Weight Loss surgery – is it the answer?

Starting in 2021, I will be working in partnership with Mark Grant (Southern Weight Loss) to provide a comprehensive service for clients before and after private weight loss surgery.

Considering weight loss surgery? Here are some things to think about

Weight loss surgery will only benefit you if you are willing to make lifestyle changes to work alongside the reduced intake you will experience because of physical restriction created by surgery. It will not let you “eat what you want.”

If you eat for emotional reasons or because of past trauma, you need to work on the reasons you eat. A fair number of clients I see who have the need for weight loss surgery can be eligible for sensitive claims counseling.

Weight loss surgery seldom normalizes body weight. You are likely to be overweight or obese when you achieve your goal weight. The weight loss is to improve function and health, not to achieve cosmetic perfection. You will still find yourself judged as a big person, even if you achieve the weight loss goal we calculate as a successful outcome.

You will have skin folds. If you want a surgical revision of skin folds you will need to work with a plastic surgeon. Skin revision is seldom done in the public system unless there is a health problem caused directly by the excess skin.

Food is more than nutrition

A Maori woman who had weight loss surgery said to me once, “I wish I had known how tough it would be attending events on the marae when I can only eat a little bit of food”. Although she had been extremely public about her journey, the social and cultural pressures that occurred when at events where she was receiving manakitanga were substantial.

The challenges you face with food won’t go away with surgery, and this can put you at increased risk of co-addiction.

Do I recommend weight loss surgery?

After over 25 years of working with a specialist interest in weight management, I am confident that surgery is the primary treatment option for some clients. I have one person starting that journey at the moment and another who I am thinking we should discuss whether she starts down the pathway.

Here are some things to ask yourself if you are thinking of surgery

  • What is my reason for wanting weight loss surgery?
  • How will my losing weight affect my relationships with others?
  • If someone in my close circle of relationships starts sabotaging my weight loss efforts either during the preparation or post-surgical period am I willing to confront that behavior and potentially lose the relationship?
  • Am I willing to make efforts to understand the reasons I eat, including participating in psychotherapy if necessary?
  • Am I willing to work on being physically active every day and make choices to spend less time undertaking inactive leisure?
  • Am I willing to either explain why I can’t eat more, or just say “no thanks” when there is social and cultural pressure to eat?
  • Am I willing to accept I will still be judged as an overweight person by society and by people in health who do not understand the nature of weight loss surgery?

If you are considering surgery and want to talk about it, please do not hesitate to make contact with me.

Meal Boxes for families – are they a healthy option?

Recently I was asked if the meal box options were healthy. Because I am a cook-from-scratch girl I asked the clients to send me the recipe sheets of the meals they really liked and I reviewed them. This is one company only but it is some good points to look at and think about when deciding if your meal box is healthy.

  1. Most of the per person servings were 3,500kJ (900kcal) which is fine if you are active, male and not wanting to lose weight. For many of them it would be possible to reduce the portion size by ¼ to ⅓ and still feel full.
  2. Many of them are quite high in sodium. If there is more than 1000mg sodium in a serving then this is 3g of salt which is about the amount we should have in the whole day. When I looked closely, I suspect that much of the sodium comes from either the spice blends (salt is commonly added to these) or some of the processed ingredients such as tortillas or pesto.  The two ways of reducing sodium would be to omit any salt in the recipes and to use spice blends without salt. I have a set of spice blends that I will share. I also recommend if you are buying your own to replicate these recipes you use the FoodSwitch App to find the lower sodium options.
  3. Some are heading up into the unacceptable range for saturated fat in the recipe. It was common to see small amounts of butter added to improve recipes – most of it unnecessary like the salt.  With ingredients like cheese, coconut milk and cream there would be ways of using less or using reduced fat options instead.
  4. I have less problem with the use of oil, but unmeasured things like “dash, splash and drizzle” can add up in terms of total amounts added. For the record aim for 1tsp per person per meal when you are adding oil
  5. Many of these could do with a fibre boost and if you were recreating the recipes you would reduce the amount of meat and increase pulses and bean to achieve this.

