SUMMA HEALTH SYSTEM

BARIATRIC CARE CENTER

Laura Ilg RD, LD

Adrian Dan MD, FACS

GOALS

The Many Benefits of Bariatric surgery and

Weight Reduction

Bariatric Care Center

Surgical Weight Loss Program

Medical Weight Loss Program

Behavioral Weight Loss Program

The Role of the Dietitian in the BCC

Discuss the 3 types of surgery we perform

Laparoscopic Roux-en-y Gastric Bypass

Laparoscopic Sleeve Gastrectomy

Laparoscopic Adjustable Gastric Band

OBESITY IS A BIG PROBLEM

A major health problem worldwide

Affects 25% of the industrialized world

American Statistics

65% of adults are overweight (BMI >25)

31% of adults are obese (BMI >30)

16% of adolescents are overweight

9% (15.6 million people) are morbidly obese

(BMI >35)

Medical expenditures of $117 billion in 2000

400,000 obesity related deaths annually

National Institute of Diabetes and Digestive Disease (www.niddk.nih.gov)

WE CAN HELP!

As medical professionals we can help to change

all of this

Weight loss and improvements in health can be

accomplished in many non-surgical ways.

Statistics show that diet and exercise only works

for 1 in 20 (5%) of people who are morbidly obese

Surgery is one of the best ways to obtain

consistent, permanent weight loss for obese

individuals

The benefits of surgery outweigh the risks of staying

morbidly obese

BARIATRIC SURGERY

Bariatric is a Greek word

Baros- (weight)

-iatrike (medicine)

Bariatrics is a field of medicine encompassing the

study of being overweight, it’s causes, prevention

and treatment

MEDICAL CO-MORBIDITIES RELATED TO

OBESITY

Diabetes

Hypertension

Hyperlipidemia

Cardiovascular issues

Respiratory issues

Sleep apnea

Arthritis

Depression

Menstrual irregularity

Stress incontinence

RESOLVED!

Following bariatric surgery these medical

conditions can be resolved…

Type 2 diabetes 95%

Hypertension 92%

Cardiac function 95%

Sleep apnea 75%

Osteoarthritis 82%

GERD 98%

Stress incontinence 87%

Hyperlipidemia, depression and menstrual irregularity

can all be improved greatly

OTHER BENEFITS

There are other physical, economic and social co-morbidities that can be resolved

Many people take these things for granted

Being able to wear the type of clothing you want

Tying your shoelaces

Crossing your legs

Sitting comfortably in a restaurant, theater, bus, airplane, waiting areas, toilets, etc.

Being hired/ promoted without discrimination

Walking without difficulty

Riding a bike

Playing with children/ grandchildren

HUGS!

SOCIAL BIASES

Considered “different”

People stare

Lazy

Dirty

Unattractive

Lack will power

*Studies show that society has low respect for

obese individuals. The same as they would for

alcoholics and drug addicts.

What these do all have in common is that

they are all a DISEASE!

A DAILY INSPIRATION

Obviously bariatric surgery and medical weight

loss can help to prevent and cure disease and

change lives

It’s a challenging and extremely rewarding field

to work in

Our patients become “family”

It’s an honor to be a part of their journey

SURGICAL WEIGHT LOSS PROGRAM

Bariatric Care Center has been helping patients lose weight since 2004

Our Team:

Bariatric Program Director

3 Surgeons Certified in Bariatric and General Surgery

1 General Physician certified in weight loss management

1 Certified Nurse Practitioner

2 RN Case Managers

1 Registered Dietitian

1 Exercise Physiologist

1 Psychologist

Many office staff including: LPNs, MAs, MOAs, financial and billing specialists, etc.

WHO ARE OUR PATIENTS

2011 Demographics

238 NEW surgical patients

185 female patients (78%)

53 male patients (22%)

Average age: 48 years old

Average BMI: 48.4

WHO ARE OUR PATIENTS

These patients are coming to us after years of yo-yo dieting

Some have struggled since they were very young children

Weight has been affected by genetics, eating disorders, food addiction, emotional eating, poor habits, busy schedules, lack of nutrition knowledge, medications and disease to name a few.

Some people feel surgery is the “Easy way out” or it’s “too extreme”

Not at all easy

Life changing

GETTING STARTED

Patients must meet certain medical criteria to be considered for surgery BMI of >35 with associated medical co-morbidities

BMI of >40

Documentation of diet attempts considered ineffective

Informational Group Seminar

One-On-One Appointment with Surgeon

Enroll in Program

Physician monitored diet and exercise evaluations (depending upon insurance company)

Nutrition assessment

Psychological evaluation

Cardiology, pulmonary, gastrointestinal and sleep evaluations, blood work-up

SCHEDULING SURGERY

Once the patient is cleared and authorized by

insurance we can SCHEDULE SURGERY! Many

insurance companies cover bariatric surgery. There

is a small fee to be a part of our program.

After surgery is scheduled ALL patients must:

Follow Optifast program

Attend a 4 hour Pre-op Teaching Class

Attend a 2 hour Exercise Class

Meet with surgeon for final visit

Complete pre-op testing

After all of this is complete it is time for

SURGERY!

SURGERY STATS

2011 Statistics

Laparoscopic Roux en Y 198

Open Roux en Y 6

Laparoscopic Adjustable Gastric Band 11

Laparoscopic Sleeve Gastrectomy 25

Revisional Surgery 19

259 Total Surgeries!

MORE TO COME

REGARDING

SURGERY…

MEDICAL WEIGHT LOSS

We offer a 14 week medical weight management program for those patient not interested in surgery

This program includes at least 3 visits with our general physician specializing in weight loss management

At least 2 visits with the dietitian

1 group exercise class and 1 one-on-one appointment with our exercise specialist

Enrolled patients are given the tools and support needed to make healthy lifestyle changes.

Patients are also recommended to meet with our psychologist as needed.

BEHAVIORAL WEIGHT LOSS MANAGEMENT

PROGRAM

Our Bariatric Psychologist will also see patients

who struggle with emotional eating behaviors

through the Behavioral Weight Loss

Management Program. These patients can be

referred from the Bariatric Care Center or from

other doctor’s offices

These patients may or may not be interested in

surgery

THE DIETITIAN’S ROLE

Surgical patients

Bariatric Nutrition Assessment (BNA)

Teach Optifast Class

Teach nutrition part of pre-op class

Visit to review diet in hospital upon discharge

Post-op follow up visits 1 week, 1 month, 3 months, 6

months and 1 year for Roux en Y and Sleeve Gastrectomy

patients

Post-op follow up visits monthly for Laparoscopic

Adjustable Band patients

Medical patients

See for initial nutrition assessment and 1 follow up visit

Call patients 2 times during program to follow up on diet

and exercise compliance

DIETITIAN’S ROLE

Review surgical and medical patient’s lab results and

contact them if they have any abnormal vitamin levels.

It is very important for our patients to take the

recommended vitamin supplements

If they fail to do so, they WILL become deficient

Proctor all of our monthly Bariatric Support Group

meetings.

Anyone is welcome to attend

40-80 attendants per group

We provide relevant topics and speakers

Patients are welcome to share their personal stories

Recommended to all patients

PLEASE WELCOME

DR. ADRIAN DAN…