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Obesity surgery can lower blood sugars better than drugs -- worth the risk?

By Lindsay Tanner, The Associated Press

Obesity surgery worked much better at reducing and even reversing diabetesthan medication and lifestyle changes in one of the most rigorous studies of its kind. But the researchers and others warn that possible serious complications need to be considered.

The yearlong study indicates that the most common weight-loss surgery, gastric bypass, can effectively treatdiabetes in patients with mild to moderate obesity — about 50 to 70 pounds overweight, the researchers reported Tuesday in the Journal of the American Medical Association.

Other studies have shown the operation can reverse diabetes in severely obese patients, although sometimes the disease comes back.

About a third of the 60 adults who got bypass surgery in the new study developed serious problems within a year of the operation, though some cases were not clearly linked with the surgery. That rate is similar to what's been seen in previous studies.

But for the most serious complications — infections, intestinal blockages and bleeding — the rate was 6 percent, slightly higher than in earlier research.

The most dangerous complication occurred in one patient when stomach contents leaked from the surgery site, leading to an overwhelming infection, leg amputation and brain injury. Lead author Dr. Sayeed Ikramuddin, an obesity surgeon at the University of Minnesota, called that case "a fluke."

A journal editorial says such devastating complications are rare, but that "the frequency and severity of complications ... is problematic" in the study and that the best way to treat patients with both obesity and diabetes "remains unknown."

A research review in the journal said more long-term evidence on risks and benefits is needed to determine if obesity surgery is an appropriate way to treat diabetes in patients who aren't severely obese — at least 100 pounds overweight.

More than 20 million Americans have Type 2 diabetes; most are overweight or obese. Diabetics face increased risks for heart disease and strokes, and poorly controlled diabetes can damage the kidneys, eyes and blood vessels.

About 160,000 people nationwide undergo various types of obesity surgery each year. Bypass surgery, the type studied, involves stapling the stomach to create a small pouch and attaching it to a lower part of the intestines.

The American Society for Metabolic & Bariatric Surgery says obesity surgery is safe and that the death rate is less than 1 percent, lower than for gallbladder and hip replacement surgery.

The study involved 120 patients at five hospitals in New York, Minnesota and Taiwan. All patients got medicines fordiabetes, obesity, cholesterol and/or high blood pressure. They all were advised to cut calories and increase physical activity.

Sixty patients also had surgery, and the two groups were compared after one year.

The surgery group lost on average nearly 60 pounds and 75 percent lowered blood sugar levels to normal or near normal levels. The non-surgery group lost an average 17 pounds and just 30 percent reached the blood-sugar goal. The surgery group also needed less medication after the operation.

The researchers say the diabeteschanges were likely due to the weight loss but that hormonal changes affecting blood sugar may have contributed.

The surgery group showed a trend toward having less high blood pressure and elevated cholesterol — both major risk factors for heart disease, although those between-group differences could have been due to chance.

Ikramuddin, the lead author, said the study results don't mean that all mildly obese diabetics should have obesity surgery, but that "in the correct patient, surgery might be an important thing to consider."

Randy Jackson's Journey with Diabetes

Join our Beyond Type 2 Program and "Own Your Blood Sugars!"

http://diabetesawarenesssite.com/randy-jacksons-journey-with-diabetes/?utm_source=social&utm_medium=dbsaware&utm_campaign=randy-jacksons-journey-with-diabetes&utm_term=20131104

Schools institute stricter policies on food allergies

Schools institute stricter policies on food allergies

November 1, 2013, AT 7:29 am

By Today Show

Schools across the country have accepted stricter policies on handling food allergies, from training in allergy injector pens to providing non-food incentives. The CDC has posted the full advisory on their website.

Tom Hanks reveals he has type 2 diabetes on 'Late Show'

Tom Hanks reveals he has type 2 diabetes on 'Late Show'

October 8, 2013, AT 6:03 am

By Randee Dawn, TODAY contributor

Tom Hanks on "The Late Show with David Letterman."

When Tom Hanks sat down with David Letterman on Monday's "Late Show," he surprised everyone by making a startling health announcement. He's been diagnosed with type 2 diabetes. 

"I went to the doctor, and he said, 'You know those high blood sugar numbers you've been dealing with since you were 36? Well, you've graduated! You've got type 2 diabetes, young man,'" Hanks told Letterman (click through to the video of last night's show, and start at approximately the 15-minute mark).