I just completed the consultation with the couple who made the query and they are going to have a go with making the changes discussed. We talked about the importance of food skills, and I dedicate the seasoning mixes below to their efforts. All mixes will last 6 months in sealed containers so you can make in advance, label them well and use them during this winter to make yummy options.

Tex- Mex Seasoning

  • 1 TBSP                  chili powder
  • 2 tsp                      paprika powder
  • 2 tsp                      ground cumin
  • 1 tsp                      garlic powder
  • 1 tsp                      onion powder
  • ½ tsp                     chili flakes
  • ½ tsp                     dried oregano
  • ½ tsp                     ground black pepper
  • 1 pinch                  ground cinnamon
  • 1 pinch                  ground cloves

Caribbean Jerk Seasoning

  • 1 TBSP   onion powder
  • 1 TBSP   garlic powder
  • 2 tsp                      cayenne pepper
  • 2 tsp                      smoked paprika (regular paprika is fine)
  • 1 tsp                      allspice ground
  • 1 tsp                      black pepper ground
  • ½ tsp                     red pepper flakes
  • ½ tsp                     cumin ground
  • ½ tsp                     nutmeg ground
  • ½ tsp                     cinnamon ground
  • 1 TBSP                  brown sugar
  • 1 tsp                      thyme dried
  • 1 tbsp                    parsley dried

Tandoori spice mix

  • 2 tsp                      sweet paprika
  • ½  tsp                   ground cumin
  • ½  tsp                    ground coriander
  • ¼  tsp                    ground turmeric
  • 2 pinches             chilli powder
  • 1 tsp                      garam masala
  • ½   tsp                   dried mint

Paste

Mix 2 TBSP with ⅓ C yogurt and 2 tsp lemon juice to get a paste, refrigerate for 12 hours.

Chermoula (Moroccan Spice)

  • 2 TBSP                  ground cumin
  • 1 TBSP                  ground coriander
  • 1 ½  tsp                 chili powder
  • 1 ½  tsp                 sweet paprika
  • 1 tsp                      ground cinnamon
  • ¾  tsp                    ground allspice
  • ¾ tsp                     ground ginger
  • ½  tsp                    cayenne
  • ½  tsp                    turmeric

Seitan – “spring” this tasty protein on your vegans

Seitan is a  non-meat protein used in plant-based diets. In many countries, it is available commercially as meat product substitutes, but it is generally fairly pricey. As well as its use as a source of protein it has the springy mouth texture that is missing in many vegetarian products.

How to make it

Recipe

  • 2 C gluten flour
  •  1 reduced salt vegetarian stock cubes or 2 tsp reduced salt vegan stock powder
  • 1 ½ C water
  • 2 TBSP canola oil
  • 4 TBSP reduced salt soy sauce
  • 2 tsp dried ginger
  • 2 cloves of garlic or 2 tsp crushed garlic

Put the gluten flour in a large bowl. Mix all other ingredients in a smaller container. Pour wet into dry and combine through stiring then tip out onto a surface and kneed for 5 minutes. Cut into 4 pieces. Place into steamer on grease proof paper brushed with a small amount of oil. Steam over a large volume (at least 4 C) of steaming liquid made with 1  reduced salt stock cube and 2 TBSP of reduced  salt soy sauce. After 30 minutes remove from paper and turn over in the steamer. Steam another 10 minutes. Remove from pan and cool.

I have used this in a stir-fry with 4 C of seasonal vegetables. The vegetables are cooked first with 1 TBSP of oil and a splash of water to wilt them slightly once the pan is hot. After about 6 minutes the seitan is added with a sauce. In this case I used 2 TBSP of sweet katsu sauce and 1 TBSP of sesame oil.  I cooked the stir-fry for about another 2 minutes to make sure the seitan is cooked through. I served it with rice noodles.

Nutritional analysis of Seitan

731 kJ (174kcal), protein 22.3g, fat 7.2g, saturated fat 0.6g, carbohydrate 4.9g, sugar 0.2 g , sodium 427mg

Ingredients in Seitan

Here in New Zealand, we are fortunate that we can get hold of the main ingredients with relative ease. I have found that I can find the ingredients in either bulk food shops like Bin Inn, at my local supermarket and in various health food shops. If you are going to make it regularly you will want to find the best deals.

