Monday, May 13, 2013

Trading Surgical Scrubs for an Apron: Why teaching patients to cook is the most important thing I do after surgery

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Swapping Surgical Scrubs for an Apron
As I surgeon I spend more time today teaching patients how to cook than I do operating on them.  This is, we discovered, the single most important thing I do for a patient to keep them from coming back to my operating room - and, as it turns out, keeping them out of other surgeon's operating rooms also.

healthy cooking dr simpson lap band surgeon
One of my favorite events: teaching a cooking class - I get to swap my surgical scrubs for an apron
Doctors ask patients many health related questions: do they smoke and do they use a seatbelt, but I ask patients if they cook. It is not a coincidence that the majority of my patients, when they first meet me, tell me that they don’t cook. They “eat out.” That usually means they eat at fast-food places or chain restaurants. Which means they eat crap. It also means they eat too much.
They have no appreciation for what real food is, and who can blame them? But when they first taste a tree-ripened peach, or cook their first bit of chicken from a chicken that was raised  on a range, or discover that they can make a great taco from lentils - their eyes open.
I tell my patients that my goal, besides the successful surgery, is for them to change their lifestyle.  Every patient knows this, and nods, but then I tell them what I mean by that: I tell them they have to cook.  I tell them that I am going to turn them into food snobs. That in five years they won't eat the same thing they eat now, that they will have such an appreciation for food and what they eat that they won't want to go out to eat - unless it is an amazing restaurant.  Imagine- a weight loss surgeon telling a patient with morbid obesity that they want them to really  love food. I believe in this so strongly that it is a part of the surgical consent they sign in their first consultation with me.
Evolution of a Surgeon -Cook
This isn't common among surgeons today - in fact I know only one other surgeon, also a weight loss surgeon, Garth Davis, who does this. I didn't always do this - this was a result of years of watching weight loss surgery patients come and go, and then studying the successful ones. When a patient goes from morbid obesity to a normal weight, and then stays that weight for at least five years I enter them into a special data base. Every year I question those patients about what they do.  I also have patients that never leave morbid obesity - they might loose some weight, but they never get to a point where they get out of that dangerous weight group in spite of aggressive stomach surgery and intestinal re-routing.  That group I also question. For years my questions were about eating habits, and how much they exercised - and there were some clear patterns: 77% of patients who kept off their weight for over five years exercised. But then one year I asked two simple questions that I had never asked before - (a) Do you cook - and did you before and (b) What things do you eat today that you didn't eat before surgery. Over 500 patients who were successful - all of them cooked, and 85% didn't before (I don't consider heating things up in a microwave or preparing processed packages cooking). Further, of the successful patients - none were eating the same things they ate before surgery (their diet had changed dramatically). Of the group who were not successful - over 300 patients who had never left morbid obesity - most ate the same foods they ate before, over 80% didn't cook more than re-heat something - most ate out, at the same places.
Then it hit me- it became personal. I realized that there was a time in my life when I had gained far more weight than I care to admit to. I spent almost a year eating out at chain restaurants.  At my highest weight I was over 230 pounds. I got away from those places, and started to cook at home again - and started to loose the weight.  Mind you, it is still an ongoing process - but every year for the last ten years I weigh less than the year before.  The only significant time that changed was when my wife was pregnant two years ago and I gained weight helping her eat her way through pregnancy (she is back to a size 2, I am ten pounds away from where I was then - but still less. )

