salt and pepper to taste, chopped tomatoes, hot sauce, if needed.

I have been running for 15 years.  Looking back through my journals and workout logs, they give me insight and a better understanding of the way I think, act, and react to circumstances in my life.  Forbearance and discipline were key principles in my success as an athlete.  I needed patience and tolerance toward myself because very few times did I completely surrender to the plan and finish it to completion. My patience and tolerance paid off when I ran with perseverance and faith in believing I was going to break my own personal record.  Discipline was very important.  I had to do the work; I had to stick to the plan no matter what life threw at me. I planned my day around my training and not the other way around.  I had to make many sacrifices and give up a lot of things that were fun but not conducive to my training.  I cut my late night hang-out sessions with my girlfriends to a minimum in order maintain balance and structure.  I was easily tempted and led astray, but I had a dream and it was my dream.  If I was going to live it out, I couldn’t live just like everyone else. The desire on my heart was mine for the taking. 

Today, forbearance and discipline apply to our exercise.  Exercise has been scientifically proven to have physical and mental benefits.  If we exercise on a regular basis or get some kind of physical activity every day, we’re more likely to feel better, look better, and be healthier.  Whether our goal is weight loss, happiness or more energy, daily exercise can help us get there. And let’s show forbearance toward ourselves—we are worth it, and we will get there!  We’ll need discipline because it feels like we’re making a lot of sacrifices compared to the way we used to live.  Now we’re waking up a little earlier to hit a work out; not going back for seconds just because it tastes good; and going home a little earlier when we go out with friends.  But we’re gaining happiness, energy, endurance and strength, less disease, sleep, a longer life…and of course, weight loss. 

In college I found being patient, kind, and tolerant easier than being disciplined. Saying “No” to cookies my roommate just baked; and “No,” to girl’s nights out was a difficult task. But I knew I had to put myself in situations where I wasn’t tempted to not train: to not fuel my body with energy rich nutrients; to not get a proper nights rest.  I wanted to so badly to just be like everyone else, but I wasn’t.  I would be happy living that way for the moment but it wasn’t sustainable because the plan for my life was so much greater than that.  I disciplined myself and obtained my goal, but I also gained forbearance and understanding to help others do the same thing.

Today I am blessed to work with both young and old, and have found we all extend forbearance towards others, but not necessarily to ourselves. Forbearance and discipline will always be key to meeting our goals. My passion is to watch each individual overcome their obstacles mentally, physically, and emotionally.  We all want to trust the plan, but we struggle with believing and accepting we are worthy of the transformation.  It is not easy to say no to eating the bag of skittles and soda like the girl in the cubical next door or the ice-cream the rest of my friends are grabbing. There is power in controlling oneself when provoked or offended. For some of us forbearance can seem like “long-suffering,” as we tolerate the circumstances to allow ourselves to be transformed inside and out. Most of my clients that are disciplined are fully confident I can help them achieve their goals, but may struggle with being kind, tolerant, and patient with themselves. We all have our struggles and need to practice. I believe we are all capable of holding back and enduring as we obtain and reach our goals!

Here is a photo of LifeShape Patient Lori R. and me after the 2013 Running Zone Gecko 5k.

Ten years ago today I was attending me very first Lap-Band training coarse in Tijuana Mexico. As I reflect on the past ten years, I would like to thank all the members of the LifeShape team both past and present that have made my weight loss practice such an interesting, fulfilling, and enjoyable part of my life.

My entree into weight loss surgery was a bit circuitous. I did my general surgery training from 1988 to 1993 at Keesler Air Force base. In this period weight loss surgery was very much a niche field with only certain centers with any significant volume of weight loss surgery. At Keesler we did NO weight loss surgery. My original plan after residency training was to become a critical care / trauma surgeon. I started a critical care fellowship in the Intensive Care Unit at Vanderbilt University in 1993. Several years prior to my arrival at Vanderbilt a large number of weight loss surgeries called the Jejunal ileal bypass were done. There were several issues with this surgery so by the time I began my fellowship, a number of these patients were brought the the operating room for reversal of their bypass surgery. As the ICU fellow, I was involved with their care in the ICU. Many of these patients had nutrient malabsorption issues complicating surgical recovery.  This left me with a fairly negative view of weight loss surgery.

After leaving my fellowship, I began my Air Force surgical career and became very interested in minimally invasive surgery. I began performing a wide variety of laparoscopic surgeries and shifted my focus from trauma/critical care. I moved to Melbourne 15 years ago and began my practice including a very significant practice in upper GI surgery / anti-reflux surgery. A little over 10 years ago, Lynne Stoldt spoke to me about this “new outpatient weight loss surgery” called the Lap-Band. She said the surgery was similar to anti-reflux surgery which was one of my specialties. She had been introduced to the surgery having worked as a consultant to a surgery center in Dalton Georgia. The surgeon at the center was Dr. Jamie Ponce. Dr. Ponce is a pioneer of lap-band surgery, an investigator in the original FDA trial for lap-band, and is now President of the ASMBS. For months Lynne would tell me “you should go check it out”, “you should go visit Dalton and see for yourself”. I was very hesitant because not only did I have my prior negative view of weight loss surgery, but at the time the local Melbourne experience with weight loss surgery, in my view, did not have an acceptable safety profile. Lynne can be very persistent so I somewhat begrudgingly consented to go to Dalton. In March of 2003, Dr. Ponce was very gracious to let me come and watch a few surgeries. I remember very clearly that on the drive from Atlanta airport to Dalton I was hoping that he would also have some patients in the  office so I could talk to someone who had this Lap-Band thing. It turned out that several of the health care workers had bands and spoke highly of it. Dr. Ponce spoke passionately about obesity, the safety of the band, and the strong positive impact he was having on his patients. I came back to Melbourne and started the process of learning more about the band.

Getting training on the band, at the time, was no easy process. With some difficulty we tracked down the company rep for the makers of the Band. They required I submit my operative experience in upper abdominal laparoscopic surgery and “apply” for training. At the time I was a bit surprised. “Don’t you want to sell your product?” I thought to myself.

I was able to arrange for training and ten years ago I found myself, unlikely as may seem, in Tijuana Mexico. At the time there were no US training courses for Lap-Band. (the following year I attended one of the first US courses just for good measure) The list of people who spoke at that meeting is truly impressive. I feel as though I owe them a debt of gratitude not only for the training they provided, but also for the positive image of weight loss professionals they projected. I could have just as easily returned from Tijuana after hearing some jaded cynical speakers and told Lynne to call the whole thing off.

So ten years later, I have had the privilege of caring for over a thousand patients. I have expanded our team and opened the LifeShape fitness studio. I have had the opportunity to publish multiple studies and presented studies at national and international meetings. Most of all I would like to thank the many LifeShape patients who have entrusted us in their care. I can’t wait to see what the next ten years brings.