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??????