Jefferson University Hospitals

Frequently Asked Questions

How do I make an appointment with a bariatric surgeon at Jefferson?

Scheduling an appointment is easy: Simply call 1-800-JEFF-NOW or use our online appointment request form. However, before you schedule a consultation, be sure you have addressed the items we've outlined on the Preparing for Your Consultation page.

How do I know if I am a good candidate for bariatric surgery?

The Jefferson Bariatric and Metabolic Surgery Program uses the National Institutes of Health (NIH) guidelines to determine eligibility for bariatric surgery. If you are 100 pounds overweight, or 75 pounds overweight with an obesity-related condition (for example, high blood pressure, diabetes or sleep apnea), you're likely a candidate for surgery. However, we will review your medical history to further determine eligibility.

How do I choose between a gastric bypass and sleeve gastrectomy surgery?

The sleeve gastrectomy is a relatively straight forward procedure that reduces the size of the stomach and offers excellent weight loss results with less nutritional concerns and less long-term complications. In the simplest terms, gastric bypass delivers more weight-loss benefit but comes with greater risk of complications. Some patients simply aren't comfortable assuming the risks of gastric bypass.

In light of recent data that shows poor long-term outcomes and high rates of long-term complications with gastric banding, we have stopped performing adjustable gastric banding at Jefferson. 

For many patients, the biggest consideration is the amount of weight you will lose on average. People who have a gastric bypass surgery typically lose more than those who have sleeve gastrectomy. For example, if you are 200 pounds overweight, you will lose, on average 110 pounds with the sleeve gastrectomy and 120 to 140 pounds with a gastric bypass.

Ultimately, though, if you are a good candidate for one procedure you are usually a good candidate for both and the choice is yours – you need to feel comfortable with your decision.

What do I need to bring with me to my first appointment?

You can find a complete "to-do" list on our Preparing for Your Consultation page.

What will happen at my first consultation?

A lot will happen at your first consultation, so you should plan to be here for a few hours. First, we will review your health history questionnaire (which you will receive in the mail from us). You will meet with the surgeon and dietitian. We will discuss the benefits and risks of the procedures and address all of your questions. We'll start arrangements for you to have a psychiatric consultation, a sleep study and a cardiac consultation. We’ll also arrange for some outpatient routine testing, which you may be able to get that day.

Will my insurance cover the surgery?

Most insurers cover the surgery if it is medically necessary – and if you meet the NIH criteria, it is medically necessary. You can learn more about the approval process at our Insurance Considerations for Bariatric Surgery page.

How much does the surgery cost if my insurance doesn't cover it?

We do offer cash-pay options for this type of surgery. The actual fees for the hospital, anesthesia and surgeon are variable based on actual patient costs, but generally speaking, the total fee ranges from $25,000 to $30,000.

How can I best prepare my body for surgery?

There are some important ways you can prepare for surgery:

  • Be as active as you can. If your physician approves it and you’re physically able, start walking every day.
  • If you're using tobacco, stop. This is critically important, as you can’t have weight-loss surgery if you're actively using tobacco. And the longer you quit before surgery, the easier it will be not to resume after surgery.
  • Try to eat as healthfully as you can. Taking in less fat before your surgery will make your surgery and recovery easier.

Can my family and friends help me through this process?

We strongly encourage you to get your family and personal support network involved in your decision to pursue weight-loss surgery. They can help you through the decision by acting as a supportive sounding board. They can help you make good food choices and recover to your normal activities postoperatively.

Also, they need to be as prepared for life after surgery as you are. If you have a spouse and/or children, it’s essential that they be aware of the benefits and risks of what you're undertaking and the lifestyle changes you’ll be making after surgery. Those who are closest to you have the best ability to help you be successful (or to undermine your success).

What are the potential risks of this surgery?

We've already outlined the benefits and risks of fully laparoscopic roux-en-Y gastric bypass, laparoscopic and sleeve gastrectomy surgery. The bottom line is this: with bariatric surgery the benefits are great, but there is a slight risk of a serious complication that could even possibly lead to death.

Of course, every surgery has risks. Ultimately, the risks of this surgery are less than the risk of a morbidly obese person doing nothing about his or her weight and not very dissimilar from many other types of abdominal surgery.

What medical tests will I have to undergo before my surgery?

To limit risk, we have our patients undergo extensive testing before surgery. The routine tests include:

  • Blood tests
  • Chest X-ray
  • Cardiac consultation (and any tests that the cardiologist deems necessary)
  • Sleep study (to evaluate for sleep apnea)
  • Upper endoscopy to examine the stomach for inflammation or lesions, which could increase the risks of leakage, ulcers or erosion of the band

What should I purchase before going in for my surgery?

