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Eating Well after Weight Loss Surgery
Over 150 Delicious Low-Fat High-Protein Recipes to Enjoy in the Weeks, Months, and Years after Surgery
By Patt Levine
By Michelle Bontempo-Saray
With Meredith Urban
Foreword by Jon Gould, MD
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- Trade Paperback (Revised) $17.99 $22.99 CAD
- ebook (Revised) $11.99 $15.99 CAD
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In April 2003 Patt Levine underwent “Lap-Band” gastric surgery, one of the primary bariatric surgeries being widely practiced today. As a lifelong foodie, she was expecting the worst when her surgeon’s nutritionist handed her dietary guidelines to follow post-surgery, and she was right. With her decades of cooking skills, she immediately set out to devise low-fat dishes that would be just as delicious pureed and chopped as they would be served whole. As an added problem, she wanted to cook for her husband at the same time. This first-ever cookbook for the hundreds of thousands who are lining up for bariatric bypass surgery is proof that it can be done. With collaborator Michele Bontempo-Saray, the author has created 125 recipes that contain no added sugar, are very low in fat, and get their carbohydrates almost exclusively from fruits and vegetables. Each recipe includes specific guidelines for preparation of the dish for every stage of the eating programs for Lap-Band, gastric bypass, and Biliopancreatric Diversion Duodenal Switch (BPD-DS) patients, as well as suggestions for sharing meals with those who have not gone through gastric surgery. Creative recipes cover every meal and food-breakfast and brunch, soups, vegetables, main courses, and sweet indulgences.
THE WEIGHT WARS
I WAS NOT ALWAYS fat. In fact, I was a skinny kid. In my teens and early twenties, I loved my curves. But once I started working, I started gaining—a couple of pounds here, a couple of pounds there. So, I tried diet pills. They worked for a while, but I was so manic and moody while taking them, no one could stand me. When I went off them, I gained all my weight back, plus some. Then I tried dieting. You know, grapefruit, broiled steak, and salad, and I never, never ate more than the guys I was dating (one of the golden oldie definitions of “being a lady”). Then I met my husband, a great guy with a great appetite. Any amount that I ate was less than he could put away. So, I started gaining and gaining and gaining. I tried Weight Watchers, lost 40 pounds, hit a plateau, and gained it all back and more. I tried going to the gym. That certainly helped, but once my career started taking off and I was working nights, and weekends, and traveling constantly, exercise became erratic, then nonexistent. So, I gained. Then I tried the Atkins diet, which was perfect for me because I’m a real carnivore. The first time I tried it, I tested purple all the time (that means that I successfully put myself into ketosis, which is the goal), but I barely lost anything. Then I gained. I tried Atkins again. This time I lost 40 pounds, hit a plateau, and gained it all back plus some. Sound familiar?
Over a period of about twenty years, I had more than doubled my weight. I weighed over 345 pounds. I could barely walk a block without stopping to rest. I couldn’t fit in theater or airplane seats. I actually broke furniture. After a bout with pneumonia, which landed me in the hospital for over a week, my primary care physician suggested that I consider weight-reduction surgery. My pulmonologist concurred. So, I did research, talked to a number of people who had undergone the surgery, and decided to do it.
My doctor referred me to Dr. William Inabnet, a renowned expert in bariatric surgery and a thoroughly professional and truly compassionate man. He and his staff seemed to understand exactly what I was going through and how I had gotten to this point, without being judgmental. We decided that I was a good candidate for laparoscopic Lap-Band bariatric surgery. The surgery was successful, but then the real battle began. As Dr. Inabnet and his staff reminded me, the surgery is only a tool.
Now I had to rethink not only the amount that I ate, but the kinds of foods that I ate and, oh, yeah, start exercising.
Cooking has always been one of my greatest passions—I think I started cooking when I was eight years old. And once I discovered that cooking for other people brought me unconditional approval, well, let’s just say that it became a defining part of my persona. Whereas cooking had once played a major role in my weight gain, now I was determined that it would be a significant factor in my weight loss. You see, I love a challenge in the kitchen. For years, I had whipped up gourmet dishes around other people’s likes and dislikes, allergies and restrictions. Now, I would put that talent to work for me.