"It's controllable," Hanks added quickly. "Something's going to kill us all, Dave."

Letterman said he too suffers from high blood sugar but controls it with diet.

Type 2 diabetes is the most common ofdiabetes, which occurs when the body does not properly metabolize insulin,according to the American DiabetesAssociation.

There was some good news, said Hanks, who was actually on the show to promote his new film "Captain Phillips." The doctor told him if he could maintain his high school weight he could get rid of the diabetes. Hanks said he told the doctor, "Well, I'm going to have type 2diabetes. Because there is no way I can weigh as much as I did in high school.'"

What was his high school weight?

"I weighed 96 pounds," said Hanks. "Most of that was that big white Afro that I wore back in the '70s."'

October 8, 2013, AT 6:03 am

By Randee Dawn, TODAY contributor

Tom Hanks on "The Late Show with David Letterman."

When Tom Hanks sat down with David Letterman on Monday's "Late Show," he surprised everyone by making a startling health announcement. He's been diagnosed with type 2 diabetes. 

"I went to the doctor, and he said, 'You know those high blood sugar numbers you've been dealing with since you were 36? Well, you've graduated! You've got type 2 diabetes, young man,'" Hanks told Letterman (click through to the video of last night's show, and start at approximately the 15-minute mark).

"It's controllable," Hanks added quickly. "Something's going to kill us all, Dave."

Letterman said he too suffers from high blood sugar but controls it with diet.

Type 2 diabetes is the most common ofdiabetes, which occurs when the body does not properly metabolize insulin,according to the American DiabetesAssociation.

There was some good news, said Hanks, who was actually on the show to promote his new film "Captain Phillips." The doctor told him if he could maintain his high school weight he could get rid of the diabetes. Hanks said he told the doctor, "Well, I'm going to have type 2diabetes. Because there is no way I can weigh as much as I did in high school.'"

What was his high school weight?

"I weighed 96 pounds," said Hanks. "Most of that was that big white Afro that I wore back in the '70s."

The ADA Announces Exciting New Diabetes Insurance Changes!

The Affordable Care Act is bringing additional major health insurance changes for people with diabetes over the next few months, including—finally—the end of discrimination against people with diabetes in the health insurance market. No longer can an insurance company stamp “NO” on an application, simply because you or a family member has diabetes.

While these changes will benefit people with diabetes all over the country, we are aware that there is some confusion about how they will benefit you, your friends and your family.

That is why, at the American Diabetes Association, we are bringing you information about the Affordable Care Act to help you get insurance that best meets the needs of you and your family.

There are two important dates to keep in mind:

• On October 1, 2013, people can start signing up for health insurance through their state Marketplace. Coverage purchased in the Marketplace will go into effect as early as January 1, 2014. 
• January 1, 2014 brings a host of other changes including ending discrimination based on diabetes, ending lifetime dollar limits on benefits, and providing financial help to pay for insurance.

We have two new documents to help you understand both Marketplaces and the upcoming changes in health insurance rules related to diabetes. These documents are also available in Spanish.

In the Association’s new Q&A, “The Health Insurance Marketplace and People with Diabetes”, you will find a list of frequently asked questions about the new Health Insurance Marketplace opening in your state on October 1st. If you or anyone you know is uninsured or shopping for new coverage—or simply wants to explore other insurance options—this document will help you learn more about Marketplaces. The American Diabetes Association does not recommend specific health plans, but we want to provide you with an understanding of the new Marketplaces and link you to available resources for assistance. Click HEREto read the Q&A.

The American Diabetes Association’s new “Health Insurance Update: Protections for People with Diabetes” provides information on changes to health insurance rules which impact people with diabetes, including changes that are already in effect and some starting on the first day of the new year. We want to help you understand these changes and how they can benefit you, your friends and family. Click HERE to read the update.

Making sure that people living with, and at risk for, diabetes can access the care they need for optimal health is at the core of the American Diabetes Association’s mission. The new Marketplaces, coupled with the new health insurance rules, will help people with diabetes get the care and treatment they need. Please help spread the word about these changes by forwarding this email to friends and family affected by diabetes.

We appreciate your support and everything you do to Stop Diabetes^®.

