Thursday, October 21, 2010

Peer to Peer

This is just an idea but please think about it for a moment. If bariatric surgeons could and would connect patients in the post-surgical phase with patients who are investigating the potential for having weight loss surgery, it could prove to be an effective and inexpensive way to provide real-world information to the pre-surgical patient which may be more useful than what can be obtained alone. Pairing people who have gone through weight loss surgery (WLS) with someone thinking about it, can often give them both the support they vitally need to help them. Could weekly support sessions, one on one discussion, email communications, or even an occasional phone call be of assistance?

Success or failure in the post-surgical WLS world is almost totally dependent upon the commitment and will of the patient. The surgeon, given a good surgical outcome can essentially promise weight loss, but they cannot promise that the patient will not have some side-effects or will not regain some weight. They can explain some of the potential side-effects of the surgery on our digestive process, yet they do not discuss the potential change in lifestyles or eating strategies that may be required. There is little if any pre-surgical discussion of the discipline that is required to effectively live with the results of the weight loss surgery.

Group sessions are almost always recommended for patients both before and after weight loss surgery. This peer support does provide value to many patients, but not to all. Sitting in a group of fellow patients sometimes does not support the real and often painful discussions of the effects from the weight loss. This may be where peer to peer personal contact may be useful. Part of the reason I have been writing this blog is to get people who either are contemplating WLS or have had it, to have a place to read about real world experiences with the process, the physiological ups and downs and the potential to live a terrific new life after the weight loss. I don’t feel like some “poster child” for bariatric surgery but I have had a lot of experience with the digestive aspects of this process, with my first wife for 24 years and now for myself for two and a half years.

I have spent a lot of time discussing the process of weight loss surgery, occasionally with someone who has had it, more often with either someone who could use it, or just interested folks. It seems like there are a lot of misconceptions about the various surgeries and they tend to be lumped into the general categories of Lapband or gastric bypass. The same issues are continually brought up. These include: basic misunderstanding about the surgical processes, weight gain after the surgery; complications with the surgery, effects of having to change lifestyles, ability to eat whatever you want, restrictions, insurance support, costs, health issues and the long term implications of both weight loss as well as the psychological and emotional changes the patient goes through. These are all important issues that I believe can be best discussed in a peer to peer setting and not just in a group setting. Real life effects and real life issues are important to those contemplating the surgery.

This proposed effort is not to generate a research proposal but to stimulate thinking on the part of those reading this blog and hopefully physicians dealing with bariatric surgery to assess the level of information transfer to patients and then potentially between new patients and patients who have undergone this surgery. This could include providing the names of peers who have undergone the surgery and are willing to spend the time to discuss it with those contemplating it. Recommending adequate peer support, as well as providing the option of attending group sessions might be appropriate.

In the very personal world of post-surgical weight loss, sometimes we feel a bit adrift as to what we can, should, or need to do. How do we reconcile the demands of our jobs, including dinners with clients and maintaining the discipline we need? How do we enjoy eating with our family and friends when we constantly receive comments about how little we eat or do we want anything more? How can we enjoy eating if we can only eat eight bites? How do we see ourselves in this new world? How many times can you take in the waistband of your favorite pants?

Patients who are contemplating surgery might be better motivated themselves if given the opportunity to both discuss and receive help from another person who has faced the challenges already and has been able to effectively cope.

It appears that study is needed to evaluate which parts of a peer intervention environment are most successful. These could include: face to face discussions between pre- and post-surgical patients; phone calls offering a supportive voice and also a mechanism for answering questions, group meetings and or even one-on-one counseling with professional counselors.

In many medical issues, the time spent with the patient can be directly related to a successful outcome since this time reminds the patient to do something or to be more engaged. It is my contention that this added time provided by peer to peer discussions may be better suited to the understanding of the bariatric process, help allay fears and provide a long term view of where the patient is going. The patient needs to feel empowered and confident, knowing that they are in charge of the ultimate outcome and that it requires personal discipline and will, but also someone to talk to. It's not so much knowing what to eat but how to change behavior and how will this influence your life and lifestyle. That involves problem-solving and goal-setting skills and the evidence shows that the patient may relate better to a peer who might have more similarities than a teacher in the front of the room.

If you want to use this blog to ask questions and maybe get some answers, please feel free.

Sunday, October 10, 2010

Coming back to California

On September 29th, 2010 I returned to my home in Santa Rosa after spending over two years in Italy.  I flew from Florence to Frankurt and then to San Francisco. I dragged my four huge suitcases through Customs and I was then met by an old and dear friend who got me to Santa Rosa and my house. The reasons I left Italy are varied and complicated but suffice it to say I wasn't happy there and I am glad to be home. 

In these first days back home I have noted a lot of differences between being in Italy and being in California. The most immediate and obvious difference is not the climate (Mediterranean), or the local vegetative patterns (so like Umbria) or the language (though that is significantly easier for me to understand).  It is the size of things. The cars are bigger. The buildings are bigger.  The distances are greater.  The houses are bigger (and made of wood, mostly). However the most impressive and concerning observation was that people were bigger. 

Weight is an issue in the US and so many people are overweight. I have been observing the scene now for a few days and there are a number of factors that I have noticed that may have led to this issue.  The ads for food are certainly complicating the situation. We are advised to go to an "all you can eat" restaurant. We order the biggest plates to ensure we get our money's worth. Restaurants want to ensure that their patrons feel they are getting full value by having free pie on Wednesday, all you can eat shrimp on Friday and that best of all possible worlds, an all-you-can-eat Sunday brunch. You may never have to eat again.  Our dissatisfaction increases if we don't eat until we are stuffed.