I developed a high-protein, low-fat eating plan with virtually no “bad” carbohydrates. I allowed myself only “good” carbs from fruit and vegetables. The hard part was dealing with the restrictions for the first four months after surgery (but more about that later). Did it work? The answer is yes, although it’s still a work in progress. I have lost a significant amount of weight, and I’m looking and feeling pretty terrific, if I do say so myself. I’ve even started wearing clothes that I haven’t been able to get into for years. And what’s amazing is that, because of my ongoing weight-loss adventure, I wrote this cookbook to help other people on their road to weight loss in the weeks, months, and years after surgery. To my great pleasure, it’s become a go-to resource for other patients and health professionals. Now, I’ve updated my book to reflect the latest recommendations for bariatric surgery patients and share brand-new recipes I hope you and your whole family will love.
DEPRIVE MYSELF? NOT ME
Let’s face it, one of the reasons most people become candidates for bariatric surgery is that we love to eat. As a self-described “foodie,” I admit that I was worried when my nutritionist, Meredith Urban-Skuro, told me about the very restrictive way I would have to eat in the first months after surgery—low-fat food, pureed to the consistency of mush or chopped up in tiny bits. The suggested menus she showed me looked like a hospital soft diet—totally tasteless mush. When I was being kind, I referred to it as baby food. When I was being cynical, I called it sludge.
But just because a food’s texture is bland, that doesn’t mean its taste has to be. So, I set out to see if I could cook low-fat dishes tasty enough to stand up to pureeing or mincing, recipes that not only pleased, but also excited, my palate. As an added complication, I needed to cook for my husband at the same time.
My best friend, Michele, curious about the post-op restrictions on my diet, asked to taste some of the recipes I had developed. She immediately challenged me to write a cookbook for other bariatric surgery patients and offered to help.
This cookbook is proof that you can cook delicious food that not only satisfies your postsurgical guidelines, but also satisfies your taste buds. Yes, there is added work if you are cooking for others as well as yourself, but we’ve tried to keep it to a minimum. You can use these recipes the way they are written, or use them as a basis for experimenting to create new ones that suit your personal taste.
When I told Meredith and my surgeon that I was writing a cookbook for weight-reduction surgery patients, they were really excited.
But Meredith warned me. “Patt, I know that you are a very sophisticated cook, but not everyone who is going to use this cookbook will be, so don’t make it too complicated or esoteric.”
I said, “C’mon, get serious, people who aren’t into cooking won’t start cooking just because they had the surgery.”
That’s when Meredith told me something that surprised me. She found that many patients had discovered that unless they had control over what they ate, they ran into some problems; for instance, they ate too much because they couldn’t control portion sizes; they didn’t know how the food was prepared, so they ate unexpected fats, sugars, and other ingredients that created digestive distress. For these reasons, many of those patients were starting to cook seriously for the first time after surgery.
So, whether you have always been cooking or you are just starting to cook for the first time, I promise that you will enjoy using this cookbook. It will show you how to make delicious, satisfying food that will help you achieve and maintain your weight-loss goals over a long period of time.
ABOUT THIS BOOK: YOU CAN TURN MUSH INTO MAGIC
Let’s be honest, not everything purees well. I admit it; we had a couple of real disasters while we were developing and testing these recipes. The nice thing about this cookbook is that it progresses along with your eating program—these dishes taste terrific whether they’re pureed, chopped up, or served as solid food.
Our cookbook runs the gamut from breakfast and brunch dishes to soups, entrées, and vegetables. Plus, you’ll find an entire section on sauces that includes both savory and sweet toppings. And speaking of sweets, we’ve come up with a number of sweet indulgences that are completely allowable as well as incredibly luscious.
These recipes are high in protein, contain no added sugars, are low in fat, and contain only complex carbohydrates from fruits and vegetables. Therefore, they are protein-rich, low-calorie, and have virtually no “bad carbs.” What they do have is enough flavor and variety to keep you from feeling deprived. And, we didn’t realize until the book was finished, all the recipes are very nearly gluten-free! If you are avoiding gluten, swap gluten-free tamari for soy sauce in the few recipes that call for it, and make sure your stock and broth choices don’t contain any hidden wheat. (Do be aware that any time you modify a recipe, the nutritional information may change.)
Because this cookbook is a collaborative effort, it offers a huge amount of variety. You see, Michele and I have very different tastes in cooking and eating. She likes spicy stuff, such as curries and hot peppers. I like fruit and meat combinations and subtle seasonings. But we both agree on using high-quality ingredients. By developing these recipes together, we came up with many truly original and delectable new dishes.
We offer a wide range of recipes in each category. You’ll find variations on classic French and Italian cuisine, exotic Indian and Caribbean dishes, and recipes with Asian and Mexican influences, as well as good old American comfort food. While many of our recipes are quick and uncomplicated, some require longer cooking times or specialized steps—those are the ones that I call “Sunday cooking”—you know, the foods you cook when you have more time, which taste even better reheated the second day. You’ll be amazed at how we created some of the richest-tasting dishes without lots of fat or calories. Better than that, we came up with a luscious substitute for mashed potatoes that’s so good even meat-and-potato guys love it.