Sincerely,

Karen D. Talmadge, PhD Chair of the Board, American Diabetes Association

 

P.S. Those who are seeking assistance in choosing a health insurance plan, or who want to learn more about the Marketplaces, can also visit www.healthcare.gov, or call 1-800-318-2596.

Ramey Nutrition and Dr. Summe: Nutrition in Medicine

Ramey Nutrition Dr. Summe: Nutrition in Medicine Continued

For More Information

Going Beyond the Diabetes Medical Standard Brings Ramey NutritionPatients Beyond Their Diabetes!

Diabetes Treatment with Medical Nutrition Therapy

One of the most dangerous epidemics of our time is the logarithmic rise of Diabetes Mellitus. From insulin restriction, for weight loss, in diabulimia, to the rise of Type 2 Diabetes, now tripling in children, we have dedicated ourselves and our company to action in its purest and most effective form. We have developed a purpose-driven attack against Diabetes, depleting our community’s quality of life. Ramey Nutrition represents a rebellious transcendence from what Diabetes represents, including diet restrictions, carbohydrate counting, and a reduced life span. Our expectations include a high quality of life that identifies your goals, talents and passions as who you are, instead of the word “diabetic.”

Our Individual Consultations individualized sessions designed specifically for you; focused on issues that pertain to your current diabetes challenges, including stressors, your current lifestyle, and how diabetes presents itself.
Our Beyond Type 2 Diabetes Program lowers blood sugars and overall A1C by connecting people with Type 2 Diabetes to “Own their blood sugars.” –Beyond Type 2 Veteran. Providing support groups, yoga, and beginning level fitness we help utilize the information you have to go Beyond Type 2.
Our Individual Movement Therapy sessions are private appointments, specifically designed for your strength, fitness, movement and health goals.
Our Steele Fitness provides 2 levels of continuing, motivational, diabetes-specific fitness, for those wanting to attain and maintain non-diabetic A1C’s, with an out-of-gym experience including no mirrors, pressure, or machines.
Our Gentle ResotrativeYoga provides diabetes-specific yoga for all skill levels to encourage lowered blood sugars by reducing lifestyle stress.

4 Signs of Stress You Don’t Want to Ignore By William Cruit

Are you aware of how easily life’s challenges can have a negative effect on your entire well-being? You’ve surely had an experience or two where rough times have come upon you, and at the end of the road you feel like you’ve conquered the situation.

However, even though you were successful at handling the situation, there may be some very real side-effects which you overlook as “things that happen” in life. Some of those very things may be signs of stress which, if left unattended, can lead to further challenges down the road.

Ask yourself if the following behaviors or states of mind have been prevalent at any stage of your life. If you’re able to identify with them, chances are that unrecognized stress is manifesting and it’s important to eliminate it right away. Stress reduction methods like exercise and meditation can bring immense relief and restore your well-being.

How to Identify Physical and Mental Signs of Stress
1. Change in sleep habits. Nobody knows your body better than you do. You know how much sleep you usually get on a good night, and if you find yourself sleeping either significantly more or less than normal, chances are you’re undergoing stress. A change in sleep habits is a sure sign that something is keeping you in an unsettled state.

* Try to engage in relaxing activities at the end of each day that can help put you in the frame of mind for rest. Meditation, a soothing bath, and even laughter are good ideas.

* If your sleep issues persist, see your doctor for further guidance.

2. Frequent mood swings. Take a moment to think back over the last few days and how you handled each situation that confronted you. Did you handle everything in your usual calm, controlled, effective manner? If not, you may be dealing with stress issues.

* Frequent mood swings, especially if your mood has swung from frustration, anger and irritability to defensiveness, impatience and overreaction, are a clear indication that stress abides within you.

* Other moods and states of mind to look out for include:

Feeling depressed
Helplessness with things you can normally accomplish on your own
Irrationality in dealing with decision-making
Restlessness and anxiety
3. Nervous behavior. When you start to show physical signs of nervous behavior, it’s likely a sign that something is secretly stressing you out. Here are some signs of nervous behavior which you may need to address in a way that identifies the cause.

* Twitching

* Fiddling

* Excessive talkativeness

* Teeth grinding

* Nail biting

* Pacing

4. Indecisiveness and confusion. If you’re usually able to think things through with a clear head and now you can’t, it’s likely that you’re struggling with stress.

* Stress results in feeling out of control and overwhelmed, even with things that you can normally handle with confidence.