If you look for Seitan recipes online you will find that there is quite a variation in recipes beyond the core ingredients. Here are a couple of common additional ingredients and why I think they would be worth trying in addition to a basic recipe

Oil: Some recipes include it others don’t. I would recommend including it as it is likely to make the final product a bit more tender. I would suggest using a monounsaturated oil and my preference would be for canola oil because of its relatively high level of alpha-linolenic acid – the precursor to the long chain omega 3 fats.

Nutritional Yeast or Brewers Yeast: this will give you an umami taste and is a rich source of vitamins. It divides the world a bit like marmite or Vegemite – some people hate it others love it. Doing a small test batch with roughly 1 TBSP per 125 g of gluten flour is probably the best way forward as a trial when using it for the first time

Chickpea (bessan) flour: I would definitely consider adding this at approximately 30 g per 125 g of chickpea flour. One of the older practices with plant-based nutrition is to combine protein sources to make the protein available in a meal “complete”. Although you don’t have to do this meal by meal for a healthy vegan diet, it is good practice particularly for children who are eating a vegetarian diet and who might have smaller appetites.

Amino liquid: This is expensive and it also has more sodium than the reduced salt soy sauce I have used.

Stock: it would be easy to get a lot of sodium in this product if using full salt products all the way. I use reduced salt stock in these recipes to avoid that.

Various herbs and spices: This is the secret of seitan – you flavor it to suit. I am making a relatively plain and un-spiced one because I have two people with very sensitive taste buds in my household and I suspect I will not get many attempts to get them to try it*. Many of the recipes on the internet have fantastic suggestions about making really flavorsome varieties.  One of the first people I am going to ask to have a go at making her variation is a Maori dietitian colleague who I bet will want to see if she can get hangi flavors!

Cooking methods

In this recipe, I am doing a boiled cooking method, then on the second cook, it will be stir-fried. Having read around I think it is worth considering the following hints around cooking:

Boiled: This will be a moist seitan. Some people think it is too spongy and soggy. It would work well cooled and grated to make mince or as a casserole substitute.

Steamed: This is likely to have more concentrated flavors but I suspect it could be quite heavy unless you got the steaming temperature fairly consistently high. If you have a proper steamer it would be worth trying

Pressure cooker:  I looked this up and hope I will get a chance to try it soon. The big advantage is shortened cooking times with bigger pieces of seitan – but I must admit I had a vision of the seitan splurting out the steam release hole if you did a quick release method – and it is very clear it is a slow release method only in the recipes I looked at. If this works I will need to get cheesecloth to do it regularly as this seems to be a recommendation. I am using an old linen tea-towel at the moment.

Baked: This looks like it creates stronger flavors and drier product. Some questions are raised about how tough it gets if you cook it for a second time i.e. if you fry it. I suspect it would be a good way to have it if you were having it as a cold protein in lunches**.

* Great news, one of my fussy eaters is more than happy to try again. The other didn’t hate it, which given she has both taste and texture issues with a range of food is a glowing report.

** I experimented with this and got an interesting result. Picture below. Two things 1) Oil the pan and 2) Cook at 140 degrees rather than 180 degrees for 30 minutes

Seitan in oven dish – expanded about 4 times original size

Storage:

It needs to be kept in the fridge and sealed against drying out. Many of the storage suggestions include being covered with liquid stock especially if freezing. If that is the case then I would suggest getting reusable silicone bags to minimize the amount of fluid you need around the seitan.

It keeps in the fridge for 5-7 days and the freezer for 6 months.

Family Falafels for Freezing – the classic Middle Eastern Recipe!

Falafels are a quick protein that can be prepared and frozen for later use

PREP TIME: 15 minutes

COOK TIME: 15 minutes

TOTAL TIME: 30 minutes of actual hands on cooking with up to 24 hours of standing time.