Most of our recipes are designed to serve four people, so if you’re cooking for others, they can enjoy the same foods as you’re eating. Of course, you’ll be eating such a small amount that there may be leftovers. (Why not puree them and reheat them for lunch the next day?)
At the bottom of each recipe you’ll find preparation and serving instructions for you to follow at each post-op stage, whether you’ve had a Lap-Band, gastric sleeve, gastric bypass, or biliopancreatic diversion with duodenal switch (BPD-DS) procedure. In addition, you’ll find portion-size suggestions to help you cook for people who aren’t eating a limited diet.
Because these recipes are so delicious and interesting, we think that you and your family are going to enjoy this cookbook for years and years, even after you come to the end of your postsurgical food restrictions.
THE ROAD TO SUCCESS
Needless to say, your weight-loss journey will be unique to you, and it will depend on a number of factors. Once again, as my doctor always reminds me, the surgery is only a tool. Changing your eating and exercise habits are equally important. While we can’t do anything to help you burn those calories, we can give you a new way to cook and eat. You won’t feel deprived, because it’s absolutely delicious. And since it doesn’t restrict you to just a few limited types of food, it’s easy and healthy enough to follow for a long time, even the rest of your life.
Since I had my surgery, I’ve experienced a steady weight loss that has made me very happy. The biggest surprise was my husband (our primary guinea pig), who did not have the surgery. By going on a modified version of this eating plan (eating these recipes for breakfast and dinner), he lost a total of 45 pounds. He’s living proof that this cookbook works for anyone who needs to lose weight.
I am very happy that I decided to have bariatric surgery and I find that almost every day I reach a new, small goal. My life, which had become so restrictive due to my weight, is now full of new possibilities. It’s wonderful to once more be able to do the things I used to take for granted when I was slimmer.
Michele and I hope that this cookbook will help you find all the success that you wish for and that you will enjoy every meal that you prepare from this cookbook along the way.
Advice from a Nutritionist
by Meredith Urban-Skuro, MS, RD, CDN
WHO SAYS IT has to be difficult to find food to eat after weight-loss surgery? It may be a little challenging in the beginning, but eventually you will be able to eat almost everything in moderation. I think that this cookbook can definitely help.
There are specific guidelines that need to be adhered to after surgery to prevent complications. Each bariatric practice may do things a little differently. Always check with your surgeon and nutritionist first, as the guidelines in this book may vary from where you had your surgery.
For the first week, a liquid diet consisting of protein drinks and noncalorie beverages is usually recommended. In Weeks 2 and 3, a pureed, blended diet is recommended to lessen the chances of an obstruction caused by large particles of food. Obstructions can cause discomfort and may lead to vomiting. When pureeing foods, you may need to add more liquid (water, broth, or milk) in addition to the sauce to make it a better consistency. Advancing to solid foods can usually occur between four and five weeks after surgery. This book features very specific week-by-week preparation and portion-size guidelines at the bottom of each recipe, which can help you manage your diet progression. Check with your doctor or nutritionist on how to advance your diet. Although certain serving sizes are noted, don’t force yourself to finish your plate if you are feeling too full.
Chewing is key! Relax, enjoy, and taste the food that you are consuming. I encourage all my patients to chew at least twenty-five times. Solid food should be cut to the size of a fifth of a fingernail or smaller. If you eat too fast, don’t chew your food well, or try to progress to solid food too quickly, you may overfill and vomit.
Mealtime should take no more than thirty minutes. I recommend three meals and one to two healthy snacks during the day. Remember to measure and weigh your food so you are aware of the portion size you are eating.
The nutritional emphasis in this cookbook is on protein foods. However, we do encourage a variety of foods and well-balanced meals. A strong emphasis needs to be placed on choosing high-protein foods. Protein is essential for growth, repair, and formation of new tissue. Protein aids in wound healing, maintains lean body mass, is a source of energy, and helps prevent protein malnutrition.
Great protein choices are meat, fish, poultry, eggs, cheese, milk, yogurt, beans, soy, and nuts. Solid, dense, protein-rich foods allow you to feel satiated for a longer period of time. Make sure to choose lean cuts of meat, trim off the fat, and take the skin off the poultry to reduce your fat intake.