The best thing to do is to purchase the liquids and protein drinks you will consume for your liquid diet after surgery. Try a few varieties to see what you like and dislike. That way, you'll know what you like – and have it on hand – before the taste-altering effects of the surgery influence your choices.

Why is it better to have laparoscopic versus traditional open surgery?

With laparoscopy, weight-loss surgeries are similar on the inside – but with less pain, shorter hospitalizations (two days for gastric bypass and sleeve) and quicker recoveries for the patients. In fact, weight loss patients who have laparoscopic surgery are able to breathe more fully and get out of bed the night of their surgery. They’re also able to do more activities at home more quickly. And laparoscopic patients experience fewer hernias and wound infections, too.

How long will I have to stay in the hospital?

Because we perform surgery laparoscopically, your hospital stay is likely to be shorter than with traditional open methods. If you have a gastric bypass or sleeve, you should be able to go home two days after surgery. 

How quickly will I lose weight?

Many patients will lose a lot of weight in the first weeks following surgery. This is usually a combination of the low-calorie liquid diet and the surgery. However, the most important thing we look at is how well you are healing. Early weight loss is not an indicator of long-term weight loss. However, when you lose weight early, it is very encouraging. Most of your weight loss will be over the first 18 months, with about half of the total occurring in the first five months.

Is the postoperative diet difficult to follow?

Most patients do fine following the postoperative diet plan. It is very different from your preoperative diet. But the surgery will help you adhere to the small portions and consume less sweet and fatty foods.

Can I get pregnant after this surgery?

Yes, but there are some caveats. First, it will be essential to ensure that you’re nutritionally sound prior to doing so. Second, you should not get pregnant during the phase of rapid weight loss. Therefore, we recommend not getting pregnant for the first two to three years after your surgery. We also need your obstetrician to be comfortable treating you even though you've had a gastric bypass.

Can I regain the weight?

If you don't follow the postoperative diet plan, you can regain some or all of the weight you've lost. Most patients are able to follow the plan and maintain their healthy weight.

Today, people are more aware than ever of the risks of having a high blood cholesterol level.

High cholesterol levels can lead to clogged arteries, heart attack or stroke. So if you have high cholesterol, you should take steps to lower it. Simple dietary and lifestyle changes can reverse your course and set you back on the path of good health. For those who have coronary artery disease, or are at unusually high risk for it, lowering your lipid levels can reduce further coronary events and the possible need for interventions such as surgery or angioplasty.

What is cholesterol?

Cholesterol is a waxy substance produced by the liver that is also found in animal foods such as red meat and whole milk dairy products, which are usually high in fat as well. (Plant sources do not contain cholesterol.) Your body uses cholesterol to build cell walls and other necessary tissues. High-fat diets stimulate the liver to produce excessive cholesterol. As a result of the amount your body manufactures normally and in response to a fat-laden diet, you can accumulate too much cholesterol in your blood. That is when trouble occurs in the form of cardiovascular disease.

Cholesterol travels through the blood in packages called lipoproteins. Low-density lipoproteins (LDL), or bad cholesterol, have a tendency to cling to the inner walls of the arteries as plaque. This plaque restricts the flow of blood to the heart or brain, which can lead to heart attack or stroke. High-density lipoproteins (HDL), or good cholesterol, whisk surplus cholesterol from the blood and arterial walls, thus lowering the odds of developing cardiovascular disease.

What do my cholesterol numbers mean?

Total blood cholesterol is the number most people are familiar with. Doctors no longer measure just the total cholesterol level in your blood, because that only provides part of the picture. Your doctor should do a complete lipid profile, which includes measuring your levels of good (HDL) and bad (LDL) cholesterol and triglycerides. (Although completely different from cholesterol, triglycerides likewise are fats found in foods and manufactured in the body. Most of the fat we eat is in the form of triglyceride.) Other lipid tests are also available, if needed, to help your doctor and you define your risk level.

Ideally, your LDL cholesterol should be below 100; a desirable HDL level is 45 of higher. The lower the LDL and the higher the HDL, the more protected you are from cardiovascular disease. Most pre-menopausal women have high levels of HDL because of the female hormone estrogen, which offers added protection against heart disease. After menopause, though, a woman's risk for heart attack jumps until she is 65, by which time it is almost as great as a man's.