Checking the Sous Vide at one of our Weight Loss Fest Events
It All Changed
The focus of support group for patients went from chatting about healthy foods, to teaching them to cook. In fact, we now have mega events where we give patients a cooking lesson and do a lot of menu planning.
When patients come in the office we have a questionnaire about what they have eaten lately, and we talk about cooking. When someone who hasn't been successful wants to get back into it, we tell them they must cook (not their significant other, not their mom, them).
Adolescent Obesity
One of the hardest groups to deal with are teenagers. They want to loose weight - they are desperate for it. For years we would watch motivated teenagers with highly supportive families come in, get weight loss surgery, and a few years later regain weight (usually when they left home). I vividly recall one 20 year old who came to my office wanting her Lap-Band out because she wanted to eat like her boyfriend (who was, at 21, over 300 pounds at 5'6").
So I changed my approach. Now when a teenager comes in wanting weight loss surgery the answer is simple: they have to cook, they have to cook their meals and show me a meal plan. Sometimes they have to come with me on field trips to the Farmer's Market. Up front they are told that eating at the mall is no longer an option, if they want to loose weight.  That my goal for them is to be so good at cooking, that when they go to college their friends won't want to go out for for pizza, but have them cook. I'm up front in my skepticism of them, but tell them if they are serious, they will do this. Those teenagers who have embraced this, have loved it- one even went to culinary school.
If a Busy Surgeon Can Do It - So Can You
You can imagine the excuses I hear for not cooking. You can imagine what I tell them. And when people say they just can't do this because of work- I show them this neat invention: the lunch box.
Culinary Medicine
There are a few of us out there - physicians who cook, who teach their patients to cook, who ask what they eat. It is growing - slowly. Some of my fellow physicians who do this include Garth Davis, a weight loss surgeon from Houston, John La Puma, a fellow alum and internist, and more.  There is more press about this than doctors who do it. And cooking healthy isn't about what people think: it isn't eating chicken wraps, flavorless fish, or waxy vegetables. What people think is healthy is often more fad than fact. 
So my life and career changed and today:
I'm a Cook who Does a little Surgery
Tools of the trade - Scalpels for bigger knives
I still use a fine scalpel but I have a lot more tools now

Here is A Bit More From My Upcoming Book:
I’m a surgeon. I have seen bodies inside and out- from blocked arteries, worn out knees, herniated back discs, fatty livers, cancers, or pancreases that no longer function. When people come to me, or to my colleagues, they need our help, our intervention to get them back to health, or a functioning place. And most of the time we can help them.
The question is: how long can we keep them healthy before they need us again? What can we do to keep them healthier, longer? Is there a diet, or a food, or a program that we can prescribe our patients that will help them stay out of our operating rooms for a long time? Then, to those who have not yet gotten to the stage where they need us, is there a diet, or a group of foods, that they consume that will keep them from ever getting to us?
People who have undergone complex operations for their health, such as heart surgery, cancer surgery, hip replacement, back surgery, weight loss surgery, all need their operations- but it serves as a wake up call about their health. When we see those patients back in the office they want to know what they can do to avoid having us operate on them again – and the answer is simple: Just Cook! Those who learn to cook, some simple dishes, are doing the single best thing to avoid coming back to the operating room – besides taking their medicine.
But make no mistake about it; there are those who assume when doctors fix them they can resume their former lifestyle. Have you ever heard of a person who goes through weight loss surgery, such as gastric bypass or LAP-BAND, and regains their excess weight? They may blame the operation, instead of embracing the operation as a call to change their old habits—such as eating out and eating junk. I remember the heart surgery patient who, with new vessels in place, went right back to eating out his favorite meals of burgers and cheese. Or the cancer survivor who balks at chemotherapy yet thinks nothing of eating from restaurants that serve through a window
But my other goal is to teach patients a bit about how their body works, and what we know about the foods and nutrients. That’s not easy, because science doesn’t always agree with popular perception – and there are a lot of myths that we shatter. Every day on my Facebook page and Twitter stream I see nonsense about food: what it can cure, nonsense about what you should eat to avoid cancer, heart disease, or loose weight – posted by people who mean well and want others to be healthy, but who have no idea how the body really works.
Knowing what a body does with food, where things work is a part of the simple recipes we teach – along with a few bringing in friends of mine,  from fellow doctors, foodies, chefs, and writers who will share their own myths.
We’ve lost a generation of home cooks and gained a generation of people who eat out. Starting in the 1970s, people took less interest in learning to cook, opting instead for chain restaurants that substituted convenience for quality. Today there are five times as many restaurants opening as grocery stores- in the 1960’s there were five times as many grocery stores as restaurants. In 1986, there were fewer than 100 surgeons in the United States doing weight loss surgery. Today there are more than 2,000. In 1976 no one did angioplasties in the United States, today over 1 million angioplasties and stents are performed in the United States.

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