Ill health isn’t always about feeling aches and pains. The domino effect of stress can result in serious health challenges. For your own benefit, it’s important to pay attention to yourself and ensure you do whatever’s necessary to reduce your stress.

Vitamin D

What is vitamin D and what does it do?

Additional Resources

• Health Professional
• Datos en español
• Other Resources
• See also: Calcium

Vitamin D is a nutrient found in some foods that is needed for health and to maintain strong bones. It does so by helping the body absorb calcium (one of bone's main building blocks) from food and supplements. People who get too little vitamin D may develop soft, thin, and brittle bones, a condition known as rickets in children and osteomalacia in adults.
Vitamin D is important to the body in many other ways as well. Muscles need it to move, for example, nerves need it to carry messages between the brain and every body part, and the immune system needs vitamin D to fight off invading bacteria and viruses. Together with calcium, vitamin D also helps protect older adults from osteoporosis. Vitamin D is found in cells throughout the body.

How much vitamin D do I need?

The amount of vitamin D you need each day depends on your age. Average daily recommended amounts from the Food and Nutrition Board (a national group of experts) for different ages are listed below in International Units (IU):

Life Stage	Recommended Amount
Birth to 12 months	400 IU
Children 1–13 years	600 IU
Teens 14–18 years	600 IU
Adults 19–70 years	600 IU
Adults 71 years and older	800 IU
Pregnant and breastfeeding women	600 IU

What foods provide vitamin D?

Very few foods naturally have vitamin D. Fortified foods provide most of the vitamin D in American diets.

• Fatty fish such as salmon, tuna, and mackerel are among the best sources.
• Beef liver, cheese, and egg yolks provide small amounts.
• Mushrooms provide some vitamin D. In some mushrooms that are newly available in stores, the vitamin D content is being boosted by exposing these mushrooms to ultraviolet light.
• Almost all of the U.S. milk supply is fortified with 400 IU of vitamin D per quart. But foods made from milk, like cheese and ice cream, are usually not fortified.
• Vitamin D is added to many breakfast cereals and to some brands of orange juice, yogurt, margarine, and soy beverages; check the labels.

Can I get vitamin D from the sun?

The body makes vitamin D when skin is directly exposed to the sun, and most people meet at least some of their vitamin D needs this way. Skin exposed to sunshine indoors through a window will not produce vitamin D. Cloudy days, shade, and having dark-colored skin also cut down on the amount of vitamin D the skin makes.
However, despite the importance of the sun to vitamin D synthesis, it is prudent to limit exposure of skin to sunlight in order to lower the risk for skin cancer. When out in the sun for more than a few minutes, wear protective clothing and apply sunscreen with an SPF (sun protection factor) of 8 or more. Tanning beds also cause the skin to make vitamin D, but pose similar risks for skin cancer.
People who avoid the sun or who cover their bodies with sunscreen or clothing should include good sources of vitamin D in their diets or take a supplement. Recommended intakes of vitamin D are set on the assumption of little sun exposure.

What kinds of vitamin D dietary supplements are available?

Vitamin D is found in supplements (and fortified foods) in two different forms: D₂ (ergocalciferol) and D₃ (cholecalciferol). Both increase vitamin D in the blood.

Am I getting enough vitamin D?

Because vitamin D can come from sun, food, and supplements, the best measure of one's vitamin D status is blood levels of a form known as 25-hydroxyvitamin D. Levels are described in either nanomoles per liter (nmol/L) or nanograms per milliliter (ng/mL), where 1 nmol/L = 0.4 ng/mL.
In general, levels below 30 nmol/L (12 ng/mL) are too low for bone or overall health, and levels above 125 nmol/L (50 ng/mL) are probably too high. Levels of 50 nmol/L or above (20 ng/mL or above) are sufficient for most people.
By these measures, some Americans are vitamin D deficient and almost no one has levels that are too high. In general, young people have higher blood levels of 25-hydroxyvitamin D than older people and males have higher levels than females. By race, non-Hispanic blacks tend to have the lowest levels and non-Hispanic whites the highest. The majority of Americans have blood levels lower than 75 nmol/L (30 ng/mL).
Certain other groups may not get enough vitamin D:

• Breastfed infants, since human milk is a poor source of the nutrient. Breastfed infants should be given a supplement of 400 IU of vitamin D each day.
• Older adults, since their skin doesn't make vitamin D when exposed to sunlight as efficiently as when they were young, and their kidneys are less able to convert vitamin D to its active form.
• People with dark skin, because their skin has less ability to produce vitamin D from the sun.
• People with disorders such as Crohn's disease or celiac disease who don't handle fat properly, because vitamin D needs fat to be absorbed.
• Obese people, because their body fat binds to some vitamin D and prevents it from getting into the blood.

