# Understanding Obesity

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2 A Closer Look at Obesity Obesity is a worldwide health crisis. The prevalence of obesity in the United States alone has increased by over 50 percent in less than 40 years, meaning two of every three American adults are now considered overweight or obese. The obesity epidemic is also rapidly spreading to children. These statistics are concerning because those who are overweight or obese have a greater risk of developing many serious diseases and conditions, such as: High blood pressure Osteoarthritis and joint problems High total cholesterol or high triglycerides (dyslipidemia) Type 2 diabetes Heart disease and stroke Gallbladder disease Sleep apnea and respiratory problems Mental health and self-esteem issues Some cancers (e.g., endometrial, breast and colon) How Obesity is Diagnosed Body Mass index Body mass index or BMI is a calculation that serves as a reliable general measure of obesity. This number is calculated from your weight and height to estimate if you are in a healthy weight range. Calculating BMI is still one of the best ways to evaluate whether patients are overweight or obese. However, this screening tool does not look at someone s percentage of body fat. It also leaves out how much muscle mass a person has, as well as how much he or she exercises. The relationship between weight and BMI is influenced by age and gender. For example, women have more body fat than men at the same BMI and older people have more body fat than younger people at the same BMI. Athletes may also have a higher BMI due to more muscle mass. It s easy to calculate your BMI. Use our convenient calculator tool at bariatrics.borgess.com, or follow the steps below. 1. Multiply your weight (in pounds) by Divide the total by your height (in inches). 3. Divide that answer by your height (in inches) again. For example, a woman who is 5 6 and weighs 190 pounds would have a BMI of 31. What is a healthy BMI? Underweight: Less than 18.5 Normal/Healthy: Overweight: Obese: 30.0 and higher 2

3 Medical Weight Loss Obesity is a complex condition caused by many factors. This disease stems from much more than a lack of willpower. Obesity is a combination of genetic, cultural, environmental and other factors. With so many causes and health issues linked to obesity, long-term weight loss can be very difficult for many to achieve. Keeping weight off is an even greater challenge. Millions of Americans struggle with their weight. Obesity trends reported by the Centers for Disease Control and Prevention (CDC) confirm an approximate 30-percent obesity rate in Michigan, both statewide and in most southwest Michigan counties. The good news is that even modest weight loss (5 to 10 percent of total body weight) can yield big health benefits, including lowering blood pressure, cholesterol and blood glucose (sugar). More than ever, people today are looking for ways to lose weight and enjoy more from life, including more energy for playing with their kids, more stamina for activities, and more comfort in a restaurant booth or long car ride. If you feel unsuccessful in trying to lose weight on your own, seeking medical treatment might be an alternative. The most common approach to the treatment of obesity is lifestyle intervention, including making changes in dietary habits and intake, and physical activity. While there is no cure for obesity, the American Medical Association has recognized it as a disease a condition that with hard work and lifestyle modification, can be successfully managed. For those who are tired of gimmicky diet plans and supplements that don t produce lasting results, a professional medical weight-loss program could be an effective solution. Medical weight-loss programs provide a safe, reliable option for adults looking to get serious about shedding pounds. These programs can vary in length, intensity and structure, but they all share two important points of distinction: they offer an evidence-based treatment plan (methods are backed by trusted clinical research) and they are closely supervised by physicians and other medical professionals trained in weight-loss medicine. 3

4 Borgess: Where Less Weight Equals More Life The Borgess Medical Weight-Loss Program, led by a board-certified internal medicine specialist and diplomat of the American Board of Obesity Medicine, offers overweight and obese individuals long-term weight-loss treatment in a nurturing atmosphere. Typical candidates for medical weight loss are people who: Desire professional help with managing their weight or wish to get back on track with weight loss Have plateaued with their weight loss or haven t lost enough weight Do not have a high enough BMI to qualify for bariatric surgery Do not want to have bariatric surgery After patients receive their initial evaluation, a customized treatment approach is designed based on their specific nutritional needs and weight-loss goals. This treatment approach may include: Prescription medication Consultation with a registered dietitian An exercise plan A personalized diet prescription Behavioral coaching Guidance for long-term maintenance Other support services as needed, including sleep disorder testing and psychological counseling Preparation, education and referral for bariatric surgery (if desired) Have other medical issues that make surgery a less viable option Have insurance that doesn t cover bariatric surgery or requires enrollment in a non-surgical program before qualifying for surgery Need to lose weight to prepare for another type of surgery To schedule an appointment, please call (269) To learn more about medical weight loss at Borgess, visit bariatrics.borgess.com. 4