After weight-loss surgery, protein needs vary depending on the type of surgery you have undergone. After the Lap-Band, aim for 50 to 60 grams of protein per day. After a gastric sleeve or gastric bypass, aim for 50 to 70 grams of protein per day. After a BPD-DS, aim for 80 to 120 grams of protein a day. Not meeting your protein needs can lead to protein malnutrition—a condition that can cause fatigue, weakness, and swelling of lower extremities, as well as hair loss.
I encourage my patients to consume enough liquids between their meals to satisfy their thirst and prevent dehydration. Six to eight 8-ounce glasses of noncaloric, decaffeinated liquids are recommended per day. But do not drink immediately before, during, or after meals. Separation of liquids and solids is recommended to maintain a feeling of fullness. If you drink while you are eating it can dissolve the food and leave you feeling empty, which can cause overeating.
I hope that you will enjoy the fabulous recipes in this unique and exciting cookbook designed especially for you. The more you use it, the closer you’ll come to knowing that you cannot only eat right, but also eat well, as you strive to attain your weight loss goals.
Meredith Urban-Skuro, MS, RD, CDN received a master of science degree in clinical nutrition from New York University. She has worked with the bariatric population since 2001 and has written numerous book chapters and journal articles on nutrition and dietary guidelines for the bariatric patient. Meredith has been guest speaker at the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders.
How to Use This Cookbook
AT THE BOTTOM of each recipe, you’ll find specific guidelines for preparation and a recommended serving size for every stage of the eating programs for gastric sleeve, gastric bypass, Lap-Band, and BPD-DS patients. We have also included preparation and serving suggestions for everyone else (referred to as “Others”—people who have not had weight-reduction surgery). These guidelines are listed under the following headings: Gastric Sleeve and Bypass, Lap-Band, BPD-DS, and Others.
In addition, you’ll find a nutritional analysis breakdown below the guideline information. It includes calories, protein, fat, carbohydrates, cholesterol, fiber, and sodium. All analyses are based on an average portion size (Others’ portions). Obviously, if you are a postsurgical patient, for the first few months you’ll be eating smaller portions than the analyzed amounts, so you will be taking in even fewer calories, and less fat, carbs, cholesterol, fiber, and sodium per recipe. (Note: We rarely add salt while we’re cooking; that’s why most recipes list “Salt and pepper to taste.” Be aware that the salt and pepper you add will not be reflected in the nutritional analyses.)
You have probably discussed a food program with your doctor and nutritionist. Please check with your doctor and nutritionist to make sure they agree with these guidelines. The guidelines we are using were suggested by my nutritionist. Of course, she stressed that people’s tolerances vary greatly; so while we may recommend an ingredient or a recipe as being appropriate for a specific stage of your diet progression, only you will know what foods you can tolerate and when you can best tolerate them.
This book is based on my eating adventures and experiences after my Lap-Band surgery. I was very lucky and had almost no digestion problems from the get-go. In fact, I found that I had fewer problems after surgery than I had had before. But I realize that’s not always the case. Some people are very sensitive to specific foods after bariatric surgery. If that’s the case for you, you may want to delay trying certain recipes until later in your eating program.
For example, if you find that you are unable to comfortably digest something like beef until Week 12 or 16 but you love our recipe, which says you can eat it after Week 8, try preparing the recipe with chicken, turkey, or fish instead. You’ll notice that, because many people have problems with gas or bloating from certain vegetables, maybe you’ll have to wait until after Week 8 to eat recipes that include them. But, if you’re like me, you can eat virtually all vegetables from the very beginning.
Don’t be afraid to be flexible. Try adding new foods gradually. This book is all about making the program work for you.
Hints for Food Preparation, Cooking, and Eating
SUGGESTED KITCHEN EQUIPMENT
You will need the following:
A food processor and/or a blender
A mini-processor and/or a mini-chopper
8 (4-ounce) ramekins
A 4-quart Dutch oven or soup pot
I also recommend these optional kitchen toys:
A Spiralizer for making zasta (zucchini pasta) among other stuff
An immersion or stick blender for pureeing soups and sauces
A microwave oven is a real convenience, as it allows you to cook in larger quantities, puree or blend, store in the refrigerator or freezer, and then reheat.
TIPS FOR COOKING
Here are some things that I have discovered through my cooking experiences that may help you:
Spices, herbs, garlic, hot sauce, and mustard have almost no calories and they can make all the difference between being miserable and being satisfied. Don’t be afraid to add curry powder to yogurt as a base to puree chicken. Garlic (and we use a lot of it) can liven up just about anything.
When a recipe calls for artificial sweetener, do not use aspartame (Equal or NutraSweet) if you’re cooking or baking—aspartame breaks down when heated. Use Splenda or Truvia. (You can use aspartame for noncooked dishes.)