What happens if I don't get enough vitamin D?

People can become deficient in vitamin D because they don't consume enough or absorb enough from food, their exposure to sunlight is limited, or their kidneys cannot convert vitamin D to its active form in the body. In children, vitamin D deficiency causes rickets, where the bones become soft and bend. It's a rare disease but still occurs, especially among African American infants and children. In adults, vitamin D deficiency leads to osteomalacia, causing bone pain and muscle weakness.

What are some effects of vitamin D on health?

Vitamin D is being studied for its possible connections to several diseases and medical problems, including diabetes, hypertension, and autoimmune conditions such as multiple sclerosis. Two of them discussed below are bone disorders and some types of cancer.
Bone disorders
As they get older, millions of people (mostly women, but men too) develop, or are at risk of, osteoporosis, where bones become fragile and may fracture if one falls. It is one consequence of not getting enough calcium and vitamin D over the long term. Supplements of both vitamin D₃ (at 700–800 IU/day) and calcium (500–1,200 mg/day) have been shown to reduce the risk of bone loss and fractures in elderly people aged 62–85 years. Men and women should talk with their health care providers about their needs for vitamin D (and calcium) as part of an overall plan to prevent or treat osteoporosis.
Cancer
Some studies suggest that vitamin D may protect against colon cancer and perhaps even cancers of the prostate and breast. But higher levels of vitamin D in the blood have also been linked to higher rates of pancreatic cancer. At this time, it's too early to say whether low vitamin D status increases cancer risk and whether higher levels protect or even increase risk in some people.

Can vitamin D be harmful?

Yes, when amounts in the blood become too high. Signs of toxicity include nausea, vomiting, poor appetite, constipation, weakness, and weight loss. And by raising blood levels of calcium, too much vitamin D can cause confusion, disorientation, and problems with heart rhythm. Excess vitamin D can also damage the kidneys.
The safe upper limit for vitamin D is 1,000 to 1,500 IU/day for infants, 2,500 to 3,000 IU/day for children 1-8 years, and 4,000 IU/day for children 9 years and older, adults, and pregnant and lactating teens and women. Vitamin D toxicity almost always occurs from overuse of supplements. Excessive sun exposure doesn't cause vitamin D poisoning because the body limits the amount of this vitamin it produces.

Are there any interactions with vitamin D that I should know about?

Like most dietary supplements, vitamin D may interact or interfere with other medicines or supplements you might be taking. Here are several examples:

• Prednisone and other corticosteroid medicines to reduce inflammation impair how the body handles vitamin D, which leads to lower calcium absorption and loss of bone over time.
• Both the weight-loss drug orlistat (brand names Xenical® and Alli®) and the cholesterol-lowering drug cholestyramine (brand names Questran®, LoCholest®, and Prevalite®) can reduce the absorption of vitamin D and other fat-soluble vitamins (A, E, and K).
• Both phenobarbital and phenytoin (brand name Dilantin®), used to prevent and control epileptic seizures, increase the breakdown of vitamin D and reduce calcium absorption.

Tell your doctor, pharmacist, and other health care providers about any dietary supplements and medicines you take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines, or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients.

Where can I find out more about vitamin D?

• For general information on vitamin D:
  • Office of Dietary Supplements Health Professional Fact Sheet on Vitamin D
  • Vitamins, MedLinePlus®
• For more information on food sources of vitamin D:
  • U.S. Department of Agriculture (USDA) National Nutrient Database Web site
  • Vitamin D Content of Selected Foods, USDA
• For more advice on buying dietary supplements:
  • Office of Dietary Supplements Frequently Asked Questions: Which brand(s) of dietary supplements should I purchase?
• For information on the government's food guidance system:
  • MyPlate
  • Dietary Guidelines for Americans

Disclaimer

This fact sheet by the Office of Dietary Supplements provides information that should not take the place of medical advice. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific brand name is not an endorsement of the product.

