Bariatric surgery also has positive effects on diabetes and heart disease

Khalili Center - Man on Bike


Researchers have pointed out that in addition to weight loss, bariatric surgery also has positive effects on diabetes and heart disease.

Professor Fredrik Backhed, in collaboration with Randy Seeley and coworkers from the University of Cincinnati in the US, has shown that the positive effects of bariatric surgery are likely caused by the surgery-induced increase in bile acids. The study focuses on a specific receptor called FXR, which is involved in bile acid signaling.

Fredrik Backhed said their study shows that signaling through FXR is essential for the beneficial effects of the surgery to be achieved. This is a major breakthrough in understanding how bariatric surgery affects metabolism and in the development of new treatment strategies.

In this study, mice with or without the FXR gene underwent an operation termed vertical sleeve gastrectomy (VSG) in which approximately 80 percent of the stomach was removed. The surgical procedure is the same as that performed in humans.

The researchers observed that the operation promoted weight loss and improved glucose metabolism in mice with FXR while the operation had no effect in mice that lacked FXR.

This study also showed that VSG resulted in changes in the gut microbiota, a potentially important finding given that Fredrik Backhed’s research group has previously demonstrated that the intestinal bacterial flora is altered in obesity and diabetes.

The study has been published online in the journal Nature.


See the original posting of this article on business-standard.com


Khalili Center on The Doctors

Khalili Center The Doctors


The Doctors go into the operating room with Khalili Center patient Angela and watch how surgeon Dr. Kai Nishi uses the robot to assist with her gastric bypass surgery. Click here to watch the video!


Target Those Last 10 Pounds!

Khalili Center Losing Weight
Everyone has trouble losing that last bit of weight, even weight loss surgery patients! Try these 6 tips to lose those last 10 pounds.

What are you eating?
200 calories of tuna salad provides more energy and is more satisfying which can help you lose more weight than two, 100 calorie snack packs that leave you searching afterward for something that is actually satisfying!

What is your meal timing?
For weight control 3 meals and one snack is best!

What is your hydration?
64-80oz to metabolize fat, increase energy and minimize cravings!

How much alcohol is okay for weight control?
None, but if you already drink, limit to 1 drink one time weekly for women and 2 drinks one time weekly for men.

How are you sleeping?
7-9 hrs of steady sleep can optimize your hunger control and maximize your energy!

Exercise – do you do it?
Move your body for 50-60 minutes daily; intensity will vary based upon fitness level!



Bariatric Surgery Halves Heart Attack Risk

Khalili Center - Obese Man



Obese people who undergo bariatric (weight loss) surgery halve their risk of suffering a heart attack, new research suggests.

Bariatric surgery is a procedure carried out on people who are obese. An example of this is the insertion of a gastric band, which reduces the size of the stomach.

UK scientists set out to assess the impact of bariatric surgery on rates of heart disease and death. They carried out a detailed analysis of 14 studies, involving over 29,000 patients who had undergone this type of surgery.

The average age of the participants was 48 and the studies were carried out in Europe, North America and Australia.

The research showed that death rates among obese people who had undergone weight loss surgery fell by 40%, while the risk of suffering a heart attack was halved, compared to those who did not have surgery.

Commenting on the findings, the study’s lead author, Dr Yoon Loke, of the University of East Anglia, pointed out that obesity ‘is a worldwide problem with significant consequences on individuals and society’.

“It is associated with heart disease, type 2 diabetes, many cancers and a shorter life expectancy…We saw that surgery was potentially life-saving and could lower the risk of having a heart attack and stroke by almost 50%,” he said.

The scientists believe that these findings suggest that weight loss surgery ‘should be considered in obese patients who have a high risk of heart disease’.

Details of these findings are published in the International Journal of Cardiology.


See the original article at IrishHealth.com


Event: Softball with the Doctors




Join us for a morning of softball with the doctors! This Saturday, April 26th, from 10am to 11:30am at the softball field at 10740 Ohio Ave, Los Angeles, CA 90024 (free parking). All are welcome and pinch runners are available if you choose not to run. Bring a glove and/or a bat if you have one!

