Catholic Medical Center &
Androscoggin Valley Hospital
Surgical Weight Loss Options For a Healthier Tomorrow
Presentation Overview
Obesity Health Related Risks Who Qualifies for Weight Loss Surgery? Gastric-bypass Surgery Adjustable Gastric Banding Sleeve Gastrectomy Pre-operative Requirements Post-operative Diet Next Steps
Obesity in the US
68% of adults in US are overweight or obese One in 50 people are classified as having extreme obesity
BMI
Body mass index (BMI) > to 40 BMI of 35-39 for individuals with one or more serious co-morbidities (diabetes, sleep apnea, heart disease)
Sizing Up Your Level of Body Fat
Using the Body Mass Index (BMI)
Causes of Obesity
Body weight is the result of:
Genes Metabolism Culture Socioeconomic Status Behavior ***** Environment ***** Energy imbalance: More calories consumed than expended
Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome
Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis
Coronary heart disease Diabetes Dyslipidemia Hypertension
Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome
Osteoarthritis
Skin
Gall bladder disease
Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate
Phlebitis venous stasis
Gout
Medical Complications of Obesity Idiopathic intracranial hypertension
Stroke Cataracts
Severe pancreatitis
Weight-Related Medical Conditions
Heart disease Diabetes/glucose intolerance High blood pressure Sleep apnea Pulmonary disease Degenerative joint disease Stroke
Chronic back pain Endocrine disturbances GERD (reflux) Liver disease, gallstones Certain cancers Reproductive/menstrual problems
Risks to Your Psychological and Social Well-Being
Negative self-image
Social isolation
Discrimination
Low self esteem
Depression
Treating Obesity
Diet and exercise Weight-loss programs Appetite suppressants Hypnosis, jaw-wiring, counseling
Qualifications for Weight Loss Surgery
BMI > 40 or BMI 35 - 39 with other co- morbidities Prior weight loss attempts Long history of obesity PCP support Payer source Physically and psychologically able to withstand rigors of surgery and aftermath Ability to keep appointments pre and post operatively
Weight Loss Surgeries at CMC
Gastric Bypass Sleeve Gastrectomy Adjustable Gastric Banding
Benefits of Minimally Invasive/Robotic Assist
Smaller incisions Less pain Quicker recovery Better wound healing Decreased risk of hernia
Minimally Invasive/Robotic Surgery
5-6 small incisions used to work within the
abdomen
BYPASS
SLEEVE
BAND
Gastric Bypass
Sleeve Gastrectomy
Adjustable Gastric Banding
Excess Weight Loss
5 years • BYPASS 60% • SLEEVE 60% • BAND 50%
10 years 70% TBD 60%
BYPASS SLEEVE BAND
EWL +++ ++ ++
RISK RE-OP + + ++
DM RESOLUTION +++ ++ +
HIGH BP RESOLUTION
+++ ++ +
SLEEP APNEA RESOLUTION
+++ ++ +
COMPLICATIONS + + +
MORTALITY 0.1% 0.1% 0.01%
Procedure Comparison
Procedure Comparison
BYPASS SLEEVE BAND
Hospital stay 2 days 2 days O days
Return to work 2 weeks 2 weeks < 1 week
Which procedure is BEST? It depends… • Specific medical problems
– Looking to improve – Prohibitive to a certain procedure
• Personal habits • Commitment to follow-up • Reversibility • Foreign body placement
Effects of Bariatric Surgery
BYPASS
SLEEVE
BAND
Bariatric Surgery Reduces 5 YEAR MORTALITY RATES
SURGERY
0.68%
NO SURGERY
6.17%
Original Article Perioperative Safety in the Longitudinal
Assessment of Bariatric Surgery
The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium
N Engl J Med Volume 361(5):445-454
July 30, 2009
Surgical Weight Loss Options Team Members
Internal Medicine Physician Surgeons Dietitians Physician Assistants Nurse Practitioners Program Director Behavioral Health Specialists Exercise Physiologists
Bariatric Surgery Pre-operative Requirements
(~6months)
Information Session Complete History and Physical-Mid Level Provider EKG, Labs Other- (Stress Tests, Sleep Study, Pulmonary, Diabetes Resource) Nutritional Evaluation and Counseling ---- Loss of 8% body weight Medicaid: Loss of 15% body weight MD Appointment / Assessment and Counseling
Weight Loss Surgery Pre-operative Requirements
No smoking--smoke free at least 6 months prior to surgery (nicotine testing) Behavioral health---6 week ‘Lifestyle Change’ group Cost: $160 Individual psychological evaluation Exercise component / Plan Cost: $30 2 Pre-operative support groups Full understanding of risks, benefits and implications of the surgery
When checklist complete…
Consult with the surgeon OR ~3-4 weeks after meeting with surgeon Pre-operative nutrition teaching (2 week very low calorie diet, Post-operative teaching) Weight loss monitored and must be maintained or surgery may be cancelled Pre-op testing at CMC- ~week before surgery
What About Food??? (5 Phases)
Phase 1: Clear liquids Phase 2: Full liquids and protein shakes Phase 3: Pureed Phase 4: Ground Phase 5: Regular Fluids Vitamins Diet : Advanced by OTC staff only
NEXT STEPS
Submit to The Obesity Treatment Center:
PCP Referral Demographic Form Medical / Psychological Questionnaire (15 pages) Copy of your last History and Physical
****Other: medical/surgical records
Questions??????