Triglyceride levels above 150 mg/dl are abnormally high. A high triglyceride level often accompanies a higher total cholesterol and LDL cholesterol level, and especially a lower HDL cholesterol. The combination of high triglycerides and low HDL levels in concert with disorders such as diabetes or high blood pressure is termed "metabolic syndrome." Metabolic syndrome is strongly associated with abdominal obesity, which itself has been shown to put you at risk for coronary artery disease. Whatever your cholesterol counts, keep in mind other important risk factors as well. Age, heredity, family history, high blood pressure, diabetes, smoking and lifestyle should all be considered when evaluating your risk of cardiovascular problems.

How can I lower my cholesterol level?

You can take control of your cholesterol by making lifestyle changes. Eating a heart-healthy diet is often an effective way to bring your blood cholesterol within a normal range. Limit saturated fat to no more than 7 percent of your daily calories and trans fat to no more than 1 percent, and substitute more whole-grain and high-fiber foods.

Load up on fish, fruit, vegetables, beans, rice and other whole grains in place of meat or baked goods. Switch to low-fat or skim milk dairy products. When you must cook with fat, choose the monounsaturated varieties, such as olive or canola oils. Don't overdo your use of even these oils, however, as they are still high-fat foods. Fat in the diet stimulates the liver to raise blood cholesterol levels; it is not just eggs that elevate blood cholesterol.

Additionally, since regular exercise has been shown to increase the level of good cholesterol, get active. Because smoking reduces the level of good cholesterol, smokers should quit. Everyone should maintain a normal body weight, as above-normal weight and obesity contribute to abnormal lipid levels, as well as diabetes, high blood pressure and other disorders. The rewards of changing your habits are well worth it; for every 1 percent drop in bad cholesterol, you get a 2 percent drop in cardiovascular risk.

Are foods labeled 'Cholesterol Free' safe bets?

Don't be fooled by food labels that say "cholesterol free." Foods bursting with saturated fat are sometimes disguised with these healthier-sounding labels. Likewise, products made with hydrogenated vegetable oils may seem good for you but are actually rich in fat. Current U.S. Food and Drug Administration regulations cut down the hype surrounding terms used on food labels, such as "cholesterol free." To prevent being misled, however, read nutrition labels to learn the amount of fat in a serving. A truly low-fat product contains three grams or less of fat for every 100 calories.

Should I consider cholesterol-lowering drugs?

Drugs that can help normalize blood cholesterol may be necessary for people at higher risk who can't control their levels through diet. Dietary changes should often be tried before medication, however. Within three months of following a low-fat diet, you should notice a reduction in your cholesterol count. If this self-care method doesn't lower your cholesterol to an acceptable level, you may need to add medication to your regimen, particularly if you have other risk factors for cardiovascular disease. Since drugs that lower cholesterol can have side effects, however, you should consult your physician before deciding if medication is appropriate.

Do I need to worry about my child's cholesterol levels?

Research indicates that one out of four children and teenagers has a high cholesterol level. Clearly, it's never too early to start thinking about your child's cholesterol. Although the American Academy of Pediatrics does not recommend universal screening of all children, it's wise to test children over two years of age who have a family history of early heart attacks or elevated cholesterol. Overweight children or those with high blood pressure, diabetes or other risk factors for heart disease should also be screened. An abnormal level warrants dietary modifications, but it is best to consult your doctor in individual cases.

Eating habits are established at a young age, and regardless of whether your child has a clean bill of health, you should set an example for a healthy future by serving low-fat meals to children over two years old. Remember, though, that children need some fat in their diets to help them grow.

How can I ensure an accurate cholesterol test?

It's usually better to get tested at your doctor's office rather than at a mass screening at a mall. To obtain a correct measurement of blood cholesterol, you need to fast for 12 hours prior to an HDL/LDL/triglyceride workup for a total profile.

How often should cholesterol be checked?

A high cholesterol level produces no warning symptoms, so it makes sense to test periodically. The American Heart Association recommends a lipid profile by age 20 or earlier in some cases. If your levels are acceptable, return to your doctor every five years for subsequent checks until age 45; after that, screenings should be scheduled every three years.

Before menopause, some degree of protection is afforded to most women, but they should still be tested. After menopause, all women should have their cholesterol measured every three to five years.

Can a cholesterol level ever be too low?

Usually, a low cholesterol level is a good health indicator. In other cases, it may point to a systemic disease that needs treatment. Ask your family physician to discuss your cholesterol measurement with you.

 

What is high blood pressure?