We look forward to seeing you there!
Cheering crowd and players alike are needed!


Chicken and Asparagus Lemon Stir Fry



We love this high protein bariatric friendly recipe because it is fast and easy to make on a busy night and it is full of satisfying nutrition to keep your energy high!


  • 1 1/2 pounds skinless chicken breast, cut into 1-inch cubes
  • Kosher salt, to taste
  • 1/2 cup reduced-sodium chicken broth
  • 2 tablespoons reduced-sodium shoyu or soy sauce (or Tamari for GF)
  • 2 teaspoons cornstarch
  • 2 tablespoons water
  • 1 tbsp canola or grapeseed oil, divided
  • 1 bunch asparagus, ends trimmed, cut into 2-inch pieces
  • 6 cloves garlic, chopped
  • 1 tbsp fresh ginger
  • 3 tablespoons fresh lemon juice
  • Fresh black pepper, to taste


  • Lightly season the chicken with salt. In a small bowl, combine chicken broth and soy sauce. In a second small bowl combine the cornstarch and water and mix well to combine.
  • Heat a large non-stick wok over medium-high heat, when hot add 1 teaspoon of the oil, then add the asparagus and cook until tender-crisp, about 3 to 4 minutes. Add the garlic and ginger and cook until golden, about 1 minute. Set aside.
  • Increase the heat to high, then add 1 teaspoon of oil and half of the chicken and cook until browned and cooked through, about 4 minutes on each side. Remove and set aside and repeat with the remaining oil and chicken. Set aside.
  • Add the soy sauce mixture; bring to a boil and cook about 1-1/2 minutes. Add lemon juice and cornstarch mixture and stir well, when it simmers return the chicken and asparagus to the wok and mix well, remove from heat and serve.


  • Servings: 4, Size 1 1/4 cups
  • Calories: 268
  • Protein: 41 grams
  • Carb: 10 grams
  • Fat: 7 grams



Recipe from Skinnytaste.com


Seeing Yourself Eat

Khalili Center - See Yourself Eat


What do you look like when you eat?

What would you see if you watched yourself eat?

This is a great exercise for weight loss surgery patients and non-weight loss surgery patients alike!


Circle the words below that would describe you.
(Spaces at the bottom are for you to add words that might be missing from this list!)











• During the meal, pretend that there is a mirror across from you, showing you what you look like as an eater.

• What would you like to see during the meal?
• What could you do to make that image have as much grace and dignity as possible?


Some things to think about

• How do you sit?
• How many bites a minute do you take?
• Is your attention on your food, or other people’s food?
• How big are the bites that you take?
• Do you put food in your mouth while you are still chewing some food already in there?
• How much food is on your plate? Do you have a plate?
• What size is your portion?
• Are you poised and dignified while eating?

The next time you‘re at a restaurant, take a moment and observe people around you eating. Then and always, do a self-check, by observation instead of judgment, and ask, how are you eating?


Easter Cobb Salad

Khalili Center - Easter Cobb Salad


We love this delicious holiday recipe because you can modify the ingredients to make it bariatric friendly!
Layer hard boiled eggs, chicken, turkey, tomatoes and avocado or use turkey bacon, add cucumbers, carrots, whatever you like…Delicious and beautiful!!



  • 2 cups shredded romaine lettuce
  • 1/2 head of Boston lettuce (or Iceberg), coarsely chopped
  • 2 hard-boiled large eggs, separated, whites and yolks finely chopped
  • 5 slices of bacon, cooked and crumbled
  • 1 ripe hass avocado, cut into 1/2-inch pieces
  • 6 oz chicken breast, cooked and diced
  • 2 tomatoes, finely chopped
  • 1/2 cup crumbled blue cheese


  • Arrange chopped lettuce on the bottom of a large platter.
  • Layer the chicken, bacon, tomato, egg and avocado in neat rows over the greens.
  • Top with your favorite dressing, or try this tomato vinaigrette (extra)….