We want to order bigger thicker milk shakes, larger orders of fries, and foot long burgers.  If a two patty hamburger with bacon and cheese is good, wouldn't a three patty hamburger with bacon and cheese be better? It's a bigger slice of pie at the end of the meal or that newest chocolate dessert. The mantra is "Super-size me" and that is exactly what is happening. People are becoming super-sized.

The laws of thermodynamics are immutable. Calories in have to equal calories out, or you gain weight. Slowly or quickly, it is basic physics. As I watch people walk past or eating at a restaurant or buying groceries at the local market I am very concerned about what we are doing to ourselves.  I am not judgemental regarding weight. I have been there at 300 pounds for most of my life. I have suffered the consequences of that weight, including diabetes, high blood pressure, and the inability to move around as quickly as I once did. I had a "friend" ask me once how did I fit into my Porsche.

So today I am reflecting. It is reflections based upon what I have done in my own life to increase the possibility of living longer and healthier. In a recent study, people were asked to determine what the calorie count was for a hamburger and fries. The general consensus was 650 calories. Then a side of broccoli was added to the plate with the burger and fries and the people were asked again what was the calorie count. This time it went down to just above 600 calories. The perception seemed to be that if you have steamed veggies on your plate it must somehow be better for you, and also lower in calories. It is like giving up wine with dinner because you think drinking wine is why you have gained weight. Then you eat three platefuls of food. But have no wine. It might be better to drink the wine and eat less food.

Its time to take some control of your eating habits and determine for yourself what you want your life and health to be.

Friday, October 8, 2010

A busy few months

The last few months have been very busy and I have had little chance to update the blog. This season has been a particularly busy one for Amore Sapore. The daily grind started early at about 5AM, when we got up to start prepping for the meal that evening. I would make up the set ups for the antipasti and check the menu for the day's shopping needs. I might also make a loaf of beer bread or some oatmeal cookies. At 8:30 I would head for the store to get all the things we would need for that evening. Usually this was the fresh things, like fruit, salad materials, meats, gelato or anything else we needed.

The morning was spent getting the preliminary cooking done. If it was a class that evening, we did a relatively minimal prep since the students were going to be doing most of the actual work. We did ensure that all of the materials and foods were there and ready to pack into the car.  I had several carry bags that had cooking implements and a set of pans that I always took. The kitchens in some of these houses were often deficient in some pans and I found it easier just to take everything we would need. Bags were packed and checked and then we took a short nap. It was going to be a long day.

At about 5PM we packed the car and left for the dinner location. We had two spots this summer where we had to make a drive of over an hour. One to Perugia and another to near Montepulcino in Tuscany. The rest of the cooking venues were within 15 to 20 minutes drive.

It was a very busy summer  and we cooked a wide variety of menu items. The following is an annotated list of dishes from the Amore Sapore menus in  August and September:

Bruschetta with artichokes and Pecorino romano
Bruschetta with mushrooms
Ricotta with peperone and flatbread
Salami plate
Chicken Piccata
Insalata Caprese, mozzarella, tomatoes and basil
Panna cotta
Local Pecorino cheese with honey, marmalatta and chutney
Figs stuffed with Gorgonzola and prosciutto
Bruschetta with artichoke pate
Veal scaloppini with Marsala sauce
Grilled porterhouse steaks
Poached pears and sweetened mascarpone
Crostini with caramelized pears and Gorgonzola
Figs with prosciutto
Stuffed peppers with sausage and cheese
Potato and cheese ravioli  with tomato sauce
Roasted sausages and grilled grapes
Flourless chocolate walnut cake with chocolate ganache
Crostini with salmon
Spinach and garlic saute
Pumpkin ravioli with walnut sauce
Chicken breast with saffron and ginger
Pumpkin gratin
Pears in Chianti with mascarpone
Salmon crostini, cream cheese and lemon marmalatta
Gnocchi with fresh basil pesto
Veal scaloppini with mushrooms
Fettuccine with walnut sauce
Crostini with cannellini beans, onions and marmalatta
Cucumbers and goat cheese and roasted tomatoes
Spinach and cheese ravioli
Roast Quail stuffed with sausage and wrapped in pancetta
Chard sauteed with olive oil and anchovies
Bruschetta with goat cheese and tomatoes
Slow roasted tomatoes with marinated mozzarella
Bruschetta with ricotta and peppers
Marinated cucumbers
Roast Salmon
Wild Rice pilaf
Prosciutto rolls with goat cheese, lemon and rucola
Eggplant Bolognese
Bruschetta with broccoli rabe
Farro and lentil soup
Pear cake with a caramelized pear and ricotta gelato
Bruschetta with spiced sausage
Bruschetta with ricotta, honey and peperoncino
Cucumbers with goat cheese and roasted cherry tomatoes
Gnudi (inside out ravioli)
Braised rabbit with peppers, onions and olives
Frittata with mushrooms, peppers and artichokes

Its been a yummy summer and my weight has stayed constant at 165 pounds. Eating and living Eight Bites at a time can be fun and satisfying and you can still enjoy the wide variety of dishes and items we prepared without gaining weight. Eat well and enjoy your life.