High blood pressure, also known as hypertension, is the most prevalent cardiovascular condition. Sixty million men and women have blood pressure that's too high, and up to one third of them are unaware of it. Doctors call hypertension “the silent killer” because it usually causes no physical symptoms and people feel perfectly fine, even when their blood pressure is elevated. But damage to their bodies is occurring nonetheless.

If there are no symptoms, how can I tell if I have high blood pressure?

You can't, only your doctor can. Checking your blood pressure regularly, at least once a year, is the only way to determine if you have this condition. Even if you have a healthy blood pressure reading now, you can't necessarily count on it staying low forever.

What's a normal blood pressure?

A blood pressure reading consists of two numbers. The first and upper number (systolic pressure) represents the pressure in your arteries as the heart contracts to pump blood through the circulatory system. The second and lower number (diastolic pressure) is the pressure in your arteries between beats, when the heart is resting. Either the systolic or diastolic measurement, or both, can be elevated when your blood pressure is too high. High readings mean your heart is working unnaturally hard to circulate blood.

For adults, a blood pressure reading less than 120/80 mmHg, read as “120 over 80,” is considered normal blood pressure. Both numbers must be in the normal range for your blood pressure to be considered normal. Stage 1 hypertension is defined as a pressure between 140 and 159 systolic or 90 and 99 diastolic. People with Stage 2 hypertension have a systolic reading of 160 or higher or a diastolic of 100 or higher.

A new category of pre-hypertension has been recognized with blood pressure between 120 and 139 systolic or 80 and 89 diastolic. These patients need to be followed closely. Therapeutic lifestyle changes (diet, exercise) are recommended prior to antihypertensive medication.

If your doctor tells you your blood pressure is a little high, don't panic and assume this permanently places you into the category of hypertensive. Your doctor may do several blood pressure checks over a few months and in a variety of circumstances to get a true reading. Your doctor may also ask you to measure your pressure at home as well. You and your doctor should begin treatment when measurements indicate that your blood pressure is consistently elevated; more severe elevations may require immediate treatment, though.

How serious is high blood pressure?

High blood pressure should not be taken lightly. It's a risk factor for deadly conditions such as coronary heart disease, heart attack, stroke and kidney disease. High blood pressure contributes to atherosclerosis, the build-up of sticky plaque on the artery walls, making it difficult for blood to flow freely. When arteries in the brain or heart become clogged, you can suffer a stroke or heart attack. Impaired vision occurs when tiny blood vessels in the back of the eye rupture or become blocked. Kidney impairment results when vessels in the kidneys are narrowed.

What causes high blood pressure?

It's rare to pinpoint a specific cause of high blood pressure. Doctors do know that hypertension runs in families, and that lack of exercise, stress, being overweight, smoking and drinking heavily contribute to and even worsen hypertension. African Americans have a higher rate of hypertension and tend to have more severe hypertension than whites, but it's not yet known why this occurs. It's suspected that genes and diet play some role, though. Certain medical problems, such as sleep apnea and chronic kidney disease, may cause blood pressure to rise, and some medicines can raise your blood pressure.

Does sodium cause high blood pressure?

Although salt restriction may reduce the blood pressure of some hypertensive people, sodium itself does not cause hypertension. However, most Americans consume way too much salt. Excess sodium can lead to fluid retention. More fluid in the body raises the total volume of blood flowing through your system; the higher the volume, the higher your blood pressure.

Cardiologists typically recommend low-sodium diets for those with hypertension or with a family history of the disease because, in many people, blood pressure falls significantly if salt intake is restricted. These people are "salt sensitive," meaning their blood pressure rises when they ingest large amounts of sodium, and drops when they reduce sodium intake.

How is high blood pressure treated?

In general, the best approach to prevent and control high blood pressure is one that involves small, easy lifestyle fixes. Exercising regularly, giving up cigarettes, reducing stress and limiting sodium and alcohol intake can bring blood pressure down to safer levels. In fact, for many people with hypertension, losing 10 or 20 pounds can lower their pressure to a more normal range. Making physical activity a regular part of your everyday life, along with a reduced-fat diet, can help you shed excess pounds. Studies show that the DASH diet, which is low in salt, fat and cholesterol and rich in low-fat or non-fat dairy products, fish, poultry, nuts, nutrients, protein and fiber, reduces blood pressure.

These lifestyle improvements are the first step to controlling high blood pressure, no matter your age or risk status. The exception is if your blood pressure is so alarmingly high that immediate antihypertensive medication is needed.

What medications are used to treat high blood pressure?