5 Bariatric Surgery Today, bariatric surgery is helping thousands live healthier, longer lives. Although it depends on the patient and procedure, many individuals will not only lose a significant amount of weight after surgery, but also no longer need to take medications for other chronic health conditions, such as high blood pressure, diabetes, asthma and heartburn. You could be a candidate for bariatric surgery if you meet any of the following criteria: You are more than 100 pounds over your ideal body weight Your BMI is over 40 You have a BMI of more than 35 and are living with chronic health issues like high blood pressure and diabetes You are unable to achieve a healthy weight for a long period of time, even after completing a medical weight-loss program (or medically supervised dieting) Should you decide to have bariatric surgery, you must be willing to make permanent diet and lifestyle changes to realize lasting success. The type of surgery you have (Roux-en-Y gastric bypass, sleeve gastrectomy or adjustable gastric banding) will depend on your specific goals, health status and surgeon s recommendation. Based on our track record of favorable outcomes, the Borgess Bariatric Surgery program was named a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American College of Surgeons, and the American Society for Metabolic and Bariatric Surgery. We hold the honor of being the first and only facility in southwest Michigan to earn this designation. 5

6 Roux-en-Y Gastric Bypass Gastric pouch Bypassed portion of stomach Sleeve Gastrectomy As with gastric bypass, sleeve gastrectomy is most often performed laparoscopically. During the procedure, about 75 percent of the stomach is removed, leaving a narrow gastric sleeve (about the size of a banana). No intestines are removed or bypassed during this procedure. Duodenum Jejunum Bypassed duodenum food digestive juice Jejunum In gastric bypass surgery, stapling creates a small stomach pouch about the size of a golf ball. The remainder of the stomach is stapled shut and divided from the pouch. The outlet from this newly formed pouch empties directly into the lower part of the small intestine (the jejunum). This is done by dividing the small intestine just beyond the upper portion (the duodenum) for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. Whenever possible, gastric bypass is performed laparoscopically (minimally invasive, with small incisions). Laparoscopic procedures are considered less invasive because they often result in reduced hospitalization, shorter recovery periods, less pain and fewer postoperative complications for patients. Gastric bypass helps people lose weight by limiting what they eat. The new stomach pouch enables you to feel full after only a small amount of food. Food also bypasses part of your digestive system, reducing the amount of calories naturally absorbed by the body. Sleeve gastrectomy greatly reduces the size of the stomach, limiting the amount of food that can be eaten at one time. It does not cause decreased absorption of nutrients or bypass the intestines. After eating a small amount of food, patients feel full quickly and continue to feel satisfied for several hours. The procedure can also cause a decrease in appetite, as sleeve gastrectomy can lower the amount of the hunger hormone produced by the stomach. This hormone reduction is thought to contribute to weight loss after the procedure. Adjustable Banding Adjustable gastric banding involves the placement of an adjustable silicone elastic band on the upper part of the stomach, typically using a laparoscopic technique. The band is adjusted postoperatively by injecting or withdrawing saline into a port placed Stomach pouch Adjustable band Port placed under skin Gastric sleeve (new stomach) Removed portion of stomach under the skin during surgery. By dividing the stomach into two portions, food intake is regulated and patients feel full on smaller amounts of food. While the rate of weight loss is slower than with other bariatric procedures, gastric banding s minimally invasive features help to reduce a patient s postoperative pain, length of hospital stay and recovery time. Gastric banding is also the only reversible surgical procedure for weight loss. 6

7 Why Choose Borgess We understand that achieving positive outcomes requires a comprehensive program that combines multiple specialties. That s why Borgess delivers a multidisciplinary approach that provides you with the personalized information and support you need from the latest weight-loss surgeries to ongoing dietary, exercise and psychological support. Many people who come to us have tried other options for losing weight. They find that Borgess offers a special capability and nurturing support to help them finally follow through on their decision to lose weight and resolve related medical conditions for a longer, healthier and more fulfilling life. Locations Borgess Bariatric Center 1722 Shaffer Street, Suite 124 Kalamazoo, MI (medical weight loss) Borgess Surgical Specialties 1717 Shaffer Street, Suite 108 Kalamazoo, MI (bariatric surgery) Borgess Health Park 3035 Capital Avenue SW Battle Creek, MI (non-surgical clinic) Committed to Quality At Borgess, the commitment to favorable outcomes goes well beyond surgery. Our full continuum of care includes: Bariatric informational seminars A quality-control committee to continue evaluating bariatric practices and provide the best care possible Surgeons credentialed in bariatrics, and specially trained in laparoscopic and minimally invasive techniques Dedicated and specially trained bariatric nurses, as well as dietitians, exercise therapists, psychotherapists, physical therapists and sleep disorders specialists Weight management guidance from a credentialed medical weight-loss physician A bariatric program leader A designated bariatric hospital unit with private, comfortable rooms and furniture to accommodate patients Lifetime support after surgery Comprehensive pre- and post-operative education to help ensure successful, long-term weight loss A bariatric support group led by a certified bariatric nurse Bariatric cooking and fitness classes An annual bariatric reunion celebration To find out more about surgery options or information on dietary, psychological and insurance issues, please call (269) to register for one of our free inperson bariatric seminars. For more information, or to view our online seminar in the convenience of your own home, visit bariatrics.borgess.com. 7 12/14

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