If we haven’t specified a low-sodium product but you find one in your market, go ahead and try it. That this will bring the sodium level in the nutritional analysis down—which is ideal for just about anyone.
As someone who used to cook with lots of butter and olive oil, I was amazed that switching to cooking sprays didn’t really change the taste of my favorite dishes. But I did find that the flavor of the cooking sprays does often make a difference. That’s why in most recipes I specify which cooking spray to use—butter-flavored, olive oil, or canola oil.
In those rare recipes in which butter or margarine is necessary, I use a little bit of butter or light margarine. Here’s a hint: even though the manufacturers of Benecol margarine and other “heart-healthy” lighter margarines (which have half the calories of butter or regular margarine) recommend that they not be used for cooking, you can use them for quick sautéing, such as making eggs.
Most cooks have their own personal favorite ingredient. In my case, I cannot cook without some brand of concentrated chicken or beef broth (such as Bovril or Bovrite, Knorr, and Campbell’s). I don’t mix it with water. I add a teaspoon or two straight from the jar to recipes for maximum flavor. Note: you can order Bovril and Bovrite at Amazon.com.
When a recipe calls for eggs, I generally use an egg substitute (such as Egg Beaters or Better’n Eggs). When I need whipped egg whites, I usually use egg-substitute whites (such as AllWhites). But in a few instances—for example, when I make flans or custardlike dishes—I do find that only whole large eggs or whole egg yolks will work. By the way, egg substitutes are pasteurized, so using them in uncooked recipes is not a health hazard.
When a recipe calls for fresh lemon or lime juice, heat the fruit in the microwave on HIGH for 10 seconds. It makes it easier to juice.
Why reinvent the wheel? Commercially prepared brands of fat-free, sugar-free ice cream, sherbet, and frozen yogurt are as good, if not better, than any that we could devise (and we tried). Of course, they taste terrific when you top them or layer them with one of our dessert sauces. But be careful: many of these diet desserts are made with sugar alcohols (sorbitol and mannitol, for example), which can cause gas, diarrhea, and bloating.
I’ve found that freezing and storing excess food in ice cube trays lets me easily defrost and reheat small portions later on.
TIPS FOR EATING
Here’s a hint that’s really worked for me: since you can only eat a small amount at each meal, use a salad plate instead of a dinner plate, and a salad fork and teaspoon instead of a dinner fork and soup spoon. You may also want to invest in some small dessert-size bowls, which are perfect for soups and purees.
If you need to slow down your eating, try using chopsticks—and remember to chew each mouthful twenty-five times (Meredith made me write that).
When eating with others who can have regular-size portions, try to pace yourself to match the other person so that you don’t finish eating before he or she does.
When pureeing your food, if you find that the puree is too dry, add a little water, milk, stock, or broth.
TIPS FOR DRINKING
At my first meeting with my nutritionist, she stressed how important it was that I learn to eat without drinking any liquids immediately before, after, or during my meals. This was one of the toughest things for me to do, as I was the type of person who would tell the waiter at a restaurant to just leave the water pitcher on the table.
I assumed that she stressed this “no drinking rule” because my food capacity was so diminished she did not want me to fill up on liquids. Wrong! She explained that drinking liquids with meals makes the food wash down more easily, so you may actually end up eating more than you should. Obviously, this will defeat the purpose of your surgery.
But even though you can’t drink liquids with meals, you do need to drink at least six to eight 8-ounce glasses of water or other noncaloric liquid each day. I keep a glass of diet iced tea or a bottle of water within grabbing distance at all times (except mealtimes, of course).
GENERAL TIPS FOR JUST GETTING ALONG
Since the first few months of soft food allows you no opportunity for chewing, try chewing sugar-free gum. Before I took this advice (offered by my brother-in-law), I found myself clenching and grinding my teeth. Even if you are not a gum-chewer (and I wasn’t), keep it handy and chew a piece when no one else is around. Meredith disagrees with this so I’m including her warning: chewing gum can cause lots of gas.
Here’s an interesting personal discovery I made that may help you, too: Meredith had warned me that after surgery I might have problems with constipation. She suggested that I take a daily fiber supplement, such as Citrucel or Benefiber, and I found that sometimes it worked and sometimes it didn’t. Then I had an idea: instead of fiber (after all, I was getting plenty of fiber from fruits and vegetables), what if I took one 400 IU softgel of vitamin E every day? I don’t know if it was the vitamin E itself or the tiny amount of soybean oil it was suspended in that was the magic ingredient—but it worked!
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