Table of Contents

• What is vitamin D and what does it do?
• How much vitamin D do I need?
• What foods provide vitamin D?
• Can I get vitamin D from the sun?
• What kinds of vitamin D dietary supplements are available?
• Am I getting enough vitamin D?
• What happens if I don't get enough vitamin D?
• What are some effects of vitamin D on health?
• Can vitamin D be harmful?
• Are there any interactions with vitamin D that I should know about?
• Where can I find out more about vitamin D?
• Disclaimer

Reviewed: June 24, 2011

The Flaw in Weight Loss Advertising by PUGET SOUND BARIATRICS on FEBRUARY 7, 2013

Are you a better person when you are skinny? Of course not. That’s the flaw in weight loss advertising. In order to encourage people to make a change in their life companies must attract their customers to becoming a skinnier version of themselves. When excessive praise is placed on being thin a disproportionate amount of criticism is dumped upon being overweight.



For example, the self-labeled “diet” food Special K has launched a new campaign called “What Will You Gain When You Lose?” Obviously they want to encourage people to be happy rather than living life chained to a number, but the message really gets confused when you view their image gallery of mostly paid participants as they describe what skinny people are privileged to experience.



Can someone who isn’t skinny experience peace, delight, pep, pride, sex appeal, or contentment about who they are? Of course they can, but that’s the problem with Kellogg’s advertising message or any weight loss pitch. Lose the weight and you’ve earned the right to feel happy about who you are…

Rather than piling praise upon being thin it would be more appropriate to focus on the benefits of weight loss like curing diabetes, reducing the risk of chronic diseases, and even longer life. Losing weight just so you can have “pizzaz” is a shallow reason to start a diet. Do it for your own health and do it for the ones you love.

Obesity is a lifestyle problem, not a reflection of who you are. Don’t let advertisers tell you what you can and can not experience based on how you look or what you weigh.

Steele Fitness Expansion

Job Details

Fitness trainers have a number of job responsibilities. They should be well-educated in the areas of human anatomy and physiology. Trainers perform physical assessments on new clients and decide on specific goals that the client should accomplish over the course of the training period. Trainers design and direct workout programs that are tailored to the patients' needs and goals, teach and demonstrate the use of gym equipment, observe patients exercise, and correct any improper techniques, maintain equipment, and administer first-aid if necessary.

Skill Requirements

Fitness trainers should be self-motivated, energetic, organized and responsible. They should be good communicators and attentive to their clients' needs, being willing and able to adjust workout programs at the last minute. They should be apt at coordinating schedules and managing time wisely and effectively. Being able to utilize and implement new technology, equipment and techniques is also an essential aspect of the fitness trainer.

Job Environment

Located in Seattle’s University District and Shoreline on Ballinger Way, Ramey Nutrition is a nutrition clinic offering individual and group nutrition counseling, support groups, yoga, and group and individual fitness. We take a patient-centered approach by listening to patient needs, providing nutritional and emotional support and individualizing treatment for our patients.
While our current patient services primarily consist of Eating Disorders treatment and recovery, Diabetes management and weight-management, it is our desire to build a strong team who can assist any patient with any nutrition/fitness-related issue. Desired areas of growth include: fitness for weight management, blood sugar control, increased body strength, stress management through movement, flexibility, and an accommodation for a variety of fitness levels and abilities

Minimum Qualifications
• Bachelors or Masters degree

• Certified Personal Trainer and CPR-certified within first month of employment
• One (1) year experience working in a fitness related field
• Ability to work well independently with little supervision, and strong motivational expertice with resistance to movement
• Ability to listen and communicate effectively
• Strong counseling, teaching, and leadership skills
Desired Qualifications • Familiar with and interested in the psychological impact of movement and fitness
• Ability to organize, prioritize work, and handle multiple tasks
• Experience in and comfortable with leading groups

Schedule

Trainers should have flexible schedules in order to meet the varying schedules of our providers. Scheduling may vary depending on the Ramey Nutrition Location, and patient need. Some appointments with patients may last as short as 15 minutes up to two or more hours, depending on patient need, however this is all done under the guidance and direction of the Diabetes/Weight Management Director.

*If interested in position, please send resume, cover letter and completed answers to questions to Bonnie Atkisson Bonnie@rameynutrition.com

Steele Fitness!

Tonight @5:45pm come experience Steele Fitness for only $10/drop in!
http://rameynutrition.com/steele-fitness#