Ingredients

  • 1 1/2 cups dry chickpeas
  • 1/2 cup chopped white onion
  • 5-7 medium cloves garlic
  • 1 – 1 1/2 tsp sea salt (plus more to taste)
  • 1 tsp black pepper
  • 2-3 tsp ground cumin
  • 1 pinch ground cardamom
  • 1 tsp ground coriander
  • 1 pinch cayenne pepper (optional)
  • 1/2 cup chopped fresh herbs (I usually have parsley, corriander and basil) OR
  • 2 TBSP dried herbs
  • Up to 1/2 C pea flour or gluten free flour
  • 2 C cooking oil (I prefer rice bran or canolla oil)

Instructions

  • Rinse (uncooked) chickpeas. Put into a bowl and pour boiling water over them. Allow to soak for a minimum of 90 minutes, but they are better if soaked overnight. Drain well in a sieve before using
  • Put chickpeas in food processor and add all ingredients except the pea flour and oil. Mix to combine thoroughly, scraping down sides as needed. This may take up to 4-5 minutes to fully incorporate all of the spices and herbs. You’re looking for a near paste with only very small bits of chickpeas and herbs.
  • Refrigerate for a minimum of 30 minutes and up to 12 hours in a sealed container (otherwise you will have a strongly garlic smelling fridge)
  • Remove from refrigerator and scoop out 1 1/2 Tbsp amounts and try to form into a smooth ball. If this is crumbling at all add 1/4 C chickpea flour and mix, then try the ball making again. If this still crumbles repeat this adding 1 TBSP of flour each time.
  • Once your falafels are formed (approx 24 from this recipe), heat oil in a moderate sized pot over a moderate heat. There should be a consistent sizzle when you drop the falafel into the pot. Cook for 3-5 minutes until dark golden. Drain on a paper towel on a rack.. Continue until all falafel are cooked. Adjust heat as needed if they’re browning too quickly, or aren’t cooking quickly enough.
  • To freeze, fry falafel and let cool. Then add to a freezer safe container and freeze up to 1 month. Reheat in a an oven or microwave.

Yogurt – a basic ingredient at a lower cost

Yogurt can be made lower cost

If you come and see me you will probably hear me talking about yogurt.

Unsweetened, low-fat yogurt can be a useful basic ingredient, but many people want it at a lower cost. Here is my top tip.

Yogurt using yogurt mixes

You will find yogurt mixes on the supermarket shelves. Usually one sachet makes 1 kg of yogurt. If you are using yogurt as an ingredient or snack you could get through several sachets each week. I have found you can make very good yogurt this way

  • 30g (2 TBSP) yogurt mix
  • 140g (1 1/4 C) skimmed milk powder

Make up as per instructions on the yogurt mix. Seal the remaining yogurt mix for use over 2-3 weeks.

You may find the yogurt weeps a bit more than usual, just stir in the moisture before you use it.

Can you make plant-based yogurt a similar way?

Watch out for a future post on this, I have just ordered some ingredients 🙂

Make milk powder work hard for your family

Three years ago I made this facebook post. It is still the most shared post I have made to date.

What do you need to make milk from milk powder?

Using milk powder to make up liquid milk requires you to have three things

  • Electronic scales OR appropriate measuring cups for the milk powder
  • A sealable washable jug that can be stored in the refrigerator.
  • A clean, palatable water supply

There are two type of milk powder, whole milk powder and skim milk powder. Whole milk when made up as per the label makes standard, dark blue milk. Skimmed milk powder when made up as instructed makes skimmed milk. Most people would consider skimmed milk to be water bewitched and totally undrinkable. Trim and calci-trim milk both have more skim milk powder added, making them thicker and more palatable

Measures for milk powder

All measures are metric, powder is lightly poured in and leveled.

  • C = metric cup (250ml)
  • t = teaspoon (5ml)
  • T = tablespoon (15ml)
 Whole Milk PowderSkimmed Milk powderWater
Whole (Dark Blue)125 g  (1 C)825 ml
Half fat (Light Blue)50 g
(3/8 C plus 2 t)
65 g ( ½ C)835 ml
Trim101 g

 (3/4 C and 2 tsp)

899 ml
Calci-trim135 g (9/8 C)815 ml
How much milk powder do you need to make up different varieties of milk

Top tips for making milk

  1. Pour  200 ml of water in clean container.
  2. Add all the milk powder and mix well by either shaking or using a whisk
  3. Top up to 1L by adding the rest of the water
  4. Allow to stand for 30 minutes in the fridge before using.