  • 1 medium ripe tomato
  • 1 clove crushed garlic
  • 1 tbsp red wine vinegar
  • 3 tbsp extra virgin olive oil
  • 1 tsp dijon mustard
  • 1 tbsp lemon juice
  • 2 tbsp water
  • 1/2 tsp oregano
  • salt and fresh pepper to taste
  • 1 tbsp minced shallot


  • Chop tomato in food processor. Add crushed garlic, vinegar, lemon juice, water, dijon mustard, oregano, salt and pepper. Pulse a few times until smooth. Add chopped shallot and mix to blend. Set aside to allow the flavors to blend well.



  • Servings: 8
  • Calories: 141.9
  • Protein: 11.0 grams
  • Carbs: 5.2 grams
  • Fat: 9.3 grams


  • Servings: 8 • Size: 2 tbsp
  • Calories: 50.8
  • Protein: 0.2 grams
  • Carbs: 1.3 grams
  • Fat: 5.1grams

Recipe from Skinnytaste.com


Life After Bariatric Surgery: The Weight Loss Surgery Lifestyle

Khalili Center - Happy


Life after Bariatric Surgery
Bariatric surgery is not a quick fix. It’s an ongoing journey toward weight loss through lifestyle changes. After surgery, the difference in your body makes it physically easier to adjust your eating and lifestyle habits. Fortunately, you will not have to go through the process alone. A team of professionals will be there to support your efforts. Positive changes in your body, your weight, and your health will occur, but you will need to be patient through the recovery process.

Diet After Bariatric Surgery
The changes made to your gastrointestinal tract will require permanent changes in your eating habits that must be followed for successful weight loss in your new life after bariatric surgery. Postsurgery dietary guidelines will vary by bariatric surgeon. You may hear about postsurgery guidelines different from the ones you receive. It is important to remember that these guidelines will be different depending on the surgeon and type of procedure which can be either Lap Band, Gastric Sleeve, or Gastric Bypass surgery. What is most important is that you follow your surgeon’s guidelines. The following are some of the generally accepted dietary guidelines for a healthy diet after bariatric surgery:

  • When you start eating solid food, it is important to chew your food thoroughly and eat very slowly. It is important to wait two to three minutes after swallowing before putting the next bite of food in your mouth. You will not be able to digest steaks or other chunks of meat if they are not ground or chewed thoroughly.
  • Don’t drink fluids while eating. They will make you feel full before you have eaten enough food. Fluids consumed with meals can cause vomiting and dumping syndrome, and can lead to feeling hungry sooner after a meal.
  • Don’t eat desserts and other items with sugar if they have more than 3 to 5 grams per serving size.
  • Avoid carbonated drinks, high-calorie nutritional supplements, milk shakes, foods high in fat, and foods that have no nutritional value.
  • Avoid alcohol.
  • Limit snacking between meals. Eating after bariatric surgery will be much different than before!

Going Back to Work After Bariatric Surgery
Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Most patients return to work and are able to exercise within one to three weeks after their laparoscopic gastric bypass. Patients who have had an open procedure do so about six weeks after surgery.

Birth Control and Pregnancy
It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.

Long-Term Follow-Up after Bariatric Surgery
Although the short-term effects of weight loss surgery are well understood, there are still questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years will need to be studied, and can depend on your diet after bariatric surgery. Over time, you will need periodic checks for anemia (low red blood cell count) and Vitamin B12, folate and iron levels. Follow-up tests will be conducted at least yearly and more often as indicated.

Life After Bariatric Surgery; Support Groups
The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most learn, for example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Our surgeons have support groups in place to assist you with short-term and long-term questions and needs, including the most effective exercise and diets after bariatric surgery. Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients in their life after bariatric surgery.


Click here to read the full article at www.obesityhelp.com


Exercise Before and After Weight-Loss Surgery

Khalili Center - Running


Days after Holli Dunayer-Shalvoy’s gastric bypass surgery in 2005, she ventured out onto the beachside boardwalk near her Long Beach, New York, home. Her first walks were short, but each day they got a little bit longer. Now, three years after her surgery and more than 120 pounds lighter, Dunayer-Shalvoy runs four miles every morning.