Adopting a healthier lifestyle is often the only measure many people with high blood pressure need to take to bring their reading down. Others, however, need to combine medication with a healthy lifestyle to make their pressure respond in a more favorable way. Diuretics rid the body of excess salt and water. This reduces the volume and, therefore, the pressure of your blood. Beta-blockers keep your heart from pumping too hard and too fast, thus reducing blood pressure.

Calcium blockers, alpha blockers, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) all relax blood vessels, lowering resistance and, therefore, blood pressure. Calcium channel blockers relax the muscles in the blood vessel walls, alpha blockers interfere with impulses from the brain and nerves that constrict vessels, and ACE inhibitors and ARBs block the action of an enzyme that causes arteries to narrow.

Are there any drawbacks to medications?

When trying to bring blood pressure down to normal levels with medication, some people complain of fatigue, depression and a general sense of "not feeling right." Since high blood pressure rarely has symptoms, the treatment sometimes seems worse than the disease, and some patients stop taking medication, which isn't a wise idea. Hypertension is a lifelong disease that requires lifelong treatment.

Yet, there's no reason to tolerate unpleasant side effects if you're on medication. There are many factors that figure into the choice of antihypertensive medication. With advances in drug therapy, sometimes all that's needed to get rid of undesirable complications is a minor reworking of the type of medication, the dosage, how frequently you take it or how it's delivered to your body.

What is the goal of treatment?

The treatment goal for most adults is to get and keep blood pressure below 140/90 mmHg. For adults who have diabetes or chronic kidney disease, the goal is to get and keep blood pressure below 130/80 mmHg.

Am I eligible for the liquid fast portion of the Comprehensive Weight Management Program?

The Jefferson Comprehensive Weight Management program is designed for people with a body mass index (BMI) of 30 or more, who have or are at risk of serious medical conditions. The Program also accepts people whose BMI is between 25 and 30 if they have health risks such as hypertension, diabetes, high cholesterol and sleep apnea. To determine whether you are eligible, please call us at 215-955-5732 or use our e-mail form.

How long will the liquid fast portion of the Comprehensive Program take?

The liquid fast and transition to food can take up to 24 weeks. However, maintenance lasts a lifetime. Maintenance sessions are available one to two times per week and many participants continue to attend them long after losing weight. Some also continue to use OPTIFAST® products after the fast period. Our Program is one the largest maintenance programs in the country because we emphasize maintenance.

I've tried every diet out there, losing weight each time, only to gain it back. What makes this Program any different than all the others?

Our Weight Management Program is unique from most others because it is medically as well as behaviorally oriented. After your informational session, you will schedule an appointment with our medical staff for a physical assessment. During this appointment, we take a complete medical history, which includes blood work and a review of current medical conditions and medications. We also give you the tools to become personally responsible for your weight management and offer ongoing education programs.

How often do I have to attend meetings?

During the initial phase of the Program, you will attend meetings once a week. Please consider your schedule before committing to the program. Attendance at these sessions is very important. If you are chronically unable to attend the sessions, we may ask you to discontinue until you have more free time. If you expect to miss a session, we ask that you contact us and arrange a make-up time.

As you transition out of the initial phase, you will attend six education sessions throughout the six-week transitional phase. Even if you have been extensively educated about food in the past, we find that most people learn new information and approaches to old topics. For that reason, attendance at all six sessions is mandatory.

Maintenance groups are offered one to two times per week. 

What are my options if I want to lose weight but don't want something as drastic as the Comprehensive Program?

We have two additional programs:

  • One-session weight loss class
  • Six-session weight loss class

Why should I exercise?

Exercise offers many health benefits to women. Aerobic exercises, such as brisk walking, swimming, jogging, and cycling, are beneficial because they give you energy and increase your cardiovascular (heart and lung) endurance. Weight-bearing exercises, such as walking or jogging, and resistive exercises, such as weight training, can help prevent the loss of bone mass (osteoporosis) common to older women. In general, exercise lessens many of the symptoms of premenstrual syndrome and menopause. Some medical studies have shown a link between regular exercise and reduced risk for certain women's cancers. And of course, any regular exercise routine will help you to lose weight or maintain your ideal weight, which makes you look better and feel better.

Can anyone begin an exercise program?

Anyone in good health can start an exercise program. Of course, if you are pregnant or under a doctor's care for any other reason, get your doctor's approval before starting any new physical activities. Likewise, see a doctor first if you have high blood pressure, smoke, are overweight or are over 40 years old and have never exercised before.