What is the relative cost of this?

  • My jug cost $10
  • Milk powder works out at $11 for a 1kg bag or $6 for a 400g bag.
  • Making up milk from powder works out at between $1.30 and $1.80  per L
  • This compares to shop bought milk that can range from $1.30 per L (cheap, Blue or Trim milk) to $2.70/L (Calci trim)
  • Making up milk will pay for the jug very quickly

Milk Jug suppliers

Luminarc Quadro Glass Jug 1L

I found this jug at a catering supplies store. Recently I have seen similar in supermarkets. My sister has found she prefers shorter jugs, because her dishwasher doesn’t clean the whole length of the jug. The most important features of the right jug is that it is easy to clean and is sealable so your milk doesn’t get taint from foods like garlic in the fridge.

Use your grains for better meals

Whole grains can be cooked and frozen for faster use

Whole grains are a great option for anyone and we encourage their use in the Eating and Activity Guidelines for Adult New Zealanders. They are an important source of minerals and vitamins. Adding grains to meals makes it easier to get 30g fibre in your day.

You can cook whole grains on the stovetop or in a rice cooker. Some smaller grains can escape out the vent hole of a rice cooker. Cut a circle of baking paper to cover the top of your rice cooker under the lid. You can also cook grains in a pressure cooker. Cooking time is affected by the PSI of your cooker.

Table: Cooking volumes and times for a range of whole grains available in New Zealand

GrainLiquid for stovetop:Bring to a boil, then simmer for:Liquid for pressure cookerPressure Cooker timeCooked amount
1 C Brown Rice2 ½ C45-55 min1 ½ to 2C12-20 min3 C
1 C pearl barley3 C45-60 min2 ½ to 3 C10-20 min3 ½ C
1 C Rolled Oats**2 C10 min2C10 min3 C
1 C Millet, hulled2 ½ C25-35 min3 C8 – 10 min4 C
1 C Quinoa1 ¾ C12-15 min2 C2-4 min3 C
1 C amaranth2 C20 min2 ¼ C5-7 min3 C
1 C coarse polenta3 C30-40 min4-5 C10 min3 C
1 C buckwheat groats2 C20 min1 ¾ C2-4 min2 ½ C
These are approximate guidelines, you will need to use your own pressure cooker manual to determine time more accuately.

Some whole grains are very quick to prepare. These whole grains are cooked, then dried again, so only need to be hydrated before use.

1 C bulgar wheat add 2 C boiling water – allow to stand for 20 minutes, drain, fluff with a fork, and serve

1 C cous-cous add 1 ½ C boiling water. Stand for 10 minutes, drain, fluff with a fork and serve.

Freezing grains

Most people are unaware you can successfully freeze grains. Once you have cooked your grains, drain them well. Spread grains on a shallow tray. Allow grains to cool for 10-15 minutes. Freeze the grains on the tray for up to 12 hours. Break off the tray into a container to use as free-flow grains – to be reheated in the microwave.

Grains freeze well for up to 3 months. Grains are more likely to be freezer burned if you eat them after this time. Make sure your bags are well labeled and you plan their use into your menu!

Start 2021 by understanding how to make a positive first step to health.

It is that time of year again where people will be thinking about New Year’s resolutions to lose weight. In January there will be all kinds of pills, potions and plans purchased. Most will result in bank accounts being lighter, but nothing else really changes. This is because none of these purchases is a positive first step to health.

I recently came across the idea of false first steps in behavior change. In a nutshell, when we imaging making change it is common that we buy something as an aid to improving our competence…then we find we still fail because we haven’t worked on the skills needed to make substantive changes.

We take a false first step because buying something gives us a dopamine rush that feels like we have achieved something. Our first use might also give us a dopamine surge, but if we slip up or lapse, we will believe it is our fault and stop trying within a few days or few weeks.

