Some of the diseases and conditions associated with obesity include:

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1 WEIGHT-LOSS SURGERY

2 facts about obesity Obesity is rapidly becoming the nation s number-one health problem. Of the 97 million Americans who are overweight, 10 million are considered morbidly obese. Obesity is considered morbid when it reaches the point of significantly increasing the risk of obesity-related health conditions or serious diseases that can cause death or disability. About 300,000 deaths a year are associated with being obese. Some of the diseases and conditions associated with obesity include: Diabetes Hypertension Sleep apnea Stroke Heart disease Gallbladder disease and gallstones High cholesterol Osteoarthritis Infertility Pregnancy complications Cancer Respiratory problems Gout Urinary incontinence

3 weight-loss surgery is not for everyone, but it might be for you According to the National Institutes of Health, anyone weighing 20 percent or more than their ideal body weight is obese. At that point, the extra weight becomes a health risk, contributing to a number of conditions, many of which are life-threatening. If you are obese, weight-loss surgery may be an option to help you control your weight. To qualify, you must: Be at least 100 pounds overweight, have a body mass index (BMI) of 40 or greater without co-morbidities, or have a BMI of 35 or greater with at least two co-morbidities related to obesity; Be between the ages of 15 and 65; Be able to show serious past attempts to lose weight through medically supervised diets, exercise, or programs such as Weight Watchers or Jenny Craig ; Have no significant physical, medical, emotional or psychological problems that would make surgery unnecessarily risky; and, Be able to participate in long-term treatment and follow-up. According to the National Institutes of Health, anyone weighing 20 percent or more than their ideal body weight is obese.

4 There is a normal-size person on the inside just waiting to be set free an array of bariatric surgical services because we know one size fits all really doesn t apply Gastric Bypass Roux-en-Y The most common form of bariatric surgery, gastric bypass Roux-en-Y is considered the gold standard in bariatric surgery today, and is designed to restrict the amount of food you can eat and to bypass a portion of the small bowel, allowing less food to be absorbed. Surgeons divide the stomach to create a small pouch that restricts food intake to about one ounce. This new stomach known as the pouch is then attached to the small intestine, bypassing the lower stomach and a portion of the small bowel. Advantages of gastric bypass Roux-en-Y include rapid weight loss, reduced co-morbidities, reduced desire to eat, reversibility and a proven track Advantages of gastric bypass Roux-en-Y include rapid weight loss, reduced co-morbidities, reduced desire to eat, reversibility and a proven track record of long-term weight loss maintenance. record of long-term weight loss maintenance. Adjustable Gastric Banding (or LAP-BAND System) Designed to restrict food intake without interfering with the body s normal digestive processes, adjustable gastric banding allows for a hollow silastic band to be placed around the upper part of the stomach, creating a small pouch and a narrow passage into the stomach. The pouch can hold only a small amount of food, usually about an ounce. The narrow passage slows the emptying of food into the rest of the stomach, causing you to feel fuller longer. The diameter of the band can be adjusted to increase or decrease the diamenter of the passage into the stomach, and thus, the amount of food that can be consumed. Advantages include proven success, reversibility, less impact on the anatomy, a shorter recovery period and normal digestion and absorption.

5 Biliopancreatic Diversion/Duodenal Switch (BPD/DS) The duodenal switch is being performed as a revision, and as an initial surgical procedure in select patients through our program. Because of the nature of the procedure, it is considered a more radical procedure in bariatrics today. The BPD/DS combines malabsorptive elements to achieve weight loss. Because of the complexity of this surgery, we are currently the only program in Texas offering this procedure. The BPD/DS includes a partial gastrectomy, which reduces the stomach along the greater curvature, effectively restricting its capacity while maintaining its normal functionality. This means that part of the stomach is permanently removed. Unlike the unmodified BPD and gastric bypass Roux-en-Y (RNY), which use a gastric pouch and bypass the pyloric valve, the DS procedure keeps the pyloric valve intact. This eliminates the possibility of dumping syndrome, marginal ulcers, stoma closures and blockages, all of which can occur after other gastric bypass procedures. In addition, the DS procedure keeps a portion of the duodenum in the food stream. The preservation the pylorus/duodenum pathway means that food is digested normally in the stomach before being excreted by the pylorus into the small intestine. As a result, the DS procedure enables more normal absorption of many nutrients (including protein, calcium, iron, and vitamin B12) than is seen with the gastric bypass Roux-en-Y procedure. The malabsorptive component of the BPD/DS rearranges the small intestine to separate the flow of food from the flow of bile and pancreatic juices. This inhibits the absorption of calories and some nutrients. Further down the digestive tract, these divided intestinal paths are rejoined and food and digestive juices then begin to mix, and limited fat absorption occurs in the common tract as food continues on toward the large intestine.