“You hear the doctors say, ‘You have to exercise,'” Dunayer-Shalvoy says. “I think it’s not a given that you’re going to do that. That is where you separate people and their will to succeed. I wanted it. I was hungry for a different life.”

Exercise Is Crucial for Weight-Loss Success

Exercise after gastric bypass surgery is critical for effective weight loss, says Christopher Still, DO, director of the Geisinger Obesity Institute in Danville, Pennsylvania, and a member of the Integrated Health program of the American Society for Metabolic and Bariatric Surgery (ASMBS).

“When we lose weight rapidly, we lose muscle,” Dr. Still says. “Muscle gauges and controls our metabolism. Exercise is a safe and effective way of maintaining lean body mass, which maintains metabolism and will facilitate [healthy] weight loss.”

A recent study reported in the journal Obesity found that of 190 patients who underwent bariatric surgery, 68 percent said that they became physically active in the year after the procedure — “active” defined as at least 200 minutes per week of walking or other moderate or vigorous exercise. The exercisers lost an average of 13.2 more pounds than inactive patients and also suffered from less depression and anxiety and had higher scores in general health.

Exercise also shortens recovery time for bariatric surgery patients and reduces the risk of postsurgical complications. In addition, physical activity improves mood and reduces stress, according to the ASMBS. “People who choose to put an emphasis on exercise lose more weight and have an easier time with weight maintenance,” Still says.

Kristine Salmon, an exercise physiologist with the Banner Good Samaritan Bariatric Center in Phoenix, offers the following example of a typical exercise program recommended to bariatric surgery patient:

6–12 Months Before Surgery

Patients who start an exercise regimen before surgery are twice as likely as those who don’t to have an easy time adjusting to exercising after surgery, according to a Harris survey conducted for ASMBS. But exercise is almost always difficult for people who carry a lot of extra weight. For this reason, starting slow is imperative. If you are morbidly obese and are contemplating an exercise regimen, you should have a cardiac evaluation by your internist. The goal, says Salmon, should be 20 to 30 minutes of physical activity three days a week. Some sample exercises:

  • Walking for 10 minutes, twice a day.
  • Marching in place for 20 minutes while sitting in a chair (especially effective for people with back problems).

1–6 Months After Surgery

You should resume an exercise regimen two to three weeks after bariatric surgery. The goal is to increase range of motion so you can take off your shoes, for example, and pick things up off the ground. Strength-training exercises are also important because as you lose weight you will lose muscle. You should work toward 30 minutes of continuous exercise three to five days per week by the time six months have passed. Sample exercises during this stage:

  • Walking, biking, or swimming exercises for aerobic fitness.
  • Resistance training with dumbbells, weight bands, or gym machines to build muscle mass.

6–12 Months After Surgery

A year after gastric bypass, you should be able to perform 45 minutes of exercise at least four times a week. Salmon recommends varying workouts so your body is constantly challenged. Strengthening the stomach muscles is also important because it helps improve your posture, which will change as you lose more weight. Some sample exercises:

  • Yoga, dancing, aerobics, or kickboxing for 45 minutes four times a week.
  • Resistance training using dumbbells while sitting on a balance ball, which helps to strengthen the abdominal muscles.

1 Year–Plus After Surgery (Long-term Maintenance)

Now that more than a year has passed since surgery, you’ve probably lost more than 100 pounds. Such a drastic change can leave many patients thinking that they no longer need to exercise, but “we tell patients that exercise is not an option, it’s a must,” Salmon says. At this stage the recommendation is the same as that for the general population: 45 minutes of exercise at least four days per week. Sample exercises:

  • Interval training on a treadmill, varying speed and incline, for 45 minutes.
  • Hiking, running, or bicycling — take your exercise outdoors and be proud of your new body and how good it feels to be physically fit.

This article was reposted from everydayhealth.com

The information presented in the blog pages of Khalili Center is for educational and informational purposes only and should not considered personal medical advice. Consult with your personal physician/care giver regarding your own personal medical care.