So how do we make positive first steps to health successfully?

Keep trying: practice makes perfect on the first steps to health

Draw on what you already know about the first step to health

You know more about the first step to health than you think. You are likely to have had something you used to do in the past that falls into the “eating better” category, but you no longer do. An example might be taking lunch from home instead of buying it. Look at why you have stopped doing it, and ask yourself how you could restart it. One of the commonest reasons for stopping doing something is a perceived “lack of time”.  As a total non-morning person, I know that if leave my lunch making to the morning it won’t happen. To take lunch I need to prep it the night before and have it ready to grab and go. If I set a goal of doing it every day, I am likely to set myself up for failure, so I might say “most week days”. This allows for unexpected events and the odd forgotten pick up. Start working on this thing you have previously had success on and make notes of your success or otherwise

Examine why rather than criticise

If you lapse from doing the new behavior, use your logical mind to answer the question “So what went wrong?” “You are a lazy arse”, is not a logical mind response, so you look beyond that statement. “Why didn’t I want to make my lunch in the evening. What did I choose to do instead ?” Many of us have such strong critical narratives we struggle to look at something logically. If this is you, I recommend that you imagine you are advising a close friend. This exercise will prevent you from being casually cruel to yourself. Learning to challenge the inner critic is a major first step to health.

Try, try and try again to make the first step to health

Have you ever watched a child learning to walk? They will pick themselves up dozens of times and keep trying to succeed. We need to keep trying. Even when we feel like we are never going to make it. It is about recording and celebrating the successes. If we can change the mindset and learn from our failures rather than getting into self-criticism, we will develop that goal into a habit. Resilience and perseverance are tools in the first step to health.

Sit with the discomfort rather than trying to solve it.

If we are aware that we have a problem, it causes us discomfort. We want to get rid of the discomfort as soon as possible. Hence the impulse to buy that diet program or gym membership.  Instead, we should sit with the discomfort and use it to help focus our minds on what aspect of the problem we can solve first.  For example, you may be someone who drinks a couple of glasses of wine or beer during the evening.  If you are trying to lose weight you might start a diet plan that says “No alcohol”. Instead, sit with the discomfort and say “how could I moderate the amount I drink?”  You could recognize that the first glass is consumed fast because you are a bit thirsty. From that, you could decide you have a glass of water before you hit the drinks.  That might work or it might be a bit of a “meh” option. What could you do to that water to make it more appealing? Herbs, lemon, ice, nice glass, sparkling. All are options.  It can be a big trap at this point to think you need to spend money to make this happen. Again, sit with it and consider how you could implement this idea with minimal cost. Learnign to avoid quick fixes when we feel discomfort is a first step to health.

Borrow or hire before you buy

In the example above you might decide you will use sparkling water. Again, the impulse to solve involves buying something.  What about borrowing a SodaStream from a family member or friend for 4 weeks to see if you can stick with the change most of the time. By giving a time limit you will make an effort to either make this work and if it hasn’t you can return the item with thanks to the owner. If you can’t find one going spare, consider getting a second hand one and setting a timeline to give it away or re-sell it if you aren’t using it.

It is still OK to buy tools that will enhance your ability to do something better, but using research and finding out if you will use them before you buy them is an important step to health.

What does success look like?

I see many dozens of people who have spent thousands of dollars on failed lifestyle changes. Success is about making a change and sticking with it. It is hard to break the pattern of false first steps, and we need to realize that, like everything, making a successful lifestyle change will take practice.

If you had 6 healthy habits at the end of 2021 that you didn’t have in 2020, wouldn’t that feel great?

How does seeing a dietitian fit into this model?

The people I love working with are aware of their main problems with food, and rather than expecting a diet sheet, they want to know what to do to improve things. They also may find themselves so prone to being critical of failure that they get stuck regularly. My role may be to help you make specific goals towards change and to help you identify your self-sabotage and share tricks to overcome it.

If you had 4 new healthy habits by the end of 2021, wouldn’t you feel great?
If you want to see if you can work with me email me to arrange a 10 minute no-obligation phone call