6 Vertical Banded Gastroplasty (VBG) Revisions The VBG procedure was very popular a few years back, and while it was a good attempt to offer patients a solution to permanent weight loss through surgery, we have found that this surgery has a high rate of failure. Because the surgery relies on patients throwing up when they overeat, the pressure put on the pouch from vomiting eventually causes the staple line to disrupt or the band to erode. Many patients find that they can eat more because (1) their pouch has stretched due to the pressure exerted on it from vomiting, (2) their staple line disrupted, allowing food to enter the larger stomach and thus allowing greater food consumption, or (3) the band has eroded, causing pain and possible severe complications. Many options for revisions are available; however, we recommend that most patients convert their VBG procedure to a gastric bypass Roux-en-Y to optimize their weight loss. Vertical Banded Gastroplasty (VBG) Reversals Like most bariatric procedures, our surgeons can completely reverse a vertical banded gastroplasty if that s what the patient desires. Both revisions and reversals can be performed either open or laparoscopically depending on the patient s surgical history and take about 1 to hours each to complete. Gastric Bypass Roux-en-Y Revisions Sometimes, an initial procedure may need to be revised. Reasons for revision include: Mechanical failure of surgery Regaining original weight lost Intractable nausea & vomiting Gastric Bypass Roux-en-Y Reversals Our surgeons are literally on the cutting edge in the field of bariatrics, having performed more gastric bypass reversals than any other program in the United States. Our patients come from all over the United States, and while a reversal is rarely needed, it can be done. While very rare, reasons for complete reversal include: Intractable nausea & vomiting or excessive diarrhea resistant to medical management Excessive weight loss Emotional and/or psychological problems with required lifestyle adjustments Both revisions and reversals can be performed either open or laparoscopically depending on the patient s surgical history and take about 1 to 1 1/2 hours each to complete. How Surgery Is Performed It s all in the approach In the laparoscopic approach, surgeons make a series of tiny incisions in the abdomen rather than the larger incision required in the open approach. A small camera and tiny surgical instruments are inserted, allowing surgeons to operate while viewing the procedure on a video monitor. Laparoscopic procedures can be used in gastric bypass Rouxen-Y, adjustable gastric banding, and sometimes in revisions and reversals, however, not everyone is a candidate for the laparoscopic approach. Your surgeon will decide which approach is best for you. Both revisions and reversals can be performed either open or laparoscopically depending on the patient s surgical history. Our surgeons have performed hundreds of revisional surgeries, giving our patients wonderful and successful outcomes. Many times, a revision is exactly what a patient needs in order to be successful in their weight loss goals.

7 Preparing for Your Surgery Preparing for bariatric surgery begins long before the actual procedure ever takes place. The first step is attending a free pre-operative educational seminar where you ll learn the facts about weight-loss surgery, including why and how it s done, discussion of risks and complications, life as a post-op patient, and what kind of weight loss you can expect. Next steps include attending live support group meetings; undergoing psychological and nutritional evaluations and medical diagnostics studies; completing the required medical history paperwork; and meeting with your surgeon. If the first round of tests indicate the need for additional testing, your doctor may order additional tests to obtain the most comprehensive medical information possible. This exhaustive process will help determine if bariatric surgery is the right option for you and will help to identify potential health problems and reduce the risk of complications. The first step is to attend a free pre-operative educational seminar where you ll learn the facts about weight-loss surgery, including why and how it s done, discussion of risks and complications, life as a post-op patient and what kind of weight loss you can expect.

8 life after surgery becoming the you you were meant to be After surgery, you ll have to eat and drink differently and make the necessary changes in order to maintain a healthy lifestyle, and dedicate yourself to following proven guidelines for long-term success. While it will be a challenge at first, committing to these important lifelong personal practices will maximize the benefits of surgery. Our bariatric program addresses every issue you re likely to face in the months and years to come after surgery. This includes information about diet and exercise, returning to work, sex, birth control, pregnancy, long-term follow-up care, the impact of surgery on your closest relationships including your relationship with yourself and reconstructive cosmetic surgery. Maintaining a healthy body weight is more than just a function of weight-loss surgery. It s a lifelong commitment to maintaining a healthier lifestyle. Maintaining a healthy body weight is more than just a function of weight-loss surgery. It s a lifelong commitment to living a healthier lifestyle. Memorial Hermann Memorial City Hospital s Weight-Loss Surgery Support Group will allow you to share your personal journey and experiences with others who understand and support your goals. In the process of sharing, you ll encourage someone coming behind you who will benefit from your experience as well. For More Information If you have questions about weight-loss surgery, please call us at If you would like to attend one of our free pre-operative educational seminars, please call CARE (2273) to register to attend.

9 Bariatric Surgical Services 921 Gessner Road Houston, Texas CARE

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