Why is exercise good for my heart? Why is that important?

Your heart is a muscle that pumps blood throughout your body. Regular aerobic activities strengthen your heart by making it work harder. At the same time, they increase your body's ability to use energy-giving oxygen. Since heart disease is the number one killer of women in this country, building cardiovascular endurance — that is, strengthening the heart, lungs, and circulatory system — should be a priority in every woman's fitness program. Aerobic exercises are the most efficient way to do this. Remember, though, that for effective conditioning, you must choose activities that elevate your heart rate and keep it elevated for a period of at least 20 minutes straight, three times a week. Stopping and starting in the middle of your exercise is not as effective. However, it's okay to start slowly and, as the days and weeks go by, progress up to at least 20 minutes. Also, every exercise session should include a proper warm-up and cool-down with stretching.

How can I tell if I'm working my heart hard enough?

In order to improve cardiovascular fitness, you must exercise hard enough to make your heart beat faster than it does at rest. How much harder will depend on your age and physical condition. To calculate this you can use this simple formula: 220 – age x 75% = your target heart rate. A general rule of thumb is, you should be able to talk, but not sing while performing your activity. If you can't talk, you're working too hard; if you can sing, you're not working hard enough.

How often should I exercise?

You should exercise at least three times a week. Aerobic exercises can be performed every day with no adverse effects. Resistive exercises, such as weight training or toning exercises, should be done every other day, to allow your muscles to recover. If you break your fitness pattern — especially if you stop exercising for more than six weeks — you will lose your conditioning benefits. You will need to begin building up your endurance all over again.

Do housework or childcare count as exercise?

Any activity is better than no activity. Certainly, heavy housework and chasing after children can increase your heart rate temporarily and give you some muscle tone. But these are no substitute for a regular fitness routine.

I've been exercising, but I'm still not losing weight.

A balanced, low-fat diet with the appropriate number of calories, combined with a sustained exercise program, is the best way to lose weight. If you exercise regularly without cutting calories or fat grams, you will lose weight more slowly. However, you should still notice a change in your body as your muscles become firmer.

As you progress in your exercise program, your body replaces fat cells with muscle, which weighs more. Thus, you may begin to look more slender even before a change shows up on the scale. As you continue to exercise, you will lose weight.

Will exercise affect my menstrual cycle?

A vigorous exercise routine can affect a woman's menstrual cycle. With excessive, intense exercise, you may find that you have less frequent menstrual periods, or you may not menstruate at all. Of course, these changes can be due to factors other than exercise. If you stop menstruating, consult your doctor to find the cause.

Other menstrual irregularities, such as bleeding or spotting between periods, and bleeding and pain after sexual intercourse, are not related to exercise. If you experience changes in your menstrual cycle, see your doctor.

I'm pregnant. Can I still exercise?

Exercising during pregnancy can help keep you both fit and comfortable as your pregnancy progresses. It will also help you get back into shape more quickly after your baby is born. Consult with your doctor about specific exercises you wish to do — your fitness level before you got pregnant and your condition during pregnancy will determine what exercise routine is acceptable for you.

You will find that the extra weight you are carrying will make you work harder as you exercise. Other changes that occur during pregnancy, such as a shift in the body's center of gravity, and the increased laxity of joint ligaments, will affect what one can do. Let your body guide you, and don't push yourself. Some healthcare institutions and fitness facilities offer special exercise classes for pregnant women.

Walking is an excellent exercise during pregnancy, particularly for women who did not exercise regularly before becoming pregnant.

OK, I'm sold. How do I begin?

Getting started is the hardest part of getting fit. Here are some tips to help get you on your way:

  • Plan time for exercise as you would a business meeting or other important engagement. Write it down in your calendar or appointment book.
  • Find a buddy to exercise with, someone who will keep tabs on you. The peer pressure might be just what you need to stay motivated.
  • Tell yourself you're only going to exercise for five minutes. Chances are, once you get started, you'll do more.
  • The number-one reason for quitting is lack of time. Choose a spot to exercise that's convenient to home or work.
  • Pick an activity that's fun for you.
  • Vary your routine.

Have a backup routine for emergencies. For instance, if you normally walk outside and it's raining, walk in a mall instead. Or exercise to videotapes.

Remember that part of being fit includes weight control, proper nutrition, stress reduction and healthy lifestyle choices. Becoming fit means saying "no" to unhealthy habits such as smoking, alcohol and drug misuse. A fit lifestyle can increase the number and quality of the years ahead of you.

For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.